The Role of Core Stability and Core Muscles in Ankylosing Spondylitis: A Review of Functional and Clinical Importance
Year 2023,
, 545 - 552, 31.01.2023
Uğur Verep
,
Elanur Çiçek
,
Seher Özyürek
Abstract
Purpose: Physiotherapy and exercise training are one of the cornerstones in the treatment of patients with ankylosing spondylitis (AS). However, although the effects of exercise programs and their superiority over each other have still not been determined, research on this subject is continuing in the literature day by day. Due to the pathophysiology of AS, the spine is one of the most affected areas of the musculoskeletal system. Therefore, stabilization of the lumbopelvic region and the spine, which is the reference point for the core muscles, is important for the treatment and management of this disease.
In this review, the involvement of core muscles and core stability in patients with AS and the literature on core training programs will be discussed.
References
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- Blair HAJD. Secukinumab: a review in ankylosing spondylitis. 2019;79(4):433-43.
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- Rudwaleit M, Van Der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Annals of the Rheumatic Diseases. 2009;68(6):777-83.
- Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. The New England journal of medicine. 2016;374(26):2563-74.
- Gündüz OH, Özcan-Ekşi EE, Giray E, Yağci İ. What Impairs Balance in Ankylosing Spondylitis? Posture or Disease Activity? Arch Rheumatol. 2017;32(3):221-6.
- Ebrahimiadib N, Berijani S, Ghahari M, Golsoorat Pahlaviani F. Ankylosing Spondylitis. Journal of Ophthalmic and Vision Research. 2021.
- Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. Kelley's Textbook of Rheumatology E-Book: Elsevier Health Sciences; 2012.
- Siebert S, Sengupta R, Tsoukas A. Axial spondyloarthritis: Oxford University Press; 2016. (c: 7, peripheral muskuloskeletal involvement in axial spondyloarthritis p: 49-52)
- Sarac DC, Bayram S, Tore NG, Sari F, Guler AA, Tufan A, et al. Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis. 2022;28(1):e135-e40.
- Huxel Bliven KC, Anderson BE. Core Stability Training for Injury Prevention. Sports Health: A Multidisciplinary Approach. 2013;5(6):514-22.
- Kibler WB, Press J, Sciascia A. The Role of Core Stability in Athletic Function. Sports Medicine. 2006;36(3):189-98.
- Brumitt J, Matheson JW, Meira EP. Core Stabilization Exercise Prescription, Part I. Sports Health: A Multidisciplinary Approach. 2013;5(6):504-9.
- Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. Journal of Biomechanics. 1999;32(1):13-7.
- Ebenbichler GR, Oddsson LI, Kollmitzer J, Erim ZJM, sports si, exercise. Sensory-motor control of the lower back: implications for rehabilitation. 2001;33(11):1889-98.
- Cresswell AG, Oddsson L, Thorstensson A. The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Experimental Brain Research. 1994;98(2).
- Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Experimental Brain Research. 1997;114(2):362-70.
- Hodges P, Butler J, McKenzie D, Gandevia SJTJop. Contraction of the human diaphragm during rapid postural adjustments. 1997;505(Pt 2):539.
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- Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Journal of spinal disorders. 1992;5(4):390-6; discussion 7.
- Vasileiadis I. Injury prevention strategies in football: A systematic review. Sport Mont. 2020;18(3):109-13.
- Resorlu H, Savas Y, Aylanc N, Gokmen F. Evaluation of paravertebral muscle atrophy and fatty degeneration in ankylosing spondylitis. Modern Rheumatology. 2017;27(4):683-7.
- Zhang Y, Xu H, Hu X, Zhang C, Chu T, Zhou Y. Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis. International Journal of Rheumatic Diseases. 2016;19(4):420-9.
- Hopkins GO, McDougall J, Mills KR, Isenberg DA, Ebringer A. Muscle changes in ankylosing spondylitis. British journal of rheumatology. 1983;22(3):151-7.
- Akgul O, Gulkesen A, Akgol G, Ozgocmen S. MR-defined fat infiltration of the lumbar paravertebral muscles differs between non-radiographic axial spondyloarthritis and established ankylosing spondylitis. Modern Rheumatology. 2013;23(4):811-6.
- Neerinckx B, Lories R. Mechanisms, impact and prevention of pathological bone regeneration in spondyloarthritis. Current Opinion in Rheumatology. 2017;29(4):287-92.
- Perrotta FM, Lories R, Lubrano E. To move or not to move: the paradoxical effect of physical exercise in axial spondyloarthritis. RMD Open. 2021;7(1):e001480.
- Acar Y, Ilçin N, Gürpinar B, Can G. Core stability and balance in patients with ankylosing spondylitis. Rheumatology International. 2019;39(8):1389-96.
- Sarac DC, Bayram S, Tore NG, Sari F, Guler AA, Tufan A, et al. Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2022;28(1):e135-e40.
- Rausch A-K, Baltisberger P, Meichtry A, Topalidis B, Ciurea A, Vliet Vlieland TPM, et al. Reliability of an adapted core strength endurance test battery in individuals with axial spondylarthritis. Clinical Rheumatology. 2021;40(4):1353-60.
- Levitova A, Hulejova H, Spiritovic M, Pavelka K, Senolt L, Husakova M. Clinical improvement and reduction in serum calprotectin levels after an intensive exercise programme for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis. Arthritis Research & Therapy. 2016;18(1).
- Özdal M. Effect of Core Training on Inspiratory Muscle Strength in well-trained Men. J Biology of Exercise. 2016;12(1).
- Romagnoli I. Chest wall kinematics and respiratory muscle action in ankylosing spondylitis patients. European Respiratory Journal. 2004;24(3):453-60.
- Ünlü E, Pamuk ÖN, Erer B, Dönmez S, Çakir N. Diaphragmatic movements in ankylosing spondylitis patients and their association with clinical factors: an ultrasonographic study. Rheumatology International. 2012;32(2):435-7.
- Üşen A, Kuran B, Yılmaz F, Aksu N, Erçalık C. Evaluation of the internal oblique, external oblique, and transversus abdominalis muscles in patients with ankylosing spondylitis: an ultrasonographic study. Clinical Rheumatology. 2017;36(11):2497-500.
- Drăgoi R-G, Amaricai E, Drăgoi M, Popoviciu H, Avram CJCr. Inspiratory muscle training improves aerobic capacity and pulmonary function in patients with ankylosing spondylitis: a randomized controlled study. 2016;30(4):340-6.
- Başakçı Çalık B, Kabul EG, Taskın H, Atalay OT, Aslan UB, Tascı M, et al. The efficiency of inspiratory muscle training in patients with ankylosing spondylitis. 2018;38(9):1713-20.
- Altan L, Korkmaz N, Dizdar M, Yurtkuran M. Effect of Pilates training on people with ankylosing spondylitis. Rheumatology International. 2012;32(7):2093-9.
- Roşu MO, Ţopa I, Chirieac R, Ancuta C. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial. Rheumatology International. 2014;34(3):367-72.
- Oksuz S, Unal E. Comparison of the effects of aerobic training alone versus aerobic training combined with clinical Pilates exercises on the functional and psychosocial status of patients with ankylosing spondylitis: A randomized controlled trial. Physiotherapy Theory and Practice. 2021:1-11.
- Linden SVD, Valkenburg HA, Cats A. Evaluation of Diagnostic Criteria for Ankylosing Spondylitis. Arthritis & Rheumatism. 1984;27(4):361-8.
- Rausch Osthoff A-K, Juhl CB, Knittle K, Dagfinrud H, Hurkmans E, Braun J, et al. Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis. 2018;4(2):e000713.
- Martey C, Sengupta R. Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice. Curr Opin Rheumatol. 2020;32(4):365-70.
- Gravaldi LP, Bonetti F, Lezzerini S, De Maio F. Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Healthcare. 2022;10(1):132.
Year 2023,
, 545 - 552, 31.01.2023
Uğur Verep
,
Elanur Çiçek
,
Seher Özyürek
References
- Wang Y and Ji Quanbo, Overview Ankylosan Spondylitis, Wang Y. Surgical Treatment of Ankylosing Spondylitis Deformity: Springer; 2019. 1, p:3
- Deodhar A, Gensler LS, Magrey M, Walsh JA, Winseck A, Grant D, et al. Assessing Physical Activity and Sleep in Axial Spondyloarthritis: Measuring the Gap. Rheumatology and Therapy. 2019;6(4):487-501.
- Blair HAJD. Secukinumab: a review in ankylosing spondylitis. 2019;79(4):433-43.
- Fernandez-Ruiz R, Efthimiou P. Clinical Genetics in Rheumatology. Absolute Rheumatology Review: Springer; 2020. p. 447-65.
- Onen F, Akar S, Birlik M, Sari I, Khan MA, Gurler O, et al. Prevalence of ankylosing spondylitis and related spondyloarthritides in an urban area of Izmir, Turkey. 2008;35(2):305-9.
- Wang R, Ward MM. Epidemiology of axial spondyloarthritis: an update. Current Opinion in Rheumatology. 2018;30(2):137-43.
- Sieper J, Poddubnyy D. Axial spondyloarthritis. The Lancet. 2017;390(10089):73-84.
- Rudwaleit M, Van Der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the Rheumatic Diseases. 2011;70(1):25-31.
- Rudwaleit M, Van Der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Annals of the Rheumatic Diseases. 2009;68(6):777-83.
- Taurog JD, Chhabra A, Colbert RA. Ankylosing Spondylitis and Axial Spondyloarthritis. The New England journal of medicine. 2016;374(26):2563-74.
- Gündüz OH, Özcan-Ekşi EE, Giray E, Yağci İ. What Impairs Balance in Ankylosing Spondylitis? Posture or Disease Activity? Arch Rheumatol. 2017;32(3):221-6.
- Ebrahimiadib N, Berijani S, Ghahari M, Golsoorat Pahlaviani F. Ankylosing Spondylitis. Journal of Ophthalmic and Vision Research. 2021.
- Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. Kelley's Textbook of Rheumatology E-Book: Elsevier Health Sciences; 2012.
- Siebert S, Sengupta R, Tsoukas A. Axial spondyloarthritis: Oxford University Press; 2016. (c: 7, peripheral muskuloskeletal involvement in axial spondyloarthritis p: 49-52)
- Sarac DC, Bayram S, Tore NG, Sari F, Guler AA, Tufan A, et al. Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis. 2022;28(1):e135-e40.
- Huxel Bliven KC, Anderson BE. Core Stability Training for Injury Prevention. Sports Health: A Multidisciplinary Approach. 2013;5(6):514-22.
- Kibler WB, Press J, Sciascia A. The Role of Core Stability in Athletic Function. Sports Medicine. 2006;36(3):189-98.
- Brumitt J, Matheson JW, Meira EP. Core Stabilization Exercise Prescription, Part I. Sports Health: A Multidisciplinary Approach. 2013;5(6):504-9.
- Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. Journal of Biomechanics. 1999;32(1):13-7.
- Ebenbichler GR, Oddsson LI, Kollmitzer J, Erim ZJM, sports si, exercise. Sensory-motor control of the lower back: implications for rehabilitation. 2001;33(11):1889-98.
- Cresswell AG, Oddsson L, Thorstensson A. The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Experimental Brain Research. 1994;98(2).
- Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Experimental Brain Research. 1997;114(2):362-70.
- Hodges P, Butler J, McKenzie D, Gandevia SJTJop. Contraction of the human diaphragm during rapid postural adjustments. 1997;505(Pt 2):539.
- Hodges PW. Core stability exercise in chronic low back pain. The Orthopedic clinics of North America. 2003;34(2):245-54.
- Panjabi MM. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Journal of spinal disorders. 1992;5(4):390-6; discussion 7.
- Vasileiadis I. Injury prevention strategies in football: A systematic review. Sport Mont. 2020;18(3):109-13.
- Resorlu H, Savas Y, Aylanc N, Gokmen F. Evaluation of paravertebral muscle atrophy and fatty degeneration in ankylosing spondylitis. Modern Rheumatology. 2017;27(4):683-7.
- Zhang Y, Xu H, Hu X, Zhang C, Chu T, Zhou Y. Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis. International Journal of Rheumatic Diseases. 2016;19(4):420-9.
- Hopkins GO, McDougall J, Mills KR, Isenberg DA, Ebringer A. Muscle changes in ankylosing spondylitis. British journal of rheumatology. 1983;22(3):151-7.
- Akgul O, Gulkesen A, Akgol G, Ozgocmen S. MR-defined fat infiltration of the lumbar paravertebral muscles differs between non-radiographic axial spondyloarthritis and established ankylosing spondylitis. Modern Rheumatology. 2013;23(4):811-6.
- Neerinckx B, Lories R. Mechanisms, impact and prevention of pathological bone regeneration in spondyloarthritis. Current Opinion in Rheumatology. 2017;29(4):287-92.
- Perrotta FM, Lories R, Lubrano E. To move or not to move: the paradoxical effect of physical exercise in axial spondyloarthritis. RMD Open. 2021;7(1):e001480.
- Acar Y, Ilçin N, Gürpinar B, Can G. Core stability and balance in patients with ankylosing spondylitis. Rheumatology International. 2019;39(8):1389-96.
- Sarac DC, Bayram S, Tore NG, Sari F, Guler AA, Tufan A, et al. Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases. 2022;28(1):e135-e40.
- Rausch A-K, Baltisberger P, Meichtry A, Topalidis B, Ciurea A, Vliet Vlieland TPM, et al. Reliability of an adapted core strength endurance test battery in individuals with axial spondylarthritis. Clinical Rheumatology. 2021;40(4):1353-60.
- Levitova A, Hulejova H, Spiritovic M, Pavelka K, Senolt L, Husakova M. Clinical improvement and reduction in serum calprotectin levels after an intensive exercise programme for patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis. Arthritis Research & Therapy. 2016;18(1).
- Özdal M. Effect of Core Training on Inspiratory Muscle Strength in well-trained Men. J Biology of Exercise. 2016;12(1).
- Romagnoli I. Chest wall kinematics and respiratory muscle action in ankylosing spondylitis patients. European Respiratory Journal. 2004;24(3):453-60.
- Ünlü E, Pamuk ÖN, Erer B, Dönmez S, Çakir N. Diaphragmatic movements in ankylosing spondylitis patients and their association with clinical factors: an ultrasonographic study. Rheumatology International. 2012;32(2):435-7.
- Üşen A, Kuran B, Yılmaz F, Aksu N, Erçalık C. Evaluation of the internal oblique, external oblique, and transversus abdominalis muscles in patients with ankylosing spondylitis: an ultrasonographic study. Clinical Rheumatology. 2017;36(11):2497-500.
- Drăgoi R-G, Amaricai E, Drăgoi M, Popoviciu H, Avram CJCr. Inspiratory muscle training improves aerobic capacity and pulmonary function in patients with ankylosing spondylitis: a randomized controlled study. 2016;30(4):340-6.
- Başakçı Çalık B, Kabul EG, Taskın H, Atalay OT, Aslan UB, Tascı M, et al. The efficiency of inspiratory muscle training in patients with ankylosing spondylitis. 2018;38(9):1713-20.
- Altan L, Korkmaz N, Dizdar M, Yurtkuran M. Effect of Pilates training on people with ankylosing spondylitis. Rheumatology International. 2012;32(7):2093-9.
- Roşu MO, Ţopa I, Chirieac R, Ancuta C. Effects of Pilates, McKenzie and Heckscher training on disease activity, spinal motility and pulmonary function in patients with ankylosing spondylitis: a randomized controlled trial. Rheumatology International. 2014;34(3):367-72.
- Oksuz S, Unal E. Comparison of the effects of aerobic training alone versus aerobic training combined with clinical Pilates exercises on the functional and psychosocial status of patients with ankylosing spondylitis: A randomized controlled trial. Physiotherapy Theory and Practice. 2021:1-11.
- Linden SVD, Valkenburg HA, Cats A. Evaluation of Diagnostic Criteria for Ankylosing Spondylitis. Arthritis & Rheumatism. 1984;27(4):361-8.
- Rausch Osthoff A-K, Juhl CB, Knittle K, Dagfinrud H, Hurkmans E, Braun J, et al. Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis. 2018;4(2):e000713.
- Martey C, Sengupta R. Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice. Curr Opin Rheumatol. 2020;32(4):365-70.
- Gravaldi LP, Bonetti F, Lezzerini S, De Maio F. Effectiveness of Physiotherapy in Patients with Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Healthcare. 2022;10(1):132.