original paper Physiotherapy Quarterly (ISSN 2544-4395)

2023, 31(4), 1–6

© Wroclaw University of Health and Sport Sciences

Effect of a 6-week core stability training program on active trunk repositioning:

a randomised controlled trial
doi: https://doi.org/10.5114/pq.2023.117222

Amal A. Elborady , Omaima E. Saleh, Amira A.A. Abdallah

Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Egypt

Abstract
Introduction. Core stability training has recently attracted attention for improving muscle performance. This study aimed to
examine the effect of core stability training on active trunk repositioning error.
Methods. Forty healthy males, randomly assigned into two equal groups – experimental and control groups – participated in
the study. Their age, weight, height, and BMI ranged between 18–22.5 years, 64–85 kg, 1.63–1.83 m, and 19.4–25 kg/m2, respec-
tively. The Biodex Isokinetic dynamometer was used to assess the absolute error (AE) at both 30° and 60° trunk flexion, meas-
ured at a 60°/s angular velocity. Data were recorded twice; before (pre-test) and after (post-test) a 6-week period during which
the experimental group was trained.
Results. Mixed 3-way ANOVA revealed that the AE was significantly lower at 60° trunk flexion in both groups at pre-test, and in
the control group at post-test compared with 30° flexion (p < 0.05). In addition, the AE decreased significantly in the post-test
in the experimental group only at both trunk flexion angles compared with pre-test (p < 0.05).
Conclusions. The decreased active trunk repositioning error with core stability training indicates improvement in trunk proprio-
ception. Thus, core stability training could be beneficial if added to rehabilitation programs that aim to improve trunk proprioception.
Key words: core, isokinetic, repositioning error, proprioception

Introduction is associated with and caused by back muscle fatigue [11].

Although, core training has been extensively studied with much
The ‘core’, also known as the ‘lumbo-pelvic-hip complex’, emphasis on its effect on pain [12], trunk muscles’ cross-sec-
refers to that space bounded by the diaphragm superiorly, tional area [13], trunk muscles’ strength and endurance [14]
pelvic floor and hip girdle inferiorly, abdominal and oblique and the body’s overall balance [15], there is a lack of knowledge
muscles anterolaterally and the paraspinal and gluteal mus- on the effect of core stability exercises on trunk proprioception.
cles posteriorly [1]. These muscular structures impart corset- Therefore, this study was carried out to explore the effect
like stability for the spine [2]. Spinal stability is further improved of a 6-week beginners’ core stability exercise program on
with increased intra-abdominal pressure. Stability increases trunk proprioception assessed through measuring the active
by about 1.8 times with doubling of the pressure [3]. repositioning error; the difference between reposition angle
Core stability depends on simultaneous integration among and target angle. Assessing active trunk repositioning has
the active (muscles), passive (bones and ligaments), and clinical relevance, as its affection is related to lower extremity
neural control subsystems. Good stability aims at maintain- injury. It was found that for every degree increase in the aver-
ing neutral spinal alignment and transferring loads properly to age active trunk repositioning error, the odds ratio of knee
and from the extremities, with much emphasis on prevent- injury increases 2.9 times, and the odds ratio of ligament/
ing injury [4]. Core stability is considered as essential a factor meniscal injury increases 3.3 times [16]. Thus, if core stability
in the basic patterns of movements as joint stability, mobility, exercises are proven to reduce active trunk repositioning
strength, neuromuscular control, balance, and propriocep- error, it is anticipated that the risk of knee injury could be re-
tion [5]. duced. We hypothesised that our core stability program would
Proprioception, in part, refers to one’s awareness of their decrease active trunk repositioning error.
limb positioning, usually measured through active and pas-
sive joint position sense [6]. In the spine, the proprioceptors Subjects and methods
(mechanoreceptors) are found in the facet joints, interver-
tebral discs, spinal ligaments, and paraspinal muscles [7]. Participants
Muscle spindles, present in the paraspinal muscles, are re-
sponsible for monitoring the trunk position and motion, es- Forty healthy male college students participated in the
pecially the mid-range of trunk motion [8]. Since monitoring study. Their age, weight, height, and BMI ranged between
trunk motion is crucial for producing motion patterns, it is 18–22.5 years, 64–85 kg, 1.63–1.83 m, and 19.4–25 kg/m2,
anticipated that any deficit in proprioception would nega- respectively. The BMI was specified for the participants as it
tively affect the quality of motion [9]. affects postural stability and thus may affect proprioception
It has been shown that proprioceptive deficits cause de- [17]. Participants were randomly assigned into two equal
layed reflexive responses with consequent delays in muscle groups; the experimental or control group. All participants
contraction, which is necessary to protect the joint against ex- had their back and abdominal muscle strengths assessed
cessive motion [10]. In addition, reduced trunk motion control as grade four by a manual muscle test and normal flexibility

Correspondence address: Amal A. Elborady, Department of Biomechanics, Faculty of Physical Therapy, 7 Ahmed El Zaiat Street, Bein El
Sarayat, Giza, Egypt, e-mail: dr_mouly@hotmail.com; https://orcid.org/0000-0003-0700-5851

Received: 15.09.2021
Accepted: 14.02.2022

Citation: Elborady AA, Saleh OE, Abdallah AAA. Effect of a 6-week core stability training program on active trunk repositioning: a randomised
controlled trial. Physiother Quart. 2023;31(4):1–6; doi: https://doi.org/10.5114/pq.2023.117222.
 A.A. Elborady, O.E. Saleh, A.A.A. Abdallah
Effect of a 6-week core stability training program on active trunk repositioning Physiother Quart 2023, 31(4)

of the trunk extensors, lateral flexors and rotators as well as for statistical analysis. The AE is used to assess the proprio-
hip flexors. The manual muscle and flexibility tests were con- ceptive performance; it determines the individual’s accuracy
ducted by the same examiner. Volunteers were excluded if in reproducing the position and is measured in degrees [18].
they had a history of any previous back and/or abdominal sur- The sense of joint position was assessed starting from
geries and/or diseases, any previously perceived episodes a neutral spine position, with the participant being blindfolded
of low back pain within one year of being involved in the study, to limit visual cueing. Each participant actively flexed the trunk
any previous core stability training program experience, any up to 30° and 60°, which were identified to be the target
previously diagnosed trunk deformity, any previous or con- positions. Starting the testing procedure with either the 30°
current neuromuscular or neurological problems that may or 60° angle was randomly selected by asking the participant
affect proprioception (e.g. spinal cord tumour, or epilepsy), to select one of two folded pieces of paper placed in a con-
any previously diagnosed vestibular system affection, any tainer. After exercising in the randomly chosen position, the
current systemic illness (e.g. diabetes mellitus), any current participant was allowed to rest for as long as it took the exam-
medications, or if having a history of drug abuse. Each in- iner to change the back support inclination angle of the isoki-
cluded participant then signed an informed consent. The netic chair in preparation for the next test. The participant’s
study was approved by the Institutional Ethical Approval Re- trunk moved at an angular velocity of 60°/s. The target posi-
view Board of the Faculty of Physical Therapy, Cairo University. tion, whether 30° or 60°, was identified when the back sup-
port of the chair automatically stopped there. The participant
Procedures was instructed to remember each target position while it was
held for five seconds. The participant returned to the neutral
This study involved a pre-test post-test control group position, then was instructed to flex the trunk to the target
design. A Biodex System 3 Pro multijoint testing and reha- position and mark the position by pressing a ‘hold’ button
bilitation system (Biodex Medical Systems, Shirley, NY, USA) (Figures 1, 2). This procedure was repeated three times for
was used for measuring the active trunk repositioning error calculating the mean values of the AE, which were used for
after stabilising the participant’s sacral base to minimise hip the data analysis. Lower values of the AE indicate that the
and pelvic involvement, and to ensure that the trunk move- sense of position is more accurate.
ment is consistent with the isokinetic system dynamometer. The AE was measured twice for each participant of both
Before starting the test, a familiarisation session was con- groups; before and after the 6-week study period. During this
ducted to acquaint the participant with both the device and 6-week period, experimental group participants performed
the test to be performed. Three trials, with a pre-adjusted rest a pre-determined core stability program, while those in the
period of 10 seconds in between each two successive trials, control group did not. This pre-determined core stability pro-
were performed by each participant for averaging, where the gram included a warm-up period followed by three main core
mean absolute error (AE) value (the difference between the stability exercises; ‘Curl-Up’, ‘Side-Bridge’, and ‘Bird-Dog’,
reposition angle and target angle) was recorded and used which are components of the Saal and Saal [19] dynamic

A B

Figure 1. Repositioning test at 30-degree trunk

flexion; start (A) and end (B) positions

A B

Figure 2. Repositioning test at 60-degree trunk

2 flexion; start (A) and end (B) positions
 A.A. Elborady, O.E. Saleh, A.A.A. Abdallah
Physiother Quart 2023, 31(4) Effect of a 6-week core stability training program on active trunk repositioning

lumbar stabilisation efficacy program. The pre-determined has followed the tenets of the Declaration of Helsinki, and has
program consisted of three phases, each lasting for two con- been approved by the Research Ethical Committee of the
secutive weeks. A set of 15 repetitions for each exercise was Faculty of Physical Therapy, Cairo University (approval No.:
performed once each training day in the first phase, twice P.T.REC/012/002580).
each training day in the second phase, and three times each
training day in the third phase. Each participant trained three Informed consent
days per week [20]. The detailed treatment procedure has been explained to
The warm-up period involved a ‘Cat-Camel’ motion of the the participants, along with the risks and benefits, and written
spine (5–8 spine flexion-extension cycles). This warm-up ex- informed consent was taken.
ercise was carried out to reduce spinal viscosity and neural
tension. In the ‘Curl-Up’ exercise, the participant was asked Results
to raise the head and upper shoulders off the therapeutic mat
and hold the final position for 7–8 seconds [21]. Forty healthy individuals, randomly assigned to two groups;
In the ‘Side-Bridge’ exercise, the participant was instruct- experimental and control, participated in the study. As indi-
ed to bridge the torso between the elbows and knees. Once cated by the unpaired t-tests, there were no significant differ-
he mastered and tolerated this exercise, the challenge was ences (p > 0.05) for the mean values of the weight, height and
increased by bridging using the elbows and feet. The partici- BMI between both groups. However, there was a significant
pant raised the pelvis from the therapeutic mat and held it difference (p < 0.05) for the mean value of the age between
in a straight line ‘plank’ position for 7–8 seconds. This exer- both groups (Table 1).
cise was performed on both sides, right and left.
In the ‘Bird-Dog’ exercise, the participant adopted a quad- Table 1. Descriptive statistics and unpaired t-tests for the mean
ruped position, then he raised opposite upper and lower demographic and anthropometric data of the experimental and
limbs (right arm and left leg, then left arm and right leg) to control groups
be in line with the trunk. He was asked to hold the posture Experimental Control
for 7–8 seconds. Abdominal bracing was to be maintained group group
t-value p-value
throughout all the conducted exercises without holding his (n = 20) (n = 20)
breath [21]. (mean ± SD) (mean ± SD)

Age (years) 19.35 ± 1.11 20.45 ± 1.64 2.488 0.018*

Statistical analysis
Weight (kg) 70.15 ± 6.44 72.45 ± 6.91 1.089 2.300
Three independent variables were tested in this study,
Height (cm) 174.7 ± 7.02 176.3 ± 7.24 0.760 0.452
each with two levels. They were the trunk flexion range of
motion factor (30° and 60° trunk flexion positions), the time * significant at < 0.05
factor (pre-test and post-test conditions) and the tested group
factor (experimental and control groups). The dependent var- The Mixed 3-Way ANOVA and the pairwise tests revealed
iable was the active repositioning error. that the AE was significantly lower at the 60° trunk flexion
SPSS version 17 for Windows was used for the statistical position compared with the 30° position in the pre-test con-
analysis. First, data screening for normality assumption, test- dition for the experimental group, the pre-test condition for
ing for the presence of extreme scores, as well as the pres- the control group and the post-test condition for the control
ence of significant skewness and kurtosis was carried out group. However, there was no significant difference between
using the Kolmogorov-Smirnov and Shapiro-Wilk normality the trunk flexion positions in the post-test condition for the
tests. Screening for the homogeneity of variance assump- experimental group. In addition, the AE decreased signifi-
tion was also conducted. Once it was determined that the cantly in the post-test condition compared with the pre-test
normality and homogeneity assumptions were not violated, condition for the experimental group at both trunk flexion
a parametric analysis was carried out. Mixed 3-Way Analysis positions. However, there was no significant difference in the
of Variance (ANOVA) was conducted to compare between AE between the pre- and post-test conditions for the control
the 30° and 60° trunk flexion positions, the experimental and group at both trunk flexion positions.
the control groups, and the pre- and post-test conditions. Finally, there were no significant differences in the AE be-
Finally, the ANOVA was conducted to test the interactions tween both groups in the pre-test at the 30° trunk flexion posi-
among the three independent variables (range of motion, tion, nor at the 60° trunk flexion position. However, there were
tested group & time) with the alpha level set at 0.05. Subse- significant decreases in the AE of the experimental group
quent multiple pairwise comparison tests were conducted compared with the control group in the post-test conditions
with Bonferroni adjustment of the alpha level. at both 30° and 60° trunk flexion positions. Tables 2 and 3
present the mean values of the active repositioning error at
Ethical approval the 30° and 60° trunk flexion positions in the pre- and post-
The research related to human use has complied with all test conditions for both groups together with the pairwise
the relevant national regulations and institutional policies, comparison tests.

Table 2. Descriptive statistics for the mean values of the Absolute error
Experimental group (mean ± SD) Control group (mean ± SD)

pre-test post-test pre-test post-test

At 30° trunk flexion 5.7 ± 2.26 3.2 ± 1.66 5.27 ± 1.93 6.09 ± 2.83

At 60° trunk flexion 4.4 ± 1.68 3.17 ± 1.76 4.33 ± 1.43 4.8 ± 1.81
3
 A.A. Elborady, O.E. Saleh, A.A.A. Abdallah
Effect of a 6-week core stability training program on active trunk repositioning Physiother Quart 2023, 31(4)

Table 3. Multiple pairwise comparisons for Absolute error at 30° and 60° trunk flexion in the pre- and post-tests in the experimental
and control groups
p-value

Multiple pairwise comparison tests for the absolute error at both trunk ranges of motion

30° vs. 60° (experimental group) 0.006*

pre-test
30° vs. 60° (control group) 0.045*

30° vs. 60° (experimental group) 0.95

post-test
30° vs. 60° (control group) 0.047*
Within-subject effect
Multiple pairwise comparison tests for the absolute error for both ‘pre’ and ‘post’ tests

pre-test vs. post-test (control group) 0.13

30°
pre-test vs. post-test (experimental group) 0.001*

pre-test vs. post-test (control group) 0.23

60°
pre-test vs. post-test (experimental group) 0.003*

Multiple pairwise comparison tests for the absolute error between the tested groups

experimental vs. control group (pre-test) 0.52

30°
Between-subjects effect experimental vs. control group (post-test) 0.001*

experimental vs. control group (pre-test) 0.90

60°
experimental vs. control group (post-test) 0.006*
* significant at < 0.05

Discussion angle and the muscle spindles can respond across the en-
tire physiologic range of motion, unlike the joint and cutane-
Spinal stability is the pillar upon which normal function ous mechanoreceptors [26], at 60° trunk flexion, the cuta-
of the spine and the active generation of forces in the trunk neous and joint receptors share proprioceptive information
depend. It is also essential for the transfer of forces between with the muscle receptors that arises in the brain, helping and
the upper and lower limbs [22]. Injuries to the core muscles supporting the muscle receptors. On the other hand, 30° trunk
may lead to spinal instability which, if sustained during move- flexion is a midrange angle in which the muscle receptors are
ments, is associated with insufficient strength and endur- almost the only contributors to proprioceptive information,
ance of the trunk-stabilising muscles, leading to inappropriate which may result in lower proprioception acuity than that at
recruitment of the trunk muscles, mainly the abdominal ones. the end ranges. These findings are in agreement with those
Accordingly, any trunk-stabilising muscle weakness must be reported by Willems et al. [27].
identified and corrected, as this weakness may be a predis- Another finding in the current study was a decrease in
posing factor for muscle and joint injury [23]. the mean value of the active repositioning error at 30° in the
As revealed by the findings of the current study, the mean post-test of the experimental group that is more than that at
values of the active repositioning error increased significantly 60°, which may have caused the insignificant difference be-
at 30° trunk flexion compared with 60° trunk flexion in the tween both angles as the mean values of the active reposi-
pre-test condition for the experimental group, the pre-test tioning error at both degrees in the post-test are close to
condition for the control group, and the post-test condition each other.
for the control group. However, there was no significant dif- On another note, the statistical analysis revealed that
ference in the active repositioning error between both test- there were no significant differences in the active reposition-
ed trunk flexion positions in the post-test condition for the ing error between the pre- and post-test conditions in the con-
experimental group. trol group for either the 30° or the 60° trunk flexion positions
The cause of the significant increases in the mean values as they did not conduct any training program. However, there
of the active repositioning error at 30° flexion compared with were significant decreases in the active repositioning error
60° flexion may be attributed to the fact that activation of con- in the post-test conditions at both 30° and 60° trunk flexion
scious proprioceptors located in the joint capsule is related compared with the pre-test conditions in the experimental
to the joint angle. At the mid-range of joint motion, these pro- group. This may be attributed to improvement in trunk pro-
prioceptors are not stimulated enough to contribute to pro- prioception resulting from the 6-week core stability training.
prioception. Whereas, at the end ranges of motion, they are The core training might have caused neural adaptations in-
thought to signal proprioceptive information. Cutaneous re- volving more efficient neural recruitment patterns, faster ner-
ceptors respond in the same way as joint receptors at the vous system activation, improved synchronisation of motor
extremes of ranges of motion [24]. units and lowered neural inhibitory reflexes [28].
In addition to that, the role of ligamentous receptors in The improvement in trunk proprioception found in the
serving proprioceptive information can be neglected [25]. So, current study after performing the core program is indirectly
the muscle proprioceptors are, to a great extent, the only joint supported by other studies that investigated the effect of core
position sensors in the midranges of motion. Since the 60° stability training on dynamic balance and postural control.
4 trunk flexion angle is closer to the end range than the 30° The findings of the study conducted by Samson [29] to assess
 A.A. Elborady, O.E. Saleh, A.A.A. Abdallah
Physiother Quart 2023, 31(4) Effect of a 6-week core stability training program on active trunk repositioning

the effect of a 5-week core stabilisation training program on Acknowledgement

dynamic balance in tennis players revealed that the Star Ex- The authors would like to express their sincere gratitude to
cursion Balance Test (SEBT) scores were increased in both all the participants who kindly volunteered to participate in
groups, indicating improvement of dynamic balance, which this study.
was suggested to result from the test-retest effect. However,
the post-test results were not significantly different between Disclosure statement
both groups. Regardless of the non-significant outcome, Sam- No author has any financial interest or received any finan-
son suggested that the increased SEBT scores are a sign of cial benefit from this research.
improvement in dynamic balance in the core stability training
group. Conflict of interest
In the same context, Aggarwal et al. [30] conducted The authors state no conflict of interest.
a study to determine the effect of core stability training on
dynamic balance and muscle performance in non-profes- References
sional outdoor sports players. Three groups (core stability 1. Akuthota V, Nadler SF. Core strengthening. Arch Phys
training, balance training and control) were evaluated for dy- Med Rehabil. 2004;85(3 Suppl 1):86–92; doi: 10.1053/j.
namic balance using the SEBT and for core stability using the apmr.2003.12.005.
pressure bio-feedback Sahrmann core stability test. The sta- 2. Smith CE, Nyland J, Caudill P, Brosky J, Caborn DNM.
tistical analysis revealed that the core stability training group Dynamic trunk stabilization: a conceptual back injury
was improved in both dynamic balance and core stability. prevention program for volleyball athletes. J Orthop Sports
The findings by Piegaro [31], who examined the effect of Phys Ther. 2008;38(11): 703–20; doi:10.2519/jospt.2008.
core stability training on balance, tested via the Biodex bal- 2814.
ance system and SEBT in healthy individuals, disagreed with 3. Stokes IAF, Gardner-Morse MG, Henry SM. Abdominal
those of Samson [29] and Aggarwal et al. [30], which revealed muscle activation increases lumbar spinal stability: analy-
improvements in dynamic balance after core stability training. sis of contributions of different muscle groups. Clin Bio-
Piegaro’s statistical analysis revealed that there was no sig- mech. 2011;26(8):797–803; doi: 10.1016/j.clinbiomech.
nificant difference between the pre- and post-test conditions, 2011.04.006.
which was thought to be attributed to the short duration of 4. Bliven KCH, Anderson BE. Core stability training for in-
the core program, which lasted for four weeks. jury prevention. Sports Health. 2013;5(6):514–22; doi:
The last finding of the current study was the lack of sig- 10.1177/1941738113481200.
nificance in the active repositioning error between both groups 5. Cook G, Burton L, Hoogenboom B. Pre-participation
for either the 30° or 60° trunk flexion positions in the pre-test screening: the use of fundamental movements as an as-
condition. This insignificance may be attributed to the homo- sessment of function – Part 1. N Am J Sports Phys Ther.
geneity of the sample. Yet, there were significant differences 2006;1(2):62–72.
at each of the 30° and 60° trunk flexion positions in the post- 6. Riemann BL, Lephart SM. The sensorimotor system,
test condition, with lower mean values recorded in the ex- part 1: the physiologic basis of functional joint stability.
perimental group. This indicates improvement in trunk pro- J Athl Train. 2002;37(1):71–79.
prioception in the experimental group after conducting the 7. Johnson EO, Babis GC, Soultanis KC, Soucacos PN.
6-week core stability program. The improvement in trunk pro- Functional neuroanatomy of proprioception. J Surg Or-
prioception may be attributed to the therapeutic effects of thop Adv. 2008;17(3):159–164.
the exercises. 8. Brumagne S, Cordo P, Lysens R, Verschueren S, Swin-
nen S. The role of paraspinal muscle spindles in lumbo-
Limitations sacral position sense in individuals with and without low
back pain. Spine. 2000;25(8):989–994; doi: 10.1097/00
Our study has several limitations. Using the back attach- 007632-200004150-00015.
ment seat provided the participant with sensory feedback 9. Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysli-
because it was intimately attached to his body. The findings wiec LW. Comparison of trunk proprioception between
cannot be generalised to the female population, as the study patients with low back pain and healthy controls. Arch
was limited to healthy male individuals. The fact that the iso- Phys Med Rehabil. 2010;91(9):1327–1331; doi: 10.1016/
kinetic dynamometer does not measure trunk repositioning j.apmr.2010.06.004.
errors in the frontal or transverse planes also did not allow the 10. O’Sullivan PB, Burnett A, Floyd AN, Gadsdon K, Logiu-
researchers to evaluate trunk proprioception from all three dice J, Miller D, et al. Lumbar repositioning deficit in
planes of motion. Finally, the isokinetic system used in this a specific low back pain population. Spine. 2003;28(10):
study does not evaluate sense of movement (threshold to 1074–1079; doi: 10.1097/01.BRS.0000061990.56113.6F.
detect passive movement and direction of movement). So, 11. Boucher JA, Abboud J, Descarreaux M. The influence of
the researchers could not evaluate all aspects of propriocep- acute back muscle fatigue and fatigue recovery on trunk
tion. Based on the abovementioned findings of the current sensorimotor control. J Manipulative Physiol Ther. 2012;
study, the alternative hypothesis is accepted. 35(9):662–8; doi: 10.1016/j.jmpt.2012.10.003.
12. Kaprail M, Kaur P, Valecha F, Panihar U. To study the
Conclusions effects of core stability exercise in desk job patients with
mechanical low back pain. Sport Exerc Med Open J.
The decreased active trunk repositioning error with core 2019;5(1):18–20; doi: 10.17140/SEMOJ-5-170.
stability training indicates improvement in trunk propriocep- 13. Bae SH, Lee HG, Kim YE, Kim GY, Jung HW, Kim KY.
tion. Thus, core stability training would be beneficial if added Effects of trunk stabilization exercises on different sup-
to rehabilitation programs that aim to improve trunk proprio- port surfaces on the cross-sectional area of the trunk
ception. muscles and balance ability. J Phys Ther Sci. 2013;25(6):
741–745; doi: 10.1589/jpts.25.741.
5
 A.A. Elborady, O.E. Saleh, A.A.A. Abdallah
Effect of a 6-week core stability training program on active trunk repositioning Physiother Quart 2023, 31(4)

14. Ebrahimi H, Balouchi R, Eslami R, Shahrokhi M. The 31. Piegaro A. The Comparative Effects of Four-Week Core
effect of 8 weeks of core stabilization exercises on dis- Stabilization and Balance Training Programs on Semi-
ability, abdominal and back muscle strength in patients Dynamic and Dynamic Balance. Master’s Thesis, Mor-
with chronic low back pain due to disc herniation. JPS- gantown, West Virginia University; 2003.
BS. 2014;2(4):9–20; doi: 10.22077/JPSBS.2014.18.
15. Szafraniec R, Barańska J, Kuczyński M. Acute effects
of core stability exercises on balance control. Acta Bio-
eng Biomech. 2018;20(3):145–151; doi: 10.5277/ABB-
01178-2018-02.
16. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cho-
lewicki J. The effects of core proprioception on knee in-
jury: a prospective biomechanical-epidemiological study.
Am J Sports Med. 2007;35(3):368–373; doi: 10.1177/
0363546506297909.
17. Rezaeipour M. Evaluation of postural stability in over-
weight and obese middle-aged men. Turk J Med Sci.
2018;48(5):1053–1057; doi: 10.3906/sag-1709-108.
18. Cossich V, Mallrich F, Titonelli V, de Sousa EB, Vela­
sques B, Salles JI. Proprioceptive deficit in individuals
with unilateral tearing of the anterior cruciate ligament
after active evaluation of the sense of joint position. Rev
Bras Ortop. 2014;49(6):607–602; doi: 10.1016/j.rboe.
2013.07.003.
19. Saal JA, Saal JS. Nonoperative treatment of herniated
lumbar intervertebral disc with radiculopathy. An outcome
study. Spine. 1989;14(4):431–437; doi: 10.1097/0000
7632-198904000-00018.
20. Fredericson M, Moore T. Muscular balance, core stability,
and injury prevention for middle- and long-distance run-
ners. Phys Med Rehabil Clin N Am. 2005;16(3):669–689;
doi: 10.1016/j.pmr.2005.03.001.
21. McGill S. Low Back Disorders: Evidence-Based Preven-
tion and Rehabilitation. 2nd ed. Champaign: Human Ki-
netics; 2007.
22. Haher TR, O’Brien M, Kauffman C, Liao KC. Biomechan-
ics of the spine in sports. Clin Sports Med. 1993;12(3):
449–64.
23. O’Sullivan PB, Twomey L, Allison G. Dysfunction of the
neuromuscular system in the presence of Low back
pain-implications for physical therapy management. J
Manual Manipulative Ther. 1997;5(1):20–26; doi: 10.1179/
jmt.1997.5.1.20.
24. Eric R, James H, Thomas M. Principles of Neural Sci-
ence. 3rd ed. New York: Elsevier Science; 1991.
25. Grigg P. Peripheral neural mechanisms in proprioception.
J Sport Rehabil. 1994;3(1):2–17; doi: 10.1123/jsr.3.1.2.
26. Macefield G, Gandevia S, Burke D. Perceptual respons-
es to microstimulation of single afferents innervating
joints, muscles and skin of the human hand. J Physiol.
1990;429:113–129; doi: 10.1113/jphysiol.1990.sp018247.
27. Willems T, Witvrouw T, Verstuyft J, Vaes P, Clercq D.
Proprioception and muscle strength in subjects with
a history of ankle sprains and chronic instability. J Athl
Train. 2002;37(4):487–493.
28. Staron RS, Karapondo DL, Kraemer WJ, Fry AC, Gor-
don SE, Falkel JE, et al. Skeletal muscle adaptations
during early phase of heavy-resistance training in men
and women. J Appl Physiol. 1994;76(3):1247–1255; doi:
10.1152/jappl.1994.76.3.1247.
29. Samson K. Effect of Five-Week Core Stabilization Train-
ing-Program on Dynamic Balance in Tennis Athletes.
Master’s Thesis, The School of Physical Education, West
Virginia University; 2005.
30. Aggarwal A, Zutshi K, Munjal J, Kumar S. Effect of core
stabilization training on dynamic balance in non-profes-
sional sports players. Indian J Physiother Occup Ther.
6
2010;4(4):18–22.