Professional Documents
Culture Documents
The Effect of Core Stability Training On Functional Movement
The Effect of Core Stability Training On Functional Movement
https://doi.org/10.1123/jsr.2017-0107
© 2018 Human Kinetics, Inc. ORIGINAL RESEARCH REPORT
Context: Preparticipation examinations are the standard approach for assessing poor movement quality that would increase
musculoskeletal injury risk. However, little is known about how core stability influences functional movement patterns.
Objective: The primary purpose of this study was to determine the effect of an 8-week core stability program on functional
movement patterns in college athletes. The secondary purpose was to determine if the core stability training program would be
more effective in those with worse movement quality (ie, ≤14 baseline functional movement screen [FMS] score). Design: Quasi-
experimental design. Setting: Athletic training facility. Participants: One-hundred college athletes. Main Outcome Measures:
Functional movement patterns included the FMS, lateral step-down, and Y balance test and were assessed before and after the 8-
week program. Intervention: Participants were placed into one of the 2 groups: intervention and control. The intervention group
was required to complete a core stability training program that met 3 times per week for 8 weeks. Results: Significant group ×
time interactions demonstrated improvements in FMS, lateral step-down, and Y balance test scores in the experimental group
relative to the control group (P < .001). Independent sample t tests demonstrate that change scores were larger (greater
improvement) for the FMS total score and hurdle step (P < .001) in athletes with worse movement quality. Conclusions: An
8-week core stability training program enhances functional movement patterns and dynamic postural control in college athletes.
The benefits are more pronounced in college athletes with poor movement quality.
Musculoskeletal injuries are an inherent risk of athletic par- injury risk in male football players,9 female college athletes,10 and
ticipation. Noncontact injuries represent ∼20% of all injuries male military candidates.11 The lateral step-down (LSD) test can be
sustained during games and 40% of injuries sustained during used to rate the quality of movement based on the alignment of the
practices.1 Researchers have found that noncontact injuries occur trunk, pelvis, and knee12 with scores ranging from 0 to 6.13 The Y
because of high-velocity movements coupled with the lack of balance test (YBT) was developed to quantify dynamic balance in
preparatory muscle coordination and/or inappropriate reactive 3 reach directions.14 Poor YBT scores have been shown to be a
muscle activity.2 Risk factors for noncontact injuries are therefore predictor of lower-extremity injury.3
modifiable and have been identified through movement patterns, Neuromuscular control15 and core stability16 have emerged as
right-to-left asymmetries, and balance abnormalities.3 The prepar- potentially important intrinsic factors that affect an athlete’s risk of
ticipation examination is a standard approach for assessing move- injury. Several researchers have identified the importance of core
ment quality that would increase musculoskeletal injury risk.4,5 stabilization as a key element for proper movement of the lower
Athletes need an adequate amount of balance, core stability, extremities17,18 and promoting proximal stability for distal mobil-
and neuromuscular control to safely and effectively perform the ity.19–21 However, Okada et al22 found no significant correlations
necessary movements of their sport.6 A fundamental movement between core stability and FMS scores. Core stability is a complex
pattern is a basic movement utilized to simultaneously examine concept and has been defined as the ability to control the position and
muscle strength, flexibility, range of motion, coordination, balance, motion of the trunk over the pelvis and to allow optimum production,
and proprioception.5 Functional movement is defined as the ability transfer, and control of force and motion to the terminal segment in
to produce and maintain an adequate balance of mobility and integrated athletic activities.19 Willson et al23 demonstrated a rela-
stability along the kinetic chain while integrating fundamental tionship between trunk muscle activity and lower-extremity move-
movement patterns with accuracy and efficiency.7 ment such as jumping, which suggests that decreased core stability
The functional movement screen (FMS) was developed to may predispose an athlete to injury19 and that core training may
evaluate movement performance during 7 movement patterns.8 reduce such risk.6,19 Unfortunately, few studies have integrated core
Scores from each movement are summed for a maximal composite stabilization exercises into injury prevention programs.6 Although
score of 21, and a composite score of ≤14 is suggestive of increased several investigations have quantified the effects of corrective ex-
ercises and general rehabilitation programs on movement quality,24,25
there is a paucity of information on the effects of a core stability
training program on functional movement patterns.
Bagherian is with the Department of Sports Injuries and Corrective Exercises, Shahid
Therefore, the primary purpose of this study was to determine
Rajaee Teacher Training University, Tehran, Iran. Ghasempoor is with the Department
of Sports Injuries and Corrective Exercises, University of Tehran, Kish International
the effectiveness of an 8-week core stability training program on
Campus, Kish, Iran. Rahnama is with the Department of Sports Injuries and Corrective functional movement patterns including FMS, LSD, and YBT in
Exercises, University of Isfahan, Isfahan, Iran. Wikstrom is with the Department of college athletes. The secondary purpose was to determine if the
Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, core stability training program was more effective in college
NC, USA. Bagherian (sajjadbagherian@yahoo.com) is corresponding author. athletes with poor movement quality (ie, ≤14 baseline FMS score)
1
2 Bagherian et al
than college athletes with good movement quality (ie, >14 baseline
FMS scores). We hypothesized that the group receiving core
stability training would be effective at improving functional move-
ment patterns relative to a control group and that the effect of the
training protocol would be greater in those who had poor move-
ment quality.
Methods
Participants
This quasi-experimental study consisted of 100 physically active
and healthy male college athletes between 18 and 22 years of age.
College athletes (basketball = 40, futsal = 40, volleyball = 12, and
martial arts = 8) were defined as students who participated in
intercollege sports, were currently in their off-season, and were
training at least 3 times per week (>1.5 h/wk). All participants were
currently free from any kind of musculoskeletal injury, had not
sustained any kind of musculoskeletal injury within the past
6 weeks, and had never undergone surgery for a musculoskeletal
condition.26 Female athletes were not asked to participate due to
cultural constraints, specifically the inappropriateness of a male
researcher testing female participants.
Sample size was calculated based on previously published
Downloaded by Ebsco Taiwan on 03/22/19
of 10 participants to achieve an interrater reliability consistent with employed. Minimal detectable change (MDC) scores were calcu-
previously published values. lated to determine the minimal change required within our depen-
For LSD test, the tibial tuberosity of each participant was dent variables to confidently determine that the change was due to
marked with a 1-cm sticker to facilitate its visualization during the the intervention. MDC scores were determined using intersession
test. The testing procedure was orally explained to each participant reliability and the standard error of measurement from the control
and followed by a demonstration. The side tested first was alter- group data collected during the pretest and posttest. MDC scores
nated between consecutive participants. Participants performed the were calculated as the standard error of measurement multiplied by
test on a 15-cm step. Participants were instructed to keep the trunk the square root of 2. The standard error of the measure was
straight and hands on the waist and to bend the knee of the stance calculated as the SD from the first test multiplied by the square
leg until the contralateral heel touched the floor next to the step. root of 1 minus the intersession reliability.31
They were asked not to put any weight on the contralateral heel
once it reached the floor and to immediately reextend the knee and
return to the starting position. Participants were also asked to try to
maintain the knee of the stance leg over the second toe of the
Results
ipsilateral foot during the test while looking straight ahead but At baseline, participant demographics and pretest scores did not
without visual (eg, mirror) or auditory (eg, verbal) corrective cues. differ between the groups (P > .05). Significant group × time inter-
Participants performed 5 practice repetitions followed by 5 conse- actions were observed for FMS task scores (F7,92 = 12.9, P = .001)
cutive test repetitions. Participants performed the test with a and YBT reach distances (F3,96 = 25.2, P = .001). The interactions
2-second downward and a 2-second upward duration. The exam- demonstrate much larger improvements over time in the experi-
iner was positioned 3 m in front of the participant during the test. mental group relative to the control group. Some but not all FMS
The test was scored on a 7-point scale (0–6) according to the criteria scores drove the significant interaction and can be seen in Table 1.
outlined by Piva et al.13 The examiner faced the subject and scored All of the individual YBT reach directions demonstrated a signifi-
the test based on 5 criteria: (1) arm strategy, (2) trunk movement, cant improvement following the experimental but not the control
(3) pelvis plane, (4) knee position, and (5) maintain steady unilat- group. In addition, significant group × time interactions were iden-
Downloaded by Ebsco Taiwan on 03/22/19
eral stance. Total score of 0 or 1 was classified as good, 2 or 3 was tified for the FMS total scores (F1,98 = 52.2, P = .001) and LSD
classified as medium, and ≥4 was classified as poor movement (F1,98 = 67.7, P = .001) highlighting improvement in the experi-
quality. mental but not in the control group. The significant improvements
Dynamic postural control was assessed using the YBT that noted in the experimental group are further supported by the
assesses an individual’s ability to dynamically reach in the anterior, medium to large ESs observed and the associated 95% confidence
posteriormedial, and posteriolateral directions. All participants intervals that do not cross 0 (Table 1). Finally, the improvements in
were instructed to stand in single-limb stance on the dominant total FMS score, deep squat, in-line lunge, rotary stability, anterior
limb with the most distal aspect of their great toe at the center of the reach, posteriormedial reach, and LSD all exceeded the MDC score
grid. Participants then completed 3 maximal reach distances in each calculated from the control group data providing further evidence
direction while maintaining the single-limb stance. Scores were that the core stability training program resulted in meaningful
normalized by dividing the directional averages by a participant’s improvements in functional movement quality and dynamic pos-
leg length (distance from the anterior superior iliac spine to the tural control.
medial malleolus). Prior to completion, participants practiced each Independent sample t tests revealed that the core training
distance 3 times. Test trials were discarded and repeated if the program resulted in only 2 significant differences between high-
individual was unable to maintain a single-limb stance throughout and poor-quality movers: FMS total score (t58 = 3.7, P = .001) and
the test, removed their hands from their hips, lifted their stance limb hurdle step (t58 = 2.7, P = .01). Both results suggest that the core
heel off the ground, or placed more than minimal weight onto the stability training program was more effective for poor-quality
reach foot.3 The YBT has high interrater and interrater reliability.30 movers (Table 2). Although the average change scores and ESs
were larger in the poor movement quality group, the associated
Data Analyses 95% confidence intervals of all variables overlap suggesting
comparable effects on functional movement quality and dynamic
Data were analyzed using SPSS statistical software (version 22; postural control regardless of an individual’s baseline movement
IBM, Armonk, NY). To assess the effects of the training program quality.
on individual FMS tests and YBT directions, separate 2 × 2-mixed-
model multivariate analysis of variance (ANOVA) were run with
group (experimental or control) and time (pre and post) as the Discussion
independent variables. If the multivariate ANOVA revealed
significant differences, follow-up univariate 2 × 2 ANOVAs and The primary purpose of this study was to determine the effect of an
pairwise comparisons were performed to identify specific out- 8-week core stability program on functional movement patterns
comes that differed and the locations of those differences. For including FMS, LSD, and YBT. Our results support our a priori
the FMS total score and LSD, separate univariate 2 × 2 ANOVAs hypothesis and demonstrate that an 8-week core stability program
were completed. Prechange to postchange scores between quality significantly improves functional movement patterns and dynamic
movers (>14 total FMS score) and poor-quality movers (≤14 total postural control. The secondary purpose was to determine if a core
FMS score) within the experimental group were calculated using stability program is more effective for individuals with poor
independent sample t tests and bias-corrected Hedges’ g ESs with movement quality at baseline (≤14 FMS total score). Our results
95% confidence intervals. Hedges’ g ESs were interpreted as partially support our a priori hypothesis as only the FMS total and
follows: <0.2 as small, 0.21 to 0.5 as moderate, and >0.8 as large. hurdle step change scores differed between high- and low-quality
For all comparisons, statistical significance of P ≤ .05 was movers after the intervention.
(Ahead of Print)
4 Bagherian et al
Table 2 Summary of Experimental Group Results for Each Assessment With Considering Total FMS Scores
Downloaded by Ebsco Taiwan on 03/22/19
Core stability is defined as the ability to control the position the lumbo–pelvic–hip complex and is defined as the capacity to
and motion of the trunk over the pelvis to allow optimum produc- maintain equilibrium of the vertebral column within its physiologic
tion, transfer, and control of force and motion to the terminal limits by reducing displacement from perturbations and maintain-
segment in integrated athletic activities.19 Core stability involves ing structural integrity.21 For example, Hodges and Richardson20
(Ahead of Print)
Core Stability Training on Functional Movements 5
examined the sequence of muscle activation during whole- measures are subjective in nature. Similarly, group assignment
body movements and found that some of the core stabilizers based on convenience is a limitation and may have introduced a
(ie, transverses abdominals, multifidus, rectus abdominals, and sampling bias into the results. Future research is needed to confirm
oblique abdominals) were consistently activated before any limb these initial results with blinded assessors and trainers, randomized
movements. These findings support the theory that movement group assignment, and a mix of male and female participants.
control and stability are developed in a core-to-extremity
(proximal–distal) and a cephalocaudal progression (head-to-toe).
Core stability exercises are implemented according to the theoreti- Conclusions
cal framework that dysfunction in core musculature is related to Eight weeks of core stability training are effective at enhancing
(musculoskeletal) injury; therefore, exercises that restore and functional movement patterns and dynamic postural control in
enhance core stability are related to injury prevention and college athletes. Core stability training may be more effective for
rehabilitation.6 poor-quality movers, but further research is needed.
The FMS, YBT, and LSD were created to assess functional
movement capacity and may indirectly measure intrinsic factors
such as muscle strength and activation, neuromuscular control, and Acknowledgments
core stability.3,12,22 Neuromuscular control15 and core stability16 The authors would like to acknowledge the college athletes who partici-
have emerged as potentially important intrinsic factors that affect pated, the research assistants who were instrumental in the collection of the
an athlete’s risk of injury. Similarly, decreased core strength may data, and also the Shahrekord Technical Institute for their support and use
contribute to injuries of lower-extremity by reducing the ability of of their facilities. No financial assistance was obtained for this study. This
stabilizing the lower-extremity. Multiple investigations have at- research did not receive any specific grant from funding agencies in the
tempted to determine if movement quality is sensitive to change public, commercial, or not-for-profit sectors. There are no conflicts of
following interventions. For example, Bodden et al24 found that interest to declare.
4 weeks of corrective exercises were able to improve FMS scores.
Similarly, Bagherian et al32 found significant improvement on
Downloaded by Ebsco Taiwan on 03/22/19
(Ahead of Print)
6 Bagherian et al
12. Rabin A, Kozol Z. Measures of range of motion and strength among 24. Bodden JG, Needham RA, Chockalingam N. The effect of an
healthy women with differing quality of lower extremity movement intervention program on functional movement screen test scores in
during the lateral step-down test. J Orthop Sports Phys Ther. mixed martial arts athletes. J Strength Cond Res. 2015;29:219–225.
2010;40:792–800. PubMed ID: 20972344 doi:10.2519/jospt.2010.3424 PubMed ID: 23860293 doi:10.1519/JSC.0b013e3182a480bf
13. Piva SR, Fitzgerald K, Irrgang JJ, et al. Reliability of measures of 25. Wright MD, Portas MD, Evans VJ, Weston M. The effectiveness of
impairments associated with patellofemoral pain syndrome. BMC 4 weeks of fundamental movement training on functional movement
Musculoskelet Disord. 2006;7:33. PubMed ID: 16579850 doi:10. screen and physiological performance in physically active children. J
1186/1471-2474-7-33 Strength Cond Res. 2015;29:254–261. PubMed ID: 25072666 doi:10.
14. Hertel J. Sensorimotor deficits with ankle sprains and chronic ankle 1519/JSC.0000000000000602
instability. Clin Sports Med. 2008;27:353–370. PubMed ID: 26. Letafatkar A, Hadadnezhad M, Shojaedin S, Mohamadi E. Relation-
18503872 doi:10.1016/j.csm.2008.03.006 ship between functional movement screening score and history of
15. Myer GD, Ford KR, Palumbo OP, Hewett TE. Neuromuscular training injury. Int J Sports Phys Ther. 2014;9:21. PubMed ID: 24567852
improves performance and lower-extremity biomechanics in female 27. Imai A, Kaneoka K, Okubo Y, Shiraki H. Effects of two types of trunk
athletes. J Strength Cond Res. 2005;19:51–60. PubMed ID: 15705045 exercises on balance and athletic performance in youth soccer players.
16. Peate W, Bates G, Lunda K, Francis S, Bellamy K. Core strength: a Int J Sports Phys Ther. 2014;9:47. PubMed ID: 24567855
new model for injury prediction and prevention. J Occup Med Toxicol. 28. Onate JA, Dewey T, Kollock RO, et al. Real-time intersession and
2007;2:3. PubMed ID: 17428333 doi:10.1186/1745-6673-2-3 interrater reliability of the functional movement screen. J Strength
17. Leetun DT, Ireland ML, Willson JD, Ballantyne BT, Davis IM. Core Cond Res. 2012;26(2):408–415. PubMed ID: 22266547 doi:10.1519/
stability measures as risk factors for lower extremity injury in athletes. JSC.0b013e318220e6fa
Med Sci Sports Exerc. 2004;36:926–934. doi:10.1249/01.MSS. 29. Smith CA, Chimera NJ, Wright NJ, Warren M. Interrater and
0000128145.75199.C3 intrarater reliability of the functional movement screen. J Strength
18. Willson JD, Ireland ML, Davis I. Core strength and lower extremity Cond Res. 2013;27:982–987. PubMed ID: 22692121 doi:10.1519/
alignment during single leg squats. Med Sci Sports Exerc. JSC.0b013e3182606df2
2006;38:945–952. PubMed ID: 16672849 doi:10.1249/01.mss. 30. Plisky PJ, Gorman PP, Butler RJ, Kiesel KB, Underwood FB, Elkins
Downloaded by Ebsco Taiwan on 03/22/19
(Ahead of Print)