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Trunk Muscular Endurance TestingI must emphasise that assessing muscle endurance associated with a reduced chance of back problems is best done by more than just the SideBridge Endurance Test. Ideally you would assess flexor and extensor endurance also and these tests are preformed in the Kin 343 and 342 courses.For the purposes of Kin143 we will For the purposes of Kin143 we will have every “able have every “able bodied” student bodied” student onlyonlyperformperform the side bridge tests due the side bridge tests due to the limited lab time we have. to the limited lab time we have. But by all means But by all means conduct the flexor and extensor teconduct the flexor and extensor tests yourself and sts yourself and include these scores in your course projectinclude these scores in your course project!!Protocols for these tests are on the powerProtocols for these tests are on the power--point slides point slides accessible via the Kin143 Web page.accessible via the Kin143 Web page.Data from Stuart McGill (a Canadian researcher from McGill University)provides suggested ratiosin the table below. This is because absolute endurance is probably secondary to the relationship between muscle groups as it is thought muscle imbalances are a primary cause of back problems.For example, McGill points out that often people with low back problems have relative weaker extensor strength relative to their flexor strength (rather than actually having weaker muscles). Mean Endurance Times (seconds) and Ratios RSB = Right Side Bridge LSB = Left Side BridgeSD = Standard DeviationTable adapted from:Stuart McGill. Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign, IL: Human Kinetics, 2002.MenWomenAllTaskMeanSDMeanSDMeanSDExtension161611856017362Flexion136661348113476RSB953275328333LSB 993778328636Ratios Normalized to the Extensor Endurance Test Flexion/ Extension Ratio0.840.720.77RSB/LSB ratio0.960.960.96RSB /Extension Ratio0.580.400.48LSB / Extension Ratio0.610.420.50
Interpreting Endurance Scores from the Four Back Tests (Extension, Endurance, RSB and LSB)Obviously if you are far from the norms shown above in any of the four tests then this may be cause for concern. Normal distribution would predict that if you are below one standard deviation in these tests (e.g. below 100 seconds for males in the extensor test) then you are in the bottom 16% of the population (conversely a score of 262 seconds or above puts you in the top 16%). However, care must be taken as people with higher body weight may tend to score lower (note that females have higher endurance scores than males in extension).For the mean values you would simply decide if your score was “Above Mean”, “At Mean”, or “Below Mean”.As stated McGill argues that interpreting absolute endurance is probably secondary to the relationship among the three muscle groups (flexors, lateral, and extensors). He suggests the following limits on discrepancies between the endurance scores. Scores outside these limits suggest unbalanced endurance. Right-Side Bridge / Left Side Bridge Endurance Ratio≤0.05McGill suggests the RSB/LSB ratio should not differ from unity (1) by more than 0.05 (i.e. the ratio should be between 0.95 and 1.05). Mathematically this is written: 0.95≤ RSB/LSB Ratio ≤ 1.05. Outside of these values the muscle balance is UNACCEPTABLE (within values ACCEPTABLE). So when evaluating your RSB/LSB ratio you should refer to these suggested values rather than the mean ratio shown in the table above. Flexion / Extension Endurance Ratio ≤1.0Therefore if this ratio gives a result less than or equal to 1.0 it is ACCEPTABLE; a ratio greater than 1.0 is UNACCEPTABLE. Notice that the mean ratio is 0.84 for males and 0.72 for females so do not use these values to decide whether the result is acceptable or not. Side Bridge (either side) / Extension Endurance Ratio≤0.75Therefore if this ratio gives a result less than or equal to 0.75 it is ACCEPTABLE; a ratio greater than 0.75 is UNACCEPTABLE. Notice that the mean ratio is around 0.60 for males (depending on side) and 0.41 for females (depending on side) so again do not use these values to decide whether the result is acceptable or not.. Despite an obvious and warranted focus on muscles crossing the pelvis, there is no doubt that a short and weak pectoralis muscles can cause a hunched posture and lead to back pain. For this reason, overall flexibility (adequate range of motion) is still a desirable goal as are overall muscular strength and endurance. Assessment during the acute phase of back pain is obviously not going to be helpful. But exercise itself can help most back problems (approximately 95%, see KIN 143 lecture notes), so there is no need for subjects to be completely free of pain before testing.