Lumbar Strain

Lumbar strain is one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. It is classified as "acute" if it has been present for days to weeks. If the strain lasts longer than 3 months, it is referred to as "chronic."

Definition: 

              

               Lumbar strain,  muscle strains and sprains are the most common causes of 

low back pain. The back is prone to this strain because of its weight-bearing function and involvement in moving, twisting and bending. Lumbar muscle strain is caused when muscle fibers are abnormally stretched or torn.

Occurrence:

              Strains are defined as tears (partial or complete) of the muscle-tendon unit. Muscle strains and tears most frequently result from a violent muscular contraction during an excessively forceful muscular stretch.You can define acute and chronic strains are characterized by continued pain attributable to muscle injury. Low back pain is the second most common symptom that causes patients to seek medical attention in the outpatient setting. Approximately 70% of adults have an episode of LBP as a result of work or play.

Symptoms:

                 Common symptoms include pain, which is diffuse in the lumbar muscles, with some radiation to the buttocks. The pain could be exacerbated during standing and twisting motions, with active contractions and passive stretching of the involved muscle the pain vil increase.

                 Other symptoms are point tenderness, muscle spasm, possible swelling in and around the involved musculature, a possible lateral deviation in the spine with severe spasm, and a decreased range of motion. 

Physiotherapy Prevention:

                  In the acute phase of a lumbar strain Cold therapy should be applied (for a short period up to 48 h) to the affected area to limit the localized tissue inflammation and edema. Recent studies have found that continuing ordinary activities within the limits permitted by the pain leads to more rapid recovery than bed rest. TENS and ultrasound are often used to help control pain and decrease muscle spasm, mild stretching exercises along with limited activity.

Some stretching Activities:

Single or double knee to chest:

                   Lie down on your back with your knees bent and your heels on the floor. Pull your knee or knees as close as you can to your chest, and hold the pose for 20 seconds. Repeat this 3 to 5 times.

 Back stretch:

                    Lie on your back, hands above your head. Bend your knees and , keeping your feet on the floor, roll your knees to one side, slowly. Stay at one side for 20 seconds repeat 3 to 5 times.

• Kneeling lung (stretching iliopsoas)

• stretching piriformis

• stretching quadratus lumborum

                   Progression of strengthening exercises should begin once the pain and spasm are under control. The muscles requiring the most emphasis are the abdominals, especially the obliques, the trunk extensors and the gluteals. 

                    Additionally back muscle strengthening exercises, core muscle strengthening exercises , these will help to get recovery soon from lumbar strain.

Bell's Palsy And its Rehabilitation

BELL'S PALSY:                       

                   

                       Bell’s palsy is a condition that causes a temporary weakness or paralysis of the muscles in the face. It can occur when the nerve that controls your facial muscles becomes inflamed, swollen, or compressed. The condition causes one side of your face to droop or become stiff. 

                       You may have difficulty smiling or closing your eye on the affected side. In most cases, Bell’s palsy is temporary and symptoms usually go away after a few weeks. Although Bell’s palsy can occur at any age, the condition is more common among people between ages 16 and 60

Symptoms:  

                       The symptoms of Bell’s palsy can develop one to two weeks after you have a cold, ear infection, or eye infection. They usually appear abruptly, and you may notice them when you wake up in the morning or when you try to eat or drink.

                    Bell’s palsy is marked by a droopy appearance on one side of the face and the inability to open or close your eye on the affected side. In rare cases, Bell’s palsy may affect both sides of your face.

                    Other signs and symptoms of Bell’s palsy include: Drooling of saliva due to unable to close their mouth. Feeling difficulty while eating and drinking. Unable to so Some of facial expressions like smiling and frowning. Facial muscle weakness. Sometimes you can seen muscle switches in the face. Their face , mouth and eye will be try, May be having headache. They are having sensitivity to sound.

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Causes:

             Bell's palsy occurs when the seventh cranial nerve becomes swollen or compressed, resulting in facial weakness or paralysis. 

The viruses that have been linked to the development of Bell’s palsy include:

Herpes simplex,  which causes cold sores and genital herpes. HIV, which damages the immune system

• Sarcoidosis, which causes organ inflammation
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• Herpes zoster virus, which causes chickenpox and shingles
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• Epstein-Barr virus, which causes Mononeucleosis

Your risk of developing Bell’s palsy increases if you: are pregnant, have diabetes,have a lung function, have a family history 

Medications:

• Corticosteroid drugs, which reduce inflammation
• Antiviral medication, such as Ipubrofen, which can help relieve mild pain
• using eye drops and an eye patch (for your dry eye)
• placing a warm, moist towel over your face to relieve pain
• Physiotherapy Management:
•      
•            Massage is very useful in Bell's Palsy . "Y'' shaped taping is very useful to prevent further weakness, and maintain the weakness. Electrical muscle stimulation. Some of useful home based activities are balloon  blowing, making bubbles, blowing air out through the tight fist etc.

Muscle Energy Technique

Muscle Energy Technique:

               Muscle Energy Technique (MET) is a manual therapy technique that uses the gentle muscle contractions  by isometric contractions (only 20% of force) of the patient to relax and lengthen muscles by use of muscle stretching and normalize joint motion. In olden days for stretching muscles we used to do passive stretching exercises only, then it became change into active or self stretching. Now the stretching modified or developed as well in the name of Muscle energy technique.

             

                It is defined as“ Muscle Energy Technique is a direct manipulative procedure that uses a voluntary contraction of the patient’s muscles against a distinctly controlled counter-force from a precise position and in a specific direction”. 

                  MET is often applied to patients who suffer from muscle spasms to relax their muscles. The process of lengthening shortened or spastic muscles, to improve weakened ligament and muscle strength, will directly improve range of motion. This procedure is performed when a patient is asked to contract a muscle for approximately 5-seconds against the resistant force applied by the physiotherapist (around 20% of patient's power) . The muscle contraction is performed by the client 3 to 5 times in a row in the hopes to stretch the muscle further each time.

                  Muscle Energy Technique is derived from the theory that if a joint is not used to its full range of motion, its function will lessen and it will be at risk of suffering strains and injuries. This form of physiotherapy makes use of a patient’s own muscle energy (the force); while the physio therapist presents a stationary surface (resistance) the patient will contract their muscle against in order to stretch the muscle and joint to its full potential.

Indications of MET:

                   Muscle energy techniques can be applied safely to almost any joint in the body. Many athletes use MET as a preventative measure to guard against future muscle and joint injury. It is mainly used by individuals who have a limited range of motion due to facet joint dysfunction in the neck and back, and for broader areas such as; shoulder pain, scoliosis, sciatica, unsymmetrical legs, hips or arms (for example when one is longer or higher then the other), or to treat chronic muscle pain, stiffness or injury.

There are two types of MET:

• Post-Isometric Relaxation (PIR) The therapist stretches and lengthens a muscle as it relaxes right after a client contraction. This lengthens, relaxes and realigns the muscle fibers. This is useful with chronic conditions to assist in resetting the muscle tone.
  
• Reciprocal Inhibition (RI) It is a law of body dynamics that when you contract a muscle the opposing or reciprocal muscle must relax.  The physiotherapist has the patient’s muscle perform a contraction against resistance which relaxes the opposing muscle and minimizes the aggravation to the injured muscle and soft tissue.
  

Role of Rehabilitation in Developmental Delay

Delay is when your child doesn'treach their developmental milestones in expected times. If your child is temporarily lagging behind, that is not called developmental delay. Delay can occur in one or many areas—for example, gross or fine motor, language, social, or thinking skills etc.

Causes: Developmental delay can have many different causes, such as genetic causes (like Down Syndrome), or complications of pregnancy and birth (like prematurity or infections). Some causes can be easily reversed if caught early enough, such as hearing loss from chronic ear infections. In neonatal period, if infants get some deadly infections like meningitis, encephalitis and etc also lead to developmental delay.

Prevention: Since there are so many different conditions that can lead to developmental delays, there isn’t one “right way” to prevent developmental delay. What’s important is to be aware of when your baby should be reaching developmental milestones and to consult your pediatrician if you think there may be a problem. Early intervention is key in helping your child overcome any developmental delays. Morally prevention is better than cure.

Diagnosis: Children diagnosed with a developmental delay are often later diagnosed with a developmental disability that explains why they are not reaching their developmental milestones. A child with poor motor skills might later be diagnosed with cerebral palsy or muscular dystrophy. A child that is not reaching their cognitive or social milestones might later be diagnosed with intellectual disability, learning disability, or autism. In some children, the developmental delays resolve and no diagnosis is made. 

Treatment: There is no one treatment that works for every child with a developmental delay. Children are unique; they learn and grow and develop in their own way, at their own pace, based on their strengths and weaknesses. Any treatment plan will take this uniqueness into account and be designed to focus on individual needs. Early intervention services are the main theme of treatment, but any underlying conditions that have led to developmental delay will need to be treated as well. Early intervention therapies may include: Physiotherapy, Speech therapy, Occupational therapy and Behavioral therapy. We have to design treatment methods for each and every kids according to their disability.

Prognosis: The child’s progress depends in large part on the underlying diagnosis for the delay and the individual child’s strengths and challenges. Early identification and treatment will optimize a child’s progress.  With a proper treatment plan, most children should progress in their development although the rate of that progress and the extent that the delays resolve is highly variable depending upon the underlying condition.  Some children may “catch up” to peers over time while others may have disabilities that persist into adult life.  Many of these adults may be independent in their function, some individuals may have mild disability requiring limited societal supports, and others may require extensive supports due to the extent of their disability... 

PHYSIOTHERAPIST ROLE:

Motor Developmental delay is when a child does not progress as expected in achievement of specific milestones such as learning to sit, crawl, walk, play or talk.  All babies and children develop milestones at their own pace but “every child should do certain tasks by a certain age”. 

Early intervention is best:   “There are studies that are now reporting that children who have intervention early do better than children who do not have intervention.   Physiotherapists are mainly concerned with the development of body postures and large movements (gross motor skills).  However, they need to understand the way children develop all their skills, including hearing, speech, vision, fine movements, social behavior and play, in order to assess or treat a child with suspected motor delays.

If there are concerns regarding a baby’s or toddler’s gross motor development, they will usually benefit from assessment by a physiotherapist specializing in pediatrics.  Ideally, a child should start physiotherapy as early as possible.  Physiotherapy can help babies develop from a very early age, by placing them in beneficial positions and helping them to move.  At Therapies for Kids  physiotherapists only work with children  and provide  assessment, advice and / or treatment .

When you first bring your child into Therapies for Kids our physiotherapists will do a detailed assessment of your child's motor skills, including looking at their gross and fine motor skills, their reflexes, muscle strength, range of movement, balance and postural reactions and their sensory development.  From this your physiotherapist will discuss with you your concerns and assist in the development if a plan to help you to assist your child gain motor skills.

Physiotherapists focusing on:

• 1. assist your child to achieve physical milestones such as sitting, crawling and standing
• 2. assist your child to gain improved independence in activities of daily living
• 3. improve posture,motor control, muscle strength balance and coordination
•     improve confidence
• 4. liase with carer’s and teacher’s to assist them to understand your child’s needs and how they can  assist your child with gaining motor skills and independence

Role of Dance in Parkinsonism

Parkinson Disease is a progressive neurodegenerative disease. Common symptoms of PD are resting tremor, bradykinesia, rigidity, mask face, and difficulties with gait. Gait difficulties include short and shuffling steps, festination and/or freezing of gait, difficulty turning or walking backward, and impaired ability to perform dual tasks when walking.  Individuals with PD are also at an increased risk of falls.

Dance address each of the previously mentioned key areas in the following ways, 

• The use of music to accompany dance movement can act as an external cue to facilitate movement.
• The use of specific movement strategies when teaching the dance steps.
• The need to control dynamic balance and respond to perturbations when interacting with other participants facilitates balance exercises.
• Dance helps enhance strength and flexibility. It may also improve cardiovascular functioning if done at a sufficient intensity

 Some of benefits are,

Motor benefits

Dance is shown to benefit individuals with Parkinson's disease by enhancing motor function through stretching, stepping and balance. Individuals who participated in a dance intervention ranging from 90 minutes of dance per week for 8 weeks, to 2 hours, two times per week for 2 years, showed improvements in various outcome measures, when compared to a regular exercise group. The motor improvements could be due to repetition, direction change, and step sequencing that are inherent in dance and transfer into effective, regular gait patterns.Furthermore, basal ganglia may be activated during rhythmic movements, and enhanced by the auditory cues in the music accompanying dance.

Cognitive benefits:

The changing visual and auditory stimuli, unique to dance, facilitate cognitive improvements when compared to regular exercise programs for PD patients. A dance class creates an environment where individuals must control continuously changing patterns of movement to match the instructor. Dance has been shown to reduce time taken to correctly complete the MRT (Mental Rotation Task) as dance aids in imagery formation and judgement. The attention required to anticipate movements, and respond to changes in music or instruction is unique to dance and can enhance the activity of the basal ganglia loops and frontal lobes. This is supported by greater improvement in FAB (frontal assessment battery). When compared to traditional rehabilitation (balance exercises, gait training) there were moderate improvements in cognitive test scores at the 8 week follow up, supporting dance therapy as being able to impact higher cortical functions in the long term.

Mental health benefits:

Mental health benefits for individuals with Parkinson's disease are exclusive to dance when compared to control and regular exercise treatment. Improvement shown in mood, motivation and enjoyment can be related to feelings of unity. There are improved AP (apathy scale) and SDS (self-rating depression scale) scores after dance intervention in patients with PD. It has been suggested that dance therapy can decrease fear of falling through practicing position changes in a controlled environment. Overall, health related quality of life and emotional well-being has been increased through dance for people living with PD.

Other benefits:

When compared to regular exercise and control groups, dance for PD yields greater gains in UPDRS (Unified Parkinson's Disease Rating Scale).  Personal, cultural, and social preference need to be considered to improve adherence to treatment program.

Fitness Program

Starting a fitness program may be one of the best things you can do for your health. Physical activity can reduce your risk of chronic disease, improve your balance and coordination, help you lose weight — and even improve your sleep habits and self-esteem. And there's more good news. You can start a fitness program by using following steps steps.

1. Assess your fitness level

To assess your aerobic and muscular fitness, flexibility, and body composition, consider recording:

• Your pulse rate before and immediately after walking 1 mile (1.6 kilometers)
• How long it takes to walk 1 mile or 400 meters, or how long it takes to run 1.5 miles (2.41 kilometers)
• How many half situps, standard pushups or modified pushups you can do at a time
• How far you can reach forward while seated on the floor with your legs in front of you
• Your waist circumference, just above your hipbones
• Your body mass index

2. Design your fitness program

• Consider your fitness goals. Are you starting a fitness program to help lose weight? Or do you have another motivation, such as preparing for a marathon? Having clear goals can help you gauge your progress and stay motivated. 
• Create a balanced routine.
  The Department of Health and Human Services recommends getting at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity.
  For example, try to get about 30 minutes of aerobic exercise on most days of the week. Also aim to incorporate strength training of all the major muscle groups into a fitness routine at least two days a week.
• Start low and progress slowly. If you're just beginning to exercise, start cautiously and progress slowly. If you have an injury or a medical condition, consult your doctor or an exercise therapist for help designing a fitness program that gradually improves your range of motion, strength and endurance.
• Build activity into your daily routine. Finding time to exercise can be a challenge. To make it easier, schedule time to exercise as you would any other appointment. Plan to watch your favorite show while walking on the treadmill, read while riding a stationary bike, or take a break to go on a walk at work.
• Plan to include different activities. Different activities (cross-training) can keep exercise boredom at bay. Cross-training using low-impact forms of activity, such as biking or water exercise, also reduces your chances of injuring or overusing one specific muscle or joint. Plan to alternate among activities that emphasize different parts of your body, such as walking, swimming and strength training.
• Allow time for recovery. Many people start exercising with frenzied zeal — working out too long or too intensely — and give up when their muscles and joints become sore or injured. Plan time between sessions for your body to rest and recover.

• Put it on paper. A written plan may encourage you to stay on track.                          

• 3. Assemble your equipment

• You'll probably start with athletic shoes. Be sure to pick shoes designed for the activity you have in mind. For example, running shoes are lighter in weight than cross-training shoes, which are more supportive.
  If you're planning to invest in exercise equipment, choose something that's practical, enjoyable and easy to use. You may want to try out certain types of equipment at a fitness center before investing in your own equipment.

  4. Get started

  Now you're ready for action. As you begin your fitness program, keep these tips in mind:
  • Start slowly and build up gradually. Give yourself plenty of time to warm up and cool down with easy walking or gentle stretching. Then speed up to a pace you can continue for five to 10 minutes without getting overly tired. As your stamina improves, gradually increase the amount of time you exercise. Work your way up to 30 to 60 minutes of exercise most days of the week.
  • Break things up if you have to. You don't have to do all your exercise at one time, so you can weave in activity throughout your day. Shorter but more-frequent sessions have aerobic benefits, too. Exercising in 10-minute sessions three times a day may fit into your schedule better than a single 30-minute session.
  • Be creative. Maybe your workout routine includes various activities, such as walking, bicycling or rowing. But don't stop there. Take a weekend hike with your family or spend an evening ballroom dancing. Find activities you enjoy to add to your fitness routine.
  • Listen to your body. If you feel pain, shortness of breath, dizziness or nausea, take a break. You may be pushing yourself too hard.
  • Be flexible. If you're not feeling good, give yourself permission to take a day or two off.

  5. Monitor your progress

  Retake your personal fitness assessment six weeks after you start your program and then again every few months. You may notice that you need to increase the amount of time you exercise in order to continue improving. Or you may be pleasantly surprised to find that you're exercising just the right amount to meet your fitness goals.
  If you lose motivation, set new goals or try a new activity. Exercising with a friend or taking a class at a fitness center may help, too.
  Starting an exercise program is an important decision. But it doesn't have to be an overwhelming one. By planning carefully and pacing yourself, you can establish a healthy habit that lasts a lifetime.

LUMBAR DISC HERNIATION AND ITS PHYSIOTHERAPY REHABILITATION

What is Herniated Disc?

Each disc of the spine is designed much like a jelly donuts. As the disc degenerates from age or injury, the softer central portion can rupture (herniate) through the surrounding outer ring (annulus fibrosus). This abnormal rupture of the central portion of the disc is referred to as a disc herniation. This is commonly referred to as a "slipped disc."

The most common location for a herniated disc to occur is in the disc at the level between the fourth and fifth lumber vertebrae.The lower back is also critically involved in our body's movements throughout the day, as we twist the torso in rotating side to side and as we hinge the back in flexion and extension while bending or lifting. Sometimes people are telling as "muscle catch" or there was  a sound like "click". So therapists or doctors only can clearly diagnose the condition through a lot of investigations

                                                            Symptoms

The symptoms of a herniated disc depend on the exact level of the spine where the disc herniation occurs and whether or not nerve tissue is being irritated. Disc herniation can cause local pain at the level of the spine affected.

If the disc herniation is large enough, the disc tissue can press on the adjacent spinal nerves that exit the spine at the level of the disc herniation. This can cause shooting pain in the distribution of that nerve and usually occurs on one side of the body and is referred to as Sciatica. For example, a disc herniation at the level between the fourth and fifth lumbar vertebrae of the low back can cause a shooting pain down the buttock into the back of the thigh and down the leg. Sometimes this is associated with numbness, weakness, and tingling in the leg. The pain often is worsened upon standing and decreases with lying down. This is often referred as pinched nerve

If the disc herniation occurs in the cervical spine, the pain may shoot down one arm and cause a stiff neck or muscle spasm in the neck.

If the disc herniation is extremely large, it can press on spinal nerves on both sides of the body. This can result in severe pain down one or both lower extremities. There can be marked muscle weakness of the lower extremities and even incontinence of bowel and bladder. This complication is medically referred to as cauda equina syndrome.

Special Investigations for Lumbar disc herniation:

Usually we are looking for, how orthopaedicians or therapists diagnose the condition through their knowledge, without using special equipment. They are using some physical examination, patient history, on time examination, special tests etc .. to find out the condition. After that they are confirming through special investigations by use of special equipment( MRI,CT,X RAY, Etc). Here I gonna discuss about some physical examinations, usually they are using to rule out the condition.

Straight Leg Raise (SLR);  
The patient is in supine position and the examiner raises the leg (on the symptomatic side). The knee stays fully extended. When the angle at the hip in which the SLR is reached differs in comparison to the other leg, or when pain is produced during the test, the test is considered to be positive.

Slump test: the sitting patient (with convex back) bends his head forward and stretches his leg out with the toes pointing upward. The purpose is to stretch the neural structures within the vertebral canal and foramen. If the pain is reappear, test is positive

Lasègue’s test: it’s an extension of the SLR: the therapist lowers the leg to an extent of five to ten degrees. Then, the foot is passively dorsiflexed. The test is considered to be positive when the ipsilateral leg pain (sciatica below the knee) occurs upon elevation.

Crossed Lasegue test (XSLR): This test is considered to be positive when the pain (sciatica) can be reproduced upon passive extension of the contra-lateral leg.

Scoliosis: the therapist is going to evaluate this parameter using visual inspection. Scoliosis might be a potential indicator of lumbar disc herniation. Research has proven that the diagnostic performance of this test is really poor. The sensitivity and specificity are really low.

Muscle weakness or paresis: the examiner measures strength during ankle dorsiflexion or extension of the big toe (without or against resistance). 
Dorsal flexion impaired --> L4 radiculopathy
Toe extension impaired --> L5 radiculopathy
If the possible range at the symptomatic side differs from the non-symptomatic side, then the test is considered to be positive.

Reflexes: weakness or absence of the Achilles tendon reflex possibly refers to S1 radiculopathy.

Forward flexion test: the purpose is to bend forward in standing position. There is no consensus regarding the criteria that have to be considered in order to determine if the radiant pain is caused by disc herniation. Some studies use limitation of forward flexion as main criteria, while others use back/leg pain as the primary indicator.

Hyper extension test: the patient needs to passively mobilize the trunk over the full range of extension, while the knees stay extended. The test indicates that the radiant pain is caused by disc herniation if the pain deteriorates.

Manual testing and sensory testing: looks for hypoaesthesia, hypoalgesia, tingling or numbness. One example of testing: the patient closes his eyes and the examiner strikes the skin bilaterally and simultaneously. The patient is asked if he feels any differences between the left and right side. The test is considered to be positive when there is a dermatomal distribution. Although, the diagnostic performance of sensitivity and specificity is poor. 

                       Physiotherapy Intervention:

Physiotherapists can help in you in lot ways to recover from the back pain by doing some of their therapies like Shock wave, Ultrasound, TENS, and IFT etc ,as well as by their special manipulation and particular exercises for this herniated disc. PT may include deep tissue massage, hot/cold therapies, hydrotherapy, and exercise. Physical therapy often plays a major role in herniated disc recovery. Its methods not only offer immediate pain relief, but they also teach you how to condition your body to prevent further injury

Stretching: There is low-quality evidence found to suggest that adding hyper extension to an intensive exercise program might not be more effective than intensive exercise alone for functional status or pain outcomes. There were also no clinically relevant or statistically significant differences found in disability and pain between combined strength training and stretching, and strength training alone.

Behavioral graded activity program: A global perceived recovery was better after a standard physiotherapy program than after a behavioral graded activity program in the short term, however no differences were noted in the long term.

Ultrasound and shock wave therapies: Ultrasound is used to penetrate the tissues and transmitting heat deep into the tissues. The aim of ultrasound is to increase local metabolism and blood circulation, enhance the flexibility of connective tissue, and accelerate tissue regeneration, potentially reducing pain and stiffness, while improving mobility. Shock wave applies vibration at a low frequency to the tissues (10, 50, 100, or 250 Hz). This causes an oscillatory pressure to decrease pain. The available evidence does not support the effectiveness of both therapy strategies for treating disc herniation.

Transcutaneous electrical nerve stimulation (TENS): TENS uses an electrical current to stimulate the patients muscles. Electrodes on the skin send a tiny electrical current to key points on the nerve pathway. It is generally believed to trigger the release of endorphins, which are the body's natural pain killers and reduce muscle spasms. For this reason, TENS therapy contribute to pain relief and improvement of function and mobility of the lumbosacral spine.

Manipulative treatment: Manipulative treatment on lumbar disc herniation appears to be safe, effective, and it seems to be better than other therapies. However high-quality evidence is needed to be further investigated.

Core strengthening exercises: A strong core is important to the health of the spine. The core (abdominal) muscles help the back muscles support the spine. When your core muscles are weak, it puts extra pressure on your back muscles. So it is important to teach core stabilizing exercises to strengthen your back. It is also very important to train the endurance of these muscles. A core stability program decreases pain level, improves functional status, increases health-related quality of life and static endurance of trunk muscles in lumbar disc herniation patients. Individual high-quality trials found moderate evidence that stabilisation exercises are more effective than no treatment.