Biomechanical Behavior of Injected Cement Spacers versus Traditional Cages in Low-Density Lumbar Spine under Compression Loading.

Background and Objectives: Osteoporosis renders the use of traditional interbody cages potentially dangerous given the high risk of damage in the bone-implant interface. Instead, injected cement spacers can be applied as interbody devices; however, this technique has been mainly used in cervical spine surgery. This study aimed at investigating the biomechanical behavior of cement spacers versus traditional cages in lumbar spine surgery. Materials and Methods: Destructive monotonic axial compression testing was performed on 20 human cadaveric low-density lumbar segments from elderly donors (14 f/6 m, 70.3 ± 12.0 y) treated with either injected cement spacers (n = 10) or traditional cages (n = 10) without posterior instrumentation. Stiffness, failure load and displacement were compared. The effects of bone density, vertebral geometry and spacer contact area were evaluated. Results: Cement spacers demonstrated higher stiffness, significantly smaller displacement (p < 0.001) and a similar failure load compared to traditional cages. In the cage group, stiffness and failure load depended strongly on bone density and vertebral height, whereas failure displacement depended on vertebral anterior height. No such correlations were identified with cement spacers. Conclusions: Cement spacers used in lumbar interbody stabilization provided similar compression strength, significantly smaller failure displacement and a stiffer construct than traditional cages that provided benefits mainly for large and strong vertebrae. Cement stabilization was less sensitive to density and could be more beneficial also for segments with smaller and less dense vertebrae. In contrast to the injection of cement spacers, the optimal insertion of cages into the irregular intervertebral space is challenging and risks damaging bone. Further studies are required to corroborate these findings and the treatment selection thresholds.

A New Interlaminar/Interspinous and Facet-Joint Stabilization System in Lumbar Degenerative Disk Disease: 2 Years of Results.

INTRODUCTION: In lumbar degenerative disk diseases (DDDs), we include a wide range of lumbar pathologies. Lumbar spinal stenosis with or without spondylolisthesis is a common cause of lower-limb pain in elderly patients. The surgical treatment of lumbar DDD consists of the decompression of the neural structures or the decompression and fusion of the involved motion segment. Unfortunately, rigid spinal implants followed by fusion cause increased stresses on the neighboring spinal segments, often leading to adjacent segment degeneration. The aim of this paper is to present a new system for interlaminar/interspinous and facet-joint stabilization and fusion. MATERIAL AND METHODS: From March 2018 to June 2021, 175 patients with severe lumbar back and/or leg pain were operated on with this device after the failure of conservative treatment for a minimum of 6 months. For this study, we considered 75 available patients with a minimum follow-up time of 24 months. Patients rated their back pain and leg pain on a visual analog scale (VAS) after surgery and at the last follow-up; also, the postoperative consumption of analgesic drugs was investigated. Finally, patients were asked whether they would undergo this kind of surgery again or recommend it. The device is designed to promote a better and more efficient intervertebral fusion: Bone Ingrowth technology allows the system to achieve the best response from the bone tissue. RESULTS: All procedures were performed without any complications. A reoperation was required in five cases (6.7%) because of implant failure. In one case, a spinous process and unilateral articular process fracture occurred. In four cases, a subcutaneous ISCHIA (one case) or FILICUDI (three cases) pullout was observed. Significant improvements following lumbar surgery were observed when evaluating the postoperative VAS values, analgesic drug consumption levels, and patients' satisfaction ratings. Evident fusion was seen in 58 of 75 patients (77.3%). CONCLUSIONS: Our interspinous/interlaminar and facet-joint implant solution, associated with bone grafting, provided vertebral fusion in most stenotic patients with Grade I DS undergoing bilateral microdecompression (BMD) or bilateral decompression via the unilateral approach (BDUA). A higher number of patients and a longer follow-up will certainly be required to completely validate these new devices, but this minimally invasive surgery (MIS) is currently very encouraging and satisfactory.

Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study.

BACKGROUND: Facet joint is a potential structure to be the source of chronic low back pain (LBP) affecting lumbar motion, pain, and disability. Other than the recommended treatment of lumbar stabilization exercise (LSE), several manual procedures including muscle energy technique (MET) are commonly used in physical therapy clinic. However, little evidences of the effects of MET have been reported. OBJECTIVE: This study aimed to compare the immediate effects of MET and LSE in patients with chronic LBP with suspected facet joint origin. METHODS: Twenty-one patients with low back pain were recruited and randomly assigned to receive treatment either MET or LSE. The outcomes were kinematic changes, pain intensity, and disability level. Lumbar active range of motion (ROM) of flexion, extension, left and right lateral flexion, and left and right rotation were evaluated using the three-dimension motion analysis system at baseline and immediately after treatment. Pain intensity was evaluated using visual analogue scale (VAS) at baseline, immediately after, and two days after treatment. Thai version of the modified Oswestry disability questionnaire (ODQ) was utilized at baseline and two days after treatment. The mixed model analysis of variance was used to analyze all outcomes. RESULTS: The results showed that all outcomes were not different between groups after treatments. Although there were statistically significant improvements after the treatments when collapsing the groups, the minimal clinically important change was found only for pain but not for lumbar movements and disabilities scores. CONCLUSION: The effect of MET and LSE alone in single session might not be intensive enough to improve movements and decrease disability in patients with chronic LBP with suspected facet joint origin.

Effects of 12-week lumbar stabilization exercise and sling exercise on lumbosacral region angle, lumbar muscle strength, and pain scale of patients with chronic low back pain.

[Purpose] The purpose of this study is to investigate the effects of lumbar stabilization exercise and sling exercise on lumbosacral region angle, lumbar muscle strength, pain scale of patients with chronic low back pain. [Subjects and Methods] The subjects of this study were 29 chronic low back pain patient women who were selected among participants in exercise class at K Region Health Promotion Center in South Korea and were randomly assigned to the lumbar stabilization exercise group (n=10), sling exercise group (n=10), and the control group (n=9). Both lumbar stabilization and sling exercise programs were executed for 60 minutes, three times a week, for 12 weeks. Before and after exercise we measured lumbosacral region angle (lumbar lordosis angle, lumbosacral angle, sacral inclination angle), lumbar muscle strength, and pain scale in all subjects. Two-way analysis of variance was conducted to analyze experimental data. In order to analyze the interaction effect, we conducted paired t-test before and after treatment. [Results] Lumbar stabilization exercise group and sling exercises group did not affect lumbar lordosis angle, lumbosacral angle and sacral inclination angle. Whereas the lumbar flexion muscle strength and lumbar extension muscle strength significantly increased in the lumbar stabilization exercise group and sling exercise group. The flexibility increased in the lumbar stabilization exercise group and sling exercise group. The pain scale decreased in the lumbar stabilization exercise group and sling exercise group. [Conclusion] Both lumbar stabilization exercise and sling exercises are useful therapeutic approaches to chronic back pain.

Dynamic lumbopelvic stabilization for treatment of stress urinary incontinence in women: Controlled and randomized clinical trial.

OBJECTIVES: To compare the results of the dynamic lumbopelvic stabilization (DLS) exercises with exercises for the pelvic floor muscles (PFM) in women with stress urinary incontinence. METHODS: Randomized controlled clinical trial comparing 17 women submitted to the DLS with 16 women submitted to the exercises for the PFM. The evaluated outcomes were incontinence severity, quality of life (QoL), and impression of improvement in three moments. Significance was set at 5%. RESULTS: For socio-demographic and clinical variables, only climacteric was more prevalent in the DLS group (82% vs. 44%, P = 0.02). Soon after the intervention, there was no difference between the groups in relation to the outcomes evaluated. In the evaluation after 90 days, the DLS group presented better values for the severity of the losses (4.1 ± 2.6 vs. 5.7 ± 2.4, P = 0.006, d = 0.64), daytime frequency (4.6 ± 0.4 vs. 6.2 ± 0.6, P < 0.001, d = 2.67), and nighttime frequency (0.4 ± 0.3 vs. 1.4 ± 0.5, P < 0.001, d = 2.50), QoL and impression of improvement (P < 0.001). CONCLUSIONS: After treatment, the DLS plus PFM exercise patients had results similar to those performing PFM exercises alone. However, the DLS plus PFM exercises were superior in the outcomes of incontinence severity, QoL, and impression of improvement in the post-90-day evaluation, showing longer lasting effect.

Effect of lumbar stabilization exercise on disc herniation index, sacral angle, and functional improvement in patients with lumbar disc herniation.

[Purpose] This study aimed to examine the effects of pelvic movements on the back function of patients with lumbar disc herniation when lumbar stabilization exercise was applied to the patients, suggest an intervention method that can be used in future clinical therapies. [Subjects and Methods] Thirty patients with lumbar disc herniation underwent the intervention 30 minutes per day, three times per week for 4 weeks. Of them, 15 patients were assigned to the balance center stabilization resistance exercise group (experimental group I) and the other 15 were assigned to the three-dimensional stabilization exercise group (experimental group II). Before the intervention, disc herniation index was measured using magnetic resonance imaging, sacral angle was measured using X-ray, and back function was measured using the KODI. Four weeks later, these three factors were re-measured and analyzed. [Results] There was a significant pre- versus post-intervention difference in disc herniation index, sacral angle, and KODI in experimental group I and a significant difference in disc herniation index and KODI in experimental group II, and each group of disc herniation index and sacral angle had a significant difference. In experimental group I, each disc herniation index and sacral angle had a negative correlation. [Conclusion] The lumbar stabilization exercise, which controls balance using pelvic movements, improves mobility and stability of the sacroiliac joint; therefore, it increases pelvic and back movements. These kinds of movements not only improved proprioception sense, they also had positive effects on lumbar disc function recovery.

Comparison of electromyographic activities of lumbar iliocostalis and lumbar multifidus muscles during stabilization exercises in prone, quadruped, and sitting positions.

[Purpose] The purposes of this study were: 1) describe a hierarchy of electromyographic activity production, using percentage maximum voluntary contraction of lumbar iliocostalis and lumbar multifidus muscles during prone, quadruped and sitting exercises; and 2) identify optimal recruitment exercises for both lumbar iliocostalis as a global multi-segmental stabilizer and lumbar multifidus as a segmental stabilizer. [Subjects] Twelve healthy volunteers (six male and six female) aged 24 to 45 participated. [Methods] Surface electromyographic activity data were collected bilaterally from lumbar iliocostalis and lumbar multifidus muscles during exercises. [Results] Two-way ANOVA showed that prone extension, and prone alternate arm and leg lifting exercises produce a statistically significant difference in percent maximum voluntary contraction of lumbar iliocostalis and lumbar multifidus bilaterally compared to other exercises. Quadruped alternate arm and leg lifting exercises produce greater activity in lumbar multifidus muscle than sitting exercises [Conclusion] Prone exercises generate the greatest electromyographic activity and may be the most effective exercises for strengthening both lumbar iliocostalis and lumbar multifidus muscles. Quadruped alternate arm and leg lifting produces electromyographic activity at the recommended percent maximum voluntary contraction for training the lumbar multifidus in its role as a segmental stabilizer and is an effective training exercise for this goal.

The effect of lumbar stabilization exercise on the pulmonary function of stroke patients.

[Purpose] This study was aimed at assessing the effect of lumbar stabilization exercise on the pulmonary function of stroke patients. [Subjects and Methods] The subjects were randomly allocated into lumbar stabilization exercise group and a general physical therapy group. The program consisted of 30-min sessions conducted 3 days a week for 8 weeks. Pulmonary function was assessed based on lung performance parameters, including forced vital capacity, forced expiratory volume at 1 second, ratio of forced expiratory volume at 1 second to forced vital capacity, and peak expiratory flow. [Results] In the assessment of pulmonary function, the values of all the lung performance parameters were significantly increased in the lumbar stabilization exercise group but were significantly decreased in the general physical therapy group. [Conclusion] These results indicate that lumbar stabilization exercise had a more positive effect on pulmonary function than general physical therapy.

The comparison of abdominal muscle activation on unstable surface according to the different trunk stability exercises.

[Purpose] This study aimed to determine the effect of abdominal muscle activities and the activation ratio related to trunk stabilization to compare the effects between the abdominal drawing-in maneuver and lumbar stabilization exercises on an unstable base of support. [Subjects and Methods] Study subjects were 20 male and 10 female adults in their 20s without lumbar pain, who were equally and randomly assigned to either the abdominal drawing-in maneuver group and the lumbar stabilization exercise group. Abdominal muscle activation and ratio was measured using a wireless TeleMyo DTS during right leg raise exercises while sitting on a Swiss ball. [Results] Differences in rectus abdominis, external oblique abdominis, and internal oblique abdominis muscle activation were observed before and after treatment. Significant differences were observed between the groups in the muscle activation of the external oblique abdominis and internal oblique abdominis, and the muscle activation ratio of external oblique abdominis/rectus abdominis and internal oblique abdominis/rectus abdominis. [Conclusion] Consequently trunk stability exercise enhances internal oblique abdominis activity and increases trunk stabilization. In addition, the abdominal drawing-in maneuver facilitates the deep muscle more than LSE in abdominal muscle. Therefore, abdominal drawing-in maneuver is more effective than lumbar stabilization exercises in facilitating trunk stabilization.

Effects of lumbar stabilization exercises on the flexion-relaxation phenomenon of the erector spinae.

[Purpose] This study evaluated the differences in the flexion-relaxation phenomenon (FRP) of the right and left erector spinae muscles in asymptomatic subjects and the effect of lumbar stabilization exercises on these differences. [Subjects and Methods] Twenty-six participants (12 in the exercise group and 14 in the control group) with a difference in the FRP in the right and left erector spinae muscles were recruited from among healthy students attending Silla University. The exercise group performed two lumbar stabilization exercises (back bridge exercise and hand-knee exercise) for 4 weeks. The control group did not exercise. [Results] No significant group-by-exercise interaction was found. The right and left erector spinae muscles did show a difference in FRP between the control and exercise groups (119.2 ± 69.2 and 131.1 ± 85.2 ms, respectively). In addition, the exercise group showed a significant decrease in post-exercise (50.0 ± 27.0 ms) compared to pre-exercise (112.3 ± 41.5 ms) differences in the right and left FRP. [Conclusion] These results suggest that lumbar stabilization exercises may counter asymmetry of the FRP in the erector spinae muscles, possibly preventing low back pain in the general population.

The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain.

[Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance.

The effects of a bridge exercise with vibration training and an unstable base of support on lumbar stabilization.

[Purpose] The aim of this study was to examine the effects of a bridge exercise with vibration training and an unstable base of support on lumbar stabilization. [Subjects] This study assigned healthy adults in their 20s to a bridge exercise with a sling and vibration group (BESV, n=20) and a bridge exercise with a sling group (BESG, n=20). [Methods] Electromyography was used to comparatively analyze the activity of the internal obliques (IO), external obliques (EO), and rectus abdominis (RA) when local vibration was applied during a bridge exercise that used a sling as an unstable base of support. [Results] There were statistically significant increases in the activity of the IO and EO within each group after the intervention. The activity of the IO and the EO was significantly higher in the BESV group than in the BES group after the intervention. [Conclusion] The bridge exercise performed using vibration training on an unstable base of support increased the activity of the IO and the EO, which improved lumbar stabilization.

Effects of selective exercise for the deep abdominal muscles and lumbar stabilization exercise on the thickness of the transversus abdominis and postural maintenance.

[Purpose] The purpose of this study was to examine the effects of selective exercise for the deep abdominal muscles (SEDA) and lumbar stabilization exercise (LSE) on the thickness of the transversus abdominis and postural maintenance on an unstable base of support. [Subjects and Methods] The subjects of this study were 20 male and 10 female adults in their 20s without lumbar pain. They were equally and randomly assigned to a SEDA group and a LSE group. The thickness of the transversus abdominis was measured using ultrasound imaging during rest and drawing-in. The thickness of the transversus abdominis was measured when subjects raised their right and left legs while lying on a Swiss ball. [Results] Initially, there were no differences between the two groups. After the intervention, significant differences were observed in all parameters. A significant interaction between group and period was not found for any parameters. [Conclusion] In conclusion, both SEDA and LSE thickened the transversus abdominis, which is a deep abdominal muscle, thereby adjusting posture, and stabilizing the trunk. These exercises increased the thickness of the deep abdominal muscles. They are important exercises for improving the stability of athletes or patients who need postural adjustment.

The effects of lumbar stabilization exercises on foot pressure of older individuals while walking.

[Purpose] The purpose of this study was to examine the effect of lumbar stabilization on pressure distribution in old women. [Subjects] The subjects of this study were 14 women aged 65 or older who agreed to participate in this study. They had a sufficient range of motion and muscle strength to perform the postures in this study's program and were without gait problems, congenital deformity, orthopedic disorder, or neurological disorder. [Methods] The participants performed a group exercise program that promotes lumbar stabilization for 50 minutes per session by following the instructions of a physical therapist. Gait Analyzer was used to measure the foot pressure of individual participants from three measurements for each lumbar stabilization exercise, and the mean values were used. The mean values were then compared between before and after the exercises by paired t-test. [Results] Pressure in F3 and F6 statistically significantly decreased from 2.06±1.23% N/cm(2) to 1.55±1.02% N/cm(2) and from 7.40±1.52% N/cm(2) to 5.95±1.76% N/cm(2), respectively, after the intervention, but no significant differences were found in the other foot areas. [Conclusion] The lumbar stabilization exercises affected the pressure evenly over the entire foot and, in particular, in the inner area of the forefoot.

Effects of bridge exercise performed on an unstable surface on lumbar stabilizing muscles according to the knee angle.

[Purpose] This study aimed to determine the effects of bridge exercise performed on an unstable surface on lumbar stabilizing muscles according to the knee angle. [Subjects] Fifteen healthy adult men were selected for this study. [Methods] The study subjects performed the bridge exercise on an unstable surface and a stable surface, with the knees at different angles (45°, 90°, and 120°). An aero-step device was used as the unstable surface, and the flat ground was used as the stable surface. External oblique, internal oblique, and rectus abdominis muscle activities were assessed and compared using electromyography. [Results] The study results demonstrated that performing the bridge exercise on an unstable surface with a knee angle of 120° led to a greater increase in the external oblique, internal oblique, and rectus abdominis muscle activities than when performed on a stable surface. [Conclusion] The bridge exercise with the knees at a 120° angle was found to be an effective intervention for increasing the external oblique, internal oblique, and rectus abdominis muscle activities.

Effects of lumbar stabilization exercise on functional disability and lumbar lordosis angle in patients with chronic low back pain.

[Purpose] This study examined the effects of lumbar stabilization exercises on the functional disability and lumbar lordosis angles in patients with chronic low back pain. [Subjects] The subjects were 30 patients with chronic low back pain divided into a lumbar stabilization exercise group (n = 15) and a conservative treatment group (n = 15). [Methods] The lumbar stabilization exercise and conservative treatment groups performed an exercise program and conservative physical treatment, respectively. Both programs were performed 3 times a week for 6 weeks. The degree of functional disability was assessed by the Oswestry disability index, and lumbar lordosis angles were measured by plain radiography. [Results] The Oswestry disability index decreased significantly in the both groups; however, it was significantly lower in the lumbar stabilization exercise group. The lumbar lordosis angle increased significantly in the lumbar stabilization exercise group after treatment and was also significantly greater than that in the conservative treatment group. [Conclusion] Lumbar stabilization exercise is more effective than conservative treatment for improving functional disability and lumbar lordosis angles.

The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.

[Purpose] The aim of this study was to examine the effects of exercise to strengthen the muscles of the hip together with lumbar segmental stabilization exercise on the lumbar disability index, lumbar muscle strength, and balance. [Subjects and Methods] This study randomly and equally assigned 40 participants who provided written consent to participate in this study to a lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus group (SMG + LES group) and a lumbar segmental stabilization exercise group. [Results] Each evaluation item showed a statistically significant effect. [Conclusion] Clinical application of exercise in this study showed that lumbar segmental stabilization exercise plus exercise to strengthen the muscles of the gluteus resulted in a greater decrease in low back pain disability index and increase in lumbar muscle strength and balance ability than lumbar segmental stabilization exercise in chronic low back pain patients receiving the exercise treatments during the same period.

The effect of lumbar stabilization exercises and thoracic mobilization and exercises on chronic low back pain patients.

[Purpose] To investigate whether pain, balance, and stabilization of the lumbar region can be improved through thoracic mobilization in addition to lumbar stabilizaing exercises. [Subjects and Methods] This study recruited 36 subjects with chronic low back pain lasting more than 12 weeks. The subjects recruited for this study participated voluntarily, and provided their signed consent to participation. [Results] Improvement in balance was largest in the lumbar stabilization exercise group, followed by the thoracic mobilization and exercise group, and the traditional physical therapy group, in decreasing order of effect. [Conclusion] In conclusion, lumbar stabilization exercises combined with thoracic mobilization had greater effects on stabilization of the lumbar region pain relief, and improvement of the function of the patients with chronic low back pain.

The effect of thoracic spine mobilization and stabilization exercise on the muscular strength and flexibility of the trunk of chronic low back pain patients.

[Purpose] To investigate whether thoracic spine mobilization added to stabilization exercises increases the muscular strength and range of motion of the thoracic vertebrae of chronic low-back pain patients. [Subjects] This study enrolled 20 patients with chronic low back pain, who were divided into two groups. Ten subjects were randomly selected for the stabilization exercise group and the remaining 10 subjects received thoracic spine mobilization in addition to performing the stabilization exercises. [Methods] The patients performed stabilization exercises and received thoracic spine mobilization for 12 weeks. The range of motion and isometric muscular strength of the vertebrae of all subjects were measured before and after the intervention. [Results] In the comparison of muscular strength before and after the intervention, the change in muscular strength of the trunk flexors in the stabilization exercise group was 16.0±7.4 Nm, and that of the thoracic spine mobilization group was 34.2±7.6 Nm, a significant difference in each group. In the post-intervention intergroup comparison, the muscular strength of trunk flexors in the stabilization exercise group was 111.1±16.9 Nm, while that of the thoracic spine mobilization group was 125.9±11.3 Nm, a significant difference. Also, the muscular strength of the trunk extensors in the stabilization exercise group was 148.9±31.8 Nm, while that of the thoracic spine mobilization group was 182.9±37.2 Nm, a significant difference. The thoracic spine flexion in the stabilization exercise group was 29.8±9 degrees, while that of the thoracic spine mobilization group was 38.7±6.9 degrees, a significant difference. However, there was no significant difference in lumbar flexion values between the two groups. [Conclusion] Thoracic spine mobilization added to a stabilization exercise increased the muscular strength of patients with chronic low back pain.

Effect of Togu-exercise on Lumbar Back Strength of Women with Chronic Low Back Pain.

[Purpose] The present study analyzed the effect of the Togu exercise program on the lumbar back strength of middle-aged women who did not perform regular exercise, and presents an effective exercise method for middle-aged women with chronic low back pain symptom. [Subjects] The subjects were 16 women with chronic low back pain attending N University, Chungcheong-do, Korea. [Methods] Height, weight, body fat, and body mass index (BMI) were measured using a body composition analyzer (Inbody 720, Biospace, Korea), which utilizes bioelectrical impedance analysis. Using isokinetic lumbar muscle strength measurement equipment [Isomed 2000, Back system, (Germany)], peak torque/body weight, total work and average power of flexion and extension of the lumbar region were measured. For lumbar stabilization exercises, an air cushion (Germany), jumper (Germany), and aero step (Germany) were employed. First, warm-up exercise was conducted for 10 minutes, followed by 10 sets of the 3 main exercises using the above tools with 10-second rest intervals. The main exercise was done for 40 minutes in total. [Results] The paired sample t-test showed significant in the Togu exercise group peak torque of flexion, peak torque of extension, total work of flexion, total work of extension, average power of flexion, average power of extension, after the exercise showed a significant difference in the Togu exercise group. [Conclusion] The trunk muscle actiation program for middle-aged women had a significant effect on muscle strength and low back pain. Therefore the trunk muscle activation program is effective at increasing muscular strength of middle-aged women, and the results suggest improve muscle strength is effectively stabilizaties the lumbar region.