Document Type : Research Paper


1 Assistant Professor of Sport Injury & Corrective Exercise, Raja University

2 Assistant Professor of Sport Injury & Corrective Exercise, Sports Sciences Research Institute

3 Ph.D. of Sport Injury & Corrective Exercise, University of Isfahan


The purpose of this study was to assess the effect of core stability exercises on endurance and trunk control in patients with multiple sclerosis. The subjects with the age of 20-40, expanded disability status scale 1-4 and randomly allocated to the experimental and control groups. Training program for groups was carried out in eight weeks. Isometric endurance of the Trunk stabilizer muscles was measured by trunk flexor test, trunk extensor test and left and right lateral musculature test and Trunk Impairment Scale was used to measure the ability to trunk control. The data was analyzed by using analysis of covariance at a significance level of 0.05. The results showed that core stability exercises led to a significant increase on isometric endurance of the trunk stabilizer muscles and trunk control. Also, significant differences observed between isometric endurance of the trunk stabilizer muscles and trunk control in the experimental and control groups. According to research findings, the core stability exercises resulted in considerable improvements in endurance and control of the trunk in patients with multiple sclerosis.


  1. Shanazari Z, Marandi M, Minasian V. Effect of 12-week Pilates and aquatic training on fatigue in women with Multiple Sclerosis. J Mazandran Univ Med Sci. 2013; 23(98): 257-64. (In Persian).
  2. Michelle H, Joanne M. Gait abnormalities in Multiple Sclerosis: Pathogenesis, evaluation, and advances in treatment. Curr Neurol Neurosci Rep. 2011; 11:      507–15. 
  3. Asadi Gh, Shams A, Taheri H R. The effects of one period of exercise walking program on textured surface on balance in Multiple Sclerosis patients. Arak Medical University Journal (AMUJ). 2015; 18(94): 61-8. (In Persian).
  4. Granacher U, Schellbach J, Klein K, Prieske O, Baeyens J P, Muehlbauer T. Effects of core strength training using stable versus unstable surfaces on physical fitness in adolescents: A randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation. 2014; 6(40): 74-85.
  5. Ketelhut N B, Kindred J H, Manago M M, Hebert J R, Rudroff T. Core muscle characteristics during walking of patients with multiple sclerosis. J Rehabil Res Dev. 2015: 52(6); 713-24.
  6. Garner D J, Widrick J J. Cross-bridge mechanisms of muscle weakness in multiple sclerosis. Muscle Nerve. 2003; 27(4): 456–64.
  7. Bohannon R W. Lateral trunk flexion strength: Impairment, measurement reliability and implications following unilateral brain lesion. Int J Rehabil Res. 1992; 15(3): 249–51.
  8. Lanzetta D, Cattaneo D, Pellegatta D, Cardini R. Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with Multiple Sclerosis. Arch Phys Med Rehabil. 2004; 85: 279–83.
  9. Radebold A, Cholewicki J, Polzhofer G K, Greene H S. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001; 26: 724–30.
  10. Borghuis J, Hof A L, Lemmink K A. The importance of sensory-motor control in providing core stability: Implications for measurement and training. Sports Med. 2008; 38(11): 893-916.
  11. Marshall P W, Murphy B A. Core stability exercises on and off a Swiss ball. Arch Phys Med Rehabil. 2005; 86: 242–49.
  12. Kim S Y, Kwon J H. Lumbar stability exercises using the sling system. J of Kor Acad Orth Manu Ther. 2001; 7: 23–39.
  13. Seong-Hun Y, Seong-Doo P. The effects of core stability strength exercise on muscle activity and trunk impairment scale in stroke patients. J Exerc Rehabil. 2013; 9(3): 362–7.
  14. Freund J, Stetts D, Srikant V. Relationships between trunk performance, gait and postural control in persons with Multiple Sclerosis. Neuro Rehabilitation. 2016; 39: 305–17.
  15. Suri P, Kiely D K, Leveille S G, Frontera W R, Bean J. Increased trunk extension endurance is associated with meaningful improvement in balance among older adults with mobility problems. Archives of Physical Medicine and Rehabilitation. 2011; 92: 1038-43.
  16. Karatas M, Cetin N, Bayramoglu M, Dilek A. Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients. Am J Phys Med Rehabil. 2004; 83: 81–7.
  17. Freeman J, Fox E, Gear M, Hough A. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial. BMC Neurology. 2012; 12:19
  18. Freeman J A, Gear M, Pauli A, Cowan P, Finnigan C, Hunter H, et al. The effect of core stability training on balance and mobility in ambulant individuals with Multiple Sclerosis: A multi-centre series of single case studies. Multiple Sclerosis. 2010; 16(11): 1377–84.
  19. Sandra M, Feng Y, Maeurer M, Dippel F, Kohlmann T. Systematic literature review and validity evaluation of the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients with Multiple Sclerosis. BMC Neurology. 2014; 14: 58.
  20. Ravnborg M, Grønbech-Jensen M, Jønsson A. The MS Impairment Scale: A pragmatic approach to the assessment of impairment in patients with Multiple Sclerosis. Mult Scler. 1997; 3(1): 31-42.
  21. Mcgill S M, Childs A, Lieberman C. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999; 80: 941-4.
  22. Nessar T, Lee W. The relationship between core strength and performance in division 1 female soccer players. ASEP. 2009; 12(2): 21-8.
  23. Leetun D T, Ireland M L. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sport Exerc. 2004; 36: 926-34.
  24. Takuya I, Shigeru U. Association of trunk control with mobility performance and accelerometry-based gait characteristics in hemiparetic patients with subacute stroke. Gait & Posture. 2016; 44: 89–93.
  25. Verheyden N, Nieuwboer V A, Ketelaer D W. Reliability and validity of trunk assessment for people with Multiple Sclerosis. Phys Ther. 2006; 86(1): 66-76.
  26. Jeffrey M W. Core stability training. J Strength Cond Res. 2007; 21(3): 979-85.  
  27. Sato K, Mokha M. Does core strength training influence running kinetics, lower-extremity stability, and 5000-m performance in runners? J Strength Cond Res. 2009; 23(1): 133-40.
  28. Johansson R, Magnusson M. Human postural dynamics. Crit Rev Biomed Eng. 1991; 18(6): 413–37.
  29. Kibler W B, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006; 36: 189–98.
  30. Hsieh C L, Sheu C F, Hsueh I P, Wang Ch. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke. 2002; 33: 2626–30.
  31. Konin J G, Beil N, Werner G. Functional rehabilitation. Facilitating the se-rape effect to enhance extremity force production. Athl Ther Today. 2003; 8: 54–6.
  32. Richardson C A, Jull G A. Muscle control-pain control. What exercises would you prescribe? Man Ther. 1995; 1: 2–10.
  33. Akuthota V, Nadler S F. Core strengthening. Arch Phys Med Rehabil. 2004; 85:    86–92.
  34. Prosperini L, Fortuna D, Giann L C, Leonardi L, Pozzill C. The diagnostic accuracy of static posturography in predicting accidental falls in people with Multiple Sclerosis. Neuro Rehabilitation and Neural Repair. 2013; 27: 45-52.
  35. Piirtola M, Era P. Force platform measurements as predictors of falls among older people: A review. Gerontology. 2006; 52: 1-16.
  36. Verheyden G, Vereeck L, Truijen S, Troch M, Lafosse C, Saeys W, et al. Additional exercises improve trunk performance after stroke: A pilot randomized controlled trial. Neurorehabil Neural Repair. 2009; 23: 281–6.
  37. Lee B H, Baek J Y. The effects of core stability training on static and dynamic balance of stroke patients. J Kor Spor Health. 2007; 18: 623–34.