Physical Therapy Korea

Low back pain (LBP) affects nearly 70%–85% of the population at some point in their lives and is a common musculoskeletal disorder [1]. Specifically, this study focuses intensively on lumbar extension rotation syndrome, a distinct clinical presentation observed in some individuals with LBP [2,3]. The reason for selecting this condition as our focus is due to the associated problems in simultaneous lumbar and hip movements, particularly the increased lumbopelvic motion and disorders in hip lateral rotation (HLR) during initial movements [4]. These movement patterns can significantly impact the onset and progression of LBP symptoms, and symptom reduction has been reported when lumbar movements are manually restricted during HLR tests [5,6]. Therefore, this research aims to elucidate the relationship between lumbopelvic motion and HLR in individuals with lumbar extension rotation syndrome, with the goal of developing effective treatment strategies for LBP.

Sahrmann [2] found an increase in lumbopelvic rotation during the active HLR test in the prone position in people with lumbar extension rotation syndrome. The Movement System Impairment (MSI) classification system for LBP categorizes patients with mechanical LBP into five subgroups according to alignment, movements, and symptoms associated with LBP [2]. The relationship between LBP and limited HLR is of interest because decreased HLR causes compensatory lumbopelvic rotation which exerts force on the lumbar region [6]. This force results in low magnitude loading, cumulative microtrauma, increased tissue stress in the lumbopelvic region and, eventually, LBP [2,7].

The abdominal drawing-in maneuver (ADIM), a method of lumbar stabilization training, is an effective neuromuscular intervention for lumbar instability associated with LBP [8]. ADIM can be achieved by the co-contraction of the transversus abdominis (TrA), internal oblique (IO), and multifidus muscles, together with minimal contraction of other superficial abdominal and paraspinal muscles [9]. Co-contraction of the TrA and multifidus muscles restricts rotation or returns the lumbar spine to the neutral position from a rotated position by tensioning the lateral attachment of the thoracolumbar fascia [10]. Previous studies have shown that ADIM training using a pressure biofeedback unit can prevent unwanted lumbopelvic motion and enhance training effect of lumbar stability [11,12].

Limited HLR range is associated with shortened tensor fasciae latae-iliotibial band (TFL-ITB) [2]. The TFL-ITB acts as a flexor, abductor, and medial rotator of the hip joint and extensor and lateral rotator of the knee joint [13]. The altered TFL-ITB length gives rise to compensatory hip joint motion and impaired movement in the lumbopelvic region. Shortness of the TFL-ITB limits HLR and increases lumbopelvic motion in the transverse plane in patients with LBP [2]. The TFL-ITB standing stretch with arms extended overhead effectively increased TFL-ITB length [14].

Previous studies have reported using verbal instruction, tactile feedback, and manual stabilization during HLR to modify excessive lumbopelvic motion and decrease LBP [6]. However, a home exercise program is necessary to successfully modify lumbopelvic motion and reduce LBP. To our knowledge, no study of the effect of ADIM training and ADIM training plus self-stretching the TFL-ITB on lumbopelvic motion during active prone HLR has been published previously.

The purpose of the present study was to compare the effect of a 2-week intervention consisting of ADIM training or ADIM training plus self-stretching of the TFL-ITB on lumbopelvic rotation angle, lumbopelvic rotation movement onset, TFL-ITB length and pain intensity during active prone HLR in people with lumbar extension rotation syndrome accompanying shortened TFL-ITB.

We hypothesized that ADIM training plus self-stretching of the TFL-ITB would decrease the lumbopelvic rotation angle, delay the lumbopelvic rotation movement onset, increase TFL-ITB length, and decrease pain intensity more than ADIM training alone.

1. Subjects

Twenty-two subjects (16 males and 6 females) with lumbar extension rotation syndrome accompanying shortened TFL-ITB participated in this study. Inclusion criteria included a limited hip adduction range (< 10°) caused by a shortened TFL-ITB [13] and reported LBP for more than 6 months [15]. Twenty-two subjects were randomly allocated into one of two intervention groups: ADIM training, or ADIM training plus TFL-ITB self-stretching. Subjects were screened by an examiner who has completed an academic course on the MSI classification system. The examiner selected 22 subjects from 100 subjects based on the MSI classification criteria for lumbar extension rotation syndrome [2]. Of the 100 subjects examined, 78 subjects were excluded from the study because they did not meet the selection criteria for lumbar extension rotation syndrome. These classification criteria consist of alignment and movement tests. Primary tests are provocation tests that are designed to assess movements or stresses in extension and rotation motion. Secondary tests are confirming tests that are designed to correct or inhibit the extension and rotation motion. If the primary test is positive, the secondary test is performed. When movement or symptom reduced in the secondary test, finally it is confirmed as positive. A previous study reported that the percentages of agreement were 98%–100% with the kappa values ranging 0.87–1.00 for the symptom behavior items, and the percentages of agreement were 65%–100% with the kappa values ranging 0.00–0.78 for the alignment and movement items [16]. The exclusion criteria were: having (1) rectus femoris muscle shortness determined using Ely’s test, (2) iliopsoas muscle shortness determined using Thomas test, (3) femoral torsion (antetorsion or retrotorsion) determined using Craig’s test, (4) significant weakness in the hip lateral rotator muscles lower than grade 3 (fair) determined using the manual muscle testing, and (5) a history of spinal fracture or surgery, disc herniation, spinal deformity, pain or parasthesia below the knee, systemic inflammatory problem, or other serious musculoskeletal problem that could interfere with HLR in the prone position. The subject characteristics are presented in Table 1. The present study was approved by the Yonsei University Mirae Campus Human Studies Committee, and the subjects were given details of the experiment and provided written informed consent prior to their participation.

Table 1 . Subject characteristics (N = 22).

Variable	ADIM training group (n = 11)	ADIM training plus TFL-ITB self-stretching group (n = 11)	t	p-value
Gender (male/female)	9/2	7/4
Age (y)	23.1 ± 1.8	23.8 ± 2.6	–0.66	0.51
Height (cm)	170.7 ± 6.6	173.1 ± 9.8	–0.68	0.50
Weight (kg)	67.9 ± 9.1	70.3 ± 13.1	–0.50	0.61
BMI (kg/m2)	23.2 ± 2.0	23.2 ± 2.5	–0.07	0.94
Active HLR (°)	45.07 ± 3.43	44.69 ± 7.31	1.09	0.28

Values are presented as number only or mean ± standard deviation. ADIM, abdominal drawing-in maneuver; TFL-ITB, tensor fasciae latae-iliotibial band; BMI, body mass index; HLR, hip lateral rotation. P-value is comparison of groups using an independent t-test..

2. Clinical Measurements

Pain intensity was measured using a visual analogue scale (VAS). A 100-mm VAS was used to assess pain intensity in the low back [17]. The subjects were asked to rate their level of pain on a VAS consisting of a 100-mm line with 0 (no pain) at one end and 100 (the worst pain) at the other end.

TFL-ITB length was evaluated by two examiners using the modified Ober’s test [18]. An inclinometer, Johnson Magnetic Angle Locator (Johnson) was used to measure TFL-ITB length. The subject was instructed to lie on their side with the bottom leg flexed at the hip and knee to straighten the lower back. If the subject’s leg dropped less than 10° below horizontal, it was recorded as a positive test [13]. Melchione and Sullivan [19] reported good intra- and inter-rater reliability (intraclass correlation coefficient [ICC] 0.94 and 0.73, respectively) using the modified Ober’s test.

3. Kinematic Data

The kinematic data obtained from the 3-dimensional ultrasonic motion analysis system (CMS–HS, zebris Medical GmbH) were used to measure the lumbopelvic rotation angle and lumbopelvic rotation movement onset during active HLR. Two sets of ultrasound triple markers were used: one was placed on the midline of the pelvis by fastening a strap around the pelvis at the level of the posterior superior iliac spines to measure lumbopelvic kinematics (lumbopelvic rotation angle and lumbopelvic rotation movement onset) [11]. The second set of triple markers was placed under on the distal 1/3 of the fibula to measure HLR.

The kinematic data obtained from the 3-dimensional ultrasonic motion analysis system (CMS–HS, zebris Medical GmbH) were used to measure the lumbopelvic rotation angle and lumbopelvic rotation movement onset during active HLR. Two sets of ultrasound triple markers were used: the first set was placed on the midline of the pelvis by fastening a strap around the pelvis at the level of the posterior superior iliac spines. This configuration allowed for the measurement of lumbopelvic kinematics, specifically capturing rotational movements around the Z-axis (lumbopelvic rotation angle and lumbopelvic rotation movement onset) [11]. The second set of triple markers was placed just below the distal third of the fibula to assess HLR. This placement focuses on the Z-axis to quantify the degree of lateral rotation at the hip, ensuring that the subject maintains a consistent angle during the movement. The measuring sensor, which consisted of three microphones to record the ultrasound signals from the markers, was positioned lateral to the subject on the side being tested. Angles were calibrated to 0° relative to the prone position with the knee flexed at 90°. The sampling rate was 20 Hz, and the kinematic data were analyzed using the Win-data ver. 2.19 software (zebris Medical GmbH).

The lumbopelvic rotation movement onset was defined as the time at which the angle of the lumbopelvic motion exceeded a threshold of 1° [4]. The mean value of the lumbopelvic rotation angle was calculated from the last 5 seconds of isometric contraction during HLR. The mean value of three trials was calculated to determine the lumbopelvic rotation angle and the lumbopelvic rotation movement onset.

We used the intraclass correlation coefficient (ICC 3,1) to calculate the intra-rater reliability of active HLR and lumbopelvic rotation in the pre-intervention session and found excellent intra-rater reliability (ICC = 0.98 and 0.93, respectively).

4. Experimental Procedures

The procedures included clinical measurements involved in subject recruitment and laboratory measurements during the active HLR test. Subjects first completed the following clinical tests: 1) the VAS and 2) the modified Ober’s test. Following completion of the clinical tests, laboratory measurements were made. Each subject was instructed to lie prone position (Figure 1). The starting position was prone with knee flexed at 90° on the side with the shortened TFL-ITB and the other knee extended [4]. If the TFL-ITB was tight in both legs, the tighter of the two was designated as the test side. Before the HLR test, a thermoplastic splint (KLARITY Elastic, Klarity Medical & Equipment (GZ) Co. Ltd.) was placed on the knee joint to minimize excessive tibial movement caused by the knee joint laxity. Different thermoplastic splints were made for the males and females to accommodate gender differences in the circumference and width of the knee joint.

Figure 1. Hip lateral rotation position.

The laboratory procedures were as follows: 1) The degree of active HLR was determined by asking the subject to laterally rotate the hip as far as possible and 2) A target bar was positioned at 50% of the maximum active HLR to prevent excessive stretching of the soft tissue of the hip and to provide tactile feedback to stop active HLR when the medial aspect of the distal tibia touched the target bar. The subject performed HLR for 10 seconds. A 1-minute rest period was scheduled between trials. Movement speed and time were controlled using a metronome. The start signal was an auditory cue (beeper sound) emitted by the Noraxon TeleMyo system (Noraxon USA) [11]. All subjects were familiarized with the experimental procedure for approximately 30 minutes prior to the testing. The subjects were instructed to rest for 10 minutes after the familiarization period to minimize muscle fatigue.

5. Interventions

Before the intervention, the exercises were fully explained by the examiner. During the intervention period, subjects performed the ADIM and TFL-ITB stretching exercises at home following detailed instructions provided by the examiner. Because the exercises were performed at home, subjects were controlled for adherence to a set routine. Subjects were required to perform the exercises independently and report their adherence to the protocol without direct supervision. This method allowed the examiner to monitor the effectiveness of the intervention while maintaining a standardized approach for all subjects.

The interventions were ADIM training and ADIM training plus self-stretching the TFL-ITB. Subjects in the ADIM training group performed ADIM in the prone position and were provided with visual feedback using a pressure biofeedback unit (Stabilizer, Chattanooga group Inc.; Figure 2). The 3-chamber pressure cell of the pressure biofeedback unit was inflated to 70 mmHg. The subject was asked to reduce the level of pressure by approximately 10 mmHg based on visual feedback from an analog pressure gauge during prone HLR. To perform the contraction correctly, the subjects were instructed to “Pull your belly button up and in towards your spine without pelvic movement during exhalation.” It is difficult for patients with LBP to maintain a 60 mmHg level using the pressure biofeedback unit. Thus, the subjects were instructed to perform ADIM training 20 minutes a day, 7 days per week for a 2-week period.

Figure 2. Abdominal drawing-in maneuver training using a pressure biofeedback unit.

The subjects in the ADIM training plus TFL-ITB self-stretching group were instructed to first stretch the TFL-ITB and then ADIM. Subjects were told to perform TFL-ITB self-stretching 2 sets of 10 repetitions a day, 7 days per week, for a 2-week period (Figure 3). The TFL-ITB stretch was performed in the upright standing position with arms extended and hands clasped overhead. The leg to be stretched was extended, adducted, and externally rotated and then placed behind the non-tested leg. The subject was then instructed to exhale while slowly bending the trunk laterally in the direction opposite the test leg [14]. The subjects were instructed to hold the stretched position for 10 secoinds and rest for 2 minutes between sets. The subjects were instructed to stop the exercise if it caused a sharp pain or discomfort in the lumbopelvic region. Furthermore, the subjects were told that muscle fatigue and a stretched-out feeling could be expected after each stretching session.

Figure 3. Self-stretching the tensor fasciae latae-iliotibial band.

6. Statistical Analysis

Kolmogorov–Smirnov tests were performed to assess whether continuous data approximated a normal distribution. Subjects were randomly allocated to the experimental groups using the Microsoft Excel software (Microsoft Corporation); thus, we expected a homogenous distribution of variance and did not anticipate significant pre-intervention between-group differences on any outcome measure. However, we conducted an independent t-test to analyze the pre-intervention values between groups. A paired t-tests was used to determine within-group (before and after an intervention) changes and the independent t-test was used to determine between-group differences for each outcome measure (lumbopelvic rotation angle, lumbopelvic rotation movement onset, TFL-ITB length, and pain intensity). Cohen [20]’s d statistic was used to calculate the effect size for each outcome comparison and was calculated as the difference in the group means divided by the pooled standard deviation. Cohen [20]'s d of 0.2, 0.5, 0.8 were considered small, medium and large effect sizes respectively. All statistical analyses were performed using IBM SPSS software ver. 19.0 (IBM Co.).

1. Lumbopelvic Rotation Angle

The lumbopelvic rotation angle decreased significantly under the post-intervention compared with the pre-intervention (ADIM training: pre = 4.94° ± 1.18°, post = 1.82° ± 0.52°, t(10) = –2.76, p = 0.01, d = 4.22; ADIM training plus TFL-ITB self-stretching: pre = 5.48° ± 0.92°, post = 1.53° ± 0.26°, t(10) = 19.71, p < 0.01, d = 5.95). The ADIM training plus TFL-ITB self-stretching decreased the lumbopelvic rotation angle significantly more than the ADIM training alone (pre-intervention minus post-intervention, ADIM training: mean difference = 3.12° ± 0.73°; ADIM training plus TFL-ITB self-stretching: mean difference = 3.95° ± 0.66°, t(20) = –2.76, p = 0.01, d = 1.19, Figure 4).

Figure 4. Lumbopelvic rotation angle between-group differences. (A) Abdominal drawing-in maneuver training group. (B) Abdominal drawing-in maneuver training plus tensor fasciae latae-iliotibial band self-stretching group. *p = 0.01.

2. Lumbopelvic Rotation Movement Onset

The lumbopelvic rotation movement onset delayed significantly under the post-intervention compared with the pre-intervention (ADIM training: pre = 1.53 ± 0.38 seconds, post = 2.85 ± 0.86 seconds, t(10) = –5.97, p < 0.01, d = 1.82; ADIM training plus TFL-ITB self-stretching: pre = 1.58 ± 0.22 seconds, post = 3.56 ± 0.50 seconds, t(10) = –9.94, p < 0.01, d = 3.04). The ADIM training plus TFL-ITB self-stretching delayed the lumbopelvic rotation angle significantly more than the ADIM training alone (ADIM training: mean difference = 1.31 ± 0.72 seconds; ADIM training plus TFL-ITB self-stretching: mean difference = 1.98 ± 0.65 seconds, t(20) = –2.23, p = 0.03, d = 0.96, Figure 5).

Figure 5. Lumbopelvic rotation movement onset between-group differences. (A) Abdominal drawing-in maneuver training group. (B) Abdominal drawing-in maneuver training plus tensor fasciae latae-iliotibial band self-stretching group. *p = 0.03.

3. Tensor Fasciae Latae-Iliotibial Band Length

The TFL-ITB length was measured using the modified Ober’s test and was expressed as the hip horizontal adduction angle. In the ADIM training, the TFL-ITB length did not increase significantly under the post-intervention compared with the pre-intervention (ADIM training: pre = 8.09° ± 0.94°, post = 8.27° ± 1.00°, t(10) = –1.00, p = 0.34, d = 0.29). In the ADIM training plus TFL-ITB self-stretching, the TFL-ITB length increased significantly under the post-intervention compared with the pre-intervention (ADIM training plus TFL-ITB self-stretching: pre = 8.27° ± 0.90°, post = 10.54° ± 1.43°, t(10) = –6.82, p < 0.01, d = 2.06). The hip horizontal adduction angle was significantly greater under the ADIM training plus TFL-ITB self-stretching compared with the ADIM training alone (ADIM training: mean difference = 0.18° ± 0.60°; ADIM training plus TFL-ITB self-stretching: mean difference = 2.27° ± 1.10°, t(20) = –5.51, p < 0.01, d = 2.35, Figure 6).

Figure 6. TFL-ITB length between-group differences. (A) Abdominal drawing-in maneuver training group. (B) Abdominal drawing-in maneuver training plus tensor fasciae latae-iliotibial band self-stretching group. TFL-ITB, tensor fasciae latae-iliotibial band. **p < 0.01.

4. Pain Intensity

The pain intensity decreased significantly under the post-intervention compared with the pre-intervention (ADIM training: pre = 55.90 ± 8.31 mm, post = 18.18 ± 6.03 mm, t(10) = 11.57, p < 0.01, d = 3.49; ADIM training plus TFL-ITB self-stretching: pre = 54.54 ± 10.11 mm, post = 21.36 ± 9.51 mm, t(10) = 11.21, p < 0.01, d = 3.37). The pain intensity rating was lower in the ADIM training plus TFL-ITB self-stretching group than in the ADIM training group; however, the difference was not statistically significant (ADIM training: mean difference = 37.72 ± 10.80 mm; ADIM training plus TFL-ITB self-stretching: mean difference = 33.18 ±9.81 mm, t(20) = 1.03, p = 0.31, d = 0.44, Figure 7).

Figure 7. Pain intensity between-group differences. (A) Abdominal drawing-in maneuver training group. (B) Abdominal drawing-in maneuver training plus tensor fasciae latae-iliotibial band self-stretching group.

The purpose of the present study was to compare the effect of a 2-week intervention with ADIM training or ADIM training plus TFL-ITB self-stretching on lumbopelvic rotation angle, lumbopelvic rotation movement onset, TFL-ITB length, and pain intensity during active prone HLR in people with lumbar extension rotation syndrome accompanying shortened TFL-ITB.

The pre-intervention lumbopelvic rotation angle during HLR was 4.94° ± 1.18° in the ADIM training group and 5.48° ± 0.92° in the ADIM training plus TFL-ITB self-stretching group. These results agree with previous reports of excessive lumbopelvic motion in people with lumbar extension rotation syndrome [4,6,21,22]. Following the intervention in our study, lumbopelvic rotation was reduced to 1.82° ± 0.52° and 1.53° ± 0.26° in the ADIM training and ADIM training plus TFL-ITB self-stretching groups, respectively. Our results indicate that the lumbopelvic rotation angle decreased significantly following both interventions. Lumbopelvic rotation angle between-group differences were 3.12° ± 0.73° in ADIM training and 3.95° ± 0.66° in ADIM training plus TFL-ITB self-stretching. Our results indicate that the ADIM training plus TFL-ITB self-stretching decreased the lumbopelvic rotation angle significantly more than the ADIM training alone, although the difference was minimal. Our results suggest that an improved abdominal control and an elongated TFL-ITB could play a greater role in minimizing the lumbopelvic rotation angle. Our findings are consistent with previous research showing that insufficient abdominal control and shortened TFL-ITB could contribute to increased lumbopelvic rotation during active HLR [2].

The pre-intervention lumbopelvic rotation movement onset during HLR was 1.53 ± 0.38 seconds in the ADIM training group and 1.58 ± 0.22 seconds in the ADIM training plus TFL-ITB self-stretching group. This implies that the early lumbopelvic rotation movement onset could be attributed to the lack of control by the abdominal muscles and the shortened TFL-ITB. This finding concurs with the results of previous studies reporting that LBP is associated with early lumbopelvic rotation during active limb movement [5,22,23]. The results of the present study showed that the lumbopelvic rotation movement onset was significantly delayed following both interventions, suggesting that both abdominal control and stretching of the TFL-ITB contribute to the delayed lumbopelvic rotation movement onset. Moreover, our results showed that ADIM training plus TFL-ITB self-stretching delayed the lumbopelvic rotation movement onset significantly more than the ADIM training alone, although the difference was minimal. The current study suggests that treatment may require not only training of the abdominal control, but also stretching of the TFL-ITB to delay the lumbopelvic rotation movement onset during the HLR.

The ADIM training plus TFL-ITB self-stretching group showed a significantly greater increase in the hip horizontal adduction angle than did the ADIM training alone group. The present study showed that ADIM training plus self-stretching the TFL-ITB elongated the TFL-ITB. Shortening of the TFL increases ITB tension resulting in excessive lumbopelvic movement to compensate. Our results are consistent with those of a previous study showing that stretching in an upright standing position with arms extended overhead is an effective method for increasing TFL-ITB length [14].

The level of pain intensity determined using a VAS was significantly reduced following both interventions. The level of pain intensity was lower in the ADIM training plus TFL-ITB self-stretching group than in the ADIM training group; however, the difference was not statistically significant. Our results suggest that the reduction in pain may be associated with a reduction compressive stress induced by restricted lumbopelvic rotation during HLR. Previous studies reported that people with lumbar extension rotation syndrome have a tendency to extend and rotate the lumbar spine during lower-extremity movements. Furthermore, repetitive movement in a specific direction contributes to cumulative microtrauma of the lumbar tissue and eventually results in LBP [24]. The choice of subjects for this study was based on the prevalent incidence of lumbar extension rotation syndrome among individuals with non-specific LBP [25]. This condition, characterized by the tendency to extend and rotate the lumbar spine during lower-extremity movements, is common in both sedentary and physically active populations [26]. The interventions chosen ADIM training and TFL-ITB self-stretching were specifically designed to address the biomechanical abnormalities associated with this syndrome.

ADIM training aims to strengthen the deep abdominal muscles, particularly the TrA, which supports the stabilization of the lumbar spine [27]. By enhancing core stability, ADIM training can potentially reduce the compensatory movements in the lumbar spine that lead to pain and dysfunction [12]. On the other hand, TFL-ITB self-stretching is intended to decrease the tension in the lateral thigh, which can contribute to abnormal pelvic and hip mechanics during movement [28]. By reducing this tension, the stretching may decrease the compressive forces on the lumbar spine during activities, thus mitigating the risk of microtrauma and subsequent LBP [29].

Together, these interventions target both the core stabilization and active stretching which are critical in correcting the dysfunctional movement patterns seen in subjects with lumbar extension rotation syndrome [3,30]. Through these mechanisms, this approach not only provides more effective pain relief, but also contributes to the long-term health of the lumbar spine [31].

The present study has several limitations. First, we studied the effect of the ADIM training and self-stretching the TFL-ITB using a standardized movement test, and it is not clear whether our results can be generalized to other functional activities in subjects with lumbar extension rotation syndrome. Second, in our measurement of the lumbopelvic rotation motion, the angle was calculated based on movement of the level of posterior superior iliac spine marker and did not account for motion of the upper trunk that may have contributed to lumbopelvic rotation. Third, the present study used surface markers to index bone movement; thus, artifacts resulting from skin movement were present. Because the lumbopelvic rotation movement was small, skin movement artifacts may have had an impact on our outcome measure. Finally, the 2-week test period was a short-term intervention. Further research is needed to determine the long-term effect of ADIM training and self-stretching the TFL-ITB on lumbopelvic kinematics during HLR in subjects with lumbar extension rotation syndrome.

The present study compared the effect of a 2-week intervention with ADIM training or ADIM training plus TFL-ITB self-stretching on lumbopelvic rotation angle, lumbopelvic rotation movement onset, TFL-ITB length, and pain intensity during active prone HLR in people with lumbar extension rotation syndrome accompanying shortened TFL-ITB. The results indicate that compared with ADIM training alone, ADIM training plus TFL-ITB self-stretching significantly decreased the lumbopelvic rotation angle, delayed the lumbopelvic rotation movement onset, and elongated the TFL-ITB. The reported decrease in pain intensity was greater in the ADIM training plus TFL-ITB self-stretching group than in the ADIM training group; however, the difference was not significant. In conclusion, ADIM training plus TFL-ITB self-stretching performed for a period of 2 weeks may be an effective treatment for modifying lumbopelvic motion and reducing LBP.

None.

None to declare.

No potential conflicts of interest relevant to this article are reported.

Conceptualization: OL, OK, HC. Data curation: CY. Formal analysis: OL, OK, HC, CY. Methodology: OK, HC, CY. Software: CY. Supervision: CY. Validation: CY. Writing - original draft: OL. Writing - review & editing: OK, HC, CY.