Writing a Research Protocol

What is a Research Protocol?

A research protocol is a document that describes the background, rationale, objectives, design, methodology, statistical evaluation of the data, and organization of a clinical research project.

A well-written protocol will facilitate the process of obtaining institutional and ethical approval for your research and increase your chances of obtaining funding for your project.

A Good Research Protocol

- Forces the investigators to clarify their thoughts and to think about all aspects of the study, conduct, analysis of the data.

- Forms guidelines for a team working on research – help ensure study is performed similarly by different people over time

- is essential if study involves research on human subjects or on experimental animals, in order to get institution institution’s ethical approval

- is an essential component of a research proposal submitted for funding

- is used to start writing a manuscript when study completed

Developing a Research Protocol

Start with a good question - one for which the answer matters either to other researchers in the field, practicing clinicians, or patients

Convert the question to a hypothesis by asserting a position

Construct the protocol

Generate measures of exposure (treatments) and outcome

Test the hypothesis by making a comparison in two or more groups

Develop a plan for data collection and management

Determine the statistical methods for analysis, consult with statistician

Estimate the magnitude of expected difference between the two groups, as a basis for determining sample size (power calculation)

Assess feasibility of the study:

Can enough people be obtained for the study?

Can the outcome events be observed and suitably analyzed?

Research Protocol Format

Project title

Project summary

Project description

Rationale

Objectives

Subjects to study: Inclusion/ Exclusion criteria

Methodology

Data management and analysis

Sample size needed for the study

Ethical considerations

Risks and Benefits of the study

Recruitment plans, Compensation (if any)

Informed Consent, Approvals (DRB and IEC)

References

I] Project Title

Should be descriptive of the study, but concise

Clear, non-ambiguous

Arouse interest

Keep it short and Simple and Sweet

II] Project Summary

Why is the project necessary?

What do you aim to do?

What methods will you use for carrying out the project?

What will be the project outputs?

What is the projected impact of the project?

(An approximate word count: 500 words)

III] Project Rationale (Research Question)

Sets the stage for why the research project should be done. Cite appropriate references.

The condition to be studied

Treatments currently available, note gaps present

Specific treatment to be studied

Preliminary data for treatment in the condition to be studied

Purpose of the study

Discuss the anticipated results and potential pitfalls.

Describe the significance of the research including potential benefit for individual subjects or society at large.

IV] Research Objectives (Aims)

The purpose of the study (research questions and / or study objectives) should be clearly and precisely stated.

Objectives should be simple, specific, and stated in advance of performing the research.

In experimental designs, objectives will be stated as hypotheses to be tested.

Be short but complete and Be specific.

Objectives should be attainable, measurable and realistic

V] Procedures

A. Research Design

The research design should be identified and should be appropriate to answer the research question(s) under study.

Describe the type of research proposed (e.g. experimental, correlational, survey, qualitative) and specific study design that will be used (e.g. pre-test /post / test control group design, cross-sectional design; prospective longitudinal cohort design; phase III double-blind randomized control group design).

The research design, methods and procedures should help answer your research question(s) as written in your study objectives and aims

B. Sample/ Subjects/ Participants

Describe the sampling approach. For experimental designs, include justification for sample size determination.

Identify the procedures that will be used to recruit, screen, and follow study volunteers.

Specifically define the study sample (number of subjects to be enrolled, characteristics of subjects to be included in and excluded from the research).

In intervention studies, how will subjects be allocated to the treatment and comparison groups?

What are the criteria for discontinuation?

C. Measurement/ Instrumentation/ Intervention

Identify the variables of interest and study endpoints (where applicable).

Justify measurement techniques selected.

Provide validity and reliability data for selected measures.

If an intervention is performed, a description is given of the drugs available, or devices to be used, and whether they are already commercially available, or are in phases of development

D. Detailed study procedures

Methods for study data collection and for avoiding / minimizing subject risks should be included.

Include a timeline for subject evaluations and the duration of subject participation in the project.

Identify the plans the proposed safeguards for subject confidentiality (plans for coding data and for securing written and electronic subject records).

Indicate how long personal information will be stored once the study is completed.

Methods will vary with the research approach used (qualitative, quantitative).

The selected methods should be sufficiently described to justify the use of the approach for answering the defined research question.

Methods should also be described in adequate detail so that IEC members may assess the potential study risks and benefits.

Observations

What observations will be made, how they will be made, and how frequently will they be made.

Make a pilot study where required.

E. Internal Validity

Threats to internal / external validity should be considered.

Identify confounders.

Describe measures that have been taken to avoid study bias.

F. Data Analysis

Specify the analytic techniques the researcher will use to answer the study questions.

Indicate the statistical procedures (e.g. specific descriptive or inferential tests) that will be used and why the procedures are appropriate.

For qualitative data, specify the proposed analytic approaches.

VI] Sample Size

The protocol should provide information and justification on the sample size – the number of patients needed to be studied

A larger sample size than needed to test the research hypothesis Increases the cost and duration of the study and will be unethical if it exposes human subjects to any potential unnecessary risk without additional benefit

A smaller sample size than needed can also be unethical if it exposes human subjects to risk with no benefit to scientific knowledge

Calculation of sample size has been made easy by computer software programs. The principles underlying the estimation of the software sample size should be well understood

VII] Ethical considerations

Risks, Benefits of the study

Recruitment plans

Compensation for subjects in study

Informed Consent and procedure, IEC Approval

Conflict of Interest

Privacy

VIII] GCP Guidelines: https://gcp.nihtraining.com/

IX] Universal Guidelines:

CONSORT - CONsolidated Standards Of Reporting Trials

STROBE - STrengthening the Reporting of OBservational studies in Epidemiology.

X] Others:

Logistics – List of equipment/ tools required

Time Schedule – Gantt Chart

Action Plan – Procedural actions with durations

Budget – Self funded/ Sponsored

XI] Bibliography

Include a reference list of literature cited to support the protocol statement.

Vancouver Format/ APA format

XII] Registration

CTRI – Clinical Trials Registry of India

http://ctri.nic.in/

XIII] Forever Avoid Scientific Misconduct

Gift Authorship

Redundant Publication

Plagiarism

Fabrication

Falsification

References:

1. Fathalla MF. A Practical Guide for Health Researchers. WHO Regional Publications Eastern Mediterranean Series 30

2. Research Protocol. THE OHIO STATE UNIVERSITY Institutional Review Board

3. Parkman H. Writing a Research Protocol. WHO | Recommended format for a Research Protocol. http://www.who.int/rpc/research_ethics/format_rp/en/ [Viewed on Dec 14, 2015]

4. Guidelines on Writing a Research Protocol. Faculty of Health Sciences. University of Pretoria

The Hypertrophied Patella – Does it really exist?

The Knee joint reveals its mysteries far more often than expected. So often a simple case of fracture patella with a Tension Band Wiring (TBW) turns out to be a nightmare for the Physiotherapy management.

The fracture of the patella is one of the commonest conditions that a Physiotherapist encounters during the clinical practice. The patella (knee cap) is a sesamoid bone, i.e. it is a bone in between the tendon of the quadriceps muscle and is a cancellous (porous) type of a bone. Although the patella is within the tendon of the quadriceps, it does not separate the quadriceps tendon, but infact it is embedded within the extensor retinaculum of the quadriceps. The patella acts as a pulley to increase the moment arm of the knee joint and increases the efficacy of the quadriceps muscle to bring about extension of the knee joint. This is such a beautiful bio-mechanical mechanism which is really unique in the human body.

The quadriceps group of muscles are made of 4 different muscles, viz the single joint (uni-articular) 3 Vastii (Vastus Lateralis, Vastus Intermidius and Vastus Medialis) which are phasic, red muscles responsible for the knee joint anterior compartment dynamic stability and the two joint (bi-articular) Rectus Femoris which is flexor of the hip and extensor of the knee joint and is a tonic, white muscle responsible for force production and torque generation of the knee joint during extension in open and closed chain activities.

The patella works as a pulley glided by the shape of the articular surface of the femoral condyles. It has the capability to move medial to lateral, superior to inferior and rotate inwards and outwards within the articular capsule of the knee complex. This variation in movement allows the patella to move and align itself in relation to the different fibres of the vastii and rectus to bring about an efficient extension of the knee. It is generally assumed that during extension of the knee from 120 – 0 degrees, the patella aligns the fibres of the vastus lateralis fibres in 120 – 80, vastus intermidius aligned during 80-40 and vastus medialis aligned during 40 – 0 degrees of the extension. Thus the patella plays an extremely crucial role in knee extension, not by merely increasing the knee joint moment arm, but also by aligning the fibers of the quadriceps. The rectus femoris is responsible for force generation for the knee movements and is extremely crucial for activities like walking, running, kicking (a ball) etc.

Flexion of the knee is brought about by the bi-articular (2 joint) hamstrings group of muscles which constitutes of the semi-tendinosis, semi-membranosis and the biceps femoris. During flexion of the knee from 0-120 degrees, the patella undergoes a tracking movement in the inferior (downward) direction. It carefully moves within the space of the femoral condyles within its lower articular surface after around 90 degrees of knee flexion and thus reduces the tension generation in the capsule of the knee joint.

This mechanism and function of the knee is severely hampered when the patella is fractured. Although the patella is not a weight bearing bone during normal bipedal ambulation, its fracture completely disrupts the extensor mechanism of the knee making this entire system collapse. Newer line of orthopaedic surgical management offers wonders in management of the patellar fractures. The tension band wiring fixation with ‘Krichners’ wire fixation seems to be the most commonest and most reasonable line of management for patellar fractures wherein the distraction pull by the quadriceps (and the ligamentum patellae in the other direction) is converted into compression forces by the TBW thereby accelerating the early healing the restoration of the function of the extensor mechanism.

But the patella, which is a porous bone, bleeds during the course of the trauma leading to its fracture. This bleed gets confined along with patellar fracture within the extensor retinaculum and as the patella gets healed and calcified, can also get calcified. Although this is not very evident in the radiograph (X-Ray), it can still be visualised on careful observation, mainly after 4-6 weeks post fracture. But it is best evident to the clinician by palpating the patella which seems to be big and enlarged (comparison with the opposite knee is extremely useful for confirmation). This enlarged size of the patella is poorly studied in literature and thus have been coined as a “Hypertrophied Patella” by me. Although the term hypertrophy is associated and used with muscles in relation with an increase in their size and cross sectional area, it seemed appropriate to use this term for the patella in this condition also (although not an absolutely scientific term). The term “Hypertrophy of the Patella” has been used in literature by Cave (1950) and Linthoudt (2008), it has been in relation to the multiple epiphyseal dysplasia, not the adult patella per se.

The patella, which seems to be enlarged on palpation, does not function appropriately in regards to its flexion function of the knee. It is extremely difficult for the patella to move within the femoral condyles after 90 degrees of knee flexion and thus starts becoming a nightmare for the Physio to obtain a full range of the knee. Clinically, this state of the knee may not affect the extensor mechanism of the knee joint and thus, the bio-mechanical functions of the quadriceps tend to remain intact. But in few of the cases, a dysfunction in the extension mechanism has been found, primarily due to the reduced mobility of the patella. The swelling around the patella is not easily and readily manageable and as it tends to consolidate, it reduces the mobility of the patella in all the directions. This prevents the patella from being aligned to the respective fibers of the quadriceps and leads to loss of efficiency of the knee extensors. It can also lead to compression of the patella against the articular surfaces of the femur (specially the medial condyle of the femur) leading to early degeneration of the articular cartilage of the patella as a complication in the near future. Thus controlling the swelling (oedema) and restoring a normal patellar mobility becomes a priority in the early management of patellar fracture rehabilitation.

The goal for Physiotherapy management in a case of fracture patella includes:

1. Pain management

2. Controlling the swelling

3. Increasing the range of motion of the knee joint

4. Increasing the strength of the extensor mechanism

5. Increasing the strength of knee flexors

6. Early weight bearing and ambulation

7. Functional restoration

1. Pain management:

This can be obtained by Cryotherapy (or heat if swelling is not an issue), and by low velocity oscillations for knee and patella

2. Controlling the swelling:

Cryotherapy, compressions, knee brace (if required)

3. Increasing the range of motion of the knee joint:

This is the most crucial challenge. The patient cribs and curses every morning due to their inability to squat. Patellar mobilisation and quadriceps MFR helps in gaining early knee range till 90 degrees. But range beyond this is very difficult to obtain and may take as long as 6 months to be achieved. Being too impulsive and over-enthusiastic in this situation may prove to be too dangerous as repeated application of force and pressure (passively or by CPM machine etc) may cause over lengthening of the ligamentum patellae due to collagen distraction and may produce loss of efficiency of the extensor mechanism. The therapist may perceive a progressive weakness in the quadriceps strength in 4-6 weeks, not realising that the overstretching has led to dysfunction of knee extensors and loss of efficiency of force production at the tibia. This, unfortunately, cannot be reversed by any amount of strengthening of the quadriceps and thus has to be prevented at all costs.

4. Increasing the strength of the extensor mechanism and Knee flexors:

Open chain exercises till 4 weeks and later combination of open and closed kinematic chain exercises is very useful for gaining the strength of the knee muscles. Care should be taken to improve on the Endurance of the Vastii (by RPE) and the strength of the Rectus femoris and Hamstrings (by 1 RM and PRE), as per their functional needs. Also to understand the various angles that the vastii function and thus multiple angle, short arc training can be more beneficial rather than full range movements.

5. Early weight bearing and ambulation:

There is no contraindication for early weight bearing and gait training in these cases. Always, a good rapport and communication with the operating Orthopaedic Surgeon turns out to be a blessing. Full weight bearing, as early as in 4 weeks, can be obtained. Gait training is extremely crucial as the reduced patellar function affects the loading response, mid stance, pre swing and swing phases of Gait and can result in a Stiff Knee gait pattern. Pain is rarely a hindrance in Gait training.

6. Functional restoration:

Activities such as sitting on low surfaces, squatting, cross leg sitting etc, requiring more than 90 degrees of knee flexion may be very difficult to obtain for almost 4-6 months. But walking, stairs, riding etc is not much of a hassle. Always maintain good communication with the patient and surgeon and have clarity of thoughts in regards to the Physiotherapeutic management.

Thus, the patellar fracture turns out to be a simple, but challenging aspect in PT rehab. The knee gains a good range and function in the near future due to reabsorption of the excess calcification with a progressive aligned and directed force of the quadriceps and is not a matter of worry at all. (Although is a time consuming process). Although not much documented, the “Hypertrophied Patella” does seem to exist and also requires a better understanding of the knee joint and is a challenge worth accepting.

Dr. Apurv Shimpi (Community Physiotherapist)

1. Cave EF, Rowe CR. The Patella, Its Importance in Derangement of the Knee. J Bone Joint Surg Am, 1950 Jul; 32 (3): 542 -566 

2. Van Linthoudt D. Patellar hypertrophy: rare abnormality associated with a multiple epiphyseal dysplasia. Praxis (Bern 1994). 2008 Aug 13;97(16):893-7. French.

3. Gosal HS, Singh P, Field RE. Clinical experience of patellar fracture fixation using metal wire or non-absorbable polyester — a study of 37 cases. Injury, Int. J. Care Injured 32 (2001) 129–135

4. Hoshino MC,  Tran W, Tiberi JV, Black MH, Li BH,  Gold SM,  Navarro RA. Complications Following Tension-Band Fixation of Patellar Fractures with Cannulated Screws Compared with Kirschner Wires. J Bone Joint Surg Am April 2013; :653-659.

5. Baran O, Metin Manisali M, Berivan Cecen B. Anatomical and biomechanical evaluation of the tension band technique in patellar fractures. International Orthopaedics. August 2009, 33(4): 1113-1117

6. Cramer KE, Moed BR. Patellar Fractures: Contemporary Approach to Treatment. J Am Acad Orthop Surg November 1997; 5:323-331.

Effect of Induced Muscular Fatigue on Balance and Core Strength in Normal Individuals

Indian Journal of Physiotherapy & Occupational Therapy. July-September 2014, Vol. 8, No. 3

ABSTRACT

Background: Balance is the ability to maintain proper alignment of body segments with respect to each other. Muscular fatigue is a key factor which can influence performance via impaired joint proprioception and postural control. Fatigue alters the force generation capacity of the muscle and ultimately leads to task failure. The relationship between fatigue and balance is poorly understood.

The purpose of the present study was to assess if fatigue had an immediate effect on balance and core strength in healthy individuals, by checking the static and dynamic stability and the core muscle strength for spinal stability.

Aim: To find the effect of Induced muscular fatigue on Balance and Core strength in Normal Individuals.

Methodology: Functional reach tests, Single Leg Stance, Core strength were measured Pre and post Fatigue, which was induced by squats performed till RPE of 10. The data obtained was statistically analyzed using paired 't' test.

Results: A significant reduction was found in the mean single leg stance time from 10.05 seconds pre-fatigue, to 3.01 s post fatigue (p<0.05). The pre fatigue functional reach distance covered by individuals was 36.36 cms which was reduced to 29.48 cms post fatigue (p<0.05). There was also a reduction in the core muscle strength measured pre fatigue from 43.43 mmHg to 43.16 mmHg post fatigue statistically. (p<0.05)

Conclusion: Fatigue definitely has a significant reduction on Static balance, Dynamic balance & also on lumbar core strength as seen in normal individuals.

Keywords: Muscular Fatigue, Static Balance, Dynamic Balance, Core Strength

INTRODUCTION

Balance can be defined as the position of the body relative to the arrangement of the limbs and segments, for a specific activity, or the characteristic that one bears the weight of one’s body. It is the ability to maintain equilibrium in a gravitational field, and to react to destabilizing forces quickly and efficiently to regain stability via postural adjustments before, during, and after voluntary movement and in response to external perturbation. Balance, is maintained by the dynamic integration of internal and external forces and factors involving the environment. Specifically, balance can be classified as either static i.e. maintaining equilibrium with minimal movement, semi-dynamic i.e. attempting equilibrium while the base of support moves, or dynamic i.e. maintaining a stable base of support while completing prescribed movement. When an individual is in erect standing posture the integrity of stance is maintained by shifting body weight in multiple directions relative to corrective contractions of the muscles of the lower extremities and the trunk. Muscle fatigue is a complex phenomenon resulting in an exercise-induced reduction in the force-generating capacity of the muscles regardless of the task performed. The necessity of those con-tractions is expressed via the somatosensory, vestibular, and visual systems.

Impairments of the sensory systems have been associated with various pathological conditions, as well as transient physiological phenomenon, that increase the likelihood of fall or traumatic injury.

Fatigue, can affect the proprioceptive and kinaesthetic properties of joints, increase the threshold of muscle spindle discharge, which in turn disrupts afferent feedback and can alter joint awareness. The detrimental effect of fatigue on static balance has been established, but its effect on dynamic balance is unknown. To examine the ways in which fatigue affects balance, some authors have induced generalized muscle fatigue via strenuous aerobic exercise or selective muscle-fatiguing protocols. 

The relevance of fatigue to joint stability is evidenced by the relationship between postural control and the endurance of the ankle, knee and back muscles. Studies have shown the influence of foot mechanics on proximal structures i.e. core and have been studied extensively. The influence of proximal stability on lower extremity structure is known. One of the studies initially proposed that stabilization of the pelvis and trunk is necessary for all movements of the extremities. Studies have identified trunk muscle activity before the activity of the lower extremities, which authors felt served to stiffen the spine to provide a foundation for functional movements. This tendency for core instability has been suggested to predispose females to lower extremity injury. Stronger core muscles may help keep ground reaction forces (GRFs) within an optimal range. Based on previous literature and current thought, we hypothesized that fatigue would demonstrate effect on balance of the individual and significant difference in core strength. Therefore, the purpose of this study was to find out the relation between muscular fatigue and balance in normal individuals, by evaluating the static and dynamic stability and also to find if there was any change in the core muscle strength for spinal stability post induction of fatigue.

METHOD AND METHODOLOGY

The current study attempted to determine whether level of fatigue had any effect on balance & on core strength in normal individuals. To do so, experimental study design was used for this study and the study was carried out on general population in an urban region. Study approval was obtained by the institutional ethical board and an informed consent was obtained from all the subjects.

Sixty volunteers (30 men and 30 women; age range, 18-25 years; mean age, 20 ± 1.78 years) were included in the study, they were tested twice (pre and post) during same session. Any subject who had suffered a musculoskeletal injury to a lower extremity or a head injury in the 6 months before testing was excluded from the study.

The Functional reach test and single stance were used to measure the static and dynamic balance. Core strength was measured using aneroid sphygmomanometer. Subjects reported for test sessions were familiarised with the study followed by data collection for Functional reach test, single leg stance and the core strength.

Functional reach test is the measurement of difference between arm’s length and maximum forward reach in standing with a fixed base of support. (Figure 1) The subject was asked to reach as far as possible from comfortable standing posture without taking a step, losing balance and lifting the heel.

Excursion of arm from start to finish was measured with the subject standing parallel to the wall with 10 centimeters base of support. Instructions were given to avoid protraction of shoulder, flex arm near to the wall to 90 degrees and contra lateral upper limb in neutral. 1st point at tip of middle finger on wall was marked. Maintain of reach for three seconds and then again measure at tip of the middle finger. (Figure 2)

Distance between 1st and 2nd point was recorded. For the Single Leg Stance, subject was asked to perform single leg stance barefoot with the dominant leg and on the firm surface (dominant leg was found out by the ball kick test). Instructions were given to keep both the knees apart, not to touch hands to the body and to look straight and focus on any object at a distance of 1 meter. (Figure 3) Balance time was recorded until the subject could maintain the above mentioned posture without any movement.

Core Strength was measured by the pressure biofeedback method using an aneroid sphygmomanometer. Subject, in crook lying, the Cuff placed under the lumbar spine area and inflated to 40 mmHg. Subject were asked to activate core muscles (tuck in) and maintain it between 40 to 50 mmHg for 10 seconds (not more than 50 mmHg as rectus abdominis gets activated, and not less than 40 as it indicates arching of the lumbar spine.) If subject was not able to hold for 10 seconds, then rest was given for 3 minutes and asked to hold again at a lower value for 10 seconds.

Then muscular fatigue was induced. Subjects were asked to perform 90 degree squats with upper limbs in 90 degrees flexion and to be continued till rate of perceived exertion reaches 10/10 (Modified Borg Scale) that is extremely strong. The subjects were instructed to squat, as if sitting on a chair in which tibia remains relatively vertical. Subject may experience musculoskeletal or cardio respiratory fatigue. After this immediately single leg stance, functional reach test and core muscle testing was repeated.

Post fatigue measurements were compared with pre fatigue levels in single leg stance, forward reach test and core strength as well. Paired t test was used to measure pre and post performances to find any significant effects on the dependent variables with alpha set at p </=0.05.

The data thus obtained was analysed for further statistical purposes.

RESULTS

DISCUSSION

The purpose of this study was to evaluate whether fatigue affects the balance which was tested by single leg test and functional reach distance for static and dynamic balance respectively. It shows that there is a significant reduction in the single leg stance time which means the ability of the individual to maintain a stable posture is reduced. Single leg stance represents a very important phase in a normal human gait cycle. Stance phase contributes to 40% of the gait cycle. Postural control or balance can be either static or dynamic, and refers to person’s ability to maintain a stable body and body segments in response to forces that threaten to disturb the body’s structural equilibrium. Reduction in the functional reach distance can be due to diminished ability to maintain balance when the Center of Gravity and Line of Gravity shift out of the base of support in a fatigued state. This requires eccentric and isometric muscle activity by both the type 1 and type 2 muscle fibers. The key elements of muscle performance are strength, power and endurance. Studies concluded the effects of fatigue appear to be condition specific, concurring with previously reported findings that showed fatigue had more of an effect with the tandem-foam and tandem-tremor conditions. Studies also concluded that local muscle fatigue is the diminished response of muscle to repeated stimuli and is reflected by a progressive decrement in amplitude of motor unit potentials. This occurs when a muscle repeatedly contracts either statically or dynamically against imposed load. Rate of perceived exertion is an individual’s potential limitation to fatigue and is the ability to quantify the amount of fatigue to which the subjects are subjected. It would be difficult to compare the effect of fatigue on postural stability if the degree of fatigue is varied across the investigations. To rectify this, we have used the Borg RPE scale in an attempt to quantify the amount of fatigue. The RPE scale may be used as a substitute to determine exercise intensity. Using the 15-point Borg RPE scale, study showed 10 to moderate work load.

In the present study, the imposed load was the persons own body weight. Ideal squat requires greater trunk flexion to maintain balance and stronger quads contraction to support the load of the pelvis posterior to the knee axis. In repetitive squatting there is fatigue of all lower limb muscles especially glutei, quadriceps femoris, hamstrings, planter and dorsi flexors. Fatigue of the calf and thigh muscles affect postural sway in standing. Hence, the force capacity of muscles was altered. The effect of moderate fatigue on dynamic balance requires control and additional demands. In later on assessing core strength there was a difference found in the lumbar core muscle strength from 43.43 mmHg to 43.16 mmHg which was statistically significant. Research showed a clear relationship between trunk muscle stability and activity and lower extremity movement. They concluded that Core stability may provide several benefits to the musculoskeletal system, from maintaining low back health to preventing knee ligament injury & also suggested that decreased core stability may predispose to injury and that appropriate training may reduce injury suggested to contribute to the etiology of lower extremity injuries. Studies concluded that Decreased lumbo-pelvic (or core) stability contributes to the etiology of lower extremity injuries. This prospective study compares core stability measures between genders and between athletes who reported an injury during their season versus those who did not. A combination of these strength measures could be used to identify athletes at risk for lower extremity injury.

Fatigue after prolonged exercise leads to reduction in muscle glycogen. This occurs even if sufficient oxygen is available to generate energy by aerobic pathways. Fatigue leads to increase level of blood and muscle lactic acid and increase in H+ concentration in the exercising muscles. All this alters the activity of myofilaments and impairs muscular performance even when the nerve impulses continue to fire. In all when all motor units are maximally activated, fatigue is accompanied by reduction in neural activity. Here as we also see that there is affection of the lumbar core muscles post squatting, thus local fatigue will have an effect at the same site but might also produce an effect at another site in the body. So this, if not considered can be harmful.

In our everyday life, fatigue can significantly affect our balance & stability function making us predisposed to falls & injuries. A reduced muscle support to the body post fatigue will also cause abnormal joint forces and thus markedly increase the frequency of strains, sprains etc. Fatigue at distal/ peripheral area also has an effect on our core stability making us at risk of back problems & spinal damage. Thus our everyday tasks & activities should be planned & organized so as to minimize the effects of fatigue on our musculoskeletal system as with our other systems. The level of fatigue should be considered and the person should not be pushed beyond their capacity as this will increase the chance of injuries and thus reduced performance.

CONCLUSION

Muscular Fatigue causes a significant reduction in Static & Dynamic balance and also has an effect on reduction in core strength as seen in normal individuals. These results highlight the importance of proximal stabilization for lower extremity.

 Shimpi Apurv P, Kharkar Supriya A, Talreja Ankita A

References and Article at:

http://www.indianjournals.com/ijor.aspx?target=ijor:ijpot&volume=8&issue=3&article=036