Abdominal Drawing-In Maneuver is Less Effective for Core Stability During High Load Tasks: A Systematic Review

Abstract

Context: The abdominal drawing-in maneuver (ADIM) is a technique commonly used to activate deep core muscles for the prevention and rehabilitation of low back pain. However, its benefits during high-load tasks (HLT) are unclear. Objectives: The primary objective of this article is to review the literature to determine whether the use of ADIM enhances core stabilization during HLT. Additionally, we will examine if other factors, beyond load, could influence the effectiveness of this activation maneuver. Methods: A search was conducted using PubMed databases for studies that compared interventions using ADIM to those without ADIM. The literature search spanned from January 1981 to March 2024. Only studies that included kinematic assessments were selected. Results: The search yielded 359 studies, of which 24 were included in the final analysis. Task load was analyzed based on Mottram and Comerford's criteria, alongside other approaches such as the source of the perturbation applied to the subject and body position. In conditions using ADIM, better performance was observed in only 16.66% of interventions with HLT, whereas other conditions (OC) without ADIM performed better in 83.33% of interventions using HLT. When core stability was tested against external perturbations, ADIM was less effective in all scenarios. In lying positions, ADIM performed better in 4 tasks, while OC performed better in 2. In upright positions, ADIM was more effective in 7 tasks, while OC performed better in 6. Conclusions: The findings suggest that ADIM should not be used if the goal is to train core stability and strength during HLT. Abdominal drawing-in maneuver was less effective for stabilizing the core during tasks involving external perturbations, and its use was also less decisive in upright positions.