Comparison of Lateral Abdominal Musculature Activation during Expiration with an Expiratory Flow Control Device Versus the Abdominal Drawing-in Maneuver in Healthy Women: A Cross-Sectional Observational Pilot Study.

Vanesa Abuín-Porras,César Calvo-Lobo,Daniel López-López,David Rodríguez-Sanz,Carlos Romero-Morales,Mónica De La Cueva-Reguera,Paula Maldonado-Tello,Emmanuel Navarro-Flores

doi:10.3390/medicina56020084

Abstract

Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). Materials and Methods: A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Results: Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA (p = 0.001) and IO (p = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM (p = 0.001, Cohen’s d = 2.183) and at rest and with the EFCD (p = 0.001, Cohen’s d = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found (p = 0.055, Cohen’s d = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest (p = 0.038), Cohen’s d = 0.081). Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA.

Highlights

Significant differences were observed between abdominal drawing-in maneuver (ADIM), expiratory flowactive control device (EFCD), and at rest condition for the thickness of the TrA (p = 0.001) and internal oblique (IO) (p = 0.039) (Table 1)
Statistically significant differences for TrA at rest compared with the ADIM (p= 0.001), Cohen’s d = 2.183) and at rest and with the EFCD (p = 0.001), Cohen’s d = 2.843)
Muscle thickness, significant differences was reported between the EFCD and at rest (p = 0.038, Cohen’s d = 0.081)

Summary

Introduction

The lateral musculature of the abdomen comprises, from deep to superficial, the transverse (IO), and external oblique (EO) muscles [1].The TrA is a part of the deep stabilization system of the trunk, along with the multifidus, theThe TrAand is athe part of thefloor deep stabilization[2,3,4].system of the trunk,activations along withcause the multifidus, diaphragm, pelvic musculatureThese muscle an increasethe of diaphragm, and the pelvic floorcontributing musculatureto[2,3,4].These muscle activations an increase of the the intra-abdominal pressure, lumbopelvic stabilization [5]. causeIn patients with lower intra-abdominal contributing to lumbopelvic stabilization [5]. activitiesIn patientsdemanding with lowertrunk back back pain, there pressure, is a change in abdominal muscle recruitment during pain, there is a The change abdominal muscle recruitment during activities demanding stability stability [6,7,8].TrAincan be considered the most powerful musculature duringtrunk expiration byThe TrA can alsopressure be considered the mostthe powerful musculature expiration by increasing increasing abdominal and pushing diaphragm towards during the thorax, especially in forced abdominal pressure pushing diaphragmbetween towardsthe themusculature thorax, especially forced expiration expiration [6].Thereand is a closethe relationship of the in pelvic floor and the [6]. System of the trunk,activations along withcause the multifidus, diaphragm, pelvic musculature. These muscle an increasethe of diaphragm, and the pelvic floorcontributing musculatureto[2,3,4]. These muscle activations an increase of the the intra-abdominal pressure, lumbopelvic stabilization [5]. Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. For the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA

Objectives

Results

Discussion

Conclusion