Effect of head and limb orientation on trunk muscle activation during abdominal hollowing in chronic low back pain

Kevin Parfrey,Eric J Drinkwater,Sean Gt Gibbons,David G Behm

doi:10.1186/1471-2474-15-52

Kevin Parfrey, Eric J Drinkwater + Show 2 more

Open Access

https://doi.org/10.1186/1471-2474-15-52

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Abstract

BackgroundIndividuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre.MethodsThis study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter.ResultsUsing magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA.ConclusionsIndividuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups.

Highlights

Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre
Between group differences for internal obliques (IO):rectus abdominis (RA) ratio Using magnitude based inferences, for the left IO:RA ratio the control group would be at least 75% more likely to have a substantially greater ratio in the supine, asymmetrical tonic neck reflex (ATNR) left and right, cervical rotation to the right and cervical extension positions (d = −0.54, -0.52, -0.77, -0.51 and −0.54 respectively; all “moderate”) than the CLBP group
For the left RA it was likely that the CLBP group would have greater activation than the control in the supine (d = 0.97, “large”), ATNR left (d = 0.80, “large”) and right (d = 0.97, “large”), cervical rotation to the right (d = 0.70, “moderate”) and flexion (d = 0.77, “moderate”) positions (Figure 3)

Summary

Introduction

Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre (attempt to pull umbilicus inward and upward towards the spine). It is thought that if a specific exercise program is administered, which revolves around retraining the proper activation patterns during abdominal hollowing, that the altered pattern and function can be corrected [4]. The goal of this intervention is not to increase the strength of the abdominals, but rather to retrain the altered motor pattern of the abdominal musculature associated with CLBP

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