Abdominal Drawing-in Maneuver Research Articles

Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women.

Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p < 0.05) in the primiparous and multiparous women than in the nulliparous. The multiparous women presented greater (p > 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women.

Effects of mouthpiece shape and expiratory threshold loading on contraction of the lateral abdominal muscles: A cross-sectional study

BackgroundExpiratory tasks may facilitate transversus abdominis (TrA) activity for spinal stabilization. The purpose of this study was to verify whether a combination of pursed-lip breathing (PLB) and use of an expiratory threshold loading (ETL) device to increase expiratory resistance would promote TrA contraction comparable to that for a stabilization exercise. MethodsTwenty healthy men performed expiratory tasks or an abdominal drawing-in maneuver (ADIM). Expiratory tasks comprised combinations of ETL settings with 0%, 5%, or 15% of maximum expiratory pressure, and mouthpieces with a normal shape or pursed-lip shape. B-mode ultrasound imaging of the TrA, internal oblique, and external oblique muscles was performed to determine percentage changes in muscle thickness. Percentage changes among tasks were statistically compared for each muscle. FindingsTrA thickness increased with normal lips at 15% ETL, with PLB with 5% ETL, and with ADIM (p < 0.01 each). Internal oblique thickness increased under all PLB conditions (p < 0.01 each). No significant differences in external oblique thickness were seen for any tasks. The total thickness of the lateral abdominal muscles was significantly increased not only for 15% ETL tasks and ADIM, but also for PLB with 5% ETL (p < 0.02 each). InterpretationThese results indicated that PLB with 5% ETL could facilitate the same level of TrA activity as the ADIM. PLB with 5% ETL was the only task that simultaneously increased overall lateral abdominal muscles, including the internal obliques, and might be readily applicable in clinical situations.

Electromyographical Analysis On The Effects Of Performing The Side-bridge Exercise Integrating The Abdominal Drawing-in Maneuver.

Electromyographical Analysis On The Effects Of Performing The Side-bridge Exercise Integrating The Abdominal Drawing-in Maneuver.

The Effect of Virtual Reality Training on Anticipatory Postural Adjustments in Patients with Chronic Nonspecific Low Back Pain: A Preliminary Study

Objectives This study is aimed at exploring the effects of virtual reality (VR) training on postural control, measured by anticipatory and compensatory postural adjustments (APAs and CPAs, respectively), in patients with chronic nonspecific low back pain (CNLBP) and the potential neuromuscular mechanism of VR training. Methods Thirty-four patients were recruited and randomly assigned to the VR group (n = 11), the motor control exercise group (MCE, n = 12) and the control group (CG, n = 11). The VR group received VR training using Kinect Xbox 360 systems and magnetic therapy. Besides magnetic therapy, the participants in the MCE group performed real-time ultrasound-guided abdominal drawing-in maneuver (ADIM) and four-point kneeling exercise. The CG only received magnetic therapy. Surface muscle electromyography (sEMG) was used to record the muscle activities of transverse abdominis (TrA), multifidus (MF), lateral gastrocnemius (LG), and tibialis anterior (TA) during ball-hitting tasks. The muscle activation time and integrals of the electromyography activities (IEMGs) during the APA and CPA stages were calculated and used in the data analysis. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were also recorded. Results A significant interaction effect of time × group was observed on the activation time of TrA (p = 0.018) and MF (p = 0.037). The post-intervention activation time of the TrA was earlier in the VR group (p = 0.029). In contrast, the post-intervention activation time of the MF was significantly delayed in the VR group (p = 0.001). The IEMGs of TrA (p = 0.002) and TA (p = 0.007) during CPA1 significantly decreased only in the VR group after the intervention. The VAS scores of three group participants showed significant decreases after intervention (p < 0.001). Conclusions Patients with CNLBP showed reciprocal muscle activation patterns of the TrA and MF muscles after VR training. VR training may be a potential intervention for enhancing the APAs of the patients with CNLBP.

The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up.

Trunk stability exercises that focus on either deep or superficial muscles might produce different effects on lumbar segmental motion. This study compared outcomes in 34 lumbar instability patients in two exercises at 10 weeks and 12 months follow up. Participants were divided into either Core stabilization (deep) exercise, incorporating abdominal drawing-in maneuver technique (CSE with ADIM), or General strengthening (superficial) exercise (STE). Outcome measures were pain, muscle activation, and lumbar segmental motion. Participants in CSE with ADIM had significantly less pain than those in STE at 10 weeks. They showed significantly more improvement of abdominal muscle activity ratio than participants in STE at 10 weeks and 12 months follow-up. Participants in CSE with ADIM had significantly reduced sagittal translation at L4-L5 and L5-S1 compared with STE at 10 weeks. Participants in CSE with ADIM had significantly reduced sagittal translations at L4-L5 and L5-S1 compared with participants in STE at 10 weeks, whereas STE demonstrated significantly increased sagittal rotation at L4-L5. However, at 12 months follow-up, levels of lumbar sagittal translation were increased in both groups. CSE with ADIM which focuses on increasing deep trunk muscle activity can reduce lumbar segmental translation and should be recommended for lumbar instability.

The Effects of Abdominal Draw-in Maneuver on Hip, Abdominal Muscle Activation Pattern and Trunk, Pelvic Displacement during One Leg Standing

The Effects of Abdominal Draw-in Maneuver on Hip, Abdominal Muscle Activation Pattern and Trunk, Pelvic Displacement during One Leg Standing 의 이용 수, 등재여부, 발행기관, 저자, 초록, 목차, 참고문헌 등 논문에 관한 다양한 정보 및 관련논문 목록과 논문의 분야별 BEST, NEW 논문 목록을 확인 하실 수 있습니다.

INTERRATER AND INTRARATER RELIABILITY OF PRESSURE BIOFEEDBACK UNIT IN MEASUREMENT OF TRANSVERSES ABDOMINIS MUSCLE ACTIVATION IN ASYMPTOMATIC ADULTS

Background –The Transverse abdominis with its direct attachments to lumber vertebrae through thoracolumber fascia contributes as a local stabilizer of spine which have meaningful role for spinal stability. Transverse abdominis(TrA) activation is vital component in rehabilition of patients with Low back pain. The Pressure Biofeedback Unit (PBU) is a device designed to teach and measure Transverses abdominis activation by Abdominal draw-in maneuver which is often used by clinicians. Methods – 60 healthy male and female subjects were selected for study. The abdominal draw-in test was performed with the subject in a prone lying position, and the Pressure Biofeedback Unit (Chattanooga Stabilizer ) was utilized to evaluate the ability of the subject to perform this abdominal isolation test. For intrarater reliability, the examiner carried out the test twice at the interval of 2 days. For interrater reliability, 2 examiners did the test one after the other on the same day. Results – Intraclass Correlation Coefficient (ICC) were calculated to determine interrater and intrarater reliability.ICC value for inter-rater reliability is 0.87 with 95% confidence interval (0.78-0.92). ICC value for intra-rater reliability is 0.86 with 95% confidence interval (0.79 – 0.93). Conclusion - Pressure Biofeedback Unit shows good to excellent inter-rater and intra-rater reliability.

Effects of a Few Minutes of Abdominal Drawing-in Maneuver on Balance Test Results

Background: Menopause is a natural part of women's lives and is associated with a series of complications that can impair their quality of life. This study was conducted to determine the effect of educational interventions based on the Multi-Theory Model (MTM) on the quality of life among menopausal women. Methods: This randomized controlled trial was conducted on 80 menopausal women who met the inclusion criteria and were selected through the multi-stage stratified random sampling method. The participants were randomly allocated to either the control or intervention group (40 subjects per group). The intervention group participated in five 45-min educational sessions based on the MTM on the predetermined days of the week. The quality of life level scores were collected at baseline, immediately, and three months after the intervention using the Menopause-Specific Quality of Life questionnaire (MENQOL). On the other hand, the control group did not receive any intervention during the study period. Results: Analysis of variance of repeated measures showed a significant interaction between time and intervention. Therefore, the independent t-test was used to compare the mean score of quality of life, before, immediately, and three months after the intervention. The results showed a significant difference between the two groups regarding the scores immediately after and three months after the intervention. Conclusion: Structured educational program based on the MTM could be used as a simple and noninvasive intervention that helps menopausal women’s general health through menopausal symptoms relief, thereby improving their quality of life. Further interventions with larger sample sizes may be required to confirm these findings.

The immediate effect of the abdominal drawing-in maneuvertechnique on stature change in seated sedentary workers with chronic low back pain.

Many studies have measured stature change arising from loads imposed on the spine during sitting. To improve stature recovery, it is important to stabilise the lumbar spine and compensate forces from the upper body. The abdominal drawing-in maneuver (ADIM) technique has been found to mainly activate deep trunk muscles. The purpose of this study was to determine whether activation of deep trunk muscles by the ADIM technique could immediately improve stature recovery during prolonged sitting. Twenty-four patients with chronic low back pain (CLBP) were randomly allocated into different orders of experimental conditions: control (sitting without ADIM technique) and intervention conditions (sitting with ADIM technique). The latter condition required participants to complete ADIM technique for 1 min and repeat it three times throughout 41 min prolonged sitting time. Stature recovery was improved by 3.292 mm in the intervention condition compared with control condition (p-value = 0.001). Our finding demonstrated that ADIM technique improved stature recovery. Practitioner Summary: Prolonged sitting seemingly harms sedentary workers' health, particularly affecting the lower back. Activation of deep trunk muscles using abdominal drawing-in maneuver technique can promote spinal recovery. Clinicians can teach abdominal drawing-in maneuver technique to activate deep trunk muscles in chronic low back pain, thereby promoting self-management of seated stature recovery. Abbrevations: ADIM: abdominal drawing-in maneuver; RA: rectus abdominis; ICLT: iliocostalis lumborum pars thoracis; LM: lumbar multifidus; TrA: transversus abdominis; IO: internal oblique; CLBP: chronic low back pain; LBP: low back pain; RMDQ: Roland Morris disability questionnaire; NRS: numerical rating scale.

Reproducibility and Concurrent Validity of Manual Palpation with Rehabilitative Ultrasound Imaging for Assessing Deep Abdominal Muscle Activity: Analysis with Preferential Ratios.

The abdominal drawing-in maneuver (ADIM) is a clinical tool used for identifying preferential activity of deep abdominal muscles. However, concurrent validity and reproducibility of palpation during the ADIM has not been formally investigated. The aims of this study were (1) to assess intra- and interrater reliability of manual palpation during the ADIM, and (2) to determine the concurrent validity of manual palpation during the ADIM by calculating preferential activation ratio cut-off as assessed with ultrasound imaging (RUSI). Thirty-two subjects (n = 16 patients with nonspecific low back pain and 16 comparable healthy individuals) performed the ADIM in a supine hook-lying position. Two experienced assessors evaluated the presence or absence of preferential contraction of the deep abdominal muscles by palpation during the ADIM on 2 different days. Intrarater (test-retest) and interrater reliability of palpation were calculated using Cohen’s kappa coefficients. Muscle thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles at rest and during the ADIM were also measured. TrA-Contraction Ratio (TrA-CR), TrA-Preferential Activation Ratio (TrA-PAR), and Modified-TrA-PR (M-TrA-PAR) were calculated. The concurrent validity of manual palpation was determined using the correlation between manual palpation and imaging and by calculating ROC curve (operating characteristics curve), Youden index, and sensitivity and specificity. Intra- and interrater reliability of manual palpation during the ADIM was excellent (k: 0.82–1.00) and good to excellent (k: 0.71–1.00), respectively. Interrater reliability for muscle thickness ranged from good to excellent (ICC3,1 0.79–0.91). Manual palpation and TrA ratio showed low to moderate correlations (r: 0.36–0.60). When evaluating the diagnostic accuracy of manual palpation, the best predictive model (ROC value: 0.89; p < 0.001) for correct a preferential contraction of TrA was obtained when the M-TrA-PAR was ≥0.08 (sensitivity: 0.95–1.00; specificity: 0.62). Good to excellent intra- and interrater reliability of manual palpation was found during the ADIM in both patients and healthy groups. Manual palpation showed concurrent validity for identifying the preferential activity of the TrA muscle supporting its use in clinical practice.

Effect of real-time ultrasound imaging for biofeedback on trunk muscle contraction in healthy subjects: a preliminary study

BackgroundReal-time ultrasound imaging (RUSI) has been increasingly used as a form of biofeedback when instructing and re-training muscle contraction. However, the effectiveness of the RUSI on a single sustained contraction of the lumbar multifidus (LM) and transversus abdominis (TrA) has rarely been reported. This preliminary study aimed to determine if the use of RUSI, as visual biofeedback, could enhance the ability of activation and continuous contraction of the trunk muscles including LM and TrA.MethodsForty healthy individuals were included and randomly assigned into the experimental group and control group. All subjects performed a preferential activation of the LM and/or TrA (maintained the constraction of LM and/or TrA for 30 s and then relaxed for 2 min), while those in the experimental group also received visual feedback provided by RUSI. The thickness of LM and/or TrA at rest and during contraction (Tc-max, T15s, and T30s) were extracted and recorded. The experiment was repeated three times.ResultsNo significant differences were found in the thickness of LM at rest (P > 0.999), Tc-max (P > 0.999), and T15s (P = 0.414) between the two groups. However, the ability to recruit LM muscle contraction differed between groups at T30s (P = 0.006), with subjects in the experimental group that received visual ultrasound biofeedback maintaining a relative maximum contraction. Besides, no significant differences were found in the TrA muscle thickness at rest (P > 0.999) and Tc-max (P > 0.999) between the two groups. However, significant differences of contraction thickness were found at T15s (P = 0.031) and T30s (P = 0.010) between the two groups during the Abdominal Drawing-in Maneuver (ADIM), with greater TrA muscle contraction thickness in the experimental group.ConclusionsRUSI can be used to provide visual biofeedback, which can promote continuous contraction, and improve the ability to activate the LM and TrA muscles in healthy subjects.

The immediate effect of two lumbar stabilization methods on postural control parameters and their reliability during two balance tasks

ABSTRACT Background: Lumbosacral orthosis (LSO) and/or the isolated contraction of the transversus abdominis muscle by the abdominal drawing-in maneuver (ADIM) can increase lumbar stiffness, consequently influencing postural control. The purpose of this study was to compare the effects of LSO and ADIM on postural control during two balance tasks and determine their reliability. Methods: Twenty participants (50% men) randomly performed three experimental conditions: 1) without lumbar stabilization, 2) with LSO), and 3) with ADIM. Each experimental condition was tested in two postural tasks: semi-tandem and one-legged stance on a force platform for 30 seconds, while the Center of pressure postural (COP) parameters were computed. Results: The two methods of lumbar stabilization were comparable and did not significantly reduce the COP values across time, even though a few individuals presented a change in their COP data above the levels of measurement errors. The reliability of these measurements was generally acceptable and sometimes excellent ( 0.90 and ≤10% error measurement). Conclusions: Both LSO and isolated contraction of the transversus abdominis muscle by ADIM do not change postural control in one-legged stance and in semi-tandem tasks. These results have implications for use or not these methods for postural control on a rehabilitation perspective.

다리 움직임을 동반한 복부 드로우-인 기법이 뇌졸중 환자의 배가로근 두께와 몸통 조절에 미치는 영향

다리 움직임이 몸통 주위 근육에 효과적인 변화를 줄 수 있다는 근거를 바탕으로 다리 움직임을 동반한 복부 드로우-인 방법이 뇌졸중 환자들의 배가로근 두께와 몸통 조절 능력에 변화를 알아보고, 효율적인 복부 드로우-인 기법에 있어서 임상적 기초 자료를 제공하기 위해 시행하였다. 본 연구는 뇌졸중 환자 18명을 표본 추출하여, 기존의 복부 드로우-인 기법을 적용한 집단을 실험군Ⅰ(n=9)로, 다리 움직임을 동반한 복부 드로우-인 기법을 적용한 집단은 실험군Ⅱ(n=9)로 무작위 배치한 후 사전 검사로 초음파를 활용하여 마비측 배가로근의 두께를 측정하였고, 몸통 조절 능력은 몸통 손상 정도 평가지를 이용하여 측정하였다. 총 4주 간, 주 4일, 1일 1회, 30분씩 중재 프로그램을 시행한 후 사후검사를 사전검사와 동일하게 재 측정하여 분석하였다. 그 결과 두 집단 내 배가로근 두께 변화 비교에서는 두 집단 모두 복부 드로우-인 동작 시 유의한 차이가 있었으며(p<0.01), 몸통 조절 능력에서도 두 집단 모두 유의한 차이가 있었다(p<0.001). 그러나 두 집단 간 배가로근 두께와 몸통 조절 능력 변화 비교에서는 몸통 조절 능력에서만 유의한 차이가 있었다(p<0.05). 따라서 집단 간 배가로근의 두께는 차이가 없었지만, 다리의 움직임을 통해 자동 반사적인 골반 움직임이 나타나 복부 주위의 근육들에게도 효율적인 수축 반응이 나타나 더 효과적으로 몸통 조절 능력을 향상시킬 수 있는 중재방법임을 알 수 있었다.

Effect of the Abdominal Draw-In Maneuver and Bracing on Abdominal Muscle Thickness and the Associated Subjective Difficulty in Healthy Individuals.

We evaluated the trunk abdominal muscle thickness while performing different exercises to identify the most effective training and to investigate the subjective difficulty associated with exercising. Twenty-eight men (mean age: 21.6 ± 0.9 years) without orthopedic diseases were enrolled. Ultrasonic imaging was used to measure the thickness of the transversus abdominis (TA), internal oblique, and external oblique muscles while at rest and while performing the abdominal draw-in maneuver and abdominal bracing. Measurements were made in the supine and sitting positions, and the subjective difficulty in performing each exercise was examined using a 5-level evaluation scale. The TA and internal oblique muscle thicknesses were significantly greater during the abdominal draw-in maneuver (ADIM) than during bracing or resting, in the supine and sitting positions. The subjective difficulty of abdominal bracing (AB) was graded significantly higher than that of ADIM. Additionally, a correlation between subjective difficulty and muscle thickness was found for the TA and IO. Our results may contribute to the choice of more effective exercises for spinal stability.

An Evaluation of an Innovative Exercise to Relieve Chronic Low Back Pain in Sedentary Workers.

The purpose of the study was to examine the effectiveness of a novel supported dynamic lumbar extension with the abdominal drawing-in maneuver (ADIM) technique on stature change, deep abdominal muscle activity, trunk muscle fatigue, and pain intensity during prolonged sitting in chronic low back pain (CLBP) participants. Prolonged sitting can cause trunk muscle fatigue from continuous contraction of deep trunk muscles in seated postures. Deficiency of activity of deep muscles can reduce muscular support of the spine, causing stress on spinal structures, which could result in pain. Thirty participants with CLBP were randomly allocated: (a) control-sitting without exercise, and (b) intervention-supported dynamic lumbar extension with the ADIM technique. Compared to the intervention condition, the control condition demonstrated significantly greater deterioration in stature change, increased levels of deep trunk muscle fatigue, and an increase in pain during prolonged sitting. The supported dynamic lumbar extension with the ADIM technique appears to provide a protective effect on detrimental stature change and deep trunk muscle fatigue. In addition, it prevented an increase in pain intensity during prolonged sitting in people with CLBP. Sedentary behavior harms health, particularly affecting the lower back. Clinicians can use the intervention to induce dynamic lumbar movement, and this exercise can maintain deep trunk muscle activity during prolonged sitting, thereby helping to prevent low back pain (LBP) problems.

The immediate effect of the abdominal drawing-in maneuver technique on stature change in seated sedentary workers with chronic low back pain

Many studies have measured stature change arising from loads imposed on the spine during sitting. To improve stature recovery, it is important to stabilise the lumbar spine and compensate forces from the upper body. The abdominal drawing-in maneuver (ADIM) technique has been found to mainly activate deep trunk muscles. The purpose of this study was to determine whether activation of deep trunk muscles by the ADIM technique could immediately improve stature recovery during prolonged sitting. Twenty-four patients with chronic low back pain (CLBP) were randomly allocated into different orders of experimental conditions: control (sitting without ADIM technique) and intervention conditions (sitting with ADIM technique). The latter condition required participants to complete ADIM technique for 1 min and repeat it three times throughout 41 min prolonged sitting time. Stature recovery was improved by 3.292 mm in the intervention condition compared with control condition (p-value = 0.001). Our finding demonstrated that ADIM technique improved stature recovery. Practitioner Summary: Prolonged sitting seemingly harms sedentary workers’ health, particularly affecting the lower back. Activation of deep trunk muscles using abdominal drawing-in maneuver technique can promote spinal recovery. Clinicians can teach abdominal drawing-in maneuver technique to activate deep trunk muscles in chronic low back pain, thereby promoting self-management of seated stature recovery. Abbrevations: ADIM: abdominal drawing-in maneuver; RA: rectus abdominis; ICLT: iliocostalis lumborum pars thoracis; LM: lumbar multifidus; TrA: transversus abdominis; IO: internal oblique; CLBP: chronic low back pain; LBP: low back pain; RMDQ: Roland Morris disability questionnaire; NRS: numerical rating scale.

Effectiveness of Abdominal Drawing in Maneuver with Lumbar Pelvic Exercises on Swiss Ball for Spinal Flexibility Among Patients with Low Back Pain

Background: Patients with nonspecific low back pain have difficulty in their activities of daily living. Spinal flexibility problems are neglected in the patients with low back pain. These problems hampers the activities of daily living. Hence this study will help in improving their flexibility and perform ADL easily. Numerous studies have been done on spinal muscle strengthening, muscle activation to improve muscle endurance and posture in patients with low back pain but less attention has been given to spinal flexibility, which will help them to perform their ADL with ease. Low back pain is a big burden, as it causes more global disability and it is increasing among young individuals. There is paucity of studies as far as abdominal exercises in improving spinal flexibility is concerned. Aim: To find the effect of abdominal drawing in maneuver and lumbar pelvic exercises on swiss ball among patients with non-specific low back pain. Methodology: There were 35 participants in the study. The type of study is experimental. The participants involved were assessed for strength, pain and functional mobility. The participants are treated for pain, strength and functional mobility. Result: There is improvement seen in participants. The results of the participants are calculated by mean and standard deviation. The post mean value of lumbar flexion was 5.926 which was more than pre mean value of lumbar flexion that is 5.558. The post mean value of lumbar extension was 1.378 which was more than pre mean value of lumbar extension that is 1.243. The post mean value of right lumbar lateral flexion was 5.565 which was more than pre mean value of right lumbar lateral flexion that is 5.121. The post mean value of left lumbar lateral flexion was 5.578 which was more than pre mean value of left lumbar lateral flexion that is 5.578. Conclusion: : Abdominal drawing in maneuver and lumbar pelvic exercises on swiss ball are effective in improving spinal flexibility among patients with non-specific low back pain.

Clinical utility of a cluster of tests as a diagnostic support tool for clinical lumbar instability

BackgroundNumerous clinical tests have been proposed for the diagnosis of clinical lumbar instability (CLI), but a cluster of clinical tests is still needed to increase the accuracy of CLI diagnosis. ObjectiveTo evaluate a diagnostic support tool intended to identify the presence of CLI using a cluster of clinical tests. DesignAnalytical cross-sectional study. MethodsTwo hundred participants with chronic low back pain (LBP) were diagnosed with or without CLI by an orthopedic surgeon. The orthopedic surgeon made the diagnosis from classic clinical symptoms and signs. The diagnosis was used as the reference standard. An orthopedic physical therapist used four clinical tests to identify CLI in each participant, including the apprehension sign, the instability catch sign with/without the abdominal drawing-in maneuver (ADIM), the painful catch sign with/without the ADIM, and the prone instability test. ResultsFor an individual test, the apprehension sign showed a high specificity (92.6%) and a positive likelihood ratio (LR+; 2.4) but a very low sensitivity of 17.4%. A cluster of three of the four examined tests provided the most diagnostic accuracy for CLI, with a high LR+ (5.8) and a high specificity (91.7%) but low sensitivity (47.8%) and a negative likelihood ratio (LR-; 0.6). ConclusionsA cluster of three of the four examined tests was determined to comprise a powerful clinical support tool for the identification of CLI patients as tested against a reference standard diagnosis. Clinical trial registrationName of the registry: Thai Clinical Trials Registry. Registration number: TCTR20190426002.

Effect of Abdominal Drawing-In Maneuver on the Low Back Pain Oswestry Disability Index and Balance Ability in Industrial Workers with Chronic Back Pain

Purpose: The aim of this study was to compare the effect of low back pain disability and balance after applying the abdominal drawing-in maneuver to the industrial workers with chronic back pain . Methods: Sixteen healthy industrial workers(42.68±4.15) with chronic back pain a participated in the study. Subjects were divided into two groups. Control group(n = 8) applied lumbar flexibility exercise. Abdominal drawing-in maneuver group(n = 8) applied lumbar stabilization exercise using abdominal drawing-in maneuver three times a week during 6weeks. All tests were completed pre and post the intervention. The low back pain disability was measured using Korean Oswestry Disability Index(KODI). The balance ability was measured by computerized balance measurement equipment. Results: There were significant improvements in the KODI and balance ability test of those who applied the abdominal drawing-in maneuver group(p .05). In addition, the abdominal drawing-in maneuver group had a statistically significant difference in KODI and balance ability compared to the control group(p<.05). Conclusion: The above results revealed that abdominal drawing-in maneuver is effective in improvement of the KODI and balance ability in industrial workers with chronic back pain.

Cognitive Behavioral Therapy With Stabilization Exercises Affects Transverse Abdominis Muscle Thickness in Patients With Chronic Low Back Pain: A Double-Blinded Randomized Trial Study

ObjectiveNonspecific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms, such as fear-avoidance behaviors. This study aimed to evaluate the effect of cognitive behavioral therapy (CBT) associated with stabilization exercise (SE) on thickness of transverse abdominis (TrA) muscle in patients with NCLBP. MethodsForty patients with NCLBP were randomly assigned into experimental CBT associated with SE (n = 20) and control groups without SE (n = 20). Transverse abdominis muscle thickness was assessed during abdominal drawing in maneuver (ADIM) and active straight leg raise (ASLR) of the right lower limb using ultrasound imaging. Fear-avoidance belief and disability were evaluated using a fear-avoidance belief questionnaire (FABQ) and a Roland-Morris disability questionnaire (RMDQ) before and after intervention. ResultsMixed-model analysis of variance indicated that the effect of time was significant for the right and left TrA contraction thickness during ADIM and left TrA contraction thickness during ASLR (P < .05). However, the experimental group exhibited higher right and left TrA muscle thickness compared with the control group during ADIM (P = .001). Moreover, there were no significant differences between groups in the thickness of TrA muscle during ASLR (P > .05). The effect of time was significant for FABQ (P = .02) and RMDQ (P = .01); however, the effect of group was significant for the FABQ after intervention (P = .04). ConclusionsStabilization exercise associated with CBT is more effective than SE alone in improving fear avoidance belief and in increasing the thickness of the TrA muscle during ADIM task.