Abdominal Drawing-in Maneuver Research Articles

Comparison of Serratus Anterior and Abdominal Muscle Activity During Push-up Plus Exercise With Hip Adduction and the Abdominal Drawing-in Maneuver

Comparison of Serratus Anterior and Abdominal Muscle Activity During Push-up Plus Exercise With Hip Adduction and the Abdominal Drawing-in Maneuver

The Impact of Abdominal Drawing-in Maneuver and Tensor Fasciae Lataeiliotibial Band Self-stretching on Lumbopelvic Kinematics in Individuals With Lumbar Extension Rotation Syndrome

The Impact of Abdominal Drawing-in Maneuver and Tensor Fasciae Lataeiliotibial Band Self-stretching on Lumbopelvic Kinematics in Individuals With Lumbar Extension Rotation Syndrome

Sustained effects of balance stabilization by the prone abdominal drawing-in maneuver

Sustained effects of balance stabilization by the prone abdominal drawing-in maneuver

Ultrasound Biofeedback Increases Abdominal Muscle Activation in Golfers With a History of Low Back Pain.

To compare activation ratios of the transverse abdominis (TrA) during an abdominal draw-in maneuver (ADIM) and abdominal obliques during a golf swing, with and without ultrasound biofeedback, and to determine intrarater reliability of these ultrasound thickness measures. Single-session crossover study. Laboratory. Sixteen adult golfers with 2 or more episodes of low back pain (LBP) in the past year. Verbal cueing alone and verbal cueing with ultrasound biofeedback. Bilateral TrA activation ratios were calculated during an ADIM with and without ultrasound biofeedback. Activation ratios of the abdominal obliques were calculated bilaterally during golf swings with and without ultrasound biofeedback. Intraclass correlation coefficients (ICCs) were calculated for average thickness across all muscles and conditions for the nonbiofeedback trials. Transverse abdominis activation ratios were significantly higher when ultrasound biofeedback was provided bilaterally (P < 0.001). Abdominal oblique activation ratios during the golf swing were also significantly higher with ultrasound biofeedback for the lead (P = 0.014) and trail (P < 0.001) sides. Intraclass correlation coefficient values ranged from 0.92 to 0.97 (P < 0.001). Ultrasound biofeedback can increase activation ratios of the TrA during a supine ADIM in adult golfers with a history of LBP. Postswing ultrasound biofeedback increases activation of the abdominal obliques during a golf swing in golfers with a history of LBP. Ultrasound thickness measures of the TrA and obliques have excellent intrarater reliability.

Efficacy of lumbar motor control training in treatment of patients with cervicogenic headache

BackgroundCervicogenic headache (CGH), is a secondary headache arising from cervical disorders. Training core muscles have a corrective effect on the whole spine. Moreover, increased deep neck flexors (DNFs) activation is closely linked with balanced core stabilization of the global cervical-thoracic-lumbopelvic chains. This study aimed to investigate the effect of lumbar motor control training combined with cervical stabilization exercises compared to cervical stabilization exercises alone in CGH patients.MethodsFifty-two subjects of both genders with CGH and chronic mechanical neck pain (CMNP) participated in this study. They were recruited from the outpatient Physical Therapy Clinic at Mubarak Central Hospital, Giza, Egypt; their mean age was 28.1 ± 5.8 years and their BMI was 22.8 ± 1.6 kg/m2. They received treatment for three sessions per week for 4 weeks. Subjects were assigned randomly into two equal groups; the control group: received cervical stabilization exercises (axial elongation, cranio-cervical flexion, cervical extension, rowing, and Y-exercise). Study group: received cervical stabilization exercise in addition to lumbar motor control training (abdominal draw-in maneuver, side plank, and quadruped position), each exercise had a 4-week progression. Headache frequency, duration, intensity by visual analog scale (VAS), and neck functional disability by Neck Disability Index (NDI) were measured before the first session and after the last session of the 4 weeks of treatment.ResultsThere was a high statistically significant difference in post-treatment mean values of headache frequency, headache duration, headache intensity, and neck functional disability between the two groups in favor of the study group.ConclusionAdding lumbar motor control training to cervical stabilization exercise is more effective than cervical stabilization alone in decreasing headache frequency, duration, intensity, and neck functional disability in CGH patients with CMNP.Trial registrationNCT05952115. Registered 11 July 2023-retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4.

We should not keep drawing-in the abdominal wall during the core training

Objective: The goal of this article is to compile relevant literature that proposes that perhaps the abdominal drawing-in maneuver (ADIM), also known as the “abdominal hollowing maneuver” (AHM), should not be applied as a general rule during the core training. Methods and Materials: Based on current evidence, this paper evaluates whether general use of this ADIM is beneficial for the core training. In this regard, we have searched for related scientific evidence in PubMed and Google Scholar. The keywords used were: abdominal hollowing maneuver, abdominal drawing-in maneuver, lumbo-pelvic stability, core stability. Results: The literature shows us that the application of ADIM during core strengthening exercises does not meet the requirements for isolated TrA-specific retraining, can increase Inter-Rectus Distance, may be incompatible with postural stability goals, and could interfere the Rectus Abdominis input impairing the lumbo-pelvic stability during high-load exercises. Conclusion: It can be concluded that if the goal is to train core stability and strength with high-load scenarios we should not use the ADIM.

Task-Oriented Training with Abdominal Drawing-in Maneuver in Sitting Position for Trunk Control, Balance, and Activities of Daily Living in Patients with Stroke: A Pilot Randomized Controlled Trial

In many patients with stroke, trunk stabilization and balance are decreased. Trunk stabilization and balance are important to perform posture control and functional movement. This study investigates the effects of task-orientated training with the abdominal drawing-in maneuver in a sitting position on trunk control, balance, and activities of daily living in patients with chronic stroke. The study design is a randomized controlled trial. Thirty-eight patients with chronic stroke participated in this study. The task-oriented training combined with the abdominal drawing-in maneuver group (n = 13), the task-oriented training group (n = 13), and the control group (n = 12) received traditional physical therapy. Three groups participated in a total of 20 sessions, four times a week for five weeks. After the five-week training period, trunk control, balance, and activities of daily living were assessed. The task-oriented training combined with the abdominal drawing-in maneuver group demonstrated significant improvements in trunk control, balance, and activities of daily living compared to the task-oriented training and control groups (p &lt; 0.05). These results have implications for improving trunk control, balance, and activities of daily living for patients with stroke, and support the integration of this training method into standard clinical practice.

Effect of verbal instructions on trunk muscle activity during volitional preemptive abdominal contraction

ObjectiveThis study investigated the effect of Verbal Instruction (VI) strategies on trunk muscle contraction among healthy subjects. The effect of three VI Abdominal Drawing-In Maneuver (ADIM) and two VI Abdominal Bracing Maneuver (ABM) strategies on left Internal (LIO) and External Oblique (LEO) and bilateral superficial Multifidi (sMf) activation was examined. DesignWithin-subjects, repeated measure design. MethodsSurface EMG (sEMG) measured LIO, LEO, and sMf activity in 28 subjects (mean age 23.5 ± 5.5 years). Testing included five supine hook-lying and five quiet standing conditions. ResultsOne-way ANOVAs demonstrated no significant main effect for ADIM or ABM in supine or standing (p > .05). Muscle activation amplitudes during VPAC conditions demonstrated higher mean values for standing versus supine (p < .05) except for two conditions involving LEO. Friedman Tests for dominant strategy demonstrated a significant main effect for ADIM-VI and ABM-VI strategies. Post-hoc testing generally showed the dominant strategy to be significantly higher versus others. ConclusionNo single preferred VI cue for ADIM or ABM was observed. Each subject's dominant strategy dictated the most suitable VI. Standing was preferred for LIO and sMf activation, whereas position did not change LEO activation. Non-significant correlations between all muscle pairings during all ADIM and ABM strategies were observed. These findings may suggest the need for healthcare providers who understand the intricacies of trunk stability to teach and monitor VPAC with either ADIM or ABM options.

Diaphragmatic breathing combined with abdominal drawing-in maneuver for walking function in post-stroke patients: a randomized controlled study protocol

BackgroundPatients with stroke frequently experience walking dysfunction. Core training can help improve balance and walking function in patients with stroke. However, core training movements in clinical practice are numerous and differently targeted. Therefore, this study will investigate the improvement of walking function in patients with combined diaphragmatic breathing maneuver (DBM) and draw-in breathing technique (ADIM) training.MethodsThis single-blind, randomized controlled preliminary will analyze the viability of DBM combined ADIM training versus routine rehabilitation therapy in patients with stroke with early to mid-stroke. Patients will be randomly assigned to either the DBM and ADIM training or the routine rehabilitation training. We will recruit 42 stroke inpatients from the Second Rehabilitation Hospital of Shanghai who meet the trial criteria and measure the balance and walking functions and improvement of that after 4 weeks of intervention. The primary outcome is the 10 m maximum walking test (10MWT). The secondary outcomes indices include the limits of stability test (LOS), Berg balance scale test (BBS), Functional Ambulation Categories test (FAC), Timed Up and Go test (TUG), trunk impairment scale test (TIS), ultrasound indicators of the diaphragm and transversus abdominis (UI), rhythmic weight shift test (RWS), walk across test (WA), Fugl-Meyer assessment of lower extremity (FMA-LE), and Barthel index of ADL test.DiscussionThe primary objective of this project was to investigate the effects of DBM combined with ADIM on balance capacity and walking function for patients with early to mid-stroke. The outcomes of this study will hold significant implications for future clinical applications in rehabilitation.Trial registrationChinese Clinical Trial Registry (ChiCTR), ID: ChiCTR2100054897. Registered on 28 December 2021.

Comparison of Muscle Activity and Muscle Thickness According to Knee Flexion Angle during Supine Bridge Exercises using the Abdominal Drawing-in Maneuver on an Unstable Surface.

This study evaluated changes in deep trunk muscle thickness and lower extremity muscle activities during bridge exercises with the abdominal drawing-in maneuver. Bridge exercises were conducted on an unstable surface at different knee flexion angles (60º, 90º and 120º), with the aim of identifying more effective angles for bridge exercises. This study included 21 healthy adults, aged 20-27 years. Biceps femoris (BF), rectus abdominis, and rectus femoris activity was measured using surface electromyography. The thicknesses of the transverse abdominis (TrA), external oblique (EO) and internal oblique (IO) muscles were measured. BF (p = 0.000, partial η2 = 0.670) activity increased considerably as the knee flexion angle decreased. TrA (p = 0.000, partial η2 = 0.883) and IO (p = 0.000, partial η2 = 0.892) thickness significantly increased, while EO (p = 0.000, partial η2 = 0.893) thickness decreased as the knee flexion angle decreased. When performing bridge exercises using the abdominal drawing-in maneuver on an unstable surface, the knee flexion angles should be at 120º and 60º to increase trunk stability and lower extremity muscle activity, respectively.

Comparison of Muscle Activity and Muscle Thickness According to Knee Flexion Angle during Supine Bridge Exercises using the Abdominal Drawing-in Maneuver on an Unstable Surface

Comparison of Muscle Activity and Muscle Thickness According to Knee Flexion Angle during Supine Bridge Exercises using the Abdominal Drawing-in Maneuver on an Unstable Surface

Lateral abdominal muscle thickness and contractile function in women with and without stress urinary incontinence.

Stress urinary incontinence (SUI) primarily results from the weakness of pelvic floor muscles, working synergistically with the abdominal muscles. The current study aimed to compare thickness and contractile function of lateral abdominal muscles in women with and without SUI. Thirty-nine women with SUI (SUI group; age: 38.87±8.96 years, body mass index (BMI): 24.03 (5.94) kg/m2) and 42 healthy women (control group; age: 36.21±11.46 years, BMI: 23.90 (5.85) kg/m2) were included. Transverse abdominis (TrA) and internal oblique (IO) muscle thickness at rest and during abdominal drawing-in maneuver (ADIM) were measured with ultrasound imaging in B-mode using a Logiq S7/Expert device and a 9-11 MHz linear transducer. Percentage change in thickness and contractile function of these muscles were also calculated. No significant differences in the thickness of TrA and IO muscles at rest and during ADIM between the groups were found (p>0.05). The percent change in thickness and contractile function of both right and left side TrA muscles and the right side IO muscle were lower in SUI group than control group (p<0.05). The percentage change in thickness and the contractile function of the left side IO muscle did not change (p>0.05). Women with SUI had a smaller percentage change in thickness and contractile function of TrA and IO muscle than women without SUI. However, there was no difference in the morphological features of these muscles between the groups. Considering the lateral abdominal muscle, training may be important for management of SUI.

Measuring transversus abdominis activity using pressure biofeedback unit-A technical report.

Pressure biofeedback is a tool that can detect the movement of a structure and may be used as an indicator of muscle function. It's widely used to measure the transversus abdominis (TrA) muscle activity. Pressure biofeedback (PBU) monitors the abdominal wall movement by measuring the pressure change during abdominal hollowing and can indirectly evaluate the TrA muscle function, which is considered as a valuable tool. The evaluation of the training of core muscles, including the transversus abdominis, requires a reliable outcome. Various methods using different positions are used to evaluate the transversus abdominis muscle function. However, it is noted that a standard way of evaluation and training still needs to be improved in research and clinical practice. This technical report discusses the optimal position and technique to measure the TrA muscle activity using PBU, with discussions on the merits and demerits of the body positions. The technical report is presented with a literature review of the PBU measurement of TrA and through observation in the clinical practice. The evaluation methods of TrA, including the position to activate and isolate, are discussed in detail. Training core muscles does not imply TrA activation, and evaluating isolated TrA and multifidus is essential before intervention. The abdominal drawing-in maneuver effectively activates TrA in various evaluation positions of the body, but when using PBUs, it would be valid in a prone position. Different body positions are practiced to train TrA and core muscles using PBU, commonly adopted by practice are in supine. It's noted that most of the studies lack in establishing the effectiveness of the position in evaluating the TrA muscle activity using PBU. The need for insight into an appropriate technique for evaluating TrA activity is addressed in this technical report. This report presents key points on the complete technique and concludes that the prone position is superior to other positions and recommended for measuring and recording the TrA activity using a PBU.

Reliability of transversus abdominis and internal oblique muscle thickness measurement using B-mode ultrasound imaging in standing and single leg standing positions

Background: The thickness of the transversus abdominis (TrA) and internal oblique (IO) muscles are measured with high reliability by musculoskeletal ultrasound imaging (MSUSI) in the supine hook-lying and walking position. However, the reliability of the procedure to measure the TrA and IO muscle thickness measurement in the functional positions such as standing and single leg standing positions have not been well established. Objectives: To examine the reliability of MSUSI for the TrA and IO muscles thickness measurement during standing and single leg standing positions in healthy participants. Materials and methods: Ten healthy participants (aged 24.10±2.47 years) were recruited to perform MSUSI measurement of TrA and IO muscle thickness during the resting and abdominal drawing in maneuver (ADIM) in the standing and single leg standing positions. The intra-tester reliability of MSUSI measurement was performed by the same investigator in 2 different times (24 to 72 hours apart), while the inter-tester reliability was performed by 2 investigators within the same day. The intraclass correlation coefficient (ICC) whereby ICC3,3 was used to determine the intra-tester and ICC 2,3 was used to determine the inter-tester reliability of TrA and IO muscles thickness measurement using MSUSI. The standard error of measurement (SEM) and coefficient of variation (CV) were calculated. Results: The MSUSI measurements for TrA and IO muscles thickness showed high reliability in both standing and single leg standing positions (ICC3,3 and ICC2,3 &gt;0.9). Moreover, the values of SEM ranged between 0.055 to 0.662 mm, MDC ranged between 0.152 to 1.834 mm and CV ranged between 0.543 to 14.001%. Conclusion: The MSUSI measurement of TrA and IO muscles thickness could be performed with high intra and inter-tester reliability in standing and single leg standing positions among healthy individuals. The study findings on the MSUSI procedure to measure muscle thickness of TrA and IO would be useful for practice guidance in various research and clinical settings.

The effects of Pilates training on abdominal muscle thickness and core endurance in patients with Parkinson's disease: a single-blind controlled clinical study.

This study aims at examining the effects of Pilates training on the transversus abdominis (TrA) and internal obliques (IO) muscle thickness and core endurance in different positions in patients with Parkinson's Disease. Patients were divided into 2 groups as Pilates training (n = 13) and control (n = 10) groups. Pilates training was performed twice a week for 6 weeks. The participants' muscle thickness and core endurance were measured at the beginning of the study (pretraining), and the effectiveness of Pilates training was then assessed in the 6th week (posttraining) and in the 12th-week follow-up. The thickness of the TrA and IO muscles was measured with a two-dimensional ultrasonography device. Core endurance was assessed with prone bridge and sit-ups tests. The assessments of the Pilates training group after the 6-week showed a statistically significant increase in the prone bridge and sit-ups test performances, and an increase in the thickness of the IO muscle [during resting in the supine position and abdominal drawing-in maneuver (ADIM) in standing position] and the TrA muscle (during ADIM in the standing position) (p < 0.05). Pilates exercises were also shown to have improved core muscle endurance and thickness (IO thickness during ADIM in the standing position and TrA thickness during resting in the supine position, ADIM in the supine and standing position) in the Pilates training group after a period of 18 weeks (p < 0.05). Pilates training has a favorable effect on the core endurance, and the TrA and IO muscle thickness of patients with Parkinson's disease and this effect can be maintained until three months after the training.

The Relationship between Transversus Abdominis and Internal Oblique Thickness and Disease-Related Characteristics in Parkinson's Disease

Background and Aim: The core muscles are essential for spinal stability during functional activities. Trunk muscle function is affected by specific neurodegenerative processes of Parkinson's disease (PD). This study aimed to investigate whether changes in transversus abdominis (TrA) and internal oblique (IO) thickness during the abdominal drawing-in maneuver (ADIM) were associated with clinical manifestations, core endurance, and functional mobility in patients with PD. Materials and Methods: We included patients with a modified Hoehn and Yahr staging of 3 or lower. TrA and IO muscle thickness were measured using ultrasound both at rest and during ADIM, and the percent change (%) was calculated to assess TrA and IO activation. Patients performed core endurance (prone bridge and sit-ups) and functional mobility tests (timed “up and go” [TUG] and five times sit-to-stand [FTSTS]). All assessments were conducted during the “on” phase. Results: Five female and 17 male patients were included in this study. We found a statistically significant correlation between ultrasound parameters of IO and the clinical manifestations of PD (P &lt; 0.05). Correlations were observed between TrA percent change and prone bridge, sit-ups, TUG, and FTSTS (P &lt; 0.05). Conclusion: To the best of our knowledge, this is the first ultrasound imaging-based study to demonstrate the relationship between TrA and IO muscle thickness and clinical outcomes, and functional performance in patients with PD. Percentage changes in IO were associated with the clinical manifestations of PD. Increased activation of TrA during ADIM was associated with improved core endurance and mobility. The results suggest that a trunk-specific exercise program may be the cornerstone in the treatment of PD-related changes.

Feedback Type on Abdominal Drawing-In Maneuver Performance: Further Motor Control and Motor Learning Considerations

<h3>Research Objectives</h3> To compare effects of verbal, tactile-verbal and visual feedback on muscle activation of the trunk stabilizers relative to trunk-extremity movers during Abdominal Drawing-In Maneuver (ADIM). <h3>Design</h3> The study employed a quasi-experimental pre-post intervention design. <h3>Setting</h3> The study was conducted at School of Health Professions, SUNY Health Sciences University. <h3>Participants</h3> A convenience sample of 54 healthy participants between18-49 years of age were equally divided among three feedback groups: Verbal, Tactile-Verbal and Visual. <h3>Interventions</h3> All participants were instructed similarly to perform the ADIM prior to receiving intervention 2x/week over a four-week period. The feedback provided during interventions was delivered concurrently but feedback types differed amongst the groups. Verbal group received intermittent feedback based upon observance of substitution patterns. Tactile-verbal group received feedback every trial upon palpation of Transverse Abdominis. Lastly, Visual group received feedback every trial using a pressure biofeedback unit. <h3>Main Outcome Measures</h3> The percentage of maximum voluntary isometric contraction of rectus abdominis (RA), multifidus (MF), erector spinae (ES), and hamstrings (HS) as outcome measures were acquired using surface electromyography. A two-way factorial ANOVA with bootstrapping allowed comparison of pre-post difference scores across the interaction of feedback and muscle groups. <h3>Results</h3> HS activation decreased in the tactile-verbal group, relative to an increase in subjects given visual feedback. Furthermore, in the verbal group, HS activity increased relative to a decline in RA; and in the visual group, HS activity increased relative to a decrease in MF. However, no pre-post changes were seen across muscles with tactile-verbal feedback. <h3>Conclusions</h3> Although tactile-verbal feedback did not increase MF recruitment, it recruited less HS activity than verbal and especially visual feedback. Increases in HS recruitment may reflect boredom of simple task or feedback dependency. <h3>Author(s) Disclosures</h3> The authors have no disclosures.

Effects of Both Abdominal Drawing-In Maneuver and Co-Contraction of Hip Adductor Muscle while Bridge Exercise on Abdominal Muscle

Gyeong-Hui ParkㆍJin-Hwa LeeㆍYou-Mi JungㆍDongyeop Lee, PT, PhDㆍJi-Heon Hong, PT, PhDㆍJae-Ho Yu, PT, PhDㆍJin-Seop Kim, PT, PhDㆍSeong-Gil Kim, PT, PhD. KSPM 2022;17:15-25. https://doi.org/10.13066/kspm.2022.17.4.15

Application of Feedback Type on Performance of Abdominal Drawing-In Maneuver in Healthy Adults: A Quasi-Experimental Study of Motor Control and Motor Learning

ObjectiveThe aim of this study was to compare the effects of verbal, tactile-verbal, and visual feedback on muscle activation of the lumbar stabilizers relative to extremity movers during an abdominal drawing-in maneuver when feedback is withheld. MethodsThis quasi-experimental study equally divided 54 healthy adults into 3 feedback groups (verbal, tactile-verbal, and visual) who trained twice per week over a 4-week period to perform supine abdominal drawing-in maneuvers. The percentage of maximum voluntary isometric contraction of rectus abdominis, multifidus (MF), erector spinae, and hamstrings (HS) as an outcome measure was acquired using surface electromyography. A 2-way factorial analysis of variance with bootstrapping allowed for comparison of post-pre difference scores across the interaction of feedback and muscle groups. ResultsHamstring activation decreased in those receiving tactile-verbal feedback relative to an increase in participants given visual feedback. Furthermore, when using verbal feedback, HS activity increased relative to a decline in rectus abdominis, and when presenting visual feedback, HS activity increased relative to a decrease in MF. However, no post-pre changes were seen across muscles with tactile-verbal feedback. ConclusionAlthough tactile-verbal feedback did not increase MF recruitment, it produced less HS activity than visual feedback. Undesirable HS recruitment may reflect boredom or feedback dependency.

The Effect of an Abdominal Drawing-In Maneuver Combined with Low·High Frequency Neuromuscular Electrical Stimulation on Trunk Muscle Activity, Muscle Fatigue, and Balance in Stroke Patients

The Effect of an Abdominal Drawing-In Maneuver Combined with Low·High Frequency Neuromuscular Electrical Stimulation on Trunk Muscle Activity, Muscle Fatigue, and Balance in Stroke Patients