Abdominal Muscles In Patients Research Articles

A preliminary study on degenerate characteristics of lumbar and abdominal muscles in middle-aged and elderly people with varying bone mass

BackgroundWith the wide application of QCT in the clinical assessment of osteoporosis and sarcopenia, the characteristics of musculoskeletal degeneration in middle-aged and elderly people need to be further revealed. We aimed to investigate the degenerate characteristics of lumbar and abdominal muscles in middle-aged and elderly people with varying bone mass.MethodsA total of 430 patients aged 40–88 years were divided into normal, osteopenia, and osteoporosis groups according to quantitative computed tomography (QCT) criteria. The skeletal muscular mass indexes (SMIs) of five muscles [abdominal wall muscles (AWM), rectus abdominis (RA), psoas major muscle (PMM), posterior vertebral muscles (PVM), and paravertebral muscles (PM)] included in lumbar and abdominal muscles were measured by QCT. Differences in SMIs among three groups, as well as the correlation between SMIs and volumetric bone mineral density (vBMD) were analyzed. The areas under the curves (AUCs) for SMIs for prediction of low bone mass and osteoporosis were calculated.ResultsIn male group, SMIs of RA and PM in osteopenia group were significantly lower than those in the normal group (P = 0.001 and 0.023, respectively). In female group, only SMI of RA in osteopenia group was significantly lower than that in the normal group (P = 0.007). SMI of RA was positively correlated with vBMD with the highest coefficients in male and female groups (r = 0.309 and 0.444, respectively). SMIs of AWM and RA had higher AUCs varying from 0.613 to 0.737 for prediction of low bone mass and osteoporosis in both genders.ConclusionsThe changes of SMIs of the lumbar and abdominal muscles in patients with varying bone mass are asynchronous. SMI of RA is expected to be a promising imaging marker for predicting abnormal bone mass.Trial registrationChiCTR1900024511 (Registered 13–07-2019).

Ultrasonography of abdominal muscles: Differential diagnosis of late-onset Pompe disease and myotonic dystrophy type 1.

IntroductionAxial muscles are involved earlier and to a greater extent in late-onset Pompe disease (LOPD) than in myotonic muscular dystrophy type 1 (DM1). We aimed to evaluate abdominal muscles in LOPD compared in DM1 using muscle ultrasonography.MethodsPatients with LOPD (n = 3), DM1 (n = 10), and age- and gender-matched healthy subjects (n = 34) were enrolled for muscle ultrasonography. Patients with LOPD and DM1 were 20 to 59 years of age with a disease duration ranging between 7 and 30 years. A multifrequency linear transducer was used to evaluate quality and thickness in the abdominal muscles and extremities.ResultsThe quantitative muscle echo score revealed a higher Z score in abdominal muscles in Patients with LOPD (scores were relatively normal for the biceps and flexor digitorum groups). Patients with LOPD had significantly lower abdominal muscle thickness than patients with DM1. Abdominal muscle strength was significantly correlated with the muscle echogenicity, trunk impairment scale, and trunk control test. The extremities' sum score was correlated with the total Medical Research Council score.DiscussionThe increased quantitative muscle score in abdominal muscles, sparing the biceps and flexor digitorum groups, may offer differential diagnosis between LOPD and DM1. Ultrasound can easily access abdominal muscles and investigate muscle echogenicity and thickness. A quantitative approach using muscle echogenicity rather than muscle thickness may provide a greater correlation with trunk muscle function.

RESULTS OF FUNCTIONAL PERFORMANCE OF ABDOMINAL PRESS MUSCLES IN PATIENTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY IN LONG-TERM PERIOD

The Aim is to determine the level of functional ability of abdominal muscles in patients of different ages after LCH in the long-term rehabilitation period.
 Materials and methods. Lovett's manual muscle testing (MMT) was performed on 113 patients after laparoscopic cholecystectomy (LCH), who were undergoing rehabilitation at the Morshyn kurort resort complex in 2020 and 2021. The average age of patients was 52,96±0,62 years. Patients were divided into 3 groups according to three age categories: group A - women aged 18 to 44 years (n = 14); group B - aged 45 to 59 years (n = 79); group C aged from 60 to 74 years (n = 20). Inclusion criteria: patients after LCH from 1 month to 1 year after surgery. Exclusion criteria: patients who have contraindications to testing: early postoperative period; pregnancy; severe circulatory failure, the presence of patients with neuropsychiatric pathology; peptic ulcer of the stomach and, or duodenum with bleeding, patients' refusal to participate in the study.
 Methods. Evaluators were blinded during testing. Methods of synthesis, analysis and mathematical statistics. Indicators under study: functional ability of torso flexion and rotation muscles.
 In order to assess the effect of LCH on the functional ability of the abdominal muscles, MMT was performed according to the Lovett method.
 The results of the study. The results of the assessment of the functional ability of the abdominal muscles of patients after LCH in the long term indicate a decrease in the strength of the abdominal muscles in patients of three groups. Analyzing the results, it was found that the functional ability to bend the torso was the best in the youngest group A 2.86 ± 0.20 points. Slightly lower level of torso flexion was in group B 2.44 ± 0.07 points and the worst in the oldest group C - 2.20 ± 0.11 points. A statistically significant difference was found between the three groups in this indicator. In all three groups, the level of functional flexion of the abdominal muscles of patients after LCH was low. However, it was found that in three age groups there is an asymmetry in the level of muscle strength - in all patients the muscles that perform the function of torso rotation on the right are weaker than the muscles on the left side. In all three groups, there was a greater statistically significant difference between the strength of the functional ability of the abdominal muscles to rotate on the left than on the right. This result indicates that even minor surgery with minor damage to muscle fibers and fascia reduces the functional capacity of the abdominal muscles. LCH leads to an asymmetry in the strength of the external and internal oblique muscles of the abdominal press - a statistically significant decrease in the functional state of these muscles on the right compared with the strength of the muscles on the left in all age groups.
 Conclusions. The low level of functional ability of the abdominal muscles of patients after LCH in the long term requires the inclusion in the protocols of rehabilitation physical therapy and occupational therapy. Accordingly, physical therapy and occupational therapy programs at this stage should include techniques to increase the strength of the abdominal muscles, due to the postponed surgery, recovery and improvement of motor capacity.

Abdominal Muscle Use During Spontaneous Breathing and Cough in Patients Who Are Mechanically Ventilated: A Bi-center Ultrasound Study

Ultrasound may be useful to assess the structure, activity, and function of the abdominal muscles in patients who are mechanically ventilated. Does measurement of abdominal muscle thickening on ultrasound in patients who are mechanically ventilated provide clinically relevant information about abdominal muscle function and weaning outcomes? This study consisted of two parts, a physiological study conducted in healthy subjects and a prospective observational study in patients who were mechanically ventilated. Abdominal muscle thickness and thickening fraction were measured during cough and expiratory efforts in 20 healthy subjects, and prior to and during a spontaneous breathing trial in 57 patients being ventilated. In healthy subjects, internal oblique and rectus abdominis thickening fraction correlated with pressure generated during expiratory efforts (P< .001). In patients being ventilated, abdominal muscle thickness and thickening fraction were feasible to measure in all patients, and reproducibility was moderately acceptable. During a failed spontaneous breathing trial, thickening fraction of transversus abdominis and internal oblique increased substantially from baseline (13.2%[95%CI, 0.9-24.8] and 7.2%[95%CI, 2.2-13.2], respectively). The combined thickening fraction of transversus abdominis, internal oblique, and rectus abdominis measured during cough was associated with an increased risk of reintubation or reconnection to the ventilator following attempted liberation (OR, 2.1; 95%CI, 1.1-4.4 per 10%decrease in thickening fraction). Abdominal muscle thickening on ultrasound was correlated to the airway pressure generated by expiratory efforts. In patients who were mechanically ventilated, abdominal muscle ultrasound measurements are feasible and moderately reproducible. Among patients who passed a spontaneous breathing trial, reduced abdominal muscle thickening during cough was associated with a high risk of liberation failure. ClinicalTrials.gov; No.: NCT03567564; URL: www.clinicaltrials.gov.

Evaluation of abdominal exercises after stoma surgery: a descriptive study

Purpose To evaluate the feasibility of exercises for the abdominal muscles in patients after colostomy or ileostomy formation on the following parameters: muscle activity, pain, discomfort, and difficulty of performing the exercises. Materials and methods Patients with a new stoma were divided into groups based on time after surgery: Early group, 0–2 weeks (n = 12); Intermediate group, 2–6 weeks (n = 15); and Late group, 6–12 weeks (n = 10). During a single individual test session, participants in each group performed a different set of 10–11 abdominal coordination and strengthening exercises for the abdominal muscles. Activity of the abdominal muscles was measured with electromyography. Pain, discomfort, and difficulty were rated for each exercise. Results For the Early group, muscle activity reaching a predetermined threshold was measured for half of the participants in a few exercises. In both the Intermediate group and the Late group, muscle activity reaching the onset criteria was measured for all muscles for a high percentage of participants in several exercises. Both strengthening and coordinating exercises were feasible based on low ratings of pain, discomfort, and difficulty. Conclusions This study identified feasible exercises that activated the abdominal muscles at different time points after stoma formation. The observations can be used as guidance for the choice of exercises in clinical practice and future research. Implications for rehabilitation The findings of this study can be used in clinical practice as guidance for choice of exercise at different time points after surgery. This study identified useful exercises for activating the abdominal muscles in rehabilitation after stoma surgery from two weeks on. In the first two postoperative weeks, there was limited involvement of the abdominal muscles with the evaluated exercises. Most of the evaluated abdominal exercises were feasible after stoma surgery based on pain, discomfort, and difficulty.

Electrical function of the abdominal muscles after combined plastic of extensive median hernias in the context of connective tissue dysplasia

Relevance. Improving the electrical function of abdominal muscles in patients with extensive median hernias of the anterior abdominal wall can be facilitated by optimizing the choice of methods for combined hernioplasty, taking into account the clinical severity of connective tissue dysplasia among the hernia carriers.&#x0D; Objective. Study the electrical function of abdominal muscles after the methods of combined hernioplasty of extensive median hernias, taking into account the severity of connective tissue dysplasia among the hernia carriers.&#x0D; Results. The average numbers of electromyogram frequencies of the abdominal muscles of patients with extensive median hernias from the group without clinical signs of connective tissue dysplasia were almost the same after all the applied methods of combined hernioplasty. The predominance of the rectus muscles electric function over the lateral abdominal muscles among the patients of this group was 33,5 %.&#x0D; Electrofunctional rehabilitation of the abdominal muscles of patients in the second group of examinations depended on the method of combined hernioplasty and changed in the event of an increase or decrease in the severity of connective tissue dysplasia. The recovery of electroactivity of abdominal muscles in the postoperative period in patients from the second group was more significant with an increase in the number of abdominal muscles applied to aponeuroses and vagina of relaxing sections, which contributed to an increase in mobility and contractility of the musculoaponeurotic layers of the anterior abdominal wall.&#x0D; Conclusions. Thus, with an increase in the severity of connective tissue dysplasia in patients with extensive median abdominal hernias, the method of combined hernioplasty with the most pronounced relaxing effect in relation to the anterior abdominal wall promoted optimal rehabilitation of abdominal muscles.

Integrated anatomy of the neuromuscular, visceral, vascular, and urinary tissues determined by MRI for a surgical approach to lateral lumbar interbody fusion in the presence or absence of spinal deformity.

Introduction To comprehensively investigate the anatomy of the neuromuscular, visceral, vascular, and urinary tissues and their general influence on lateral lumbar interbody fusion (LLIF) surgery in the presence or absence of spinal deformity. Methods We retrospectively reviewed 100 consecutive surgery cases for lumbar degenerative disease of patients aged on average 70.5 years and of which 67 were women. A sagittal vertical axis deviation of more than 50 mm was defined as adult spinal deformity (ASD: 50 patients). The degenerative disease of the other patients was defined as lumbar spinal stenosis (LSS: 50 patients). We analyzed the relative anatomical position of the psoas major muscle, lumbar plexus, femoral nerves, inferior vena cava, abdominal aorta and its bifurcation, ureter, testicular or ovarian artery, kidney and transverse abdominal muscle in patients with ASD or with LSS, using preoperative magnetic resonance imaging (MRI). Results For patients with ASD, the L4-5 intervertebral disk was closer to the lumbar nerve plexus than it was in those with LSS (p < 0.0001), and a rising psoas sign at the L4-5 disk was significantly more frequent in patients with ASD than in those with LSS (p < 0.05). The aortic bifurcation frequently appeared at the level of L4-5 in patients with either degenerative disease, so the common iliac artery may pass near the disk. The inferior vena cava passed closer to the center of the L4-5 disk in patients with ASD than it did in those with LSS (p < 0.05). The transverse abdominal muscle at L2-3, L3-4, and L4-5 was closer to and less than 3 mm from the kidneys in many more patients with ASD than was the case for patients with LSS (p = 0.3, p < 0.05, p = 0.29, respectively). Conclusions We recommend careful preoperative MRI to determine the location of organs to help to avoid intraoperative complications during LLIF surgery, especially for patients with ASD.

Within-day and between-day reliability of thickness measurements of abdominal muscles using ultrasound during abdominal hollowing and bracing maneuvers

Ultrasonography imaging has been used as a non-invasive method to estimate the thickness and relative activities of the abdominal muscles in patients with lower back pain (LBP). However, the statistical reliability of US thickness measurements of abdominal muscles, including transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles during abdominal hollowing (AH) and abdominal bracing (AB) maneuvers has not been well-investigated. This study was performed on a total of 20 female subjects (10 with LBP and 10 without LBP) in the age range of 25–55 years to assess within-day and between-day reliability of the measurements. US measurements on maneuvers were repeated after two hours for the within-day reliability and after five days for the between-day reliability assessment. High intra-class correlation coefficient (ICC) values (>0.75) for within-day and between-day reliability assessments during AH maneuver were concluded. The ICC values were moderate for reliability assessment during AB. The ICC values for AH were greater than AB both for within- and between-day reliabilities. The small standard error of measurement and minimal detectable change values (0.16–0.78 and 0.44 to 2.15, respectively) were found for both AH and AB. We recommend real-time US imaging as a reliable way of determining the thicknesses of the TrA and IO muscle (and to some extent, EO muscle) for both healthy and LBP patients.

The Effects of a Bridging Exercise With Hip Adductor Contraction on the EMG Activities of Abdominal Muscles in Patients With Sub-Acute Stroke

The Effects of a Bridging Exercise With Hip Adductor Contraction on the EMG Activities of Abdominal Muscles in Patients With Sub-Acute Stroke

Breathing-synchronised electrical stimulation of the abdominal muscles in patients with acute tetraplegia: A prospective proof-of-concept study

Objective: To examine whether, by enhancing breathing depth and expectoration, early use of breathing-synchronised electrical stimulation of the abdominal muscles (abdominal functional electrical stimulation, AFES) is able to reduce pulmonary complications during the acute phase of tetraplegia.Design: Prospective proof-of-concept study.Setting: Spinal cord unit at a level 1 trauma center.Method: Following cardiovascular stabilisation, in addition to standard treatments, patients with acute traumatic tetraplegia (ASIA Impairment Scale A or B) underwent breathing-synchronised electrical stimulation of the abdominal muscles to aid expiration and expectoration. The treatment was delivered in 30-minute sessions, twice a day for 90 days. The target was for nine of 15 patients to remain free of pneumonia meeting Centers for Disease Control and Prevention (CDC) diagnostic criteria.Results: Eleven patients were recruited to the study between October 2011 and November 2012. Two patients left the study before completion. None of the patients contracted pneumonia during the study period. No complications from electrical stimulation were observed. AFES led to a statistically significant increase in peak inspiratory and expiratory flows and a non-statistically significant increase in tidal volume and inspiratory and expiratory flow. When surveyed, 6 out of 9 patients (67%) reported that the stimulation procedure led to a significant improvement in breathing and coughing.Conclusion: AFES appears to be able to improve breathing and expectoration and prevent pneumonia in the acute phase of tetraplegia (up to 90 days post-trauma). This result is being validated in a prospective multicentre comparative study.

Ultrasound measurement of deep and superficial abdominal muscles thickness during standing postural tasks in participants with and without chronic low back pain

BackgroundActivity of deep abdominal muscles increases the lumbar stability. Majority of previous studies indicated abdominal muscle activity dysfunction during static activity in patients with low back pain (LBP). However, the number of studies that evaluated deep abdominal muscle activity in dynamic standing activities in patients is limited, while this assessment provides better understanding of pain behavior during these activities. ObjectiveInvestigation of superficial and deep abdominal muscles activity in participants with chronic LBP as compared to healthy individuals during standing tasks. DesignCase control study. MethodsUltrasound imaging was used to measure the thickness of transverse abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles in female participants with (N = 45) and without chronic LBP (CLBP) (N = 45) during tests. The Biodex Balance System was used to provide standing tasks. The thickness of each muscle in a standing task was normalized to actual thickness at rest in the supine lying position to estimate its activity. ResultsThe results indicate increases in thickness of all muscles in both groups during dynamic as compared to static standing tasks (P < 0.05, ES > 0.5). Lower percentages of thickness change for TrA muscle and higher for EO muscle were found in the patients as compared to healthy individuals during all tests (P < 0.05, ES > 1.28). ConclusionsHigher activity of superficial than deep abdominal muscles in patients as compared to healthy individuals during standing tasks indicates motor control dysfunction in patients with CLBP. Standing tasks can discriminate the individuals with and without LBP and can be progressively used in training.

The abdominal drawing-in manoeuvre for detecting activity in the deep abdominal muscles: is this clinical tool reliable and valid?

ObjectiveThe abdominal drawing-in manoeuvre (ADIM) is a common clinical tool for manually assessing whether a preferential activation of the deep abdominal muscles in patients with low back pain (LBP) is...

Histological interpretation severity of dysplasia of connective tissue in clinical practice

In the article we make histological examination of the severity of dysplasia of connective tissue on the example of a microscopic examination of the aponeurosis of the external oblique abdominal muscles in patients with inguinal hernia and definition changes depending on the severity of the identified connective tissue dysplasia, defined clinically.

Effect of 10-week core stabilization exercise training and detraining on pain-related outcomes in patients with clinical lumbar instability

Background and aimsClinical lumbar instability causes pain and socioeconomic suffering; however, an appropriate treatment for this condition is unknown. This article examines the effect of a 10 week core stabilization exercise (CSE) program and 3 month follow-up on pain-related outcomes in patients with clinical lumbar instability.MethodsForty-two participants with clinical lumbar instability of at least 3 months in duration were randomly allocated either to 10 weekly treatments with CSE or to a conventional group (CG) receiving trunk stretching exercises and hot pack. Pain-related outcomes including pain intensity during instability catch sign, functional disability, patient satisfaction, and health-related quality of life were measured at 10 weeks of intervention and 1 and 3 months after the last intervention session (follow-up); trunk muscle activation patterns measured by surface electromyography were measured at 10 weeks.ResultsCSE showed significantly greater reductions in all pain-related outcomes after 10 weeks and over the course of 3 month follow-up periods than those seen in the CG (P<0.01). Furthermore, CSE enhanced deep abdominal muscle activation better than in the CG (P<0.001), whereas the CG had deterioration of deep back muscle activation compared with the CSE group (P<0.01). For within-group comparison, CSE provided significant improvements in all pain-related outcomes over follow-up (P<0.01), whereas the CG demonstrated reduction in pain intensity during instability catch sign only at 10 weeks (P<0.01). In addition, CSE showed an improvement in deep abdominal muscle activation (P<0.01), whereas the CG revealed the deterioration of deep abdominal and back muscle activations (P<0.05).ConclusionTen week CSE provides greater training and retention effects on pain-related outcomes and induced activation of deep abdominal muscles in patients with clinical lumbar instability compared with conventional treatment.

Breathing synchronized electrical stimulation of the abdominal muscles in patients with acute tetraplegia

Article Breathing synchronized electrical stimulation of the abdominal muscles in patients with acute tetraplegia was published on September 6, 2012 in the journal Biomedical Engineering / Biomedizinische Technik (volume 57, issue SI-1-Track-R).

Evaluation of trunk muscle activity in chronic low back pain patients and healthy individuals during holding loads

Low back pain after load-carrying is the most important disorder in musculoskeletal system and a cause of dysfunction and economic problems. Holding materials can disturb spinal stability; nevertheless, there are few researches about the pattern of trunk muscle recruitment in patients with chronic low back pain (CLBP) during load holding. Ten female patients with CLBP and ten matched healthy subjects participated in this study. Normalized electromyography activation of trunk muscles during holding loads was analyzed. The low back pain group demonstrated significantly higher activation levels of the External oblique abdominis muscle during loading 12 kg in flexed trunk position and lower activation levels of the Internal oblique abdominis muscle during loading 6 and 12 kg in neutral trunk position than the control group. With the highest external load and trunk flexion, the electrical activity of back muscles increased significantly in both groups. With increasing load, the activation of Rectus abdominis muscle in patients with CLBP and the activation of Rectus abdominis and Internal oblique muscles were increased significantly in healthy subjects. Higher activation of global and lower activation of local abdominal muscles in patients with CLBP may represent that pain changes neuromuscular control systems. The increased activity of extensor muscles during trunk flexion is probably needed for stability and controlling of flexion.

An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain

Ultrasound (US) measures are used by clinicians and researchers to evaluate improvements in activity of the abdominal muscles in patients with low back pain. Studies evaluating the reproducibility of these US measures provide some information; however, little is known about the reproducibility of these US measures over time in patients with low back pain. The objectives of this study were to estimate the reproducibility of ultrasound measurements of automatic activation of the lateral abdominal wall muscles using a leg force task in patients with chronic low back pain. Thirty-five participants from an existing randomised, blinded, placebo-controlled trial participated in the study. A reproducibility analysis was undertaken from all patients using data collected at baseline and after treatment. The reproducibility of measurements of thickness, muscle activation (thickness changes) and muscle improvement/deterioration after intervention (differences in thickness changes from single images made before and after treatment) was analysed. The reproducibility of static images (thickness) was excellent (ICC(2,1) = 0.97, 95% CI = 0.96-0.97, standard error of the measurement (SEM) = 0.04 cm, smallest detectable change (SDC) = 0.11 cm), the reproducibility of thickness changes was moderate (ICC(2,1) = 0.72, 95% CI 0.65-0.76, SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes from single images with statistical adjustment for duplicate measures was poor (ICC(2,1) = 0.44, 95% CI 0.33-0.58, SEM = 21%, SDC = 66.5%). Improvements in the testing protocol must be performed in order to enhance reproducibility of US as an outcome measure for abdominal muscle activation.

Respiratory muscle activity and respiratory obstruction after abdominal surgery

Respiratory movements in patients after abdominal surgery are frequently abnormal, with associated disturbances in the pattern of inspiratory pressure generation. The reasons for these abnormalities are not clear and have been attributed to impaired action of the diaphragm. However, an alternative is that partial airway obstruction could trigger reflex activation of the inspiratory ribcage muscles, which would cause a similar pattern of inspiratory pressure change. Direct measurement of electrical activity can indicate if reflex activation of inspiratory muscles occurs when partial airway obstruction is present. In an open study, we implanted electrodes to measure the EMG of scalene, intercostal and external oblique abdominal muscles in patients after lower abdominal surgery. Analgesia was with morphine i.v. by patient control. We used nasal cannulae to measure nasal airflow and compared EMG activity when airway obstruction was present with activity when breathing was not obstructed. The pattern of activity of the different muscles was distinct. Intercostal activity reached a maximum during inspiration, before the scalene muscles, whereas scalene activity increased in phase with increasing lung volume. Abdominal muscle activity commenced when expiratory flow had ceased and continued until the next inspiration. In all three muscle groups, partial airway obstruction did not alter muscle activity. Partial airway obstruction does not activate inspiratory ribcage muscles, in patients receiving morphine for postoperative analgesia after lower abdominal surgery. Changes in respiratory pressures and abnormalities of chest wall movement described in previous studies cannot be attributed to reflex responses and probably result from increased airway resistance and abdominal muscle action.

Physical Therapists' Evaluation of the Trunk Flexors in Patients With Low Back Pain.

Study Design: This study utilized a single blind design in the observation of 20 initial low back evaluations performed by physical therapists. The physical therapists were blinded to what the researchers were observing. Objective: The objective of this study was to determine whether or not physical therapists were quantifying the strength of trunk flexors when the patient’s chief complaint was low back pain. Background: The literature has shown that there is a relationship between back pain and decreased strength in the abdominal muscles. Therefore, it appears important for physical therapists to evaluate the abdominal muscles in patients with low back pain. Methods and Measures: Twenty physical therapists participated in the study. The researchers observed if trunk flexor strength was quantified during the initial evaluation of 20 patients with low back pain. Following the observation, each physical therapist was given a questionnaire and asked to comment on their evaluation of the trunk flexors. Results: Of the evaluations that were observed, 15% of the physical therapists evaluated the trunk flexors and 85% did not. Conclusion: This study demonstrated that therapists did not consistently quantify abdominal strength when treating patients with low back pain.