External Oblique Research Articles

Correlation between self-reported low back pain and morphological changes in abdominal wall muscles.

Morphological changes in the abdominal wall muscle in diastasis recti abdominis (DRA) patients with low back pain (LBP) symptoms and whether there is a wider interrectus distance (IRD) remain unclear. The aim of this study was to determine the correlation between DRA severity and LBP and the morphological differences in abdominal wall muscles between patients who presented with symptoms of LBP and those who were asymptomatic. A total of 57 postpartum DRA patients were enrolled, including 21 without LBP, 36 with LBP, and 30 healthy nulliparous women. The numerical rating scale (NRS) was used to evaluate the degree of LBP. The IRD and muscle thickness of the abdominal muscles were measured via an ultrasonography device at the end of a natural breathing cycle. The abdominal muscles of the rectus abdominis (RA), external oblique muscle (EO), and transversus abdominis (TrA) in the DRA patients were significantly thinner than those in the control group (p< 0.05), whereas the difference in the internal oblique muscle (IO) was not significant (p> 0.05). There were no statistically significant differences in abdominal muscle thickness or the IRD regardless of whether the patients with DRA had LBP symptoms, with similar findings between the NRS score and DRA severity (P> 0.05). In DRA patients within one year postpartum, no significant difference was found in the severity of DRA or abdominal muscles, regardless of whether they were complicated by LBP symptoms. Shortening the IRD alone may not be beneficial for improving LBP symptoms in DRA patients. The relationship between DRA and LBP and the role of the abdominal muscles in postpartum LBP should be interpreted with caution.

Spinal muscle characteristics during three different types of locomotion activities among college students with idiopathic scoliosis

Background contextPhysical activities such as walking and climbing stairs are pervasive in human daily life. Individuals with scoliosis frequently encounter dysfunction in their muscle recruitment. Multiple studies have corroborated the presence of muscle dysfunction in individuals diagnosed with scoliosis. However, there is currently a noteworthy research gap regarding the exploration of changes in muscle characteristics and disparities from those observed in individuals without scoliosis during everyday activities, specifically stair climbing.PurposeThis study aims to examine the unique patterns of muscle activity during daily life in individuals with scoliosis and distinguish the specific differences between scoliosis patients and the healthy controls. The findings of this study are significantly important for the future accurate assessment of scoliosis and the development of rehabilitation treatment plans.Study designCase–control study.Sample sizeTwenty eight idiopathic scoliosis patients and twenty eight controls.Outcome measuresRoot Mean Square(RMS), Maximum Voluntary Isometric Contraction(MVIC)%, RMS ratio(RMS convex / RMS concave).MethodsThe surface electromyography (sEMG) device used in this study was the Delsys Trigno, with a sampling frequency of 1500 Hz. It recorded the activation level, peak contraction, and average activation level of the erector spinae (at T6, T10, and L3 levels), gluteus maximus, gluteus medius, external oblique, and rectus abdominis muscles during three different types of locomotion for both the 28 individuals with idiopathic scoliosis and the 28 control participants.ResultsThe movement patterns of the idiopathic scoliosis patients significantly differ from those of the normal population during level walking and ascending or descending stairs. In level walking, there is an asymmetry in the activation levels of the T6 and L3 erector spinae muscles, with lower activation on the convex side compared to the concave side. Similarly, during stair ascent, the activation of the T6 and T10 erector spinae muscles is asymmetric, with higher activation on the convex side than the concave side. Moreover, during stair descent, the activation of the T6 erector spinae muscle is asymmetric, with higher activation on the convex side than the concave side.ConclusionsDuring level walking and stair activities, idiopathic scoliosis patients exhibit pronounced abnormal movement patterns that significantly differ from those of the control group. Under different activity conditions such as level walking, ascending and descending stairs, idiopathic scoliosis patients demonstrate abnormal muscle activation in different segments of the spine. It is crucial for clinicians to prioritize the symmetry of muscle activation in the spinal region of idiopathic scoliosis patients and consider incorporating symmetry training for these muscles.

The investigation of ultrasound to assess lateral abdominal wall activation with different types of core exercises

BackgroundCore training is the foundation of physical exercise. The activation of the lateral abdominal wall (LAW) muscles in the core muscles, particularly the transversus abdominal (TrA) muscles, has a stabilizing effect on the chest and abdomen. Therefore, we need to focus on the training effect of the TrA. There are many ways to measure the LAW. Ultrasound can assess the effect of training in real time and intuitively. Therefore, we intend to evaluate the activation of the LAW in different types of core training using ultrasound, to determine the best movements that can activate the TrA and train the core muscles.Methods22 healthy subjects (male 10, female 12, age 22.82 ± 0.98, BMI 20.78 ± 2.27) were included. The subjects were given the following instructions to perform breathing exercises at different positions: calm breathing and deep breathing at 0° hip flexion and 0° knee flexion; calm breathing, deep breathing, abdominal crunches and ball crunches at 45° hip flexion and 90° knee flexion; and calm breathing, deep breathing, abdominal crunches and ball crunches at 90° hip flexion and 90° knee flexion. The muscle thicknesses of the bilateral transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and LAW muscles were measured using ultrasonography at the end of expiration during the above movements.Results(1) The action with the greatest contraction ratio of the TrA was deep exhalation, which was significantly greater than crunch and ball crunch; (2) During deep exhalation, the TrA had the greatest contraction ratio, significantly greater than the IO and EO. (3) The TrA was thinnest during deep exhalation at 90°, followed by 45° and 0°.ConclusionIn healthy young people, deep expiration with 90° hip flexion and 90° knee flexion was the optimal action for activating the LAW, especially the TrA.

Morphological Changes in the Lumbar and Abdominal Muscles in Individuals with Sacralization

Although sacralization is one of the most common congenital anomalies of the spine, its effect on surrounding muscles is still not well known. This study was conducted to determine the size of the lumbar and abdominal muscles of the individuals with sacralization and to compare with the control group. Eighty-five participants with sacralization phenomena and fifty-six asymptomatic participants were included in this study. Sacralization was classified according to the Castellvi classification. The cross-sectional area of the multifidus lumborum, erector spinae and rectus abdominis muscles, and the section thicknesses of external abdominal oblique, internal abdominal oblique and transversus abdominis muscles were measured bilaterally on axial computed tomography images at the L1-2 and L4-5 levels. ANCOVA revealed that there is no any significant group*side interaction effect regarding muscles sizes in terms of two groups in L1-L2 and L4-L5. In addition, ANCOVA revealed a both side effect [(p=.020; η2p=.038)] and group*side interaction effect [(p=.010; η2p=.049)] regarding length of the L5 transverse process (p˃.05). Regardless of low back pain, muscle sizes are not associated with the sacralization phenomenon.

Pelvic tilt and stiffness of the muscles stabilising the lumbo-pelvic-hip (LPH) complex in tensiomyography examination.

The objective of the study was to initially validate the hypothesis about the relationship between the pelvic tilt angle in the saggital plane and the functional state of muscles stabilising the lumbo-pelvic-hip (LPH) complex expressed as a change in their stiffness in a tensiomyography examination. Forty five women aged 19-30 years took part in an observational (cross-sectional) study. The examination involved measurements using the tensiomyography method (TMG). The stiffness of muscles stabilising the LPH complex expressed as a maximal muscle displacement (Dm variable) was assessed and the relationship between muscle stiffness and the value of the pelvic tilt (PT) in the sagittal plane was determined. The analysis showed significant differences in the values of medians of the muscle displacement (Dm) values in groups identified in terms of the value of pelvic tilt (Table 1) for Erector Spinae (ES) muscles (p = 0.0012), Gluteus Maximus (GM) muscles (p = 0.0004), Rectus Abdominis (RA) muscles (p = 0.0005), Obliquus abdominis externus (OAE) muscles (p = 0.0002*) and Rectus Femoris (RF) muscles (p = 0.0071). The results of the correlation analysis performed using the Spearman rho correlation coefficient between the value of pelvic tilt and muscle stiffness (Dm) show the following significant relations for ES muscles (p = 0<0.0001), GM muscles (p<0.0001), RA muscles (p<0.0001) and OAE muscles (p<0.0001). However, a clear direction of changes in stiffness in accordance with the description of relations defined as Lower Crossed Syndrome was not confirmed. A tensiomyographic examination did not show clear relations between the value of pelvic tilt and stiffness of muscles stabilising the lumbar-pelvic-hip complex. The mechanism of Lower Crossed Syndrome (LCS) may be not the only model explaining the relations between musculofascial structures of the hip-lumbar area. The implications of the LCS should not be the only basis for the therapy of disorders resulting from an incorrect position of the pelvis in the sagittal plane.

Abdominal wall muscle ultrasound assessment and level of experience in Pilates - an exploratory study

The core refers to a group of muscles that allow optimal force transfer along the body’s kinetic chain and is critical for movement. The goal of this quasi-experimental study was to investigate the relationship between the experience level of Pilates participants and abdominal wall thickness. For this, we compared the thickness of four abdominal muscles—transversus abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA)—as measured before and after 8 weeks of Pilates training in three conditions, namely, relaxation, abdominal hollowing, and plank exercise. Eighteen participants were distributed into three groups with different levels of Pilates practice—experienced (EG; n=6), inexperienced (IG; n=7), and control (CG; n=5) groups. The RA showed a tendency to increase post-intervention in the EG (all conditions: p=0,002, p=0,006, and p=0,002, respectively for relaxation condition, abdominal hollowing and standing plank). Additionally, significant differences were found in relaxation (p=0.003, d=−0.744) and plank (p=0.009, d=−0.630) conditions in the IG. Significant differences were also registered in the EO muscle in the IG (all conditions: p=0.046, p=0.013, and p=0.008, respectively; d=0.464, d=−0.596, and d=−0.637, respectively). IO muscle thickness tended to increase in the CG in all conditions (p=0.044, p=0.006, and p&lt;0.001, respectively) and the EG in relaxation and plank conditions (p=0.009 and p=0.007, respectively). Within groups, the effects of Pilates practice were more significant post-intervention, with the exceptions being under the contraction condition in the deepest muscles (IO: p=0.109, d=0.083; TrA: p=0.194, d=0.062). Our hypothesis was partially confirmed because 8 weeks of Pilates practice have improved significantly the thickness of the RA and EO muscles in the IG.

Muscle ultrasound in Spondyloarthritis patients receiving biologic disease-modifying anti-rheumatic drugs early in treatment

Objective: This study evaluated muscle ultrasound in spondyloarthritis (SpA) patients receiving biologic disease-modifying anti-rheumatic drugs (b-DMARDs) early in treatment. Methods: A prospective study was conducted with 110 b-DMARD-naive SpA patients. The baseline and control muscle strength, physical performance tests, ultrasonographic muscle parameters, and disease activity scores of 67 controlled patients were examined. Results: During the follow-up period, there were significant improvements in the thickness of the gastrocnemius medialis (GM) muscle (p&lt;0.001), the length of the GM fascicle (p=0.031), the thickness of the rectus femoris (RF) muscle (p&lt;0.001), the cross-sectional area of the RF (RFCSA) muscle (p&lt;0.001), the thickness of the rectus abdominis (RA) muscle (p&lt;0.001), the thickness of the transverse abdominis (TA) muscle (p=0.004), and the thickness of the external oblique (EO) muscle (p=0.042). Besides, ASDAS-CRP scores were related to GM muscle thickness, RFCSA, and TA muscle thickness percent changes in patients whose disease activity regressed from high to moderate (respectively; p=0.030, p=0.040, p=0.002). Conclusion: Muscle ultrasound examination can show muscle mass improvement in SpA patients during treatment.

Correlation between the biomechanical characteristics and stability of the 143D movement during the balance phase in competitive Tai Chi.

To explore the biomechanical factors affecting the stability of athletes in the 143D balance phase of competitive Tai Chi. The Vicon 3D motion capture system, Kistler 3D force platform, and Noraxon surface electromyography (sEMG) system were used to measure the joint angle, joint moment, center of gravity, ground reaction force, and sEMG data of athletes. The stability index was then calculated according to the formula. Pearson's or Spearman's correlation tests were used to analyze the associations between the biomechanical factors and stability index. (1) Medial lateral stability index (MLSI): A significant negative correlation was found between the ankle inversion angle of the supporting leg (SL) and MLSI (p < 0.05). (2) Anterior posterior stability index (APSI): Significant negative correlations were observed between the ankle intorsion angle, integrated electromyography (iEMG) of the gastrocnemius, and muscle contribution rates of the tibialis anterior, external oblique, and gastrocnemius of the non-supporting leg (NL) with the APSI (p < 0.05). The ankle dorsiflexion moment, iEMG of the rectus femoris and tibialis anterior, muscle contribution rate of the biceps femoris, and root mean-squared (RMS) amplitude of the gluteus maximus of the SL also showed significant negative correlations with the APSI (p < 0.05). Strong and significant negative correlations were also identified between the hip intorsion angle, iEMG of the tibialis anterior, and RMS amplitude of the rectus femoris of the NL with the APSI (p < 0.01). Further strong and significant negative correlation was also found between the RMS amplitude of the biceps femoris of the SL and APSI (p < 0.01). The knee extorsion angle of the NL was positively correlated with the APSI (p < 0.05). (3) Dynamic postural stability index (DPSI): The knee adduction angle, iEMG of the tibialis anterior, and RMS amplitude of the erector spinae of the NL were significantly positively correlated with the DPSI (p < 0.05). The knee abduction and hip extension moments of the SL were also significantly positively correlated with the DPSI (p < 0.05). The ankle inversion angle of the SL impacts left-right stability, while the NL's hip and ankle intorsion angles, knee extorsion angle, and exertion on the core muscle and SL's main muscles, as well as exertion of specific muscles of the NL affect anterior-posterior stability. The hip extension and knee abduction moments of the SL, knee adduction angle, exertion on the tibialis anterior, and activation of the erector spinae of the NL significantly affect the overall stability of an athlete.

Recruitment of Abdominal and Neck Muscles During Four Different Exercises in Healthy Adults

Background and Purpose: Prolonged mechanical ventilation can greatly increase morbidity and mortality. Diaphragm weakness has been identified as a major contributor for 50% of patients; however, other muscles besides the diaphragm contribute to efficient ventilatory function. The purpose of this study was to compare the change in deoxyhemoglobin (ΔHHb) and muscle oxygen saturation (ΔSmO2) (markers of muscle recruitment) of 3 extra-diaphragmatic muscles across 4 different bed exercises. Methods: Using a pretest–posttest design, healthy participants (n = 18) performed 3 minutes of 30 repetitions of 4 exercises: resisted trunk flexion (TF), resisted neck flexion (NF), expiratory threshold loading (ETL), and neuromuscular electrical stimulation (NMES) of the rectus abdominis and external obliques. Near infrared spectroscopy was used to measure ΔHHb, and ΔSmO2 in the sternocleidomastoid, rectus abdominis, and external obliques during these exercises. Results: Increases of ΔHHb were highest for the sternocleidomastoid during NF and for rectus abdominis and external obliques during TF (P &lt; .010). The opposite pattern was shown for ΔSmO2; decreases of ΔSmO2 were largest for the sternocleidomastoid during NF and for rectus abdominis and external obliques during TF (P &lt; .005). No significant differences were observed in ΔHHb and ΔSmO2 for rectus abdominis and external obliques during ETL versus NF or NMES nor were there differences when comparing NF versus NMES for these 2 muscles. Conclusion: TF and NF are most effective for recruiting abdominal muscles and sternocleidomastoid, respectively, whereas ETL showed a variable response. Stimulation parameters of NMES and its tolerance can limit outcomes.

Dynamic Modelling of the Spine for the Estimation of Vertebral Joint Torques using Gordon’s Method

World Health Organization (WHO) recognised musculoskeletal disorder (MSD) as the main contributor to disability worldwide, with low back pain as the major disorder globally. The occupational disorder normally occurs during lifting. The weight of the load and manual handling tasks during lifting has an impact on the spine and joint torque. The purpose of this study is to propose a dynamic model of the spine that can estimate the vertebral joint torques. This study is a bimodal approach that consists of the experimental and theoretical parts. Ten healthy UniMAP students (10 males) participated in this study. The subjects were required to lift a 3kg weight plate for kinematics and EMG data collection. Retro-reflective markers were attached to the subject body, and then, the data was collected and stored in QTM software. Kinematic data was processed using C-Motion Visual3D. Eight Trigno Wireless Sensors were attached on the back muscles (left and right erector spinae, latissimus dorsi, external oblique and internal oblique). The EMG data were stored in EMG Acquisition software and subsequently, were processed using EMG Analysis software. Gordon’s method was used to develop a mathematical model of the spine. The model comprises of five kinematic chains which connected three lumbar, two thoracic and one cervical. The model calculated the value of joint torque on flexion/extension movement using Matlab and Microsoft Excel. When calculated on L5, the model gives an estimation within 0 – 30 kgm2s-2. The model was further used to estimate value of L3, L1, MAI and T2. The estimate average value of joint torque at L3 is within 5 – 25 kgm2s-2, MAI is within 0 – 6 kgm2s-2 and T2 is within 0 – 1 kgm2s-2. The average RMS values show the highest muscle activity on the right internal oblique muscle (1519 µV), followed by the right external oblique (1166 µV) and left external oblique (418 µV). The results obtained gives an insight on the value of joint torque that have been applied by the spine and the most activated back muscles during lifting.

Effects of a plank-based strength training programme on muscle activation in patients with long COVID: a case series.

This study aimed to analyse the effects of a plank-based strength training programme on muscle activation in patients with long COVID. Case series study that included patients with long COVID who participated in a 12-week trunk and pelvic muscle strength training programme. Clinical variables and the modified fatigue impact scale (MFIS) were used to assess fatigue levels. Percentage of muscle activation during a core muscle plank was measured via surface electromyography. Pre- and post-intervention results were compared using the Wilcoxon signed-rank test and evaluated with Cohen's D effect size (ES). Twenty-one subjects participated in the study; 81% female, mean age 47.5 years (range: 28-55 years), and median duration of symptoms 21 months (range: 5-24 months); 90.5% of the participants experienced fatigue (MFIS score = 38). Muscle activation during plank exercises improved across all muscles after the intervention, with significant increases in the left (p = 0.011, medium ES) and right external oblique (p =0.039, small ES) muscles and the right latissimus dorsi muscle (p = 0.039, small ES). Additionally, significant reductions in fatigue were observed in the total MFIS score (p = 0.004, medium ES) and in the physical (p < 0.001, large ES) and psychosocial subscales (p = 0.033, small ES). Results suggest that a plank-based strength training programme may be effective in enhancing trunk and pelvic muscle activation in individuals with long COVID.

Influence of Changing Hip Position on Electromyographic Activities of Selected Trunk Muscles During Bridging Exercises in Healthy Subjects: A Cross-Sectional Study

Objective: The purpose of this study was to investigate how rectus abdominis, external oblique (EO), internal oblique (IO), erector spinae, multifidus (MF), and gluteus maximus (GMax) muscle activities change with different hip positions during back and side bridging exercises. MethodsThirty-six healthy individuals participated in this cross-sectional study and performed 6 exercises including back bridging (BB) in neutral hip position, BB with internal rotation, BB with external rotation (BB + ER), side bridging with hips in neutral (SB), side bridging with hips in flexion (SB + HF), and side bridging with hips in extension (SB + HE). Muscle activity was observed using surface electromyography, normalized using maximum voluntary isometric contraction. Repeated-measures 1-way analysis of variance compared muscle readings for each position. ResultsBack bridging with internal rotation showed significant differences in EO (P = .01) and IO (P < .001) compared with other BB positions. Multifidus and GMax differed significantly in BB + ER (P = .04). Side bridging exhibited significant differences in EO (P = .02; P < .001) and IO (P < .001) compared with the other 2 SB positions, with peak in SB + HF. Erector spinae, MF, and GMax also differed significantly (P < .001, P = .02, P < .001, respectively) with peak in SB + HE. ConclusionThe findings revealed that EO and IO muscles were most active during BB with internal rotation, whereas the MF and GMax muscles were most active during BB + ER. In terms of SB, the EO and IO muscles were most active with either SB + HF or SB + HE, whereas the erector spinae, MF, and GMax muscles were most active with SB + HE.

Surface electromyographic analysis of the bilateral abdomen and back muscle during selected yoga posture

Sedentary lifestyles lead to postural deformities, Lower Back Pain(LBP) and Colorectal cancer(CRC). Practicing Yoga attains definite strength in muscles by activating muscle fibers. The Yoga poses analyzed are often used in strengthening and stability programs for the abdomen and back muscles. ObjectiveTo determine the potential use of Dolphin pose and Dolphin plank in specific strengthening endurance and rehabilitation programs via sEMG analysis in the selected bilateral abdomen and lower back muscles. MethodsSurface electromyographic analysis was conducted on bilateral muscles, including the Rectus Abdominis(RA), External oblique(EO), Internal oblique(IO), and Erector Spinae(ES), resulting in Dolphin pose(DS), Dolphin plank(DP), and High plank(HP). Data were expressed by Root Mean Square(RMS) of each bilateral muscle during each Pose normalized as 100% of maximum voluntary isometric contraction(MVIC). ResultsDolphin plank(DP) generated a very high-level muscle activation than 100% MVIC in all bilateral muscles, and there was a significant main effect of Pose e (p < 0.001). Erector spinae generated more activation in the Dolphin pose (p < 0.05) than in the HP and DS. No significant difference between bilateral activity differences in DP and DS. There was a significant difference between RRA and LRA (p < 0.001) and RIO and LIO (p < 0.0001). ConclusionFindings have suggested that the Dolphin plank could be used for abdomen strengthening, performance enhancement, and rehabilitation programs. Dolphin pose may benefit lower back stability by providing endurance to the Erector spinae muscle. So, this yoga pose can be incorporated into the yoga training module for addressing lower back pain(LBP) caused by longer sitting in a sedentary lifestyle.

Associations Between Pelvis, Trunk, and Shoulder Girdle Muscle Activity; Age; and Scores During the Closed Kinetic Chain Upper Extremity Stability Test in Baseball Pitchers

OBJECTIVE: To evaluate associations between muscle activity, age, and scores on the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). DESIGN: Quasi-experimental. METHODS: Pelvic, trunk, and shoulder girdle surface electromyography (sEMG) and kinematic data were measured in 21 high school and college male baseball pitchers (17.4 ± 2.0 years, 184.4 ± 5.7 cm, 78.4 ± 14.2 kg) while they performed the CKCUEST. Mean sEMG data were computed while in sole support on the throwing-arm side (TS) as the glove-arm side (GS) was horizontally translating. Correlations and local regressions were used to assess associations and general patterns between mean sEMG data, age, and scores. RESULTS: TS serratus anterior, TS external oblique, GS serratus anterior, and TS gluteus medius had the highest mean sEMG data. Low-to-high significant correlations were found between proximal muscle groups. Correlations with the highest magnitudes in descending order were TS external oblique and TS gluteus maximus, TS external oblique and TS serratus anterior, and GS external oblique and TS gluteus medius. Small significant associations were observed between other muscle groups and age; there were no associations between muscle activity and test performance. CONCLUSION: Associations were observed between mean muscle activity among muscle groups and age but not test outcome. JOSPT Open 2024;2(4):297-305. Epub 7 June 2024. doi:10.2519/josptopen.2024.1023

Automatic Segmentation of Ultrasound-Guided Quadratus Lumborum Blocks Based on Artificial Intelligence.

Ultrasound-guided quadratus lumborum block (QLB) technology has become a widely used perioperative analgesia method during abdominal and pelvic surgeries. Due to the anatomical complexity and individual variability of the quadratus lumborum muscle (QLM) on ultrasound images, nerve blocks heavily rely on anesthesiologist experience. Therefore, using artificial intelligence (AI) to identify different tissue regions in ultrasound images is crucial. In our study, we retrospectively collected 112 patients (3162 images) and developed a deep learning model named Q-VUM, which is a U-shaped network based on the Visual Geometry Group 16 (VGG16) network. Q-VUM precisely segments various tissues, including the QLM, the external oblique muscle, the internal oblique muscle, the transversus abdominis muscle (collectively referred to as the EIT), and the bones. Furthermore, we evaluated Q-VUM. Our model demonstrated robust performance, achieving mean intersection over union (mIoU), mean pixel accuracy, dice coefficient, and accuracy values of 0.734, 0.829, 0.841, and 0.944, respectively. The IoU, recall, precision, and dice coefficient achieved for the QLM were 0.711, 0.813, 0.850, and 0.831, respectively. Additionally, the Q-VUM predictions showed that 85% of the pixels in the blocked area fell within the actual blocked area. Finally, our model exhibited stronger segmentation performance than did the common deep learning segmentation networks (0.734 vs. 0.720 and 0.720, respectively). In summary, we proposed a model named Q-VUM that can accurately identify the anatomical structure of the quadratus lumborum in real time. This model aids anesthesiologists in precisely locating the nerve block site, thereby reducing potential complications and enhancing the effectiveness of nerve block procedures.

Evaluation of Trunk Oblique Muscle Activities in Baseball Batters Using T2-Weighted Magnetic Resonance Imaging.

Takuya, Y, Taro, I, Chihiro, K, Mana, O, Takahiro, O, and Masako, H. Evaluation of trunk oblique muscle activities in baseball batters using T2-weighted magnetic resonance imaging. J Strength Cond Res XX(X): 000-000, 2024-This study investigated abdominal oblique muscle activity using T2-weighted imaging in baseball batting. For this purpose, 17 baseball batters (21.6 ± 2.7 years, 173.9 ± 4.0 cm, 77.5 ± 7.6 kg) performed 100 toss-batting trials. Before and after toss-batting, 3 Tesla magnetic resonance imaging scans were performed to obtain the T2 values of the 4 abdominal external and internal oblique muscle pairs. The results showed that the T2 values of all abdominal oblique muscles were significantly increased after the 100 trials (p < 0.05), with no differences in these increases between the muscles. The rate of change in the T2 values was 1.0 ± 3.9% and 4.2 ± 5.2% for the external and internal oblique muscles on the pitcher's side and 3.2 ± 5.1% and 0.9 ± 2.5% for the external and internal oblique muscles on the catcher's side, respectively. These findings indicate that the activity levels of all abdominal oblique muscles during baseball battings are similar and lower than those of the agonist muscles used during resistance exercise and sprinting. These findings suggest that baseball batting is a low-intensity exercise of the abdominal oblique muscles, but adequate training of each abdominal oblique muscle may improve batting performance and prevent injury.

Abdominal muscles infiltration analgesia for donor-site pain in autologous ear reconstruction: A randomized controlled clinical trial

BackgroundCostal cartilage donor-site pain is an adverse effect of autologous ear reconstruction. This study aimed to introduce rectus abdominis and external oblique muscle infiltration analgesia (RAM+EOM-IA) for costal cartilage donor-site pain and evaluate its efficacy and safety. MethodsThe study was a randomized controlled clinical trial. Patients were randomized between intermittent RAM+EOM-IA combined with intravenous patient-controlled anesthesia (IPCA) and IPCA alone. Thirty patients were followed in the RAM+EOM-IA combined with the IPCA group and 30 patients in the IPCA alone group. The primary outcome was the numerical rating score (NRS) of pain recorded during 48 h postoperatively. Secondary outcomes included the Barthel index (BI) and rescue analgesic consumption. Sensory block areas were tested using a cold stimulus. ResultsNRS was significantly lower with RAM+EOM-IA combined with IPCA than with IPCA alone at 28 h (P < 0.01), 32 h (P < 0.01), 36 h (P < 0.01), 44 h (P < 0.001), and 48 h (P < 0.01) postoperatively. The number of patients who received rescue analgesics (P < 0.01) and consumption (P < 0.01) was significantly higher for IPCA alone. RAM+EOM-IA improved the BI at 24 h postoperatively (P < 0.001), especially for mobility (P < 0.001), using the stairs (P < 0.001) and toilet use domains (P < 0.001). At 10 and 60 min after RAM+EOM-IA, the total sensory block area in the abdomen had not extended proximally beyond the xiphoid, distally beyond the navel, and beyond midaxillary and midsternal lines on either side. ConclusionRAM+EOM-IA effectively and safely prevented costal cartilage donor-site pain by blocking anterior and lateral cutaneous branches of intercostal nerves from T6 to T10 in microtia patients.

Muscle thickness of lateral abdominal muscles in sitting and standing positions during abdominal drawing-in maneuver and abdominal bracing among healthy adults

Background: Spinal stabilization exercises, such as abdominal drawing maneuvers (ADIM) and abdominal bracing (AB), are crucial in alleviating low back pain, especially in functional positions such as sitting and standing. However, few studies have investigated the contraction patterns of the lateral abdominal muscles during ADIM and AB in these daily living positions (i.e., sitting and standing). Objective: The study aimed to investigate the thickness of transverse abdominis (TrA), internal abdominal oblique (IO), and external abdominal oblique (EO) during ADIM and AB between sitting and standing positions. Materials and methods: Twenty-four healthy adults (12 males, 12 females) without low back pain or other orthopedic conditions were assessed in sitting and standing positions while performing ADIM and AB. Real-time ultrasound imaging was used to measure the thickness of the TrA, IO, and EO during the ADIM and AB. Results: Muscle thickness of TrA and IO was significantly greater during ADIM when compared to AB (p&lt;0.05). TrA thickness during AB was significantly greater in sitting than standing (p&lt;0.05), but ADIM showed no difference in both positions. ADIM and AB can produce contraction of the lateral abdominal muscles (LAM) in both sitting and standing positions. Conclusion: ADIM and AB can produce contraction of the LAM in both sitting and standing positions. However, ADIM can activate TrA and IO muscles better than AB. Therefore, clinicians may initially consider using ADIM to teach individuals who need core stability exercises such as low back pain.

Characterizing Muscle Activity in Soccer Players with a History of Hamstring Strain Injuries during Accelerated Sprinting.

This study aimed to characterize muscle activity in male soccer players with a history of hamstring strain injuries (HSI) during accelerated sprinting. Thirteen patients each in the HSI group (history of HSI) and in the healthy group (with no history of HSI) were included. 26 male soccer players of which 13 with and 13 without HSI history were included in this study. Ten muscles were evaluated on electromyography activity during overground sprinting. The testing protocol consisted of a maximal sprint over a distance of 30 meters. One running stride was divided into the early stance phase, late stance phase, early swing phase, mid-swing phase, and late swing phase, and the average muscle activity per phase and the timing of the peak root-mean-square value appearance during each stride were calculated. Statistical analysis was performed using repeated-measures two-way ANOVA (group × phase), and multiple comparison tests were performed using the Bonferroni method when the interaction or main effect was significant. The statistical significance level was set at p < 0.05. Gluteus maximus (Gmax), gluteus medius (Gmed), and external oblique (EO) showed activity differences based on HSI history. Gmax was 30% lower, EO was 20% lower, and Gmed was 40% higher in HSI group. This study suggests that, despite previous findings that HSI is most likely during the late swing phase, the HSI group shows a higher injury risk in the early stance phase. This is due to differences in trunk and gluteal muscle activity between the late swing and early stance phases compared to the healthy group. In summary, HSI group had lower activity in the muscles contributing to trunk instability, especially EO and Gmax, before and after ground impact during accelerated sprinting, compared to Healthy.

Trans Oblique Ileal Conduit Technique Has a Low Risk of Parastomal Hernias

ObjectivesTo outline our surgical technique and outcomes of a ipsilateral "transoblique" ileal conduit performed during pelvic exenteration with a Vertical Rectus Abdominis Myocutaneous flap. We report hernia rates in a transrectus group as reference. MethodsWe identified patients from January 2007 to August 2020. The transoblique conduit is placed on the ipsilateral side as the VRAM, through the internal, external oblique, and transverse abdominis muscles. Stomal hernias were assessed radiologically. Transrectus patients were those undergoing radical cystectomy matched based on surgery date, age, and sex in a 3:1 ratio. We employed a Kaplan-Meier plot to visualize the duration between surgery and hernia. We calculated the hernia rate two years after surgery. Additionally, we present the 30-day postoperative complication rate. Results50 underwent transoblique conduits and we matched them to 190 transrectus patients. 67% were men with a median age of 62. 10/50 patients in the transoblique and 44/190 in the transrectus group developed a hernia, with a median follow-up of 2.2 years (IQR 0.8, 4.0). The two-year KM-estimated parastomal hernia rate was 14% (95% CI 1.6%, 25%) for the transoblique conduits, 21% (95% CI 15%, 28%) for the transrectus and 24% (95% CI 6.5%, 39%) for colostomies. Among the transoblique patients, 22 (44%) experienced at least one postoperative complication. ConclusionsA transoblique ileal conduit is safe in patients undergoing a right VRAM flap during a pelvic exenteration with a low parastomal hernia and complication rates.