Transversus Abdominis Activation Research Articles

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

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

Waist Circumference, a Clinical Measurement for the Activity of Transversus Abdominis

Objectives: Improving the timing and endurance of the deep abdominal muscles, notably transversus abdominis (TrA), is a known protocol for improving spinal stability. TrA is the deepest abdominal muscle, and monitoring its activity is a difficult task. Ultrasound and pressure biofeedback have been employed for monitoring the activity of TrA; however, these methods are expensive, not always available in all clinical settings, and their application requires formal training. The purpose of this study was to examine the use of a broadly known method, i.e., changes in the waist circumference, to monitor the activity of TrA. Methods: The study was carried out on 14 subjects following a pilot study of 5 participants. The thickness of TrA measured by ultrasound was considered the standard indicator for activity of TrA and was compared with simuObjectives: Improving the timing and endurance of the deep abdominal muscles, notably transversus abdominis (TrA), is a known protocol for improving spinal stability. TrA is the deepest abdominal muscle, and monitoring its activity is a difficult task. Ultrasound and pressure biofeedback have been employed for monitoring the activity of TrA; however, these methods are expensive, not always available in all clinical settings, and their application requires formal training. The purpose of this study was to examine the use of a broadly known method, i.e., changes in the waist circumference, to monitor the activity of TrA. Methods: The study was carried out on 14 subjects following a pilot study of 5 participants. The thickness of TrA measured by ultrasound was considered the standard indicator for activity of TrA and was compared with simultaneous measurement of waist circumference. Results: A significant criterion validity between the thickness of TrA and the waist circumference was established (Pearson correlation=-0.71, P=0.001), indicating an inverse relationship between changes in the thickness of the transversus abdominis muscle and waist circumference. Discussion: This result confirmed the hypothesis that changes in the waist circumference could be employed as a suitable indicator for the activity of TrA.ltaneous measurement of waist circumference. Results: A significant criterion validity between the thickness of TrA and the waist circumference was established (Pearson correlation=-0.71, P=0.001), indicating an inverse relationship between changes in the thickness of the transversus abdominis muscle and waist circumference. Discussion: This result confirmed the hypothesis that changes in the waist circumference could be employed as a suitable indicator for the activity of TrA.

Efficacy of a Core Strengthening Program for Diastasis Rectus Abdominis in Postpartum Women: A Prospective Observational Study

Background: Diastasis rectus abdominis (DRA) is characterized by a widening between the rectus abdominis muscles and thinning of the linea alba. It is common during pregnancy and may contribute to postpartum low back pain (LBP) and stress urinary incontinence (SUI). Core strengthening is thought to improve DRA, but there is no widely accepted exercise program. Objectives: To assess changes in interrectus distance (IRD) and participant-reported outcomes (PROs) after an online core strengthening program in postpartum women with DRA. Study Design: Prospective observational study. Methods: Forty-three postpartum women (36.7 ± 3.5 years) with DRA, which was diagnosed as an IRD 2.0 cm or more using musculoskeletal ultrasound, participated in a 12-week online core strengthening program focused on daily transversus abdominis activation with coordinated breathing and pelvic floor muscle engagement. IRD and PROs were assessed at baseline and 12 weeks. A subset of 19 women participated in an additional 12-week maintenance phase, and outcomes assessments were performed at 24 weeks. Results: The 12-week online core strengthening program significantly decreased IRD above and below the umbilicus at rest (slope [95% confidence interval]: −0.56 [−0.74, −0.38] and −0.26 [−0.45, −0.06]; P < .001 and P = .009, respectively) and below the umbilicus during contraction (−0.39 [−0.58, −0.20]; P < .001). Improvements in LBP-related disability (P = .002) and SUI (P = .001) were also observed. Participation in the maintenance phase significantly improved IRD at 24 weeks compared with 12 weeks (P < .0125). Satisfaction averaged 7.43 ± 2.23. Conclusions: The 12-week online core strengthening program reduced IRD and improved LBP-related disability and SUI. Program participation for 12 additional weeks further reduced IRD. These results suggest that the online core strengthening program can be used in postpartum women with DRA.

An Investigation of the Association between Transversus Abdominis Myofascial Structure and Activation with Age in Healthy Adults using Ultrasound Imaging.

BackgroundBecause of their importance in core stability, training the deep abdominal muscles, fascial structures and particularly the transversus abdominis, is a key component of many sport and physical therapy programs. However, there are gaps in knowledge about age-related changes in the structure and activation capacity of these muscles.Hypothesis/PurposeThis study investigated the association between deep abdominal muscles and fascial structures and transversus abdominis activation with age in healthy adults.Study designA cross-sectional study.MethodsEighty-six adults aged 18 to 77 participated in this study. An ultrasound image of their transversus abdominis, internal oblique, external oblique and associated fasciae was first captured at rest, then during a contraction of the transversus abdominis. Bivariate correlation analyses and hierarchical analyses were performed (significance level: p < 0.05).ResultsThe thickness of these three muscles decreases with age ( = -0.66 for external oblique, -0.51 for internal oblique and -0.58 for transversus abdominis), whereas the thickness of their fasciae increases ( = 0.39 for the fascia of external oblique, 0.54 for the fascia between internal oblique and external oblique, and 0.74 for the fascia between internal oblique and transversus abdominis). Transversus abdominis activation decreases with age (r =-0.44). Age accounts for 19.5% of the variance in transversus abdominis activation.ConclusionThese results demonstrate that normal aging is associated with changes in deep abdominal myofascial structures and transversus abdominis activation. Assessment of these metrics can provide valuable baseline information for physical therapists involved in rehabilitation and strengthening programs targeting older individuals.Level of evidenceLevel 2

Hip and Core Muscle Activation During High-Load Core Stabilization Exercises.

There is some evidence that high-load lumbar stabilization exercises, such as back bridge, can recruit both local and global muscles. Therapeutic exercises would optimize gluteus maximus (GMax), gluteus medius (GMed), multifidus (MF), and transversus abdominis (TrA) activation, while minimizing the activation of the tensor fascia latae (TFL) and erector spinae (ES) muscles in healthy individuals. Cross-sectional study. Research laboratory. Level 4. In this cross-sectional study, surface electromyography (EMG) of GMax, GMed, TFL, TrA, MF, and ES was used to quantify the gluteal-to-TFL muscle activation (GTA) index and a ratio of local to global (L/G) lumbar muscles during (1) the elbow-toe exercise in the prone position, (2) the elbow-toe with right left lifted, (3) the hand-knee with left arm and right leg lifted, (4) the back bridge, (5) the back bridge with right leg lifted, (6) the back bridge with left leg lifted, (7) the side bridge with left leg lifted, (8) the side bridge with right leg lifted, and (9) the elbow-toe with right leg horizontally lifted exercises in healthy individuals (20 men, 20 women; age, 25 ± 4 years). The back bridge exercise with left leg lift generated the highest L/G muscles activity ratio (L/G = 3.35) while the hand-knee exercise yielded the lowest L/G muscles activity ratio (L/G = 1.21). The side bridge exercise with left elbow and foot and lifting the right leg (GTA = 63.78), hand-knee exercise (GTA = 49.62), back bridge (GTA = 28.05), and elbow-toe exercise with left leg horizontally lifted (GTA = 23.02) generated the highest GTA indices, respectively. Meanwhile, the normalized EMG amplitude for GMax was significantly less than the TFL, for elbow-toe exercise (P < 0.001), back bridge with left leg lift (P = 0.001), side bridge exercise with the right elbow and foot and lifting the left leg (P = 0.002), and elbow-toe exercise with right leg horizontally lifted (P < 0.001). The highest GTA indexes were observed during (1) the side bridge lifting the dominant leg and (2) the hand-knee horizontally lifting dominant leg, respectively. The L/G ratio was highest during (1) the back bridge lifting nondominant leg, (2) back bridge, and (3) back bridge lifting dominant leg, respectively. This study supports the use of back bridge exercises to strengthen the MF and side bridges to improve gluteal muscle activation. The highest GTA index was observed in the side bridge lifting the right leg. Highest L/G ratio was in the back bridge with nondominant leg lifted. This study supports the use of back bridge exercises to strengthen the MF. This study supports the use of side bridges to improve gluteal muscle activation.

Abdominal complex muscle in women with stress urinary incontinence - prospective case-control study.

This study was designed to assess the percentage share of musculus obliquus externus abdominis, musculus obliquus internus abdominis and musculus transversus abdominis activity among women suffering from stress urinary incontinence using ultrasound imaging. The study is a retrospective analysis of prospective collected data of 84 women aged 23-62 years. In the study group are women suffering from grade 1 or 2 stress urinary incontinence according to the Stamey classification; the control group consists of women with no micturition disorders. The abdominal muscles' activity was measured by using ultrasound imaging with assessment of muscle thickness. The analysis of musculus obliquus externus abdominis in anterolateral abdominal wall activity shows a statistically significant difference between study and control groups concerning isometric tension of abdominal muscles (p = 0.012) and lower abdomen tension (p = 0.004). Women with stress urinary incontinence present higher activity of the musculus obliquus externus abdominis than women in the control group. In the case of the musculus obliquus internus abdominis, statistically significant differences were found during tension of the lower part of the abdomen (p = 0.024). Comparison of activity of the musculus transversus abdominis between study and control groups shows a statistically significant difference during isometric tension of abdominal muscles (p = 0.018). The pattern of activity of the assessed muscles differs between the study group and the control group. In the study group, the activity pattern concerns the higher activity of the musculus obliquus externus abdominis and the lower activity of the musculus obliquus internus abdominis and musculus transversus abdominis.

Comparison of two manual therapy approaches combined with exercise on pain, strength and electromyographic muscle activity in athletes with subacute mechanical low back pain

Subacute mechanical low back pain (MLBP) has been found to increase significantly in athletes in the past decade. Manual therapy combined with exercises seems to be promising option; however, its potential effect in athletes is not fully known yet. The study aimed to compare between the effects of mulligan sustained natural apophyseal glides (SNAG) combined with exercise, muscle energy technique (MET) combined with exercise therapy and exercise therapy alone on pain, strength and muscle activity in athletes with subacute mechanical low back pain (MLBP). The athletes were screened for inclusion into the study using physical examination and Oswestry Disability Index (ODI). The study was a randomized 3 arm repeated measure design and a total of thirty athletes completed the study (n = 30). Athletes in group 1 received mulligan sustained natural apophyseal glides (SNAG) combined with exercise, group 2 received muscle energy technique (MET) combined with exercise while those in group 3 were submitted to exercise only. Athletes in all groups received treatment 3 times a week for 4 weeks. The outcome measures were visual analog scale (VAS) scores, back extensor strength and electromyographic (s EMG) muscle activity of longissimus lumborum (LL) and transversus abdominis (Tr A). The VAS score were decreased in all three groups (p < 0.05); however, group 2 and group 1 were more effective than group 3 (p < 0.05). The back extensor strength increased in two groups (p < 0.05): group 2 showed a significant increase compared to group 1. The s EMG muscle activity of LL and Tr A increased in two groups (p < 0.05): group 2 showed a significant increase compared to group 1. There were significant time, group and interaction effects for the three outcome measures (p < 0.05). The addition of MET combined with exercise therapy reduces pain level, improves back extensor strength and muscle activity of LL and TrA in athletes suffering with subacute MLBP more than mulligan SNAG combined with exercise therapy and exercise therapy alone.

EMG Activity of Transversus Abdominis, Multifidus and Co-Contraction Index in Different Phases Amongst Varied Level Archers: A Cross-Sectional Study

Abstract Introduction. Core muscle activity is a necessary requirement in most sports. However, its role in archers has not been studied. Therefore, this study sought to determine muscle activity of Transversus abdominis (TA) and Multifidus (MF) and co-contraction index (CCI) using surface electromyography (s EMG) during different phases of shots in archers with different levels of training. Material and Methods. It was an observational study with a cross-sectional design. Twenty-eight healthy male archers were recruited and grouped according to their level of training: Group A (Beginners (n = 9)), Group B (Trained (n = 10)), Group C (Elite (n = 9)). The muscle activation (%MVIC) for MF and TA for 10 successive archery shots (distance: 10 meters in 200 seconds) was recorded using s EMG for all the phases of the shots along with CCI. Results. Three-way ANOVA revealed a significant difference for TA activity within groups (p ≤ 0.001) and phases (p = 0.002), A significant difference for MF activity was found within groups (p ≤ 0.001). A significant difference for CCI was found between groups (p ≤ 0.001) and in the interaction between phase × shot (p = 0.001). Conclusions. The findings of the study showed that elite archers had more activity of the core muscles (TA and MF) and their CCI was found to be much higher with respect to the trained and beginner archers. Therefore, it is essential to incorporate dynamic stabilization exercises into archery training.

Comparison of the Pressure Biofeedback Unit and Real-Time Ultrasound Imaging as Feedback Tools to Contract the Transversus Abdominis Muscle: A Randomized Controlled Trial in Healthy Older Adults.

The transversus abdominis (TrA) is a key muscle for lumbar stabilization and is often retrained in physical therapy. Feedback tools, such as the pressure biofeedback unit (PBU) and rehabilitative ultrasound imaging (RUSI), are frequently used by physical therapists to train their patients and improve their patients' ability to contract this muscle. However, the effect of these tools in rehabilitating the TrA in older adults remains to be demonstrated, as is their efficiency in transferring the skill of recruiting the TrA from a supine position to a standing position.The objective of the study was to compare the immediate effectiveness of the PBU and RUSI to reeducate the TrA muscle in a population of asymptomatic older adults (without pain). Forty participants were randomized into 2 groups (RUSI or PBU). The intervention included a training session involving 15 TrA contractions held for 10 seconds with the corresponding feedback device. The dependent variable, TrA thickness (a muscle activation indicator), was measured using ultrasound images before and after the intervention in a supine and standing position. Nonparametric analyses were used for inter- and intragroup comparisons. The results showed no between-group differences in TrA activation ratio (AR) in the supine or standing position (supine AR: TrA RUSI thickness change P = .53 vs PBU thickness change P = .73, comparison between groups P = .51; standing AR: TrA RUSI thickness change P = .003 vs PBU thickness change P = .10; comparison between groups P = .61). However, the change in TrA thickness compared to the other abdominal wall muscles in a standing position was significantly less post-intervention for the RUSI group only (RUSI P = .006 vs PBU P = .72). Both groups remained similar post-intervention for this outcome (P = .20). Neither the RUSI nor the PBU seems to have the desired effect on the activation of TrA in asymptomatic older adults.

Transversus abdominis activation does not alter gait impairments in patients with and without knee osteoarthritis

BackgroundKnee osteoarthritis accounts for more years of disability than all other forms of osteoarthritis combined. Gait kinetic and kinematic changes, in addition to reduced gait speed, are commonly observed. This study investigates whether core activation, which modifies lower extremity movement in young, active populations, can alter the gait and baseline core activation of those with knee osteoarthritis as compared to controls, and alter osteoarthritic knee pain. MethodsForty-four participants (22 controls and 22 with knee osteoarthritis) underwent biomechanical gait assessment, examining kinetic and kinematic variables, in addition to gait speed, with and without volitional transversus abdominis activation. Surface electromyography was used to measure baseline transversus abdominis activation under both conditions. Knee pain ratings were examined for those with knee osteoarthritis. FindingsNo significant biomechanical differences were observed within groups, or in the time/group interaction. Between-groups kinetic (time to first peak ground reaction force and amplitude of second peak ground reaction force) and gait speed differences were observed under both conditions. There were no differences in baseline electromyography activation between or within-groups, or within-group for self-reported pain for the osteoarthritic group. InterpretationAlthough previous studies have shown the benefit of core activation in correcting lower extremity movement patterns and kinetic loading in young, athletic populations, this study is the first to show this is not the case for persons with knee osteoarthritis. Future studies should examine the value of a progressive core stabilization program, of sufficient dose and mode, in correcting the observed gait differences in those with knee osteoarthritis.Clinical Trial Registration Number: NCT03776981

Pain Catastrophizing Is Related to Static Postural Control Impairment in Patients with Nonspecific Chronic Low Back Pain: A Cross-Sectional Study.

Purpose Pain catastrophizing may contribute to the altered trunk muscle activity in patients with nonspecific chronic low back pain (NSCLBP). It is unclear if pain catastrophizing influences static postural control in patients with NSCLBP. This study aimed to investigate the relationship between pain catastrophizing and static postural control in NSCLBP patients. Methods Sixty-eight participants with NSCLBP and 40 healthy participants were recruited. Postural control was assessed by the sway area and the sway length of the center of pressure (COP) during balance tests. Pain catastrophizing in participants with NSCLBP was assessed by the Pain Catastrophizing Scale (PCS). Bilateral transversus abdominis (TrA) activation was evaluated by ultrasound imaging-measured percent change in muscle thickness. Associations between COP parameter and PCS/subscales of PCS were examined by multiple linear regression (MLR). Results Our results observed a larger COP sway area in NSCLBP group under eyes-closed condition (p < 0.001) and a lower level of voluntary activation of the bilateral TrA (p < 0.001), compared with the healthy control group. The MLR analyses revealed that the COP area sway under eyes-closed condition was significantly associated with the PCS score/helplessness score of PCS, voluntary activation of the left TrA, and age in participants with NSCLBP (β = 0.222/0.236, 0.341/0.344, and 0.328/0.325; p=0.045/0.033, 0.002, and 0.004, resp.). Conclusions Static postural control was associated with pain catastrophizing, voluntary activation of TrA, and age in participants with NSCLBP. This indicated that pain catastrophizing may affect postural control and should be considered when interpreting balance test results and managing NSCLBP.

Effects of core stabilization exercises on thickness and activity of trunk and hip muscles in subjects with nonspecific chronic low back pain

BackgroundChanges in trunk and hip muscles are believed to be important in subjects with nonspecific chronic low back pain (NSCLBP), but little is known about specific changes, or how they might be affected by core stabilization exercises. The aim of this study was to compare six key muscles before and after these exercises. MethodsThirty two NSCLBP patients were assigned randomly into two groups: exercise (n = 17) and control (n = 15). On 5 days per week for 4 weeks, the Exercise group performed 16 core stabilization exercises and the Control group received transcutaneous electrical nerve stimulation and a ‘hot-pack’. Surface electromyography (EMG) was used to assess maximum bilateral activity of transversus abdominis (TrA), multifidus (MF) and gluteus maximus (Gmax) muscles. Ultrasound imaging was used to measure the rest and contracted thickness of these muscles. Pain and disability were assessed using a visual analogue scale (VAS) and the Oswestry Disability Index. ResultsWhen left and right-side muscle data were combined, two-way ANOVAs showed a nonsignificant interaction effect for all dependent variables (P > 0.05), significant time effects on resting muscle thickness for TrA (P = 0.01), MF (P = 0.041) and Gmax (P = 0.003), EMG signals of TrA (P = 0.038), pain and disability (P = 0.000). There were a significant group effect on contracted thickness for TrA (P = 0.032) and Gmax (P = 0.026) and disability (P = 0.017). ConclusionsCore stabilization exercises increased contracted thickness of TrA and Gmax muscles and decreased disability in subjects with NSCLBP.

Core Muscle Activity During Physical Fitness Exercises: A Systematic Review.

The aim of this study was to systematically review the current literature on the electromyographic (EMG) activity of six core muscles (the rectus abdominis, the internal and external oblique, the transversus abdominis, the lumbar multifidus, and the erector spinae) during core physical fitness exercises in healthy adults. A systematic review of the literature was conducted on the Cochrane, EBSCO, PubMed, Scopus, and Web of Science electronic databases for studies from January 2012 to March 2020. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. The inclusion criteria were as follows: (a) the full text available in English; (b) a cross-sectional or longitudinal (experimental or cohorts) study design; (c) the reporting of electromyographic activity as a percentage of maximum voluntary contraction (% MVIC), millivolts or microvolts; (d) an analysis of the rectus abdominis (RA), transversus abdominis (TA), lumbar multifidus (MUL), erector spinae (ES), and the internal (IO) or external oblique (EO); (e) an analysis of physical fitness exercises for core training; and (f) healthy adult participants. The main findings indicate that the greatest activity of the RA, EO, and ES muscles was found in free-weight exercises. The greatest IO activity was observed in core stability exercises, while traditional exercises showed the greatest MUL activation. However, a lack of research regarding TA activation during core physical fitness exercises was revealed, in addition to a lack of consistency between the studies when applying methods to measure EMG activity.

The effects of lumbar stabilization exercise on transversus abdominis muscle activation capacity and function in low back pain patients

OBJECTIVE: The main purpose of this study is to investigate the effects of lumbar stabilization exercises on pain intensity, transversus abdominis (TrA) activation capacity, functional disability, and TrA thickness in patients with low back pain (LBP). METHODS: The subjects of this study were 30 LB P patients. The experimental group performed diverse lumbar stabilization exercises (LSE) in different postures, and the control group conducted an ordinary trunk muscle strengthening exercise (TSE). All interventions were conducted 3 times per week for 6 weeks. RESULTS: Significant differences between LSE and TSE groups were shown in the pain intensity, TrA activation capacity, and functional disability after the intervention (p< 0.05). However, there were no significant differences between LSE and TSE groups in TrA thickness. CONCLUSION: This study provides clinical evidence that LSE for LBP patients is more effective than TSE in improving pain intensity, functional disability, and TrA activation capacity.

Evaluation of Postural Stability and Transverse Abdominal Muscle Activity in Overweight Post-Stroke Patients: A Prospective, Observational Study.

PurposePost-stroke hemiparesis has a significant impact on postural stability. The transversus abdominis (TrA) muscle contributes to the stability of the spine. The aim was to assess both the postural stability and the activity of the TrA muscle in overweight post-stroke patients.MethodsA group of 56 participants (61.12 ± 11.5 years) was divided into the study group (n=28 post-stroke patients, 63.7 ± 10.9 years) and control group (n= 23 healthy participants (58.5 ± 12.2 years). The Berg Balance Scale (BBS) and the Timed Up and Go Test (TUG) were used to evaluate postural stability and risk of falls. The Pressure Bio-Feedback Stabilizer (PBFS) device was used to assess functional stability.ResultsStroke had a significantly negative effect on the BBS (p < 0.001) and TUG (p = 0.001). The older age negatively affected the BBS (p = 0.001), TUG (p = 0.017), and the TrA muscle activity (p = 0.017). Higher values of body mass index (BMI) negatively affected the BBS (p = 0.028), however there were no changes of TUG results (p = 0.141), and the TrA muscle activity (p = 0.808). Also, BBS and TUG results were not associated with TrA muscle activity (p = 0.541 and p = 0.411, respectively). The results of the BBS, TUG, and PBFS did not differ according to gender (p < 0.05). Time from stroke negatively affected the TUG (p = 0.001), but had no effect on the TrA muscle activity (p < 0.05). The side of hemiparesis did not affect the postural stability (p < 0.05).ConclusionThe consequences of a stroke have an essential negative effect on postural stability. Factors such as age, gender, time from stroke, and the side of the hemiparesis have not negatively affected postural stability in overweight post-stroke patients.

ASSOCIATION OF RECRUITMENT AND ACTIVATION OF LUMBAR MULTIFIDUS AND TRANSVERSUS ABDOMINIS WITH LOW BACK PAIN IN PHYSIOTHERAPY STUDENTS; A CROSS SECTIONAL SURVEY

Background: Low back pain is one of the leading cause and commonly treated conditions among musculoskeletal disorders. Among medical professions physiotherapist demonstrate high prevalence of low back pain which is linked with the onset of LBP during undergrad study, therefore this study was conducted to evaluate LBP among undergrad physiotherapist Objective: To determine the association of recruitment and activation of lumbar multifidus and transversus abdominis with low back pain in physiotherapy students of Lahore, Pakistan. Methodology: In this cross sectional survey data of 102 undergraduate physical therapy students was collected through convenient sampling via questionnaire and physical assessment to identify the activation and recruitment of lumbar multifidus and transversus abdominis. Data was analyzed using SPSS version20. Results: No significant difference was noted between the left and right side of lumbar multifidus response in students with and without LBP. No significant difference was noted between the left and right side of transversus abdominus response in students with and without LBP. Conclusion: In this study low back pain was experienced by a large number of physiotherapy undergraduates. But no association was found between activation and recruitment of LM and TrA with low back pain.

Immediate changes in trunk muscle activation patterns during a lifting task following an abdominal drawing-in exercise in subjects with recurrent low back pain.

The abdominal drawing-in exercise could help improve delayed transversus abdominis (TrA) activation during limb movement in subjects with recurrent low back pain (rLBP). However, little is known about whether the same effect is observed during lifting tasks in subjects with rLBP. This study aimed to clarify whether a single session of abdominal drawing-in exercise could correct the altered trunk muscle activation patterns during a lifting task in subjects with rLBP. Fifteen subjects with rLBP performed lifting tasks before and immediately after three sets of 10 repetitions of isolated TrA voluntary contractions. The time of onset and activation amplitude during the lifting tasks were measured by surface electromyography (EMG) and compared between the trials before and immediately after exercise. During lifting, the onset of internal abdominal oblique/TrA (IO/TrA) and multifidus activation occurred earlier, the EMG amplitude of IO/TrA increased, and the EMG amplitude of erector spinae and multifidus decreased, compared with the pre-exercise data. These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP.

Exercise Program Reduces Inter-Recti Distance in Female Runners Up to 2 Years Postpartum

Background: Pregnancy and childbirth are associated with increased inter-recti distance (IRD)/diastasis recti abdominis (DRA), pelvic joint laxity, and decreased physical activity levels. Recreational running is an accessible, popular form of exercise that may challenge pelvic stability in postpartum women. Objectives: To assess the impact of an 8-week abdominal muscle retraining program on IRD and pelvic running mechanics in women up to 2 years postpartum. Study Design: Pre/posttest single-arm intervention study. Methods: Thirteen postpartum women (32.8 ± 2.7 years of age; 1-3 pregnancies; 7 weeks to 2 years postpartum) who were recreational runners participated. Ultrasound imaging measured IRD above and below the umbilicus. Thickness of the internal oblique (IO) and transversus abdominis (TrA) muscles was assessed with ultrasonography at rest and during performance of an abdominal draw-in maneuver. Participants underwent an 8-week abdominal muscle retraining program utilizing ultrasonography as biofeedback. Running gait was assessed with 3-dimensional motion capture at study enrollment (baseline), end of the intervention, and 6-week follow-up. Results: Inter-recti distance below the umbilicus decreased from baseline to end of intervention (P = .013) and remained stable at follow-up (P = .459). Inter-recti distance above the umbilicus, IO and TrA activation ratio, and running mechanics did not change (P > .05). Women reported increased running speed following the intervention (P = .021). Conclusion: An 8-week abdominal muscle retraining program reduced IRD below the umbilicus in recreational runners up to 2 years postpartum, suggesting therapeutic exercise may be part of conservative management for DRA.

Effects of real-time ultrasound as biofeedback on transversus abdominis activation level in patients with chronic low back pain

Objective To investigate the effects of abdominal drawing-in maneuver with real-time ultrasound biofeedback on transversus abdominis activation level during functional tasks in different positions in patients of chronic low back pain with stabilization-deficit. Methods Nineteen patients of chronic low back pain with stabilization-deficit were randomly divided into verbal instruction group(n=9) and ultrasound biofeedback group(n=10), and received abdominal drawing-in maneuver with verbal instruction and ultrasound biofeedback respectively. Percentage changes of transversus abdominis thickness during supine and upright loaded tasks were compared before and after intervention. Results After intervention, percentage changes of transversus abdominis thickness increased significantly in verbal instruction group during supinehip external rotation, straight leg raising and upright loaded functional tasks (P 0.05). Conclusions Ultrasound image could effectively assess the thickness changes of transversus abdominis in patients with chronic low back pain during supine and upright loaded functional tasks. Ultrasound image could provide chronic low back pain patients with real-time and dynamic visual feedback. However, compared with verbal instruction, adding real-time ultrasound biofeedback to abdominal drawing-in maneuver does not further increase the transversus abdominis activation level. Key words: Ultrasonography; Transversus abdominis activation; Chronic low back pain

The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain

The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain