Article

Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain.

The Journal of orthopaedic and sports physical therapy 11/2012; 43(1). DOI: 10.2519/jospt.2013.4450
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ABSTRACT STUDY DESIGN: Cross sectional, case-control study. OBJECTIVES: Measure and compare the resting thickness of the 4 abdominal wall muscles, their associated perimuscular connective tissue (PMCT), and inter-recti distance (IRD) in persons with and without lumbopelvic pain (LPP), using ultrasound imaging (USI). BACKGROUND: The muscles and PMCT of the abdominal wall assist in controlling the spine and functional deficits have been detected in LPP populations. Investigations of the abdominal wall in LPP are primarily concerned with muscle, most commonly the transversus abdominis (TrA) and internal oblique (IO). As the abdominal wall functions as a unit, it seems prudent that all 4 abdominal muscles and their associated connective tissues are considered concurrently. METHODS: B-mode USI was used to measure the resting thickness of the rectus abdominis (RA), external oblique (EO), IO, and TrA muscles, the PMCT planes, and IRD in 50 male and female subjects (25 with and 25 without LPP; mean±age 36.3±9.4 and 46.6±8.0 years, respectively). Univariate correlation analysis was used to identify covariates. Analyses of covariance and Kruskal-Wallis test (IRD) were used to compare cohorts (a=0.05). RESULTS: The LPP cohort had less total abdominal muscle thickness (LPP mean±age 18.9± 3.0 mm, Control 20.3 ± 3.0 mm; ANCOVA adjusted for body mass index [BMI], P=.03), thicker PMCT (LPP 5.5± 0.2 mm, Control 4.3 ± 0.2 mm; ANCOVA adjusted for BMI, P=.007), and wider IRD (LPP 11.5 ± 2.0 mm, Control 8.4 ± 1.8 mm; Kruskal-Wallis, P=.005). Analysis of individual muscle thickness revealed no difference in the EO, IO, and TrA, but a thinner RA (LPP 7.8 ± 1.5 mm, Control 9.1 ± 1.2 mm; ANCOVA adjusted for BMI, P<.001) in the LPP cohort. CONCLUSIONS: To our knowledge this is the first study to investigate the morphological characteristics of all 4 abdominal muscles and PMCT in individuals with LPP. The results suggest altered loading of the PMCT and linea alba, which may be secondary to an altered motor control strategy that involves a reduced contribution of the RA. Further, the change in RA and connective tissue morphology may be more evident than changes in EO, IO, and TrA thickness in persons with LPP. The causes and functional implications of these changes warrant further investigation, as does the role of the RA muscle in the development and persistence of LPP. J Orthop Sports Phys Ther, Epub 16 November 2012. doi:10.2519/jospt.2013.4450.

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    • "Therefore, the generalizability of the findings to younger, older and/ or male soccer populations may be questioned. With that said, the pattern of individual abdominal muscle contribution to overall abdominal muscle thickness observed in this investigation was consistent with previously reported values for older females (20e64 yrs) (Rankin, Stokes, & Newham, 2006; Teyhen, Childs, Stokes, Wright, Dugan, & George, 2012; Whittaker et al., 2013). "
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    Physical Therapy in Sport 11/2014; DOI:10.1016/j.ptsp.2014.10.007 · 1.37 Impact Factor
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    ABSTRACT: STUDY DESIGN: Validation study. OBJECTIVES: To investigate the association between changes in electromyographic (EMG) signal amplitude and sonographic measures of muscle thickness of 4 abdominal muscles, during 2 clinical tests, in adults with and without lumbopelvic pain (LPP). BACKGROUND: There is a trend in rehabilitation to use ultrasound imaging (USI) to determine the extent of abdominal muscle contraction. However the literature investigating the relationship between abdominal muscle thickness change and level of activation is inconclusive, and has not included clinically relevant tasks. METHODS: Simultaneous recording from fine-wire EMG and USI was performed for 4 abdominal muscles in 7 adults (mean ± SD age, 29.7±12.0 years) with and 7 adults (32.0±10.6 years) without LPP, during an active straight leg raise (ASLR) test and an abdominal drawing in manoeuvre (ADIM). Cross-correlation functions and linear regression analyses were used to describe the relationship between the 2 measures. Analyses of variance (ANOVA) were used to compare individuals with and without LPP, with a set at 0.05. RESULTS: Across all muscles, peak cross-correlation values were low (ASLR; r=0.28±0.09, ADIM; r=0.35±0.11) and there was large variability in associated time lags (ASLR; τ=0.69s±2.56s, ADIM; τ=0.53s±3.75s). Regression analyses did not detect a systematic pattern of association between EMG signal amplitude and RUSI measurements and ANOVAs revealed no differences between cohorts. CONCLUSION: These results suggest a weak relationship between EMG amplitude and abdominal muscle thickness change measured with USI during the ADIM and ASLR, and raises question about using thickness change derived from USI as a measure of muscular activity for the abdominal musculature.J Orthop Sports Phys Ther, Epub 30 April 2013. doi:10.2519/jospt.2013.4440.
    04/2013; 43(7). DOI:10.2519/jospt.2013.4440
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