Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain? A prospective study with 1-year follow-up
ABSTRACT To investigate associations between deep abdominal muscle activation and long-term pain outcome in chronic non-specific low back pain (LBP).
Recruitment of transversus abdominis and obliquus internus abdominis during the abdominal drawing-in manoeuvre was recorded by B-mode ultrasound and anticipatory onset of deep abdominal muscle activity with M-mode ultrasound. Recordings were done before and after 8 weeks with guided exercises for 109 patients with chronic non-specific LBP. Pain was assessed with a numeric rating scale (0-10) before and 1 year after intervention. Associations between muscle activation and long-term pain were examined by multiple linear and logistic regression methods.
Participants with a combination of low baseline lateral slide in transversus abdominis and increased slide after intervention had better odds for long-term clinically important pain reduction (≥2 points on the numeric rating scale) compared with participants with small baseline slide and no improvement in slide (OR 14.70, 95% CI 2.41 to 89.56). There were no associations between contraction thickness ratios in transversus abdominis or obliquus internus abdominis and pain at 1-year follow-up. Transversus abdominis lateral slide before intervention was marginally associated with a lower OR for clinically important improvement in pain at 1-year follow-up (OR 0.76, 95% CI 0.62 to 0.93). Delayed onset of the abdominal muscles after the intervention period was weakly associated with higher long-term pain.
Improved transversus abdominis lateral slide among participants with low baseline slide was associated with clinically important long-term pain reduction. High baseline slide and delayed onset of abdominal muscles after the intervention period were weakly associated with higher pain at 1-year follow-up. Clinical Trial Registration number The study was preregistered in ClinicalTrials.gov with identifier NCT00201513.
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ABSTRACT: Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment and temporal changes in clinical outcomes. Candidate publications were identified from six electronic databases. Fifteen articles were included after scrutinization by two reviewers using the predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging or M-mode ultrasound) were unrelated to temporal changes in LBP/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements while the relation between multifidus changes and clinical improvements remains uncertain. This systematic review highlighted that changes in morphometry or activation of transversus abdominis following conservative treatments tend not to be associated with the corresponding changes in clinical outcomes. The relation between post-treatment changes in characteristics of lumbar multifidus and clinical improvements remains uncertain.The journal of pain: official journal of the American Pain Society 10/2013; DOI:10.1016/j.jpain.2013.10.008 · 4.22 Impact Factor
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ABSTRACT: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. 29 studies were included: 22 studies (n = 2,258) provided post treatment effect on pain and 24 studies (n = 2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.BMC Musculoskeletal Disorders 12/2014; 15(1):416. DOI:10.1186/1471-2474-15-416 · 1.90 Impact Factor
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ABSTRACT: Study Design. A 2(group) x 2(abdominal contraction) x 2(reach activity) crossover mixed design with repeated measures for contraction and activity examined the effects of a loaded (4.6kg) forward-reach activity and Abdominal-Drawing-In-Maneuver (ADIM) on Transverse Abdominis (TrA) contraction in subjects with non-specific low back pain (NSLBP) history versus controls.Objectives. We measured TrA contraction during a loaded forward-reach activity while using the ADIM and examined if a NSLBP history affects TrA activity.Summary of Background Data. The ADIM supports trunk stability during function. Clinicians incorporate ADIM during patients' functional tasks. Pain-free individuals can sustain ADIM during function, such as forward-reach. However, this has not been tested in those with a NSLBP history.Methods. Eighteen normal and 18 NSLBP-history subjects participated. A blinded investigator recorded M-mode ultrasound imaging (MUSI) measurements of TrA thickness (mm) during 4 conditions: (1) Quiet standing without ADIM; (2) Quiet standing with ADIM; (3) Loaded forward-reach without ADIM; and (4) Loaded forward-reach with ADIM.Results. A mixed ANOVA demonstrated a significant main effect for group [F(1, 34) = 5.404, p = 0.026; Figure 2], where TrA thickness was greater for NSLBP history (7.41 + 2.34mm) versus controls (5.9 + 2.46mm). A significant main effect was observed for abdominal contraction [F (1, 34) = 49.57, p < 0.0001; Figure 3], where TrA thickness was greater during ADIM (7.47 + 2.7mm) versus without ADIM (5.84, 1.92m). A significant main effect was observed for forward-reach activity [F (1, 34) = 12.79, p = 0.001; Figure 4], where TrA thickness was greater during a loaded forward-reach (7.04+ 2.6mm) versus quiet standing (6.2 + 2.4mm). There were no significant interactions.Conclusions. Individuals can use a volitional preemptive ADIM for trunk protection during loaded forward-reach, potentially reducing injury risk. A NSLBP history increases TrA activation during ADIM, suggesting an enhanced protective role.Spine 01/2014; 2(39):E89–E96. DOI:10.1097/BRS.0000000000000091 · 2.45 Impact Factor