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A comparative study between core stabilization and superficial strengthening exercises for the treatment of low back pain in two wheeler riders
Abstract
Low back Pain (LBP) is a major musculoskeletal problem affecting the two wheeler riders. Various factors have been implicated, including lack of/uncomfortable lumbar support, the long time spent in one position, poor conditions of the road and exposure to whole body vibration (WBV). In addition to these extrinsic factors, alteration in neuromuscular control of core stabilizers and/or poor strength of the superficial muscles has also been considered to predispose an individual to LBP. Thus, present study compared the effectiveness of core stabilization v/s superficial strengthening on pain, health outcome and Transversus abdominis (TrA) activation capacity in two wheeler riders with LBP. 52 subjects were randomly allocated to either of two groups. Exercises were done after 6 weeks, 4 times in a week, each session lasting 30 minutes. Results revealed that both exercise protocols are equally effective in reducing pain and improving health outcome. However, core stabilization exercises were more effective in improving TrA activation capacity.
... The consistent utilization of motorbikes drives the drivers inclined to musculoskeletal problems like spine injury, lower back agony and plate disengagement [47]. Stress and exhaustion has a significant commitment to the reason for motorbike mishaps in non-industrial nations because of a few reasons including business related and financial conditions [48]. Driving related Musculoskeletal Disorders (DMSD) happens because of ill-advised stance, stress and rehashed body developments during driving. ...
Road transport is a critical fountain of both wellbeing and ecological concerns. As more remote correspondence, diversion and driver help frameworks multiply the vehicle market, the rate of interruption related accidents is relied upon to heighten. In any case, there is a real concern in regards with the impacts of such gadgets on street wellbeing – both according to the perspective of progress in driving styles, just as potential interruption brought about by the in-vehicle criticism. This paper gives an audit of momentum research on in vehicle driver pose and a few workstation specifically, given that this gadget has gotten the best consideration in the writing. The point of this exploration is to give a thought regarding viewpoint perspective on different vehicle and a similar report on their drivers. Various versatile vehicle we find in our everyday life. The examination showed an outline of normal vehicle driver's issues and ergonomic ramifications on driving. This examination gives a topical perspective on vehicle drivers wellbeing plan combination and a few writing audit underlined the issues and intriguing proposals
... A detailed summary of each included study (n=89) 23 77 87 96 103 108 112 116 119 120 122 135 140 McKenzie (studies: n=7, patients: n=114), 40 47 76 94 97 111 120 multimodal (studies: n=23, patients: n=756), 23- 25 32 38 40 45 50 75 82 88 91 99 102 109 114 118 124 129 131 134 137 138 Pilates (studies: n=13, patients: n=350), 23 27 29 30 33 34 51 86 94 105 111 131 139 resistance (studies: n=12, patients: n=472), 43 78 79 81 90 92 93 100 101 127 130 134 stabilisation/motor control (studies: n=39, patients: n=1062), 25 28 38 43 49 50 75 76 79-82 84 85 89-91 95-98 103-106 108-110 115 118 122-125 128 129 134 136 140 stretching (studies: n=8, patients: n=222), 31 37 89 107 117 121 126 136 water-based (studies: n=6, patients: n=144) 37 41 45 88 120 137 and yoga (studies: n=6, patients: n=387). 35 46 114 126 132 133 Non-exercise training interventions included: true control (studies: n=33, patients: n=733), 27 28 31 34 35 37 41 49 77 78 80 86 87 93-95 100 104 105 108 110-112 115-117 120 121 125 135 138-140 therapist hands-on control (studies: n=14, patients: n=506) 25 30 47 83 85 92 98 99 101 106 113 123 128 130 and therapist hands-off control (studies: n=12, patients: n=415). ...
Objective
Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP).
Design
Network meta-analysis (NMA).
Data sources
MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL.
Eligibility criteria
Exercise training randomised controlled/clinical trials in adults with NSCLBP.
Results
Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): −1.86 (–2.54 to –1.19)), resistance (SUCRA=80%; −1.14 (–1.71 to –0.56)) and stabilisation/motor control (SUCRA=80%; −1.13 (–1.53 to –0.74)) for physical function and resistance (SUCRA=80%; −1.26 (–2.10 to –0.41)) and aerobic (SUCRA=80%; −1.18 (–2.20 to –0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (–0.71 to 0.89)) and physical function (SUCRA=20%; −0.31 (–0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; −0.31 (–1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria.
Summary/conclusion
There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.
... shown to affect the ride quality in two-wheelers (Dutta et al., 2014). Continuous and prolonged use of two wheelers may lead to musculoskeletal disorders (MSDs) due to continuous exposure to whole body vibration (WBV) (Palekar et al., 2015). Since WBV has been shown to affect the biomechanical response of the rider (Li et al., 2015), the ride quality of a two-wheeler needs to be given due attention. ...
... shown to affect the ride quality in two-wheelers (Dutta et al., 2014). Continuous and prolonged use of two wheelers may lead to musculoskeletal disorders (MSDs) due to continuous exposure to whole body vibration (WBV) (Palekar et al., 2015). Since WBV has been shown to affect the biomechanical response of the rider (Li et al., 2015), the ride quality of a two-wheeler needs to be given due attention. ...
Ride discomfort apart from various other factors is caused due to whole body vibration (WBV) while driving, where road profiles act as a major source of WBV exposure to a vehicle rider. The present study develops a 6DOF lumped mass parameter model of two-wheeler coupled with rider in state space form. The model is simulated in LabVIEW12.0 under the excitation of generated random road profiles, classified as per ISO 8608:2016. The model was validated for a two-wheeler named ‘HERO SPLENDOR PRO’ on three types of road profiles i.e. good, average and poor at a vehicle speed of 20 km/h. Assessment of discomfort in simulation model, according to ISO 2631-1:1997, was done for 85 kg rider on good road profile at 40 km/h vehicle speed and the ride was found uncomfortable. ANOVA test showed that there were significant effects of road profile, vehicle speed, seat stiffness and seat damping on ride discomfort.
... Similarly the perceptions regarding 'risk' and 'safety' is also variable. Prolonged awkward posture assumed during bike riding results in driving related musculoskeletal disorders (DMSDs), low back pain (LBP) and spinal injury [2][3][4][5]. Psychological pressures like fulfilling deadlines, immense work targets, and achieving excessive incentives are also detrimental. Additionally, survey has been conducted to find out the factors influencing consumer buying behaviour of bike among Indian youths [6]. ...
BACKGROUND: Motorbikes are a cost effective and fuel efficient mode of transport but at the same time they account for huge number of Road Traffic Accidents (RTA). Bike riders are exposed to postural, psychosocial stress which may lead to accidents. OBJECTIVES: Objectives of the study are to: (1) quantify postural and psychosocial stress which may be contributory factors to accident and injury; (2) record the magnitude of aggression, sensation level and risky behaviour to employ behaviour based safety (BBS). METHODS: Healthy male motor bike riders (n= 150) were randomly taken to identify consumer purchase behaviour, assess postural stress, perceived pain and exertion. Perception of riders with respect to their safety was recorded. Magnitude of aggression, sensation and risky behaviour were also recorded among bike riders (n= 35). RESULTS: Result showed drivers experienced pain in low back (84%), thigh (82.67%), hand (81.33%), neck (68.67%) and shoulder (63.33%). Riders (62.67%) perceived the exertion as 'hard and heavy', 24.67% as 'very hard' and 12.67% as 'somewhat hard'. Majority of the riders preferred looks and style, neglecting physiological comfort and safety. Magnitude of aggression, sensation and risky behaviour among bike riders were notably high. CONCLUSIONS: Quantification of these stressors is essential to implement engineering revision and behaviour based safety.
To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain.
Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%.
As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively.
Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.
Stressors in the family and job environments have been proposed to play a role in the modulation of pain, yet direct empirical support for such a role is limited. The present study investigated the relationship between general stress, family and work environments (perceived social climate), psychological distress (anxiety, depression), and pain experience (sensory, affective, evaluative) in 33 ambulatory chronic low back pain (CLBP) subjects and 35 healthy controls matched for age, sex, socioeconomic status (SES), weight, and height. Results indicated that environmental stressors/social climate measures, including family conflict, family control, and general stress (Social Readjustment Rating Scale), were greater in the CLBP group. Distress measures were also higher in the CLBP group. Characteristics of the family and work environments were found to be more predictive of the affective and evaluative dimensions of pain. Increased family conflict was associated with increased distress and increased pain, while increased family independence was correlated with less distress and increased pain. Less peer cohesion, less physical comfort, and less job clarity were correlated with increased pain, but not distress. Work pressure was associated with decreased depression and less pain. These findings suggested the presence of both stress and operant mechanisms in the modulation of pain in the family, while operant and distraction mechanisms appear to characterize the relationship among work environment factors and pain.
Many studies have identified changes in trunk muscle recruitment in clinical low back pain (LBP). However, due to the heterogeneity of the LBP population these changes have been variable and it has been impossible to identify a cause-effect relationship. Several studies have identified a consistent change in the feedforward postural response of transversus abdominis (TrA), the deepest abdominal muscle, in association with arm movements in chronic LBP. This study aimed to determine whether the feedforward recruitment of the trunk muscles in a postural task could be altered by acute experimentally induced LBP. Electromyographic (EMG) recordings of the abdominal and paraspinal muscles were made during arm movements in a control trial, following the injection of isotonic (non-painful) and hypertonic (painful) saline into the longissimus muscle at L4, and during a 1-h follow-up. Movements included rapid arm flexion in response to a light and repetitive arm flexion-extension. Temporal and spatial EMG parameters were measured. The onset and amplitude of EMG of most muscles was changed in a variable manner during the period of experimentally induced pain. However, across movement trials and subjects the activation of TrA was consistently reduced in amplitude or delayed. Analyses in the time and frequency domain were used to confirm these findings. The results suggest that acute experimentally induced pain may affect feedforward postural activity of the trunk muscles. Although the response was variable, pain produced differential changes in the motor control of the trunk muscles, with consistent impairment of TrA activity.
Randomized controlled trial among patients with low back pain (LBP).
(1) Determine the reliability of real-time ultrasound imaging for assessing activation of the lateral abdominal muscles; (2) characterize the extent to which the abdominal drawing-in maneuver (ADIM) results in preferential activation of the transverse abdominis (TrA); and (3) determine if ultrasound biofeedback improves short-term performance of the ADIM in patients with LBP.
Ultrasound imaging is reportedly useful for measuring and training patients to preferentially activate the TrA muscle. However, research to support these claims is limited.
Thirty patients with LBP referred for lumbar stabilization training were randomized to receive either traditional training (n = 15) or traditional training with biofeedback (n = 15). Ultrasound imaging was used to measure changes in thickness of the lateral abdominal muscles. Differences in preferential changes in muscle thickness of the TrA between groups and across time were assessed using analysis of variance.
Intrarater reliability measuring lateral abdominal muscle thickness exceeded 0.93. On average, patients in both groups demonstrated a 2-fold increase in the thickness of the TrA during the ADIM. Performance of the ADIM did not differ between the groups.
These data provide construct validity for the notion that the ADIM results in preferential activation of the TrA in patients with LBP. Although, the addition of biofeedback did not enhance the ability to perform the ADIM at a short-term follow-up, our data suggest a possible ceiling effect or an insufficient training stimulus. Further research is necessary to determine if there is a subgroup of patients with LBP who may benefit from biofeedback.
Study Design: The contribution of transversus abdominis to spinal stabilization was evaluated indirectly in people with and without low back pain using an experimental model identifying the coordination of trunk muscles in response to a disturbance to the spine produced by arm movement. Objectives: To evaluate the temporal sequence of trunk muscle activity associated with arm movement, and to determine if dysfunction of this parameter was present in patients with low back pain. Summary of Background Data: Few studies have evaluated the motor control of trunk muscles or the potential for dysfunction of this system in patients with low back pain. Evaluation of the response of trunk muscles to limb movement provides a suitable model to evaluate this system. Recent evidence indicates that this evaluation should include transversus abdominis. Methods: While standing, 15 patients with low back pain and 15 matched control subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal muscles, lumbar multifidus, and the contralateral deltoid was evaluated using fine‐wire and surface electrodes. Results: Movement in each direction resulted in contraction of trunk muscles before or shortly after the deltoid in control subjects. The transversus abdominis was invariably the first muscle active and was not influenced by movement direction, supporting the hypothesized role of this muscle in spinal stiffness generation. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles. Conclusions: The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.
SummaryPressure biofeedback is a tool designed to facilitate muscle re-education by detecting movement of the lumbar spine associated with a deep abdominal contraction in relation to an air-filled reservoir. Pressure biofeedback readings of an abdominal ‘drawing-in' manoeuvre, designed to recruit the deep abdominal muscles, were taken from 45 patients. They were classified into three groups: lumbar symptomatic, non-symptomatic, and those who had previously had lumbar symptoms that had now resolved. Subjects were taught an abdominal drawing-in manoeuvre and the mean of three readings using the prone test was calculated. Comparison between groups using an unrelated ANOVA demonstrated a statistically significant difference between the lumbar symptomatic and non-symptomatic groups at the p < 0.05 level.The findings of this study provide evidence to support previous research, which indicates that a difference exists in the deep abdominal function of patients with and without low back pain. Additionally it is suggested that the pressure biofeedback unit may be considered as a useful tool to act as an indicator of deep abdominal function.
Objectives Although motor control exercises have been shown to be effective in the management of low back pain (LBP) the mechanism of action is unclear. The current study investigated the relationship between the ability to recruit transversus abdominis and clinical outcomes of participants in a clinical trial.
Methods Ultrasonography was used to assess the ability to recruit transversus abdominis in a nested design: a sample of 34 participants with chronic LBP was recruited from participants in a randomised controlled trial comparing the efficacy of motor control exercise, general exercise and spinal manipulative therapy. Perceived recovery, function, disability and pain were also assessed.
Results Participants with chronic LBP receiving motor control exercise had a greater improvement in recruitment of transversus abdominis (7.8%) than participants receiving general exercise (4.9% reduction) or spinal manipulative therapy (3.7% reduction). The effect of motor control exercise on pain reduction was greater in participants who had a poor ability to recruit transversus abdominis at baseline. There was a significant, moderate correlation between improved recruitment of transversus abdominis and a reduction in disability (r = −0.35; 95% CI 0.02 to 0.62).
Conclusion These data provide some support for the hypothesised mechanism of action of motor control exercise and suggest that the treatment may be more effective in those with a poor ability to recruit transversus abdominis.
Reviews the literature related to myogenic back pain and EMG assessment and treatment. There is evidence to support a number of patterns of muscular involvement in back pain. It has been proposed that back pain may result from a pain-spasm-pain cycle related to both splinting or protective posturing associated with physical damage and psychological and environmental stress. In addition, it has been proposed that back pain may be due to a biomechanical process secondary to aberrant patterns of neuromuscular activity. There is electrophysiological evidence that suggests that some cases of back pain are related to elevated paraspinal EMG levels and some are associated with faulty muscular/biomechanical process. Thus, there appears to be a variety of myogenic etiologies to back pain, just as there are numerous structural and neurological etiologies. The anatomy and neuromuscular physiology of the back, EMG assessment data, and EMG biofeedback treatment data are reviewed. It is suggested that an assessment of general autonomic arousal in back pain patients may be beneficial in (1) identifying patients who could benefit from more general stress-management programs and (2) providing a database for this etiological position. (82 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study examined the role of self-efficacy expectancies as outcome predictors for chronic pain patients. Post-treatment self-efficacy and concern ratings were observed to significantly correlate with medication use, exercise levels and work status at follow-up. Efficacy and concern ratings, however, failed to consistently account for a significant amount of the variance at follow-up when regression analysis was employed. Follow-up work status was predicted by concern ratings, pre-treatment pain levels and Scale 3 of the MMPI. Follow-up medication use was predicted by scores on the Beck Depression Inventory.
The association of self-efficacy expectancies with pain tolerance on the cold pressor test was examined during treatment conditions of setting quotas alone and in conjunction with monetary reinforcement and placebos in 64 college volunteers. It was found that quota setting was an effective means of increasing cold pressor pain tolerance. The addition of monetary reinforcement of quota achievement did not enhance performance, while the addition of a placebo decreased the effectiveness of quota setting. Self-efficacy expectancies were significantly correlated with pain tolerance times and were better predictors of tolerance than pain ratings. Self-efficacy expectancies and pain tolerance times at treatment were both found to predict 1 week follow-up performance.
Reduced activity levels are a frequently encountered problem among chronic pain patients which has been shown to be responsive to exercise quota systems. This study extends the knowledge of exercise quota systems by examining their effects on beliefs relevant to exercise avoidance. Results indicate that exercise quota systems produce systematic increases in both exercise levels and expectancies of capability while reducing worry and concern about exercising. These data highlight the importance of avoidance learning in chronic pain and suggest that the effectiveness of exercise quota systems is related to a deconditioning process based on exposure rather than the process of applying reinforcement to quota achievement.
Our cultural sedentariness, recently acquired, lies at the base of much human ill-being. Physical inactivity predictably leads to deterioration of many body functions. A number of these effects coexist so frequently in our society that they merit inclusion in a specific syndrome, the disuse syndrome. The identifying characteristics of the syndrome are cardiovascular vulnerability, obesity, musculoskeletal fragility, depression and premature aging. The syndrome is experimentally reproducible and, significantly, the clinical features are subject to both preventive and restitutive efforts that happily are cheap, safe, accessible and effective.
The purpose of this study was to determine whether or not surgical floor mats affect low back and leg muscle activity during prolonged standing. The EMG activity was measured continuously using surface electrodes on the paraspinal muscles of the low back and on the anterior tibialis muscles; the subjects were normal and stood on two different surfaces. Six male subjects were each instructed to stand for two hours on a specially designed surgical floor mat and then, on a separate day, to stand for two hours on a linoleum-covered concrete surface. Six other subjects carried out the same procedure, but stood on the linoleum first. There was no difference in EMG activity obtained from the anterior tibialis muscles and paraspinal muscles of the low back when the subjects stood on the surgical mat, as compared with the linoleum-covered concrete.
A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain and unilateral, segmental inhibition of the multifidus muscle. Patients were allocated randomly to a control or treatment group.
To document the natural course of lumber multifidus recovery and to evaluate the effectiveness of specific, localized, exercise therapy on muscle recovery.
Acute low back pain usually resolves spontaneously, but the recurrence rate is high. Inhibition of multifidus occurs with acute, first-episode, low back pain, and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms.
Patients in group 1 received medical treatment only. Patients in group 2 received medical treatment and specific, localized, exercise therapy. Outcome measures for both groups included 4 weekly assessments of pain, disability, range of motion, and size of the multifidus cross-sectional area. Independent examiners were blinded to group allocation. Patients were reassessed at a 10-week follow-up examination.
Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1. Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy (P = 0.0001). Other outcome measurements were similar for the two groups at the 4-week examination. Although they resumed normal levels of activity, patients in group 1 still had decreased multifidus muscle size at the 10-week follow-up examination.
Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.
A very specific type of exercise has been devised which is proving to provide effective pain relief for chronic and recurrent back pain sufferers. The exercise approach focuses on retraining a precise co-contraction pattern of the deep trunk muscles, the transversus abdominis and lumbar multifidus. The approach is based on the knowledge of how muscles provide stability for the spine in normal situations. It has been further developed according to research evidence which has demonstrated dysfunction in the deep trunk muscles in patients with back pain. The mechanism for pain relief with this specific exercise approach is believed to be through enhanced stability of the lumbar spine segments.
An operator blinded dual modality trial of measurement of the abdominal muscles during "drawing-in" of the abdominal wall.
1) To investigate, using magnetic resonance imaging (MRI), the function of the transversus abdominis muscle bilaterally during a drawing-in of the abdominal wall. 2) To validate the use of real-time ultrasound imaging as a measure of the deep abdominal muscle during a drawing-in of the abdominal wall.
Previous research has implicated the deep abdominal muscle, transversus abdominis, in the support and protection of the spine and provided evidence that training this muscle is important in the rehabilitation of low back pain. One of the most important actions of the transversus abdominis is to "draw-in" the abdominal wall, and this action has been shown to stiffen the sacroiliac joints. It is hypothesized that in response to a draw in, the transversus abdominis muscle forms a deep musculofascial "corset" and that MRI could be used to view this corset and verify its mechanism of action on the lumbopelvic region.
Thirteen healthy asymptomatic male elite cricket players aged 21.3 +/- 2.1 years were imaged using MRI and ultrasound imaging as they drew in their abdominal walls. Measurements of the thickness of the transversus abdominis and internal oblique muscles and the slide of the anterior abdominal fascia were measured using both MRI and ultrasound. Measurement of the whole abdominal cross-sectional area (CSA) was conducted using MRI.
Results of the MRI demonstrated that, as a result of draw-in, there was a significant increase in thickness of the transversus abdominis (P < 0.001) and the internal oblique muscles (P < 0.001). There was a significant decrease in the CSA of the trunk (P < 0.001). The mean slide (+/-SD) of the anterior abdominal fascia was 1.54 +/- 0.38 cm for the left side and 1.48 +/- 0.35 cm for the right side. Ultrasound measurements of muscle thickness of both transversus abdominis and the internal oblique, as well as fascial slide, correlated with measures obtained using MRI (interclass correlations from 0.78 to 0.95).
The MRI results demonstrated that during a drawing-in action, the transversus abdominis contracts bilaterally to form a musculofascial band that appears to tighten (like a corset) and most likely improves the stabilization of the lumbopelvic region. Real-time ultrasound imaging can also be used to measure changes in the transversus abdominis during the draw-in maneuver.
A systematic review of randomized controlled trials.
To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work.
MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment.
Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long-term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain.
For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions.
Intervertebral discs are exposed to compressive forces, which produces fluid loss. This loss decreases disc height, spinal length and consequently overall stature. The loss of stature has been associated with spine loading and low back pain. Abdominal exercises increase intra-abdominal pressure and unload the spine. The purpose of this study was to identify if abdominal exercises may produce acute spinal unloading compared to a known unloading position.
Nine subjects performed a loading protocol and an unloading protocol on three experimental sessions. The loading protocol consisted of three sets of military press, while three unloading protocols were: three sets of regular abdominal exercises, three sets of abdominal exercises performed in an inclined board or an unloading resting posture.
Abdominal exercises showed a greater recovery (mean (SD)) (regular=87.8 (20.4)%; inclined=70.1 (14.5)%) in comparison to the resting position (Fowler=33.6 (14.1)%), although no significant differences were found between abdominal exercises in stature recovery (P=0.07).
Abdominal exercises may be introduced between sets of resistance training to decrease the negative effect of compressive forces imposed during such highly stressing activities. Further studies are required to confirm the proposed underlying mechanisms.