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Interday Reliability and Precision of Lumbar Multifidus and Transversus Abdominis Thickness Change During Dynamic Activities

Authors:

Abstract

Lumbar Multifidus (LM) and Transversus Abdominis (TrA) contribute to the maintenance of spinal stability and often demonstrate altered/inhibited recruitment in the presence of low back pain. Recently a novel mode of exercise (EX), characterised by an unstable cyclical base of support has been proposed to provide an appropriate challenge to spinal stability and actively recruit this musculature for the purposes of improving function/rehabilitation. PURPOSE: The purpose of this study was to establish the interday reliability of thickness change measurements of LM and TrA during EX and a similarly demanding dynamic task of treadmill walking [TW] using freehand rehabilitative ultrasound imaging (RUSI). METHODS: Fifteen male (n=9) and female (n=6) participants (1.74 ± 0.07 m; 74.2 ± 11.5 kg; 28.1 ± 6.9 years) visited the laboratory on three separate occasions within a one week period. During each visit measurements of LM and TrA thickness were collected in triplicate using freehand RUSI during both EX and TW and expressed as a percentage thickness change relative to resting values (%TC). Overall reliability was assessed using two-way random effects intraclass correlation coefficients (ICC2,3) across all three visits. Standard error of measurement (SEM) and minimal detectable change (MDC) were also calculated between days 1-2 (D1-D2) and 2-3 (D2-D3). RESULTS: Overall ICC for %TC for LM during TW and EX was 0.84 and 0.84 respectively. Correspondingly, %TC SEM (and MDC) between D1-2 for LM during TW and EX was 6.4% (17.7%) and 6.4% (17.7%) respectively. Thickness change SEM (and MDC) between D2-D3 for LM during TW and EX was 5.1% (14.0%) and 5.3% (14.8%) respectively. Overall TrA %TC for TrA during TW and EX was 0.79 and 0.88 respectively. Correspondingly, %TC SEM (and MDC) between D1-2 for TrA during TW and EX was 10.1% (28.1%) and 7.4% (20.4%) respectively. Thickness change SEM (and MDC) between D2-D3 for TrA during TW and EX was 8.7% (24.2%) and 3.6% (9.9%) respectively. CONCLUSION: Typically, relative thickness change ICC values for LM and TrA are in excess of 0.75, indicating good interday reliability using freehand RUSI during both TW and EX conditions. SEM and associated MDC are also within magnitudes of change previously reported to correspond with improvements in clinical functioning.
Figure 2. Thickness change (%TC) of the lumbar multifidus (a) and transversus abdominis (b)
during treadmill walking (TW) and dynamically unstable exercise (EX) across days one (black
bars), two (white bars) and three (grey bars). Error bars denote intraday SEM.
Table 1. Interday reliability and precision of linear muscle thickness change (normalised to resting
thickness) for each assessed conditions for each of the three visits
The LM and TrA of 15 healthy adults (nine males; six females) were
assessed by ultrasound imaging during treadmill walking (TW) and
dynamically unstable exercise (EX) across three days, separated by 72
hours in a random order test-retest design.
Ultrasound images were taken in triplicate by a single operator (KG) with
a digital ultrasound imager and 60mm curvilinear transducer at 5 MHz in
B-mode during each condition. Thickness change was expressed relative
to a resting measurement (%TC). For resting LM participants lay in a
prone position with pillows placed under the abdomen to reduce the
lumbar/sacral junction to less than 10°. For resting TrA measurement
participants lay in a supine position with their hips and knees flexed to 50
and 90° respectively.
Images of LM (Figure 1a) were captured with the transducer head placed
longitudinally along the spine, lateral of the L4 spinous process and
orientated medially to identify the L4/5 zygapophyseal joint [9]. TrA
(Figure 1b) images were captured with the transducer head placed
transversely on the antero-lateral abdominal wall superior to the iliac
crest along the longitudinal midaxilary line with the muscle belly centred
on-screen and the aponeurosis clearly visible [9].
Figure 1. Exemplar ultrasound images of the lumbar multifidus (a) and transversus abdominis (b)
captured during an EX trial.
Interday reliability was assessed using two-way random effects intraclass
correlation coefficients of %TC using the mean of three consecutive
measurements (ICC2,3), where %TC was given as:
Standard error of measurement (SEM) and minimum detectable change
(MDC) were also calculated as
and
Interday Reliability and Precision of Lumbar Multifidus and Transversus Abdominis
Thickness Change During Dynamic Activities
Karl Gibbon1,2, Dr Dorothee Debuse2, Dr Angela Hibbs2, Dr Nick Caplan2
1Buckinghamshire New University, Human Performance, Exercise and Wellbeing Centre, High Wycombe, UK.
2Northumbria University, Department of Sport, Exercise and Rehabilitation, Newcastle upon Tyne, UK
Lumbar Multifidus (LM) and Transversus Abdominis (TrA) contribute to the maintenance of spinal stability
and often demonstrate altered/inhibited recruitment in the presence of low back pain. Recently a novel
mode of exercise (EX), characterised by an unstable cyclical base of support has been proposed to provide
an appropriate challenge to spinal stability and actively recruit this musculature for the purposes of
improving function/rehabilitation. PURPOSE: The purpose of this study was to establish the interday
reliability of thickness change measurements of LM and TrA during EX and a similarly demanding dynamic
task of treadmill walking [TW] using freehand rehabilitative ultrasound imaging (RUSI). METHODS: Fifteen
male (n=9) and female (n=6) participants (1.74 ± 0.07 m; 74.2 ± 11.5 kg; 28.1 ± 6.9 years) visited the
laboratory on three separate occasions within a one week period. During each visit measurements of LM
and TrA thickness were collected in triplicate using freehand RUSI during both EX and TW and expressed
as a percentage thickness change relative to resting values (%TC). Overall reliability was assessed using
two-way random effects intraclass correlation coefficients (ICC2,3) across all three visits. Standard error of
measurement (SEM) and minimal detectable change (MDC) were also calculated between days 1-2 (D1-
D2) and 2-3 (D2-D3). RESULTS: Overall ICC for %TC for LM during TW and EX was 0.84 and 0.84
respectively. Correspondingly, %TC SEM (and MDC) between D1-2 for LM during TW and EX was 6.4%
(17.7%) and 6.4% (17.7%) respectively. Thickness change SEM (and MDC) between D2-D3 for LM during
TW and EX was 5.1% (14.0%) and 5.3% (14.8%) respectively. Overall TrA %TC for TrA during TW and EX
was 0.79 and 0.88 respectively. Correspondingly, %TC SEM (and MDC) between D1-2 for TrA during TW
and EX was 10.1% (28.1%) and 7.4% (20.4%) respectively. Thickness change SEM (and MDC) between
D2-D3 for TrA during TW and EX was 8.7% (24.2%) and 3.6% (9.9%) respectively. CONCLUSION:
Typically, relative thickness change ICC values for LM and TrA are in excess of 0.75, indicating good
interday reliability using freehand RUSI during both TW and EX conditions. SEM and associated MDC are
also within magnitudes of change previously reported to correspond with improvements in clinical
functioning.
Abstract
Introduction
METHOD RESULTS
Devoid of musculature, the passive elements of the thoracolumbar and
lumbar spine, will experience structural failure under compressive
loadings of a significantly lower magnitude [1] than those experienced in
vivo [2]. Thus the human vertebral column is intrinsically incapable of
meeting the typical demands placed upon it without additional
stabilisation at a segmental level [3].
The lumbar multifidus (LM) and transversus abdominis (TrA) are
considered key contributors to this stabilisation due to their anatomical
positioning, morphology and functioning [4]. Additionally, asymmetry,
shape variances, and atrophy [5,6] of LM, as well as temporally deferred
[7] and attenuated activation [8] of TrA have been reported in some
individuals with low back pain (LBP).
Recently, a new exercise modality has been shown to automatically
recruit the local stabilising musculature of the lumbar spine, specifically
the LM and TrA [9]. This modality (EX) is analogous to an elliptical trainer,
where the feet move in anti-phase through a quasi-elliptical path,
although the device offers no peripheral resistance [10].
Numerous studies have examined various aspects of reliability and the
assessment of LM and TrA using ultrasound imaging [11]. Although, only
one study has examined the reliability and precision of RUSI during a
truly dynamic activity [12]. Here, the authors investigated the reliability
and precision in the assessment of TrA thickness changes during
treadmill walking (TW).
The purpose of the current study was to examine the interday reliability
and precision of measurement of ultrasound thickness change of the LM
and TrA during TW and EX.
TW EX
0
10
20
30
40
50
%TC
ICC2,3  Bias(95CI)±95%LOA  SEM(%) MDC(%)
Conditio
nAll D1-
D2
D2-
D3 D1-D2 D2-D3 D1-
D2
D2-
D3 D1-
D2
D2-
D3
LM
TW 0.84 0.85 0.82 -3.2 (-9.8-3.4) ± 23.3 -9.0 (-17.0--0.7) ±
29.5 6.4 5.1 17.7 14.
0
EX 0.84 0.78 0.79 10.6 (4.2--7.2) ±
22.8 -0.2 (-7.7-7.2) ± 26.2 6.4 5.3 17.7 14.
8
TrA
TW 0.79 0.74 0.77 -8.4 (-19-1.6) ± 35.7 3.2 (-4.5-10.8) ±
27.1 10.1 8.7 28.1 24.
2
EX 0.88 0.81 0.93 -3.1 (-11.0-4.4) ±
26.5 7.5 (2.4-13) ± 18.2 7.4 3.6 20.4 9.9
Abbreviations:ICC,intraclasscorrelationcoefficient;CI,confidenceinterval;LOA,limitsofagreement;SEM,
standarderrorofmeasurement;MDC,minimumdetectablechange;D1-3,Day1-3;TW,treadmillwalking;EX,
dynamicallyunstableexercise
TW EX
0
10
20
30
40
50
60
%TC
a. b.
a.
b.
Summary&Conclusion
The key findings of this study were that LM and TrA typically
demonstrated good (ICC 0.75) to excellent (ICC 0.9) intrarater
reliability for interday measurements of %TC across both conditions. One
further observation was that of consistent reductions between days one-
two and two-three in both standard error of measurement (range [6.4-
10.1 % vs. 3.6-8.7 %], respectively) and minimum detectable change
(range [17.7-28.1 % vs. 9.9-24.2 %], respectively).
References
1. CRISCO, J. J., PANJABI, M. M., YAMAMOTO, I. & OXLAND, T. R. 1992. Euler Stability of the Human Ligamentous Lumbar Spine Part II: Experiment. Clinical Biomechanics, 7, 27-32..
2. CHOLEWICKI, J., MCGILL, S. M. & NORMAN, R. W. 1991. Lumbar spine loads during the lifting of extremely heavy weights. Medicine and Science in Sports and Exercise, 23, 1179-86
3. PANJABI, M., ABUMI, K., DURANCEAU, J. & OXLAND, T. 1989. Spinal stability and intersegmental muscle forces. A biomechanical model. Spine, 14, 194-200
4. STOKES, I. A., GARDNER-MORSE, M. G. & HENRY, S. M. 2011. Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clinical Biomechanics, 26,
797-803.
5. HIDES, J. A., STOKES, M. J., SAIDE, M., JULL, G. A. & COOPER, D. H. 1994. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine, 19,
165-72.
6. KADER, D. F., WARDLAW, D. & SMITH, F. W. 2000. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clinical Radiology, 55, 145-9
7. HODGES, P. W. & RICHARDSON, C. A. 1998. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. Journal of Spinal Disorders, 11, 46-56
8. FERREIRA, P. H., FERREIRA, M. L. & HODGES, P. W. 2004. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine, 29, 2560-6.
9. DEBUSE, D., BIRCH, O., ST CLAIR GIBSON, A. & CAPLAN, N. 2013. Low impact weight-bearing exercise in an upright posture increases the activation of two key local muscles of the pumbo-pelvic region.
Physiotherapy Theory and Practice, 29, 51-60.
10. GIBBON, K., DEBUSE, D. & CAPLAN, N. 2013. Low impact weight-bearing exercise in an upright posture achieves greater lumbopelvic stability than overground walking. Journal of Bodywork and Movement
Therapies, 17, 462-468.
11. HEBERT, J. J., KOPPENHAVER, S. L., PARENT, E. C. & FRITZ, J. M. 2009. A Systematic Review of the Reliability of Rehabilitative Ultrasound Imaging for the Quantitative Assessment of the Abdominal and
Lumbar Trunk Muscles. Spine, 34, E848-E856.
12. BUNCE, S. M., MOORE, A. P. & HOUGH, A. D. 2002. M-mode ultrasound: a reliable measure of transversus abdominis thickness? Clinical Biomechanics, 17, 315-7.
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