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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

Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter (MTFS), 7489 Trondheim, Norway.
British Journal of Sports Medicine (Impact Factor: 5.03). 07/2011; 46(10):729-34. DOI: 10.1136/bjsm.2011.085506
Source: PubMed

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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Available from: Ottar Vasseljen, Aug 27, 2015
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    • "Activation of transversus abdominis (TrA), the innermost abdominal muscle, may serve as a biomarker of reduced motor control connected to LBP and is suggested to be central in the control of intervertebral movement (Hodges, 2011). Motor control of deep abdominal muscles can be improved after specific exercises (Tsao and Hodges, 2008; Hides et al., 2010), and although the results have been mixed (Vasseljen and Fladmark, 2010; Vasseljen et al., 2012), improved activation of TrA has been related to reduced LBP (Ferreira et al., 2010; Unsgaard-Tøndel et al., 2012). Delayed activation of TrA and/or obliquus internus abdominis (OI) has been observed during the threat of experimentally induced LBP (Moseley et al., 2004; Moseley and Hodges, 2005), and reduced activation of TrA onset has been observed during experimentally induced acute LBP (Hodges et al., 2003). "
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