Abstract
An important aspect of neuromuscular control at the lumbo-pelvic region is stabilization. Subjects with low back pain (LBP) have been shown to exhibit impairments in motor control of key muscles which contribute to stabilization of the lumbo-pelvic region. However, a test of automatic recruitment that relates to function has been lacking. A previous study used ultrasound imaging to show that healthy subjects automatically recruited the transversus abdominis (TrA) and internal oblique (IO) muscles in response to a simulated weight-bearing task. This task has not been investigated in subjects with LBP. The aim of this study was to compare the automatic recruitment of the abdominal muscles among subjects with and without LBP in response to the simulated weight-bearing task. Twenty subjects with and without LBP were tested. Real-time ultrasound imaging was used to assess changes in thickness of the TrA and internal oblique IO muscles as well as lateral movement (“slide”) of the anterior fascial insertion of the TrA muscle. Results showed that subjects with LBP showed significantly less shortening of the TrA muscle (P < 0.0001) and greater increases in thickness of the IO muscle (P = 0.002) with the simulated weight-bearing task. There was no significant difference between groups for changes in TrA muscle thickness (P = 0.055). This study provides evidence of changes in motor control of the abdominal muscles in subjects with LBP. This test may provide a functionally relevant and non-invasive method to investigate the automatic recruitment of the abdominal muscles in people with and without LBP.
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Baecke JA, Burema J, Frijters JE (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36(5):936–942
Bergmark A (1989) Stability of the lumbar spine—a study in mechanical engineering. Acta Orthop Scand 60(230):3–54
Bunce SM, Hough AD, Moore AP (2004) Measurement of abdominal muscle thickness using M-mode ultrasound imaging during functional activities. Man Ther 9(1):41–44
Ferreira PH, Ferreira ML, Hodges PW (2004) Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine 29(22):2560–2566
Gardner-Morse MG, Stokes IA (1998) The effects of abdominal muscle coactivation on lumbar spine stability. Spine 23(1):86–91 discussion 91–82
Geisser ME, Ranavaya M, Haig AJ et al (2005) A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. J Pain 6(11):711–726
Goldby LJ, Moore AP, Doust J et al (2006) A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine 31(10):1083–1093
Healey EL, Fowler NE, Burden AM et al (2005) The influence of different unloading positions upon stature recovery and paraspinal muscle activity. Clin Biomech 20(4):365–371
Healey EL, Fowler NE, Burden AM et al (2005) Raised paraspinal muscle activity reduces rate of stature recovery after loaded exercise in individuals with chronic low back pain. Arch Phys Med Rehabil 86(4):710–715
Henry SM, Westervelt KC (2005) The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. J Orthop Sports Phys Ther 35(6):338–345
Hides J, Wilson S, Stanton W et al (2006) An MRI investigation into the function of the transversus abdominis muscle during “drawing-in” of the abdominal wall. Spine 31(6):E175–E178
Hides JA, Richardson CA, Hodges PW (2004) Local segmental control. In: Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. Churchill Livingstone, New York, pp 185–220
Hides JA, Richardson CA, Jull GA (1996) Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 21(23):2763–2769
Hides JA, Scott Q, Jull G et al. (2000) A clinical palpation test to check the activation of the deep stabilising muscles of the spine. Int Sportmed J 1(4)
Hides JA, Stokes MJ, Saide M et al (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 19(2):165–172
Hides JA, Wong I, Wilson SJ et al (2007) Assessment of abdominal muscle function during a simulated unilateral weight-bearing task using ultrasound imaging. J Orthop Sports Phys Ther 37(8):467–471
Hodges P, Holm AK, Holm S et al (2003) Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: in vivo porcine studies. Spine 28(23):2594–2601
Hodges PW, Eriksson AE, Shirley D et al (2005) Intra-abdominal pressure increases stiffness of the lumbar spine. J Biomech 38(9):1873–1880
Hodges PW, Gurfinkel VS, Brumagne S et al (2002) Coexistence of stability and mobility in postural control: evidence from postural compensation for respiration. Exp Brain Res 144(3):293–302
Hodges PW, Kaigle A, Hansson T et al (2006) Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine 31(25):2926–2933
Hodges PW, Moseley GL (2003) Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol 13(4):361–370
Hodges PW, Moseley GL, Gabrielsson A et al (2003) Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res 151(2):262–271
Hodges PW, Pengel LH, Herbert RD et al (2003) Measurement of muscle contraction with ultrasound imaging. Muscle Nerve 27(6):682–692
Hodges PW, Richardson CA (1998) Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord 11(1):46–56
Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain—a motor control evaluation of transversus abdominis. Spine 21(22):2640–2650
Kidd AW, Magee S, Richardson CA (2002) Reliability of real-time ultrasound for the assessment of transversus abdominis function. J Gravit Physiol 9(1):131–132
Kiefer A, Shirazi-Adl A, Parnianpour M (1998) Synergy of the human spine in neutral postures. Eur Spine J 7(6):471–479
Lariviere C, Gagnon D, Loisel P (2000) The comparison of trunk muscles EMG activation between subjects with and without chronic low back pain during flexion–extension and lateral bending tasks. J Electromyogr Kinesiol 10(2):79–91
McMeeken JM, Beith ID, Newham DJ et al (2004) The relationship between EMG and change in thickness of transversus abdominis. Clin Biomech 19(4):337–342
Misuri G, Colagrande S, Gorini M et al (1997) In vivo ultrasound assessment of respiratory function of abdominal muscles in normal subjects. Eur Respir J 10(12):2861–2867
Moseley GL (2004) Impaired trunk muscle function in sub-acute neck pain: etiologic in the subsequent development of low back pain? Man Ther 9(3):157–163
Ng JK-F, Richardson CA, Parnianpour M et al (2002) EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. J Orthop Res 20(1):112–121
O’Sullivan PB, Phyty GD, Twomey LT et al (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22(24):2959–2967
Pinheiro JC, Bates DM (2000) Mixed-effects models in S and S-PLUS. Springer, Berlin
Putz RL, Müller-Gerbl M (1996) The vertebral column—a phylogenetic failure? A theory explaining the function and vulnerability of the human spine. Clin Anat 9(3):205–212
Richardson CA, Jull GA (1995) An historical perspective on the development of clinical techniques to evaluate and treat the active stabilizing system of the lumbar spine. Aust J Physiother Monogr 1:5–13
Silfies SP, Squillante D, Maurer P et al (2005) Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin Biomech 20(5):465–473
Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs. 1. Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech 8(6):285–294
Snijders CJ, Vleeming A, Stoeckart R et al (1995) Biomechanical modeling of sacroiliac joint stability in different postures. Spine State Art Rev 9:419–432
Springer BA, Mielcarek BJ, Nesfield TK et al (2006) Relationships among lateral abdominal muscles, gender, body mass index, and hand dominance. J Orthop Sports Phys Ther 36(5):289–297
Stuge B, Veierod MB, Laerum E et al (2004) The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial. Spine 29(10):E197–E203
Teyhen DS, Miltenberger CE, Deiters HM et al (2005) The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J Orthop Sports Phys Ther 35(6):346–355
van Dieen JH, Cholewicki J, Radebold A (2003) Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine 28(8):834–841
Wilke HJ, Wolf S, Claes LE et al (1995) Stability increase of the lumbar spine with different muscle groups—a biomechanical in-vitro study. Spine 20(2):192–198
Acknowledgments
The authors thank Ms Linda Blackwell, Director of Physiotherapy, Mater Health Services, South Brisbane, Australia, for provision of laboratory space and her support. The Medical Research Ethics Committees of the University of Queensland and the Mater Hospital Ethical Committee (Brisbane, Australia) granted approval for this study.
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Hides, J.A., Belavý, D.L., Cassar, L. et al. Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain. Eur Spine J 18, 410–418 (2009). https://doi.org/10.1007/s00586-008-0827-2
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DOI: https://doi.org/10.1007/s00586-008-0827-2