Comparison of the recruitment of transverse abdominis through drawing-in and bracing in different core stability training positions

Learning Transversus Abdominis Activation in Older Adults with Chronic Low Back Pain Using an Ultrasound-Based Wearable: A Randomized Controlled Pilot Study

Background/Objectives: Chronic low back pain (CLBP) is prevalent among older adults and leads to significant functional limitations and reduced quality of life. Segmental stabilization exercises (SSEs) are commonly used to treat CLBP, but the selective activation of deep abdominal muscles during these exercises can be challenging for patients. To support muscle activation, physiotherapists use biofeedback methods such as palpation and ultrasound imaging. This randomized controlled pilot study aimed to compare the effectiveness of these two biofeedback techniques in older adults with CLBP. Methods: A total of 24 participants aged 65 years or older with CLBP were randomly assigned to one of two groups: one group performed self-palpation biofeedback, while the other group used real-time ultrasound imaging to visualize abdominal muscle activation. Muscle activation and thickness were continuously tracked using a semi-automated algorithm. The preferential activation ratio (PAR) was calculated to measure muscle activation, and statistical comparisons between groups were made using ANOVA. Results: Both groups achieved positive PAR values during all repetitions of the abdominal-draw-in maneuver (ADIM) and abdominal bracing (AB). Statistical analysis revealed no significant differences between the groups in terms of PAR during ADIM (F(2, 42) = 0.548, p = 0.58, partial η2 = 0.025) or AB (F(2, 36) = 0.812, p = 0.45, partial η2 = 0.043). Both groups reported high levels of exercise enjoyment and low task load. Conclusions: In conclusion, both palpation and ultrasound biofeedback appear to be effective for guiding older adults with CLBP during SSE. Larger studies are needed to confirm these results and examine the long-term effectiveness of these biofeedback methods.

Evaluation of the thickness of the transverse muscles of the abdomen and the internal oblique muscles using ultrasound imaging in women with back pain

INTRODUCTION

It has been estimated that chronic low back pain (LBP) affects 18% of young people, and 28-42% of people in middle age, with women being more affected than men. Chronic LBP can arise from a variety of factors, among which are biomechanical changes in core muscles, such as in their thickness, which can impair spinal stability.

OBJECTIVE

To analyze the thickness of the transversus abdominis (TrA) and internal oblique (IO) and muscles on the right side in different postures.

METHODS

Sedentary women with a normal Body Mass Index were recruited. Participants with a history of chronic LBP comprised the LBP Group, and individuals without LBP, the control group. The young women underwent analysis of the thickness of the abdominal muscles using ultrasound imaging. ANOVA was used to compare changes in muscle thickness in the three positions.

RESULTS

There was no significant difference between the groups in the supine and sitting position for the TrA and IO muscles. In the sitting position with the left lower limb raised, a significant difference was observed for TrA (p = 0.0013) among groups.

CONCLUSIONS

The LBP group showed a decrease in the TrA thickness in the sitting position with the lower limb raised, when compared to the control group, indicating failure in muscle activation in this group. These findings suggest that as stability decreases, TrA thickness increases in women without LBP. Finally, in women who report having LBP, TrA recruitment is not efficient for unstable postures.

The effects of lumbar stabilization exercises with and without jaw movements in non-specific low back pain (A randomized controlled trial)

Objective

This study aimed to investigate the added effect of jaw clenching on the efficacy of lumbar stabilization exercises to manage chronic non-specific low back pain.

Methods

This randomized controlled trial was conducted at the Sindh Institute of Physical Medicine and Rehabilitation (SIPM&R) Karachi from April 2021 to April 2023. Eighty patients with chronic non-specific low back pain participated in this study. Forty patients each were randomly allocated to the lumbar stability exercise (LSE) group' and the lumbar stability exercise with teeth clenching (LSETC) group. Patients in both groups performed respective exercises twice weekly for 12 weeks. The Numeric Pain Rating Scale (NPRS), Roland Morris Disability Questionnaire (RMDQ), and Pressure Biofeedback Unit (PBU) were used to assess pain, disability, and muscle endurance respectively. Data were collected at the baseline, after six weeks and 12 weeks of intervention. A p-value of <0.05 was considered statistically significant.

Results

Both groups showed statistically significant improvements in pain, disability, and muscle endurance. Upon further stratification, participants aged 20-30 years in the LSETC group showed significantly higher scores than the LSE group for NPRS, RMDQ, and PBU after 12 weeks. Overall, the LSETC group showed relatively higher improvement in mean scores for NPRS, RMDQ, and PBU than the LSE group.

Conclusion

Lumbar stabilization exercises with and without jaw movement are effective for the treatment of chronic non-specific low back pain. The addition of teeth clenching enhanced the effectiveness of lumbar stability exercises, especially in young adults. Trial Registration: Clinicaltrials.gov (NCT04801212), Prospectively registered on March 16, 2021.

A Comparison between Core Stability Exercises and Muscle Thickness Using Two Different Activation Maneuvers

Core stability training is crucial for competitive athletes, individuals who want to improve their health and physical performance, and those undergoing clinical rehabilitation. This study compared the ultrasound (US) muscle thickness of the abdominals and lumbar multifidus (LM) muscles between seven popular trunk stability exercises performed using hollowing and bracing maneuvers. Forty-four healthy young adults, aged between 21 and 32 years, performed a plank, bird dog, beast crawl, dead bug, Pilates tap, bridge, and side planks using the bracing and the hollowing maneuver. The thickness of the transversus abdominis (TrA), internal oblique (IO), and LM muscles was measured simultaneously using two ultrasound machines. Analysis of variance designs indicated that during hollowing, the bird dog and side plank exercises resulted in the greatest increase in the muscle's relative thickness overall. The relative thickness of all muscles was significantly greater (p < 0.001) during hollowing (22.7 ± 7.80 to 106 ± 24.5% of rest) compared to bracing (18.7 ± 7.40 to 87.1 ± 20.9% of rest). The TrA showed the greatest increase in thickness (p < 0.001) compared to the IO and LM. Additionally, the IO had a greater increase in thickness (p < 0.001) than the LM. In conclusion, our findings indicate that the bird dog and side plank exercises, when performed with hollowing, showed the most significant total muscle thickness increase. Notably, the hollowing maneuver enhances the thickness of the TrA, IO, and LM muscles more than the bracing maneuver. This contributes to the discussion on optimal strategies for dynamic core stabilization.

Effects of Pilates Exercises on Core Stability After Recovery from COVID-19: A Randomized Controlled Trial

Purpose

The primary objective was to investigate the effects of Pilates exercises on CS, and the secondary objective was to assess static trunk balance after recovery from COVID-19.

Patients and Methods

145 recovered COVID-19 university students between the ages of 19 and 25 participated in this single-blinded, randomized controlled trial study. The participants were divided into a Pilates group and a control group, each of which received a home exercise program. Core muscle endurance was measured using the five basic endurance tests and static balance using the Prokin system with open eyes (OE) and closed eyes (CE) at baseline and after three months of treatment.

Results

All measured parameters showed improvement within the groups after treatment. Group comparison revealed a significant increase in the Pilates group in all core endurance tests (P<0.001). The Prokin system results showed improvement in the Pilates group after treatment, while perimeter with OE, CE, and ellipse area with EC decreased (P<0.001), but there was no significant difference in ellipse with OE between the groups.

Conclusion

Pilates exercises positively improved core muscle endurance and trunk balance in people infected with COVID-19, which will be reflected in their quality of movement patterns and quality of life.

The effectiveness of core stabilization exercise using ultrasound biofeedback on motor function, balance control, gait speed and activities of daily living in stroke patients

BACKGROUND

Patients with hemiparetic stroke experience diminished motor function, dynamic balance, and gait speed, which influence their activities of daily living (ADL).

OBJECTIVE

This study aimed to determine the therapeutic effects of ultrasound biofeedback core exercise (UBCE) on Fugl-Meyer assessment (FMA), Time up and go (TUG), 10-meter walking test (10MWT) and functional independent measure (FIM) in participants with stroke.

METHODS

Twenty-four stroke survivors consistently underwent UBCE or abdominal draw-in maneuver (ADIM) for 30 min/session, 3 days a week for 4 weeks. Clinical outcome measurements - the FMA, TUG, 10MWT, and FIM - were observed pre-and post-intervention.

RESULTS

We detected significant changes in the FMA-lower extremities, TUG, 10MWT, and FIM scores between the UBCE and ADIM groups. UBCE and ADIM showed significant improvements in FMA-lower extremities, TUG, 10MWT, and FIM scores. However, UBCE showed more favorable results than ADIM in patients with stroke.

CONCLUSIONS

Our research provides novel therapeutic suggestion of neurorehabilitation in stroke patients.

Effect of adding abdominal bracing to spinal stabilization exercise on lumbar lordosis angle, extensor strength, pain, and function in patients with non-specific chronic low back pain: A prospective randomized pilot study

TRIAL DESIGN

This study investigated the effect of adding abdominal bracing to spinal stability exercise in patients with chronic low back pain (CLBP). This prospective, randomized pilot study included 67 patients and was conducted at the sports medicine center of a single hospital.

METHODS

The abdominal bracing group (ABBG) underwent spinal stability exercise with abdominal bracing (N = 33), comprising 50 minutes training twice a week for 24 weeks. The control group performed only spinal stability exercise (N = 34) for 50 minutes twice a week for 24 weeks. The ABBG received abdominal bracing training at each session and applied abdominal bracing during the spinal stability exercise. The lumbar lordosis angle (LLA) and spine extensor muscle strength were measured. Spinal flexion angles were measured every 12° from 0° to 72°. The visual analog scale score and Oswestry disability index were measured before treatment and at 12 and 24 weeks after treatment.

RESULTS

The LLA increased over time in both the groups but was not significantly different between the groups. Spine extensor strength was improved over time in both the groups, and an interactive effect was observed at a spinal flexion angle of 60° and 72°. Pain and function were also improved over time in both the groups, but the effect was stronger in the ABBG than in the control group. In patients with CLBP, spinal stability exercise changed the LLA.

CONCLUSIONS

Although adding abdominal bracing to spinal stability exercise did not affect the changes in the LLA, abdominal bracing improved the spinal extensor strength, pain, and function in patients with CLBP. Therefore, it is recommended to add abdominal bracing to spinal stability exercise to maintain the lordosis angle and to improve CLBP symptoms.

Effect of Bridge Exercise Duration on Lateral Abdominal Muscle Thickness and Gluteus Maximus Activation

CONTEXT

Bridge exercises are extensively used in trunk-strengthening programs. The aim of this study was to investigate the effect of bridging duration on lateral abdominal muscle thickness and gluteus maximus activation.

DESIGN

Cross-sectional.

METHODS

Twenty-five young males participated in this study. Transversus abdominal (TrA), external and internal oblique ultrasound thickness, gluteus maximus electromyographic activation, and sacral tilt angle were simultaneously measured for every second during 30-second bridging exercise. The contraction thickness ratio and root mean squared signal (normalized to maximum isometric contraction signal) during 6 exercise durations (from 0 to 5, 10, 15, 20, 25, and 30 s) were also calculated and compared using analysis of variance designs.

RESULTS

TrA and internal oblique contraction thickness ratio and gluteus maximus root mean squared increased during the first 8 to 10 seconds and remained elevated until the end of the 30-second exercise (P < .05). External oblique contraction thickness ratio declined during exercise (P < .05). Five-second bridging showed less TrA thickness and anteroposterior and mediolateral sacral tilt angle and a lower anteroposterior tilt variability compared with bridges, which lasted more than 10 seconds (P < .05).

CONCLUSIONS

Bridge exercises longer than 10 seconds may be better for promoting TrA recruitment than bridges of shorter duration. Clinicians and exercise specialists could adjust the duration of bridge exercise based on the aims of the exercise program.

Spinal Muscle Thickness and Activation during Abdominal Hollowing and Bracing in CrossFit® Athletes

Exercises that improve muscle activation are essential for maintaining spinal stability and preventing low back pain. The purpose of this study was to compare the effects of abdominal hollowing and bracing on the activation of the core muscles in CrossFit® participants using ultrasound and electromyography (EMG). Twenty-four healthy adults aged 21 to 42 years old with at least two years of CrossFit® experience performed three core stability exercises (plank, side plank, bridge) with abdominal hollowing and bracing. We measured the ultrasound relative thickness of the local core muscles (transversus abdominis, internal oblique, and lumbar multifidus), and the EMG percentage of maximal voluntary contraction (MVC) of the global core muscles (rectus abdominis, external oblique, and iliocostalis lumborum). Analysis of variance tests showed that the relative thickness of the local core muscles was greater (p = 0.016) during hollowing (range from 26.8 ± 5.33 to 88.4 ± 11.9% of rest) than bracing (range from 15.9 ± 3.54 to 61.2 ± 15.9% of rest), while the EMG of the global muscles was greater (p = 0.001) in bracing (range from 24.4 ± 7.30 to 72.5 ± 9.17% of MVC) than hollowing (range from 16.4 ± 3.70 to 56.6 ± 7.65% of MVC). These results indicate that the recruitment of spinal muscles during popular exercises is achieved with both hollowing and bracing. Nevertheless, it appears that hollowing tends to recruit more of the local muscles, whilst bracing recruits more of the global muscles. The grading of the exercises varied between muscles and varied between maneuvers, especially for the surface abdominals and lumbar muscles. CrossFit® practitioners can choose to use either hollowing or bracing to activate their core muscles more selectively or more appropriately, depending on the goal and purpose of the exercise.

Transversus Abdominis Ultrasound Thickness during Popular Trunk-Pilates Exercises in Young and Middle-Aged Women

The transversus abdominis (TrA) is a core muscle that contributes to functional mobility and lumbar stability. This study aimed to compare the changes in TrA thickness during different Pilates exercises, and to identify the exercise that elicited the greatest TrA activation. Forty-four healthy women were divided into two groups: young (25-35 years old) and middle-aged (36-55 years old). TrA thickness was assessed by ultrasound while the participants performed five Pilates exercises: basic position, hundred, hip roll, side plank, and dead bug. A repeated measures analysis of variance revealed that the dead bug exercise induced a significantly higher increase in TrA thickness (relative to rest) than the other exercises (p < 0.05). The young group also showed a significantly higher overall TrA thickness than the middle-aged group (p < 0.05). The findings suggest that the dead bug exercise is the most effective for enhancing TrA activation among the Pilates exercises tested. The basic position and the hundred exercises can be used as warm-up exercises before performing more challenging exercises such as the hip roll, the side plank, and the dead bug. The sequence of exercises can be similar for both young and middle-aged women.

The Effect of Volitional Preemptive Abdominal Contraction on Biomechanical Measures During A Front Versus Back Loaded Barbell Squat

Background

Weightlifting is growing in popularity among recreational and competitive athletes. The barbell back squat (BackS) is commonly included in these training programs, while the barbell front squat (FrontS) is commonly performed as a component of other lifts such as the power clean or clean and jerk, it is less commonly practiced in isolation.

Hypothesis/Purpose

The purpose of this study was to examine the effects of VPAC performance on trunk muscle and LE biomechanical responses during loaded BackS versus FrontS in healthy subjects.

Study Design

Controlled Laboratory Study.

Methods

Healthy male subjects with the ability to perform a sub-maximal loaded barbell squat lift were recruited. Subjects completed informed consent, demographic/medical history questionnaires and an instructional video. Subjects practiced VPAC and received feedback. Surface electromyography (sEMG) electrodes and kinematic markers were applied. Muscles included were the internal oblique (IO), external oblique (EO), rectus abdominis, iliocostalis lumborum (ICL), superficial multifidi, rectus femoris, vastus lateralis, biceps femoris, and gluteus maximus. Maximal voluntary isometric contractions established reference sEMG values. A squat one-rep-max (1RM) was predicted by researchers using a three to five repetition maximum (3RM, 5RM) load protocol. Subjects performed BackS trials at 75% 1RM while FrontS trials were performed at 75% BackS weight, both with and without VPAC. Subjects performed three repetitions of each condition with feet positioned on two adjacent force plates. Significant interactions and main effects were tested using a 2(VPAC strategy) x 2(squat variation) and 2(VPAC strategy) x 2(direction) within-subject repeated measures ANOVAs. Tukey's Post-Hoc tests identified the location of significant differences.

Results

Trunk muscle activity was significantly higher during FrontS versus BackS regardless of VPAC condition. (IO: p=0.018, EO: p<0.001, ICL: p<0.001) VPAC increased performance time for both squat variations (p=.0011), which may be associated with decreased detrimental force potential on the lumbar spine and knees. VPAC led to improved ability to maintain a neutral lumbar spine during both squat variations. This finding is associated with decreased detrimental force potential on the lumbar spine.

Conclusions

Findings could help guide practitioners and coaches to choose squat variations and incorporate VPAC strategies during their treatments and/or training programs.

Level of Evidence

Level 3©The Author(s).

Activation of Anterolateral Abdominal Muscles During Sling Bridge Exercises: Comparison of Different Pelvic Positions

CONTEXT

Inappropriate activation of the anterolateral abdominal muscles affects the stability of the lumbopelvic zone and increases the appearance of pain and lesion in the area. Therefore, ways to improve its effective contraction are crucial in rehabilitation. The aim of this study was to compare the activation of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles in 3 different pelvic positions (down pelvis [DP], horizontal pelvis [HP], and up pelvis [UP]) during sling bridge exercise (SBE) to determinate which position is more effective to promote a correct contraction of the anterolateral abdominal muscles.

DESIGN

Cross-sectional study.

METHODS

Fifteen participants performed 3 variations (DP, HP, and UP) of a one-legged exercise called "supine pelvic lift" on a sling device. The thicknesses of the TrA, IO, and EO were recorded at rest and at the 3 positions using ultrasound imaging. Thickness, change ratio, lateral slide of TrA, and preferential and contraction activation ratio of TrA, IO, and EO were analyzed.

RESULTS

TrA and IO showed greater activation (P = .01) in the UP position than the other pelvic positions. In addition, UP position decreased the activation of the EO (P = .01).

CONCLUSION

Based on the results of this study, SBE in the UP position has the potential to improve normal contraction patterns of the musculature and can be used in future intervention of the lumbopelvic zone.

Comparison of core stabilization techniques on ultrasound imaging of the diaphragm, and core muscle thickness and external abdominal oblique muscle electromyography activity

BACKGROUND

To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another.

OBJECTIVE

The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude.

METHODS

Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P< 0.05.

RESULTS

Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P< 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS.

CONCLUSIONS

DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.

Validation and comparison of trunk muscle activities in male participants during exercise using an innovative device and abdominal bracing maneuvers

BACKGROUND

Abdominal bracing is effective in strengthening the trunk muscles; however, assessing performance can be challenging. We created a device for performing abdominal trunk muscle exercises. The effectiveness of this device has not yet been evaluated or comparedOBJECTIVE: We aimed to quantify muscle activity levels during exercise using our innovative device and to compare them with muscle activation during abdominal bracing maneuvers.

METHODS

This study included 10 men who performed abdominal bracing exercises and exercises using our device. We measured surface electromyogram (EMG) activities of the rectus abdominis (RA), external oblique, internal oblique (IO), and erector spinae (ES) muscles in each of the exercises. The EMG data were normalized to those recorded during maximal voluntary contraction (%EMGmax).

RESULTS

During the bracing exercise, the %EMGmax of IO was significantly higher than that of RA and ES (p< 0.05), whereas during the exercises using the device, the %EMGmax of IO was significantly higher than that of ES (p< 0.05). No significant difference was observed in the %EMGmax of any muscle between bracing exercises and the exercises using the device (p= 0.13-0.95).

CONCLUSIONS

The use of our innovative device results in comparable activation to that observed during abdominal bracing.

DIFFERENTIAL EFFECTS OF THE ABDOMINAL DRAW-IN MANEUVER IN DIFFERENT POSITIONS ON MUSCLE THICKNESS AND BALANCE RATIO IN NONSYMPTOMATIC ADULTS

Core stability mediated by the abdominal draw-in maneuver (ADIM) has been proven to be an important component of neuromuscular motor control before movement. However, no previous research has investigated which position is best for performing ADIM to achieve optimal core stability. This study aimed to define the effectiveness of performing ADIM in three different positions (prone, supine, and hook lying) on abdominal muscle thickness in nonsymptomatic participants. In total, 30 nonsymptomatic participants (mean age: [Formula: see text] years) were randomly assigned to a trial sequence using the random sequence method. The clinical outcomes were transverse abdominis (TrA), external oblique (EO), and internal oblique (IO) muscle thicknesses, which were evaluated using ultrasonography (US) and muscle thickness balance ratio. One-way repeated-measures analysis of variance (ANOVA) was used to evaluate the US data to determine if the resulting TrA, IO, and EO muscle thicknesses from the three different positions were statistically significant. Bonferroni correction was used as a post hoc test if statistical significance was found. The [Formula: see text] value was set to 0.013. One-way ANOVA showed a significant difference in the thickness of the TrA, IO, and EO muscles resulting from the different positions ([Formula: see text]). Post hoc analysis using Bonferroni correction revealed that the prone position resulted in greater changes than the supine and hook-lying positions ([Formula: see text], respectively). ANOVA did not show a significant change in the TrA, IO, and EO muscle thickness balance ratios ([Formula: see text], 0.44, and 0.59, respectively). The results provide innovative clinical evidence that performing ADIM in different positions (prone, supine, and hook lying) has different effects on abdominal muscle thickness in nonsymptomatic participants.

Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain

Low back pain is a common and important cause of disability. Chronic pain increases disability and cost. In this review, we discuss pharmacological and non-pharmacological treatment approaches for chronic low back pain in the light of current data and guidelines.

Comparison of the effects of the Feldenkrais method versus core stability exercise in the management of chronic low back pain: a randomised control trial

OBJECTIVE

To investigate the effect of the Feldenkrais method versus core stability exercises on pain, disability, quality of life and interoceptive awareness in patients with chronic non-specific low back pain.

DESIGN

A single-blinded, randomised, controlled trial.

SETTING

Outpatient, sports medicine clinic of Mazandaran medical university.

PARTICIPANTS

Sixty patients with chronic non-specific low back pain randomised equally into the Feldenkrais method versus core stability exercises groups.

INTERVENTION

Intervention group received Feldenkrais method consisting of training theoretical content and supervised exercise therapy two sessions per week for five weeks. Control group received educational programme and home-based core stability exercises for five weeks.

OUTCOME MEASURES

All patients were examined by World Health Organization's Quality of life Questionnaire, McGill Pain Questionnaire, Oswestry Disability Questionnaire and Multidimensional Assessment of Interoceptive Awareness Questionnaire. All outcomes were measured at baseline and the end of the intervention.

RESULTS

There were statistically significant differences between groups for quality of life (P = 0.006, from 45.51 to 60.49), interoceptive awareness (P > 0.001, from 2.74 to 4.06) and disability (P = 0.021, from 27.17 to 14.5) in favour of the Feldenkrais method. McGill pain score significantly decreased in both the Feldenkrais (from 15.33 to 3.63) and control groups (from 13.17 to 4.17), but there were no between-groups differences (P = 0.16).

CONCLUSION

Feldenkrais method intervention gave increased benefits in improving quality of life, improving interoceptive awareness and reducing disability index.

A Randomized Controlled Trial Investigating the Effects of Equine Simulator Riding on Low Back Pain, Morphological Changes, and Trunk Musculature in Elderly Women

Background and objectives: Studies on the effects of an equine riding simulator (ERS) program on back pain, spinal alignment, and isokinetic moments in subjects with chronic low back pain (CLBP) remain limited. The purpose of this study was to analyze changes in elderly women with CLBP who participate in an ERS program. Materials and Methods: The 80 participants were all women aged 61–84 years who were randomly assigned to either the control group (CON) or ERS group (ERSG). ERS exercise was performed for a duration of 12 weeks (three times each week). The degree of pain was measured using the Oswestry Disability Index and the visual analog scale. Body composition and spinal alignment were measured using bioelectrical impedance and raster stereography. The isokinetic moments of trunk extensor and flexor were measured before and after the training period. Results: The ERSG showed a significant decrease in back pain compared to the CON. There was a significant decrease in levels of fat in the ERSG, although no differences were shown in terms of muscle mass. However, there was an increased basal metabolic rate (BMR) in the ERSG. Spinal alignment in the ERSG significantly improved. The peak torques of the trunk extensor in the ERSG were also significantly increased. Conclusion: It can be inferred that the ERS exercise can decrease fat and improve the trunk extensor strength through increased BMR, leading to better spinal alignment and reducing back pain in elderly women with CLBP.

Effects of 3D Moving Platform Exercise on Physiological Parameters and Pain in Patients with Chronic Low Back Pain

Background and objectives: Patient-handling activities predispose women to chronic low back pain (CLBP), but sufficient evidence is not available on whether a 3D moving platform, made for core stability exercise, affects pain, trunk flexibility, and static/dynamic muscle contractions in CLBP patients. Materials and Methods: The participants were twenty-nine women who were randomly divided into a control group (CON) and a 3D exercise group (3DEG), which took part in 3D moving exercise three times a week for 8 weeks. Both groups measured a visual analog scale (VAS) about their CLBP. Body composition, forward and backward trunk flexibilities, static muscle contraction property in rectus abdominis, and erector spinae were measured by tensiomyography, which found contraction time (Tc) and maximal displacement (Dm). Dynamic muscle contraction property in the abdomen and back were measured with an isokinetic device, which could measure peak torque (Pt) and work per repetition (Wr), before and after the trial. Results: The 3DEG had a significantly decreased fat mass and waist/hip ratio, as well as improved static muscle contractions of the erector spinae. The Wr of trunk extensor of 3D exercise group were also significantly increased. In the VAS, although the scores showed a significant change in some variables, while others did not. The Δ% in feeling pain at rest or at night, during exercise, walking, sitting in a hard chair, sitting in a soft chair, and lying down in 3DEG were significantly changed after 8 weeks. This indicates that the platform exercise provided a greater reduction of pain for activities that are done on a daily basis. Conclusions: This study confirms that the 3D moving platform exercise can provide the similar effect of the core stability exercise used in previous studies. Moreover, this study suggests that 3D moving platform exercise is a suitable means to reduce fatness, to increase trunk extensor, and to increase trunk backward flexibility, which led to reduced back pain in the women with CLBP.

The Relationship Between Low Back Pain Incidence and Ultrasound Assessment of Trunk Muscles in Adult Soccer Players: A Cohort Study

Background: Few studies have demonstrated the connection between trunk muscle thickness and low back pain (LBP) in athletes. Objectives: This study aimed to define whether the thickness of the lateral abdominal muscles (LAM) and lumbar multifidus (LM) are related to LBP incidence in elite male soccer players. Methods: In this short-term cohort study, 42 elite male soccer players from professional soccer teams were followed for a season. The muscle thickness of LAM and the cross-sectional area (CSA) of the LM were assessed. The relation between the incidence of LBP and the aforementioned factors was evaluated after the cohort study. Results: Thirty-seven participants completed the study, and seven participants (18.91%) experienced LBP during the follow-up period. No significant relationship was detected between LBP and the thickness of LAM and CSA of LM (P > 0.05). None of the other variables had any relationship with LBP incidence (P > 0.05). Conclusions: The LAM thickness and CSA of LM during a resting position and drawing-in maneuver was found not to be directly related to LBP incidence in elite male soccer players in the short term. Assessing these muscles’ conditions in more functional positions could be considered for further research.