TRANSVERSUS ABDOMINIS ACTIVATION AND TIMING IMPROVES FOLLOWING CORE STABILITY TRAINING: A RANDOMIZED TRIAL

Effect of external and internal cues on core muscle activation during the Sahrmann five-level core stability test

BACKGROUND

Pain in the back or pelvis or fear of back pain may affect the timing or co-contraction of the core muscles. In both static and dynamic movements, the Sahrmann core stability test provides an assessment of core muscle activation and a person's ability to stabilize the lumbopelvic complex. Preparatory cues and images can be used to increase the activation of these muscles. To attain optimal movement patterns, it will be necessary to determine what cueing will give the most effective results for core stability.

AIM

To investigate the effects of external and internal cues on core muscle activation during the Sahrmann five-level core stability test.

METHODS

Total 68 participants (21.83 ± 3.47 years) were randomly allocated to an external (n = 35) or internal cue group (n = 33). Participants performed the Sahrmann five-level core stability test without a cue as baseline and the five-level stability exercises with an internal or external cue. External cue group received a pressure biofeedback unit (PBU), and the internal cue group received an audio cue. A Delsys TrignoTM surface electromyography unit was used for muscle activation from the rectus abdominis, external oblique, and transverse abdominis/internal oblique muscles.

RESULTS

Linear mixed effects model analysis showed that cueing had a significant effect on core muscle activation (P = 0.001); however, there was no significant difference between cue types (internal or external) (P = 0.130).

CONCLUSION

Both external and internal cueing have significant effects on core muscle activation during the Sahrmann five-level core stability test and the PBU does not create higher muscle activation than internal cueing.

M-mode ultrasound evaluation of lateral abdominal muscle postural response to load: an exploratory study

Aim

There is a need to evaluate the tissue deformation index of lateral abdominal muscles using M-mode ultrasound in a cohort of healthy subjects to establish a convenient reference point for clinical reasoning in patients. The aim of the study was to assess differences in the tissue deformation index between individual lateral abdominal muscles regardless of body side, compare these differences in the tissue deformation index on the right and left sides of the body, and evaluate side-to-side differences in the tissue deformation index within individual lateral abdominal muscles.

Material and methods

In a group of 126 healthy volunteers (59 females), the postural response of lateral abdominal muscles to external perturbation in the form of rapid arm abduction with load was recorded on both sides of the body, and the tissue deformation index was calculated.

Results

The mean values of the tissue deformation index form an increasing gradient from deep to superficial lateral abdominal muscles: 0.06%/ms for the transversus abdominis, 0.084%/ms for the internal oblique and 0.151%/ms for the external oblique (p <0.001). Side-to-side intra-muscle differences were significant only for the transverse abdominis (right: 0.047%/ms; left: 0.070%; p <0.01).

Conclusions

The tissue deformation index values differ significantly among individual lateral abdominal muscles and form a characteristic gradient: transversus abdominis < internal oblique < external oblique. The transversus abdominis muscle shows significant asymmetry in the tissue deformation index between the left and right sides of the body.

A dose response analysis of exercise prescription variables for lateral abdominal muscle thickness and activation: A systematic review

BACKGROUND

Various exercise programs are used to treat lateral abdominal muscle (LAM) impairments in people with low back pain. Factors comprising these programs include exercise type, session time, frequency, and program duration. However, specific clinical guidance about optimal exercise prescription is lacking.

OBJECTIVES

To perform a dose-response analysis on exercise prescription variables for LAM thickness and activation as measured by ultrasound imaging.

DESIGN

Systematic review METHOD: Databases were searched from their inception for studies examining the association between exercise interventions and LAM thickness/activation measured by ultrasound imaging in healthy individuals. Risk of bias was assessed using the Joanna Brigg's Institute critical appraisal tools. For each muscle, subgroup analyses were performed to determine the dose response of exercise prescription variables for LAM thickness and activation. Where there was insufficient data for subgroup analyses, data was narratively synthesised.

RESULTS

Fourteen studies comprising 395 participants were included. Statistical and narrative synthesis revealed specific local abdominal exercises, programs from four weeks duration, three sessions per week and sessions of ≥30 min were associated with greatest improvements to LAM thickness. Only the variables exercise type, program duration and session frequency showed a significant between groups difference for the subgroup analysis. The main limitation was inability to perform subgroup analyses for all variables across all muscles measured at rest and during contraction, due to non-reporting of data.

CONCLUSION

This review provides preliminary guidance to practitioners on how the LAM respond to different exercise dosages. Future research should trial these findings.

Efficacy of Core Muscle Exercise Combined with Interferential Therapy in Alleviating Chronic Low Back Pain in High-Performance Fighter Pilots: A Randomized Controlled Trial

BACKGROUND

Chronic low back pain (LBP) related to flight is a prevalent health issue in military aviation, impacting pilots. The objective of this investigation was to ascertain if the application of core muscle training in conjunction with interferential current (IFC) therapy results in a reduction in pain severity and associated disability, consequently enhancing core muscle functionality in Chinese Air Force high-performance fighter pilots experiencing chronic LBP.

METHODS

Fifty-three fighter pilots with chronic LBP were randomized into 3 groups: a core muscle exercise combined with IFC group (CG, n = 19), a core muscle exercise group (EG, n = 19), and an IFC group (IG, n = 15). The three groups underwent therapeutic intervention 5 times a week for 12 weeks. The primary outcomes were pain intensity, Oswestry Disability Index (ODI) score and SF-12 health-related quality of life (PCS and MCS) score. Secondary outcomes included evaluations of trunk muscle strength, endurance, and range of motion (ROM) during medial/lateral rotation to assess muscle functionality. Measurements were obtained both before and after the implementation of the intervention therapy.

RESULTS

After 12 weeks of intervention therapy, all the health condition parameters significantly improved among the three groups. However, the CG had a significant improvement in pain intensity compared to the EG (MD = - 0.84 scores; 95% CI = - 1.54 to - 0.15; p = 0.013) and the IG (MD = - 1.22 scores; 95% CI = - 1.96 to - 0.48; p = 0.000). Additionally, the CG led to greater conservation of ODI and improved SF-12 PCS scores than did the IG (p < 0.05). Finally, compared with those at baseline, the core muscle function parameters in the CG and EG improved significantly at the end of the study, but no statistically significant differences were observed between the two groups (p > 0.05).

CONCLUSION

Among participants with chronic LBP, three intervention therapies appear effective in reducing pain, diminishing disability, and enhancing quality of life. Also, combined therapy significantly improved pain and disability compared to the other two monotherapies; moreover, combined therapy and core muscle exercise provided similar benefits in terms of core muscle function after 12 weeks of intervention therapy.

Core stabilisation exercises reduce chronic low back pain in Air Force fighter pilots: a randomised controlled trial

BACKGROUND

There is evidence that core stabilisation, strength and endurance training contribute to reduce low back pain in the general population. However, we are not aware of the effect of these exercises on fighter aviation pilots. Therefore, the present study aims to investigate the effects of an exercise protocol on chronic low back pain in Brazilian Air Force fighter pilots. Changes in neck pain, lumbar disability, range of motion, strength and resistance were also investigated.

METHODS

Fourteen participants with chronic low back pain were randomised into two groups: stabilisation exercise group (SEG-n=7), exercise protocol twice a week for 12 weeks) and the regular exercise group (REG-n=7), which performed their own usual exercise routine. The evaluations were carried out before and after the training period. The primary outcome was the intensity of low back pain and the secondary outcomes were cervical pain, functional disability, range of motion, maximum isometric strength and trunk muscle resistance.

RESULTS

The SEG had a significant reduction in low back pain compared with the REG (difference of 2.3 points, p=0.04) and a lower rate of cervical pain (difference of 2.5 points, p=0.01) at the end of the protocol. Maintenance of trunk muscle strength was also observed in the SEG over the period, while the REG presented a decrease in flexural strength to the right side (difference between groups: -3.7%, p=0.04). There were no differences in the rates of disability, range of motion or resistance to fatigue between groups.

CONCLUSIONS

The stabilisation exercise programme focused on the core muscles was successful in decreasing the fighter pilots' chronic lumbar pain. Pilots are normally active; however, our results indicate that specific trunk training programmes should be offered considering the work needs of these subjects.

CLINICAL TRIALS

'Exercise protocol for pilots with back pain' (registered: 09 October 2018)-NCT03713814 (https://clinicaltrials.gov/ct2/show/NCT03713814).

Effectiveness of Early Postpartum Rectus Abdominis versus Transversus Abdominis Training in Patients with Diastasis of the Rectus Abdominis Muscles: A Pilot Randomized Controlled Trial

Purpose

To determine feasibility of a randomized controlled trial (RCT) comparing postpartum rectus abdominis training with transversus abdominis training in reducing the inter-recti distance in patients with diastasis of the rectus abdominis muscles (DRAM).

Method

A pilot, randomized controlled trial with longitudinal assessment following vaginal delivery at 6 and 12 weeks postpartum was completed. Forty-four women with DRAM (inter-recti distance of ≥ 30mm as measured by digital calipers) were recruited from a regional public hospital in Australia. The standard treatment group (n = 21) was provided with a 5-second transversus abdominis activation exercise in crook lying. The experimental group (n = 23) was provided with a 1-second rectus abdominis crunch exercise. Dosage was between 1-10 repetitions at baseline and between 1-20 at 6 weeks, twice a day, at least 5 days per week, prescribed depending on individual participant ability. The primary outcome measure was inter-recti distance. Feasibility measures were recruitment rate, loss to follow-up, adverse events, and exercise adherence.

Results

The rectus abdominis group achieved greater reduction of the inter-recti distance at 6 weeks (at and below the umbilicus) and 12 weeks (above, below, and at the umbilicus). Recruitment rate was acceptable (45%) and there were no adverse events, but loss to follow-up was high due to COVID-19 impacts and participants did not return exercise adherence diaries.

Conclusion

Prescription of rectus abdominis exercise during the early postpartum period following vaginal delivery resulted in a greater reduction of the inter-recti distance at 6 and 12 weeks when compared with transversus abdominis exercise. This pilot trial was impacted by high loss to follow up due to COVID-19 restrictions, but feasibility was otherwise acceptable. The findings of the study will inform future fully powered trials comparing these two exercise types in postpartum women with DRAM.

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.

Effects of stabilization exercises on disability, pain, and core stability in patients with non-specific low back pain: A randomized controlled trial

BACKGROUND

Many studies have emphasized the importance of stabilization exercises (SE) for the management of non-specific low back pain (NSLBP), yet there is no study assessing all aspects of core stability in comparing SE and other exercises.

OBJECTIVE

To investigate the effects of SE on pain and core stability by using core stability tests that focus on all aspects of core stability in patients with NSLBP.

METHODS

Thirty-seven individuals with chronic NSLBP were randomly divided into two groups as SE and conventional exercises (CE). Both groups underwent the progressive exercise program three days per week for six weeks. The assessments were conducted before and after the exercise programs. The outcome measures included pain, disability, trunk strength, trunk flexor, extensor and lateral flexor endurance, function, flexibility, and motor control during eyes open/closed.

RESULTS

All assessment parameters except motor control during eyes open improved after SE (p < 0.05). Also, all assessment parameters except motor control during eyes open/closed and lateral trunk endurance improved after CE (p < 0.05). When comparing groups for gain scores, there were more significant improvements in pain during activity, endurance and function after SE (p < 0.05).

CONCLUSIONS

SE is more effective than CE in reducing pain during activity and improving core stability regarding functionality and endurance.

Factors associated with low back pain in air force fighter pilots: a cross-sectional study

INTRODUCTION

Low back pain in military pilots is a frequent condition which constantly leads to absences from work, decreased concentration and performance during flight, as well as changes in work functions.

METHODS

This is a cross-sectional analytical study including 28 fighter pilots who underwent an evaluation comprising muscle strength and fatigue resistance, trunk mobility and application of questionnaires to identify associated clinical factors.

RESULTS

It was observed that 68% of the pilots reported low back pain with an average pain intensity of 3.7 at numerical pain scale in the last week. No significant differences were observed regarding the range of motion and trunk muscle strength when pilots with low back pain were compared with asymptomatic pilots. However, lateral right trunk muscle (mean difference=16, 95% CI 0.6 to 33.0]) and lateral left trunk muscle (mean difference=22, 95% CI 1 to 44) fatigue sooner in pilots with low back pain when the two groups were compared (p=0.04 for both).

CONCLUSION

There was a high rate of low back pain complaints among fighter pilots. There was also a significant reduction in fatigue resistance of the lateral trunk muscles in symptomatic pilots when compared with asymptomatic pilots. These factors must be considered in the physical training of this population.

Extended field-of-view ultrasound imaging is reliable for measuring Transversus Abdominis muscle size at rest and during contraction

Background

The strength and size of core muscles, including the abdominal muscles, are crucial to proper function in most activities. Therefore, it is important to reliably assess these characteristics. Our primary objective was to determine if the length, thickness and cross-sectional area of the transversus abdominis (TrA) can be visualized independently from the internal and external abdominal oblique muscles using extended field of view ultrasound imaging at rest and with contraction and to establish its intra- and inter-tester reliability.

Methods

Twenty-six individuals were recruited to participate in the study (20 F, 6 M), average age 24.0 years (SD 9.4), height 170.7 cm (SD 8.6) and weight 63.9 kg (SD 9.0). From this total number of participants, two groups of 16 randomly selected participants were assessed to determine intra- and inter-tester reliability respectively. Extended field of view ultrasound images were obtained at three vertebral levels during rest and contraction in the side lying position for both the right and left sides of the trunk.

Results

Excellent intra-tester and inter-tester reliability was seen (ICC range of 0.972 to 0.984). The overall average percent standard error of the measurement for all measurements and locations was approximately 4%. The overall average minimal difference for the thickness measurement for the resting and contraction conditions combined were as follows: intratester 0.056 (0.014) cm and intertester 0.054 (0.017) cm, for area intratester 0.287 (0.086) cm² and intertester 0.289 (0.101) cm² and for length intratester 0.519 (0.097) cm and intertester 0.507 (0.085) cm.

Conclusions

Extended field of view ultrasound imaging is an effective method of reliably capturing clear images of the TrA during rest and contraction. It provides an efficient mechanism for the analysis of muscle morphology by being able to measure the cross-sectional area, thickness, and length on one image. This methodology is recommended for studies investigating TrA function and training.

Transverse abdominis activity and ultrasound biofeedback in college golfers with and without low back pain

OBJECTIVES

To compare transverse abdominis (TrA) muscle activity in college golfers with and without a history of low back pain (LBP) and examine the effects of ultrasound biofeedback and a functional golf-setup position on TrA activity.

DESIGN

Crossover study.

SETTING

Laboratory.

PARTICIPANTS

Thirty-two (n = 32) collegiate golfers were stratified into either the LBP group (n = 16, 4.6 ± 4.5 LBP episodes) or non-LBP group (n = 16, 0.1 ± 0.3 LBP episodes) based on LBP episodes in the last 6-months.

MAIN OUTCOME MEASURES

Ultrasound measures of TrA activity were performed during standard contractions and contractions with ultrasound biofeedback. Contraction-type order was randomized between two visits. Testing was performed in two positions, supine and golf-setup positions.

RESULTS

We observed no significant differences in TrA activity between the LBP and non-LBP groups. Overall, TrA activity was greater during biofeedback contractions compared to standard contractions, and TrA activity was lower in the golf-setup position compared to the supine position.

CONCLUSIONS

We observed no differences in TrA activity between college golfers with and without LBP. College golfers with and without LBP demonstrated a greater ability to contract their TrA with real-time ultrasound biofeedback and a lower ability to contract their TrA in the functional golf-setup position compared to the traditional supine position.

Effects of core stability exercise combined with virtual reality in collegiate athletes with nonspecific low back pain: a randomized clinical trial

Background

Nonspecific low back pain (LBP) in collegiate athletes is shown to be accompanied by poor core endurance. Consequently, trunk muscle stabilization exercises for lumbar instability are widely used. Virtual reality (VR) training can activate the cerebral cortex and enhance the cortex to control balance and improve motion function. The purpose of the study was to assess the effect of combined core stability exercises (CSE) and VR training in improving body balance and function in collegiate male athletes with nonspecific low back pain (LBP).

Results

The post-values of the experimental group were significantly higher than that of the control group for the dynamic balance in anterior (p = 0.031), posterolateral (p = 0.034), and posteromedial (p = 0.037) directions. Moreover, there was a significant difference in the post-values of both groups regarding reducing the Micheli Functional Scale in favor of the experimental group (p = 0.012).

Conclusions

CSE training plus virtual reality is more effective than CSE training alone in improving total body balance and dysfunction level in collegiate male athletes with nonspecific LBP. It is recommended that clinicians consider CSE combined with VR to maximize the improvement in overall body balance when developing rehabilitation programs for collegiate athletes with nonspecific low back pain.

Trial registration

Pan African Clinical Trial Registry, PACTR201907749053096. Retrospectively registered on 15 April 2019. https://pactr.samrc.ac.za/Researcher/ManageTrials.aspx

Offloading for the Diabetic Foot: Considerations and Implications

Offloading the diabetic foot remains the major consideration for ulceration prevention and healing. This narrative literature review presents a brief overview of current guidelines for offloading the diabetic foot and discusses the implications that come with offloading treatment modalities and their effects on the kinetic chain of the lower extremity. We also present the latest innovative studies from the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science that advance the knowledge in this field and provide avenues for future research opportunities.

Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: A randomized controlled trial

BACKGROUND

Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women.

OBJECTIVE

This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP.

METHODS

Forty postpartum women participated in the study. Their age ranged from 25-35 years and their body mass index (BMI) was 25-29.9 kg/m2. They were randomly assigned into two groups equal in number. Group (A) received local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively.

RESULTS

Both groups (A and B) revealed a significant decrease (p= 0.001) in pain and functional disability and a significant increase (p= 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p= 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A).

CONCLUSIONS

PFM training should be an essential part in rehabilitation programs of PGP postpartum.

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

There are many proposed core stability exercises in a variety of positions; however, it is not clear that in which position, activation of transverse abdominis muscle is utmost. We aimed to compare the activation of transverse abdominis muscle in different core stability exercise positions through ultrasound imaging. in a 20 subjects' study we compared the effectiveness of drawing-in and bracing maneuvers on transverse abdominis in different core stability exercise positions (supine, hook lying, supine with 90° flexed knee and hip, supine with stretched knees and 90° flexed hips, bridge, bridge with one stretched knee and Bird dog). We used activation ratio and preferential activation ratio as measurements of transverse abdominis activation. Abdominal Bracing in the bridge position showed the highest activation of transverse abdominis (P<0.05). The results showed significantly higher activation of transverse abdominis, measured by preferential activation ratio, in bridge position during abdominal bracing.

Comparison of Core Stabilisation Exercise and Proprioceptive Neuromuscular Facilitation Training on Pain-related and Neuromuscular Response Outcomes for Chronic Low Back Pain: A Randomised Controlled Trial

Background

Existing literature offers little guidance for therapists who provide core stabilisation exercise (CSE) and proprioceptive neuromuscular facilitation (PNF) training to treat chronic low back pain (CLBP). Studies conducting a head-to-head comparison of CSE and PNF training for CLBP are needed.

Objective

To compare the effects of CSE and PNF training on pain-related outcomes and trunk muscle activity in CLBP patients.

Methods

Forty-five CLBP patients, ranging from 18 to 50 years of age, were randomly divided and assigned to either a four-week CSE, four-week PNF training, or control group. Pain-related outcomes, including pain intensity, functional disability and patient satisfaction, as well as superficial and deep trunk muscle activity were assessed before and after the four-week intervention, and at a three-month follow-up.

Results

Compared to the control group, those in the CSE and PNF training groups showed significant improvements in all pain-related outcomes after the four-week intervention and at three-month follow-up (P < 0.01). Following the four-week intervention, both CSE and PNF training groups demonstrated significant improvement in deep trunk muscle activity, including the transversus abdominis (TrA) and superficial fibres of lumbar multifidus (LM), compared to the control group (P < 0.05).

Conclusion

Four-week CSE and PNF training provided short-term and long-term effects on pain-related outcomes, along with increased deep trunk muscle activity in CLBP patients.