The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain

Abdominal muscle size and symmetry in normal subjects

This study was undertaken to establish normal reference ranges for abdominal muscle size and symmetry and to examine the effects on these of gender and age. We studied 123 subjects, consisting of 55 men (aged 21-72 years) and 68 women (aged 20-64 years). Real-time ultrasound imaging of the abdominal muscles was performed. Thickness of internal and external oblique (IO, EO), transversus abdominis (TA), and rectus abdominis (RA), and cross-sectional area (CSA) of RA were measured, and absolute and relative muscle thickness (percent total muscle thickness), order of thickness, and symmetry (percent difference between sides) were determined. Males had significantly larger muscles than females and size was poorly correlated with age. The pattern of relative muscle thickness was RA > IO > EO > TA. Symmetry for total absolute thickness of all three lateral muscles was 8%-9% (mean) but for individual muscles there was asymmetry of absolute size (13%-24%), whereas relative thickness was symmetrical for all muscles. These findings provide robust reference data for the abdominal muscles in normal males and females in order to enable comparison with clinical groups to assess abnormalities and establish sensitivity for evaluating the effectiveness of interventions.

Relationships among lateral abdominal muscles, gender, body mass index, and hand dominance

STUDY DESIGN

Exploratory.

OBJECTIVES

To explore whether hand dominance, gender, and body mass index (BMI) influence the thickness of the lateral abdominal muscles as measured by ultrasound imaging. To document the extent of improvement in response stability when an average of multiple measures was utilized.

BACKGROUND

Ultrasound imaging is a relatively new tool used to assess the lateral abdominal muscles. A better understanding of how these muscles contract in a healthy population can provide a reference for comparison to patients with low back pain (LBP).

METHODS AND MEASURES

Thirty-two healthy participants (17 males, 15 females) aged 18 to 45 years (mean +/- SD, 31.9 +/- 7.8 years) were studied. Measurements of muscular thickness of the lateral abdominal muscles were obtained bilaterally while the subjects were at rest, and while they performed the abdominal drawing-in maneuver. To determine the possible influence of hand dominance and gender on muscle thickness, t tests were used. Correlation coefficients were used to assess the relationship between BMI and muscle thickness. Standard error of the measurement was used to assess response stability of the ultrasound imaging technique.

RESULTS

No differences in the thicknesses of the transversus abdominis (TrA) muscle were measured during rest or while contracted, based on hand dominance (P > or = .73). Men had greater muscular thickness (P<.01), while the TrA in women represented a greater proportion of the total lateral abdominal muscles (P<.01). BMI was positively associated with muscle thickness (r> or =.66). Compared to a singular measurement, response stability improved by greater than 50% when an average of 3 measurements was used.

CONCLUSIONS

Future researchers should assess the need to control for gender and BMI as potential covariates in ultrasound imaging studies of the lateral abdominal muscles. Asymmetry in the lateral abdominal muscles in those with LBP would be in direct contrast to the bilateral symmetry measured in those without LBP.

Between-day repeatability and symmetry of multifidus cross-sectional area measured using ultrasound imaging

STUDY DESIGN

Prospective test-retest, intrarater reliability study.

OBJECTIVES

To estimate the intrarater reliability, asymmetry, and associated error with measurement of the cross-sectional area (CSA) of the bilateral S1 multifidi when measured by a physical therapist following a short course of self-directed training in ultrasound imaging.

BACKGROUND

There is increasing interest in the assessment of the lumbar multifidus during the recovery from low back injury. It is important to know the error associated with the CSA measurements obtained by a physical therapist with limited experience in ultrasound imaging when using a portable unit.

METHODS AND MEASURES

Thirty healthy females (mean +/- SD age, 23 +/- 2 years; mean +/- SD mass, 63.1 +/- 9.2 kg; mean +/- SD height, 1.63 +/- 0.06 m) participated. Fourteen subjects returned within 1 to 4 days for repeated measurements.

RESULTS

For all 30 subjects, the average (+/- SD) CSA of the left S1 multifidus (4.18 +/- 0.55 cm2) was larger (P<.05) than the right (4.11 +/- 0.57 cm2), with a standard error of the measurement (SEM) of 0.13 cm2 and average +/- SD asymmetry of 3.5% +/- 3.4%. For a subset of 14 subjects, the between-day intrarater reliability for the right S1 multifidus muscle was ICC3,1 = 0.80 (95% CI, 0.49-0.93), while the ICC for the left side was 0.72 (95% CI, 0.34-0.90). The day-to-day average differences for the left and right side were 0.02 cm2 and 0.04 cm2, respectively. For the most conservative estimate, the between-day SEM was 0.37cm2.

CONCLUSIONS

A physical therapist, newly trained in ultrasound imaging, obtained reasonable between-day intrarater reliability when imaging the S1 multifidus. A high degree of symmetry was found between the bilateral S1 multifidi in a sample of healthy subjects, which is consistent with previous reports from measurements by skilled ultrasonographers.