Effects of the abdominal drawing-in maneuver on muscle activity, pelvic motions, and knee flexion during active prone knee flexion in patients with lumbar extension rotation syndrome

The effect of chronic low back pain and lumbopelvic stabilization instructions on gluteus medius activation during sidelying hip movements

BACKGROUND

People with chronic low back pain (LBP) often demonstrate altered muscle activation with movements that involve the lumbopelvic region and hips.

OBJECTIVE

The purpose of this study was to compare gluteus medius activity during sidelying hip abduction (SHA) and sidelying hip abduction-lateral rotation (SHALR) with and without instruction for lumbopelvic stabilization in people with and without chronic LBP.

METHODS

A cross-sectional study was conducted recruiting participants with (n = 17) and without (n = 17) chronic LBP. Gluteus medius activity was recorded with surface electromyography during the performance of SHA and SHALR with and without instructions including the abdominal drawing-in maneuver for lumbopelvic stabilization.

RESULTS

For SHA and SHALR, there was a significant main effect for instruction for stabilization indicated by a decrease in gluteus medius activity with instructions (p = .001, p < .001). There was not a significant main effect of chronic LBP on gluteus medius activity between groups for either activity. There was no significant interaction effect of pain and instruction for stabilization with SHA or SHALR.

CONCLUSION

Knowledge of changes in gluteus medius muscle activation patterns with trunk stabilization instruction may help clinicians with assessment of exercise performance to optimize gluteus medius activation.

Diaphragmatic breathing combined with abdominal drawing-in maneuver for walking function in post-stroke patients: a randomized controlled study protocol

BACKGROUND

Patients with stroke frequently experience walking dysfunction. Core training can help improve balance and walking function in patients with stroke. However, core training movements in clinical practice are numerous and differently targeted. Therefore, this study will investigate the improvement of walking function in patients with combined diaphragmatic breathing maneuver (DBM) and draw-in breathing technique (ADIM) training.

METHODS

This single-blind, randomized controlled preliminary will analyze the viability of DBM combined ADIM training versus routine rehabilitation therapy in patients with stroke with early to mid-stroke. Patients will be randomly assigned to either the DBM and ADIM training or the routine rehabilitation training. We will recruit 42 stroke inpatients from the Second Rehabilitation Hospital of Shanghai who meet the trial criteria and measure the balance and walking functions and improvement of that after 4 weeks of intervention. The primary outcome is the 10 m maximum walking test (10MWT). The secondary outcomes indices include the limits of stability test (LOS), Berg balance scale test (BBS), Functional Ambulation Categories test (FAC), Timed Up and Go test (TUG), trunk impairment scale test (TIS), ultrasound indicators of the diaphragm and transversus abdominis (UI), rhythmic weight shift test (RWS), walk across test (WA), Fugl-Meyer assessment of lower extremity (FMA-LE), and Barthel index of ADL test.

DISCUSSION

The primary objective of this project was to investigate the effects of DBM combined with ADIM on balance capacity and walking function for patients with early to mid-stroke. The outcomes of this study will hold significant implications for future clinical applications in rehabilitation.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR), ID: ChiCTR2100054897. Registered on 28 December 2021.

The Effects of Abdominal Hollowing and Bracing Maneuvers on Trunk Muscle Activity and Pelvic Rotation Angle during Leg Pull Front Pilates Exercise

Pilates methods use mats for trunk muscles stabilization exercises, and leg pull front (LPF) is one of the traditional Pilates mat exercises. Abdominal hollowing (AH) and Abdominal bracing (AB) maneuvers are recommended to stabilize the trunk muscles and prevent unwanted pelvic movement during motion. This study aimed to explore the effects of AH and AB on electromyography (EMG) activity of the trunk muscles and angle of pelvic rotation during LPF. A total of 20 healthy volunteers participated in the study. AH, AB, and without any condition (WC) were randomly performed during LPF exercise. Each was repeated three times for 5 s. The trunk muscle activities were measured using EMG and rotation of pelvis was measured using a Smart KEMA device. The activities of the transversus abdominis/obliquus internus abdominis (TrA/IO) and right obliquus externus abdominis (EO) muscles were highest in LPF-AH compared to the other conditions. Multifidus (MF) activity was significantly greater in LPF-AH and LPF-AB compared to that of without any condition. The pelvic rotation angle was significantly smaller in LPF-AB. Therefore, AH maneuver during LPF for trunk muscle stabilization exercises is suitable for selective activation of the TrA/IO, and AB maneuver during LPF is recommended for the prevention of unwanted pelvic rotation.

Effects of the abdominal drawing-in maneuver on hamstring rotational activity and pelvic stability in females

BACKGROUND

The medial hamstring (MH) and lateral hamstring (LH) can be selectively trained through tibial internal and external rotation during prone knee flexion. However, no study has identified how a combined tibial rotation and lumbo-pelvic stability strategy influences MH and LH muscle activities.

OBJECTIVE

To investigate the combined effects of tibial rotation and the abdominal drawing-in maneuver (ADIM) on MH and LH muscle activities as well as pelvic rotation during prone knee flexion.

METHODS

Fifteen female volunteers performed prone knee flexion with tibial internal and external rotation, with and without the ADIM. Under each condition, MH and LH muscle activities were measured by surface electromyography (EMG), and the pelvic rotation angle by a smartphone inclinometer application.

RESULTS

The results showed increased MH (without the ADIM: p< 0.001, effect size (d) = 2.05; with the ADIM: p< 0.001, d= 1.71) and LH (without the ADIM: p< 0.001, d= 1.64; with the ADIM: p= 0.001, d= 1.58) muscle activities under internal and external tibial rotation, respectively. However, addition of the ADIM led to increased MH (internal tibial rotation: p= 0.001, d= 0.67; external tibial rotation: p= 0.019, d= 0.45) and LH (internal tibial rotation: p= 0.003, d= 0.79; external tibial rotation: p< 0.001, d= 1.05) muscle activities combined with reduced pelvic rotation (internal tibial rotation: p< 0.001, d= 3.45; external tibial rotation: p< 0.001, d= 3.01) during prone knee flexion.

CONCLUSIONS

These findings suggest that the ADIM could be useful for reducing compensatory pelvic rotation and enhancing selective muscle activation in the MH and LH, according to the direction of tibial rotation, during prone knee flexion.

Effect of Transversus abdominis muscle training on pressure-pain threshold in patients with chronic low Back pain

Background

Therapeutic training is the most commonly used treatment methods for chronic low back pain (CLBP), and the use of a pressure biofeedback unit for transversus abdominis muscle (TrA) training is one of the core muscle training methods. The study aim of this research is to explore the effects of different intensities (sham training, low-intensity and high-intensity) of TrA muscle training on people with CLBP in pressure-pain threshold (PPT).

Methods

A total of 45 patients with CLBP were recruited, of whom 44 were included in the analysis. Fifteen, 14, and 15 were included in the sham training group, the low-intensity group, and the high-intensity group, respectively. A pressure biofeedback unit was used in performing a one-time TrA training intervention involving 30 times of 180 mmHg TrA contraction training at high intensity for 10 min and 15 times of 100 mmHg TrA contraction training at low intensity for 5 min. The sham training group completed comfort exercises and did not undergo training. The evaluation indicators were as follows: PPT, short-form McGill pain questionnaire, and body surface pain radiation.

Results

High-intensity training could activate more waist core muscles than low-intensity training. Significant changes on PPT (units: kgf) were observed in the following four muscles immediately after high-intensity training: iliopsoas [0.69 (0.13–1.25) 95% CI, p = 0.020]; quadratus lumborum [0.84 (0.23–1.45) 95% CI, p = 0.012]; erector spinae [0.66 (0.18–1.15) 95% CI, p = 0.011]; transversus abdominis [0.70 (0.26–1.14) 95% CI, p = 0.004], and in three muscles after low-intensity training: quadratus lumborum [0.61 (0.17–1.05) 95% CI, p = 0.009]; transversus abdominis [0.14 (from − 0.15 to 0.43) 95% CI, p = 0.022]; piriformis [0.55 (0.13–0.98) 95% CI, p = 0.014]. The change in body surface pain radiation immediately after exercise was [− 10.87 (from − 17.51 to − 4.22) 95% CI, p = 0.003] for high-intensity training and [− 5.21 (from − 9.40 to − 1.03) 95% CI, p = 0.019] for low-intensity training.

Conclusions

TrA training could increase the PPT of the waist core muscles and reduce the radiation range of waist pain. The benefits of high-intensity training are higher than those of low-intensity training.

Trial registration

ChiCTR-TRC-13003701. Registered 18 October 2013.

Code of ethical approval: 2018069.

Comparison of the effects of the knee flexion and extension during side-lying hip abduction on the activity and onset time of the gluteus medius and quadratus lumborum

BACKGROUND: An increase in the compensatory action of the quadratus lumborum (QL) during side-lying hip abduction (SHA) can lead to lateral movement impairment of the pelvis. OBJECTIVE: To compare the effects of knee flexion (KF) and knee extension (KE) during SHA at abduction angles of 25∘, 35∘, and 45∘ on the activity and onset time of the gluteus medius (GM) and QL. METHODS: Thirty healthy men were recruited and randomly divided into two groups: those with SHA with KF and those with SHA with KE. The subjects performed SHA at three angles of abduction in a random order. Surface electromyography was used to record the muscle activities of the GM and QL. RESULTS: The QL activity decreased significantly more in the KE group than in the KF group at each of the three angles of abduction during SHA. The GM/QL activity ratio increased significantly in the KE compared to the KF group. In addition, in the KE group, the onset of the GM activity was significantly earlier than that of the QL activity. On the other hand, in the KF group, the onset of the GM activity occurred later than that of the QL activity. CONCLUSIONS: These findings indicate that KE is more effective than KF in selectively activating the GM during SHA by reducing the QL activity and firing the GM earlier than the QL.

The effect of Total resistance exercise vs. aquatic training on self-reported knee instability, pain, and stiffness in women with knee osteoarthritis: a randomized controlled trial

BACKGROUND

Knee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60-80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors.

METHODS

In this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren-Lawrence ≥ II) of KOA were selected. Patients were divided into three groups namely, aquatic (n = 12), Total Resistance exercises (TRX) (n = 12) and control (n = 12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson's questionnaire.

RESULTS

The results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p < 0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p < 0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p < 0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p = 0.05).

CONCLUSIONS

Although TRX and aquatic interventions had a similar effect on the patients' balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.

TRIAL REGISTRATION

This study was registered in the Iranian Clinical Trial Center with the number IRCT20181222042070N1, http://www.irct.ir/trial/36221, registered 02 February 2019.

Classification-Specific Treatment Improves Pain, Disability, Fear-Avoidance Beliefs, and Erector Spinae Muscle Activity During Walking in Patients With Low Back Pain Exhibiting Lumbar Extension-Rotation Pattern: A Randomized Controlled Trial

OBJECTIVE

Low back pain (LBP) has commonly been managed via classification-specific interventions in homogeneous groups. However, it is largely unknown whether treatment tailored to specific classifications is more effective than generic treatment. The purpose of this study was to evaluate the effects of classification-specific treatment on the self-reported responses and erector spinae (ES) activity of patients with LBP exhibiting a lumbar extension-rotation (ExtRot) pattern.

METHODS

In total, 39 patients exhibiting the lumbar ExtRot pattern were randomized to an experimental (n = 19) group and a control (n = 20) group. Participants in the experimental group received classification-specific treatment, which included exercise to control or prevent lumbopelvic motion during lower-extremity movement. Participants in the control group were encouraged to perform general exercises and were educated about LBP. Patient-reported pain intensity, disability, and fear-avoidance belief and ES muscle activity during walking were assessed prior to and after the intervention. Two-way analysis of covariance was used to examine the effects of classification-specific treatment.

RESULTS

After 6-week intervention, significant time-by-group interaction effects were demonstrated on pain intensity, disability, fear-avoidance beliefs-physical activity score, and ES muscle activity during walking. There were significant effects of group on pain, disability, and fear-avoidance beliefs-physical activity score after intervention. After the 6-week intervention, the ES muscle activity significantly decreased in the experimental group during walking, but does not represent an all-events decrease.

CONCLUSION

Classification-specific treatment may be effective in patients with LBP exhibiting the lumbar ExtRot pattern, reducing pain intensity, disability, fear-avoidance beliefs, and ES muscle activity during walking.

Difference of the thickness and activation of trunk muscles during static stoop lift at different loads between subjects with and without low back pain

BACKGROUND

Patients suffering from low back pain (LBP) have been reported to alter muscle contraction strategies.

OBJECTIVE

To compare activity and thickness of the trunk muscles (external oblique (EO), internal oblique (IO), transversus abdominis (TrA), and lumbar multifidus (LM)) during static stoop lift at different lifting loads between the subjects with and without LBP.

METHODS

Twenty eight subjects with LBP and twenty eight healthy subjects were recruited. The stoop lifting was performed in three conditions in 0%, 10%, and 20% of body weight.

RESULTS

The activity of EO (F= 9.513) and IO (F= 7.781) was significantly increased with increasing lifting loads in subjects with LBP (p< 0.05) but not significantly in subjects without LBP. The activity of the LM (F= 124.980) was significantly increased in response to lifting loads in both groups (p< 0.05). The percent change of TrA (F= 8.797) and LM (F= 48.170) muscles thickness was significantly increased with increasing lifting loads in both groups (p< 0.05). The percent change of TrA (F= 3.780) and LM (F= 16.314) muscles thickness in subjects without LBP was greater than those in subjects with LBP at all three lifting loads (p< 0.05).

CONCLUSIONS

The results of this study suggest that more activation of EO in subjects with LBP may contribute to increase the compressive force on the lumbar spine during stoop lift. Also, less activation of TrA and LM in subjects with LBP may contribute to decrease the lumbar stabilization during stoop lift.

Comparison of lumbar multifidus thickness and perceived exertion during graded superman exercises with or without an abdominal drawing-in maneuver in young adults

The present study aimed to investigate lumbar multifidus (LM) thickness and perceived exertion during graded superman exercises (GSE) or GSE with an abdominal drawing-in maneuver (GSE-AD) in young adults. Twelve young adult males and females, who were informed of the purpose and procedures of this study and then gave their voluntary consent to participate, were included in this study. All subjects randomly performed three GSE and GSE-AD over 3 days. Ultrasonography was used to measure the LM thickness to the left and right of the L5 region. Additionally, the issue of whole-body fatigue felt by the subject while performing the GSE or GSE-AD was measured using the Borg scale. The intrarater reliability of the LM measurement was found to be intraclass correlation coefficient (ICC[3,1])=0.97 (0.87-0.99) at resting and ICC(3,1)=0.94 (0.78-0.99) at contraction. Both the left and right LM showed significantly higher contraction during the grade 3 GSE (P< 0.05). The whole-body fatigue was significantly greater following GSE 2 and 3 than following GSE-AD 2 and 3 (P<0.05). In particular, GSE-AD had a significantly lower Borg score compared to GSE (P<0.05) and did not show any significant difference in muscle thickness (P>0.05). It is recommended that the abdominal drawing-in maneuver be applied with grade 3 GSE to enhance stability and reduce spinal fatigue.

Activity of Lower Limb Muscles During Squat With and Without Abdominal Drawing-in and Pilates Breathing

Barbosa, AC, Martins, FM, Silva, AF, Coelho, AC, Intelangelo, L, and Vieira, ER. Activity of lower limb muscles during squat with and without abdominal drawing-in and Pilates breathing. J Strength Cond Res 31(11): 3018-3023, 2017-The purpose of this study was to assess the effects of abdominal drawing-in and Pilates breathing on the activity of lower limb muscles during squats. Adults (n = 13, 22 ± 3 years old) with some Pilates experience performed three 60° squats under each of the following conditions in a random order: (I) normal breathing, (II) drawing-in maneuver with normal breathing, and (III) drawing-in maneuver with Pilates breathing. Peak-normalized surface electromyography of the rectus femoris, biceps femoris, gastrocnemius medialis, and tibialis anterior during the knee flexion and extension phases of squat exercises was analyzed. There were significant differences among the conditions during the knee flexion phase for the rectus femoris (p = 0.001), biceps femoris (p = 0.038), and tibialis anterior (p = 0.001), with increasing activation from conditions I to III. For the gastrocnemius medialis, there were significant differences among the conditions during the knee extension phase (p = 0.023), with increased activity under condition I. The rectus and biceps femoris activity was higher during the extension vs. flexion phase under conditions I and II. The tibialis anterior activity was higher during the flexion compared with the extension phase under all conditions, and the medial gastrocnemius activity was higher during the extension phase under condition I. Doing squats with abdominal drawing-in and Pilates breathing resulted in increased rectus, biceps femoris, and tibialis anterior activity during the flexion phase, increasing movement stability during squat exercises.

Volitional Spine Stabilization During a Drop Vertical Jump From Different Landing Heights: Implications for Anterior Cruciate Ligament Injury

CONTEXT

Volitional preemptive abdominal contraction (VPAC) during dynamic activities may alter trunk motion, but the role of the core musculature in positioning the trunk during landing tasks is unclear.

OBJECTIVE

To determine whether volitional core-muscle activation incorporated during a drop vertical jump alters lower extremity kinematics and kinetics, as well as trunk and lower extremity muscle activity at different landing heights.

DESIGN

Controlled laboratory study.

SETTING

Clinical biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-two young healthy adults, consisting of 17 men (age = 25.24 ± 2.88 years, height = 1.85 ± 0.06 m, mass = 89.68 ± 16.80 kg) and 15 women (age = 23.93 ± 1.33 years, height = 1.67 ± 0.08 m, mass = 89.68 ± 5.28 kg).

INTERVENTION(S)

Core-muscle activation using VPAC.

MAIN OUTCOME MEASURE(S)

We collected 3-dimensional ankle, knee, and hip motions, moments, and powers; ground reaction forces; and trunk and lower extremity muscle activity during 0.30- and 0.50-m drop vertical-jump landings.

RESULTS

During landing from a 0.30-m height, VPAC performance increased external oblique and semitendinosis activity, knee flexion, and knee internal rotation and decreased knee-abduction moment and knee-energy absorption. During the 0.50-m landing, the VPAC increased external oblique and semitendinosis activity, knee flexion, and hip flexion and decreased ankle inversion and hip-energy absorption.

CONCLUSIONS

The VPAC performance during landing may protect the anterior cruciate ligament during different landing phases from different heights, creating a protective advantage just before ground contact and after the impact phase. Incorporating VPAC during high injury-risk activities may enhance pelvic stability, improve lower extremity positioning and sensorimotor control, and reduce anterior cruciate ligament injury risk while protecting the lumbar spine.

The Effect of Distractive Function on Volitional Preemptive Abdominal Contraction During a Loaded Forward Reach in Normal Subjects

BACKGROUND

Volitional preemptive abdominal contraction (VPAC) is used to protect the spine and prevent injury. No published studies to data have examined the effect of distraction on VPAC use during function.

OBJECTIVE

To examine the effect of an auditory distraction ("Stroop task") on healthy subjects' ability to sustain VPAC by use of the abdominal drawing-in maneuver during loaded forward reach.

DESIGN

Within-subjects, repeated-measure cohort design.

SETTING

Clinical laboratory setting.

PARTICIPANTS

Convenience sample of 42 healthy individuals (ages 20-57 years).

METHODS

Transversus abdominis (TrA) thickness was measured with M-mode ultrasound imaging. Each subject performed Stroop versus no Stroop during 4 conditions: (1) without VPAC, quiet standing; (2) with VPAC, quiet standing; (3) without VPAC, forward reach; and (4) with VPAC, forward reach. An investigator blinded to the conditions measured the first 10 subjects to establish intratester reliability of probe/transducer placement and TrA measurement.

DATA REDUCTION

TrA thickness (mm) change represented VPAC performance. A single investigator measured onscreen TrA thickness twice at each second from second-6 through -10 on a recorded ultrasound imaging sequence.

RESULTS

A 2 (Stroop) × 4 (Activity) repeated-measures analysis of variance found no significant Stroop × Activity interaction [F(3, 93) = 0.345, P = .793] and no main effect for Stroop [F (1,31) = 1.324, P = .259] but found a significant main effect for activity [F (3,93) = 17.729, P < .001]. Tukey post-hoc pairwise comparisons demonstrated significant differences between VPAC versus no-VPAC conditions, except between quiet standing/yes-VPAC and loaded forward reach/no-VPAC conditions (P = .051). The interclass correlation coefficient (3,2) for probe/transducer placement reliability was 0.87, 0.91, 0.92, and 0.93 for conditions 1-4, respectively. The interclass correlation coefficient (3,2) for TrA measurement reliability was 0.96, 0.99, 0.99, and 0.99 for conditions 1-4, respectively.

CONCLUSION

A distracting executive function (Stroop task) did not produce a significant negative impact on normal individuals' ability to sustain a VPAC during quiet standing or loaded forward reach activities.

LEVEL OF EVIDENCE

II.

Effects of Volitional Spine Stabilization and Lower Extremity Fatigue on Trunk Control During Landing in Individuals With Recurrent Low Back Pain

STUDY DESIGN

Controlled laboratory study.

BACKGROUND

Recurrent low back pain (LBP) and neuromuscular fatigue are independently thought to increase the risk of spine injury. Volitional preemptive abdominal contraction (VPAC) is thought to improve lumbar spine and pelvis control in individuals with recurrent LBP. The effects of VPAC on fatigued landing performance in individuals with recurrent LBP are unknown.

OBJECTIVES

To determine the effects of VPAC and lower extremity fatigue on trunk control during landing in a population of individuals with recurrent LBP.

METHODS

Thirty-two recurrent LBP (mean ± SD age, 21.2 ± 2.7 years) and 33 healthy (age, 20.9 ± 2.3 years) subjects performed 0.30-m drop-jump landings with and without VPAC and fatigue. Trunk, pelvis, and hip biomechanical and electromyographic variables were obtained using 3-D motion capture. Hypotheses were tested using analysis of variance.

RESULTS

Volitional preemptive abdominal contraction resulted in significantly earlier muscle onsets across all muscles, with and without fatigue, in both groups (mean ± SD, 0.058 ± 0.019 seconds earlier; P≤.001) and altered lumbar lateral flexion (1.4° ± 14.8° greater right lateral flexion; P = .002). Fatigue significantly delayed muscle onsets (0.040 ± 0.014 seconds later; P≤.001) and altered pelvic obliquity (1.4° ± 11.0° greater; P≤.001) and trunk side flexion (2.0° ± 14.8° less; P≤.001). The recurrent LBP group exhibited delayed muscle onsets (0.039 ± 0.031 seconds later; P≤.004) and 4.2° less hip abduction at initial contact (P≤.008) in comparison to healthy controls.

CONCLUSION

Volitional preemptive abdominal contraction decreases some of the detrimental effects of fatigue on landing biomechanics and thus may reduce spine injury risk in individuals with recurrent LBP.

Effects of visual display terminal works on cervical movement pattern in patients with neck pain

[Purpose] This study examined changes in the onset of neck movement in young adults with and without mild neck pain (MNP) during visual display terminal (VDT) work. [Subjects] Ten control subjects and 10 subjects with MNP who were VDT workers were recruited. The upper (UC) and lower cervical (LC) spine angles in the sagittal plane were collected using an ultrasound-based motion analysis system during VDT work for 5 min. [Results] The MNP group had faster movement initiation in the UC and LC compared with the control group during VDT work. [Conclusion] These findings suggest that young adults with MNP should be cautious when performing VDT work while sitting.

The preferential contraction ratios of transversus abdominis on the variations of knee angles during abdominal drawing-in maneuver in wall support standing

The objective of this study was to determine appropriate knee angles for the abdominal drawing-in maneuver (ADIM) through evaluation of changes in contraction ratios of the abdominal muscles and activity of quadriceps muscle in relation to changes in knee angles occurring while the ADIM is performed in the wall support standing (WSS). 20 subjects performed the ADIM at different knee angles (0°, 20°, 40°, 60°) in random order, standing at a point 6 inches away from the wall with the spine maintained in the neutral position. The WSS with knee flexion at 20° showed significantly higher preferential contraction ratio (PCR) of transversus abdominis (TrA) compared to other positions (0°, 40°, 60°). Therefore, performing the ADIM in the WSS with knee flexion at 20° appears to be the most appropriate position for TrA PCR.

Comparison of erector spinae and hamstring muscle activities and lumbar motion during standing knee flexion in subjects with and without lumbar extension rotation syndrome

The aim of this study was to compare the activity of the erector spinae (ES) and hamstring muscles and the amount and onset of lumbar motion during standing knee flexion between individuals with and without lumbar extension rotation syndrome. Sixteen subjects with lumbar extension rotation syndrome (10 males, 6 females) and 14 healthy subjects (8 males, 6 females) participated in this study. During the standing knee flexion, surface electromyography (EMG) was used to measure muscle activity, and surface EMG electrodes were attached to both the ES and hamstring (medial and lateral) muscles. A three-dimensional motion analysis system was used to measure kinematic data of the lumbar spine. An independent-t test was conducted for the statistical analysis. The group suffering from lumbar extension rotation syndrome exhibited asymmetric muscle activation of the ES and decreased hamstring activity. Additionally, the group with lumbar extension rotation syndrome showed greater and earlier lumbar extension and rotation during standing knee flexion compared to the control group. These data suggest that asymmetric ES muscle activation and a greater amount of and earlier lumbar motion in the sagittal and transverse plane during standing knee flexion may be an important factor contributing to low back pain.

Cervical coupling motion characteristics in healthy people using a wireless inertial measurement unit

Objective. The objectives were to show the feasibility of a wireless microelectromechanical system inertial measurement unit (MEMS-IMU) to assess the time-domain characteristics of cervical motion that are clinically useful to evaluate cervical spine movement. Methods. Cervical spine movements were measured in 18 subjects with wireless IMUs. All rotation data are presented in the Euler angle system. Amount of coupling motions was evaluated by calculating the average angle ratio and the maximum angle ratio of the coupling motion to the primary motion. Reliability is presented with intraclass correlation coefficients (ICC). Results. Entire time-domain characteristics of cervical motion were measured with developed MEMS-IMU system. Cervical range of motion (CROM) and coupling motion range were measured with high ICCs. The acquired data and calculated parameters had similar tendency with the previous studies. Conclusions. We evaluated cervical motion with economic system using a wireless IMU of high reliability. We could directly measure the three-dimensional cervical motion in degrees in realtime. The characteristics measured by this system may provide a diagnostic basis for structural or functional dysfunction of cervical spine. This system is also useful to demonstrate the effectiveness of any intervention such as conventional medical treatment, and Korean medical treatment, exercise therapy.

Comparison of lumbopelvic rhythm and flexion-relaxation response between 2 different low back pain subtypes

STUDY DESIGN

A cross-sectional study to compare the kinematics and muscle activities during trunk flexion and return task in people with and without low back pain (LBP).

OBJECTIVE

To characterize the lumbopelvic rhythms during trunk flexion and return task in a group of healthy persons and 2 different subgroups of patients with LBP, identifying the flexion-relaxation (FR) responses in each group.

SUMMARY OF BACKGROUND DATA

The lumbopelvic rhythm is the coordinated movement of the lumbar spine and hip during trunk flexion and return and is a clinical sign of LBP. However, the reported patterns of lumbopelvic rhythm in patients with LBP are inconsistent, possibly because previous studies have examined a heterogeneous group of patients with LBP. To clarify the lumbopelvic rhythm patterns, it is necessary to study more homogeneous subgroups of patients with LBP.

METHODS

The study involved the following subjects: control group of healthy subjects (N = 16); lumbar flexion with rotation syndrome (LFRS) LBP subgroup (N = 17); and lumbar extension with rotation syndrome (LERS) LBP subgroup (N = 14). The kinematic parameters during the trunk flexion and return task were recorded using a 3-dimensional motion capture system, and the FR ratio of the erector spinae muscle was measured.

RESULTS

The flexion angle of the lumbar spine was larger in the LFRS subgroup than in the control group and the LERS LBP subgroup, and the hip flexion angle was larger in the LERS LBP subgroup than in the control group and LFRS subgroup. The FR response of the erector spinae muscle disappeared in the LFRS and LERS LBP subgroups.

CONCLUSION

These results show that the lumbopelvic rhythms are different among healthy subjects and patients assigned to 2 specific LBP subgroups. These results provide information on the FR response of the erector spinae muscle.

Differences between two subgroups of low back pain patients in lumbopelvic rotation and symmetry in the erector spinae and hamstring muscles during trunk flexion when standing

The present study was performed to examine lumbopelvic rotation and to identify asymmetry of the erector spinae and hamstring muscles in people with and without low back pain (LBP). The control group included 16 healthy subjects, the lumbar-flexion-rotation syndrome LBP group included 17 subjects, and the lumbar-extension-rotation syndrome LBP group included 14 subjects. Kinematic parameters were recorded using a 3D motion-capture system, and electromyography parameters were measured using a Noraxon TeleMyo 2400T. The two LBP subgroups showed significantly more lumbopelvic rotation during trunk flexion in standing than did the control group. The muscle activity and flexion-relaxation ratio asymmetries of the erector spinae muscles in the lumbar-flexion-rotation syndrome LBP group were significantly greater than those in the control group, and the muscle activity and flexion-relaxation ratio asymmetry of the hamstring muscles in the lumbar-extension-rotation syndrome LBP group were significantly greater than those in the control group. Imbalance or asymmetry of passive tissue could lead to asymmetry of muscular activation. Muscle imbalance can cause asymmetrical alignment or movements such as unexpected rotation. The results showed a greater increase in lumbopelvic rotation during trunk flexion in standing among the lumbar-flexion-rotation syndrome and lumbar-extension-rotation syndrome LBP groups compared with the control group. The differences between the two LBP subgroups may be a result of imbalance and asymmetry in erector spinae and hamstring muscle properties.