Core Function in Adults With Severe Asthma and Its Relationship With Breathing Symptoms

BACKGROUND

People with asthma may have skeletal muscle dysfunction but data describing core function in severe asthma are limited.

OBJECTIVE

To compare core function between people with severe asthma and healthy controls and to determine the difference between males and females. Furthermore, we aimed to investigate the association between core function and breathing symptoms.

METHOD

Adults with a diagnosis of severe asthma and healthy controls undertook an assessment that included 3 core function tests: partial sit-up, Biering-Sorensen, and side bridge. Breathing symptoms were assessed by the modified Medical Research Council dyspnea scale, modified Borg scale, and Nijmegen questionnaire.

RESULTS

People with severe asthma (n = 136) (38% male, age median [Q1-Q3] 59 y [45-68], body mass index 30 kg/m2 [26-37]) were compared with 66 people without respiratory disease (47% male, age 55 y [34-65], body mass index 25 kg/m2 [22-28]). There was no difference between groups in the partial sit-up (P = .09). However, participants with severe asthma performed worse with the Biering-Sorensen (P < .001), and the left and right side bridge test (P < .001 for both) than the healthy comparison group. Similar results were found when comparing males and females separately. Males with severe asthma had increased function compared with their female counterparts in the left side bridge test. Core function tests correlated with the breathing symptom measures, the modified Medical Research Council, modified Borg scale, and Nijmegen questionnaire (-0.51 > r > -0.19; P ≤ .03).

CONCLUSIONS

Adults with severe asthma have worse core function than their control counterparts, independent of sex. Furthermore, as core function decreases, breathing symptoms increase.

The automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without low back pain- A cross-sectional study

BACKGROUND

The postural control and abdominal muscles' automatic activity were found to be impaired in subjects with low back pain (LBP) during static activities. However, the studies are predominantly conducted on younger adults and a limited number of studies have evaluated abdominal muscles' automatic activity during dynamic standing activities in subjects with LBP. The present study investigated the automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without LBP.

METHODS

Twenty subjects with and 20 subjects without LBP were included. The thickness of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles was measured during rest (in supine), static, and dynamic standing postural tasks. To estimate automatic muscle activity, each muscle's thickness during a standing task was normalized to its thickness during the rest. Standing postural tasks were performed using the Biodex Balance System.

RESULTS

The mixed-model analysis of variance revealed that task dynamicity significantly affected thickness change only in the TrA muscle (P = 0.02), but the main effect for the group and the interaction were not significantly different (P > 0.05). There were no significant main effects of the group, task dynamicity, or their interaction for the IO and EO muscles (P > 0.05). During dynamic standing, only the TrA muscle in the control group showed greater thickness changes than during the static standing task (P < 0.05).

CONCLUSIONS

Standing on a dynamic level increased the automatic activity of the TrA muscle in participants without LBP compared to standing on a static level. Further research is required to investigate the effects of TrA muscle training during standing on dynamic surfaces for the treatment of older adults with LBP.

Laparoscopic vs. ultrasound-guided transversus abdominis plane (TAP) block in colorectal surgery: a systematic review and meta-analysis of randomized trials

BACKGROUND

The transversus abdominis plane block (TAPB) is effective for postoperative pain management in patients undergoing colorectal surgery. However, evidence regarding the optimal delivery method, either laparoscopic (L-TAPB) or ultrasound-guided (U-TAPB) is lacking. Our study aimed to compare the effectiveness of these delivery methods.

METHODS

We carried out a literature search of PubMed, Cochrane Library, Web of Science, and Google Scholar databases to include randomized studies comparing patients receiving either L-TAPB or U-TAPB during minimally invasive colorectal surgery. The primary endpoint was opioid consumption in the first 24 h after surgery. Risk of bias was assessed with the RoB-2 tool. Effect size was estimated for each study with 95% confidence interval and overall effect measure was estimated with a random effect model.

RESULTS

The literature search revealed 294 articles, of which four randomized trials were eligible. A total of 359 patients were included, 176 received a L-TAPB and 183 received a U-TAPB. We established the non-inferiority of L-TAPB, as the absolute difference of - 2.6 morphine-mg (95%CI - 8.3 to 3.0) was below the pooled non-inferiority threshold of 8.1 morphine-mg (low certainty level). No difference in opioid consumption was noted at 2, 6, 12, and 48 h (low to very low certainty level). Postoperative pain, nausea and vomiting were similar between groups at different timepoints (low to very low certainty level). No TAPB-related complications were recorded. Finally, the length of hospital stay was similar between groups.

CONCLUSION

For postoperative multimodal analgesia both L-TAPB and U-TAPB may result in little to no difference in outcome in patients undergoing colorectal surgery. Registration Prospero CRD42023421141.

Lateral abdominal muscle thickness and contractile function in women with and without stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) primarily results from the weakness of pelvic floor muscles, working synergistically with the abdominal muscles. The current study aimed to compare thickness and contractile function of lateral abdominal muscles in women with and without SUI.

METHODS

Thirty-nine women with SUI (SUI group; age: 38.87 ± 8.96 years, body mass index (BMI): 24.03 (5.94) kg/m2) and 42 healthy women (control group; age: 36.21 ± 11.46 years, BMI: 23.90 (5.85) kg/m2) were included. Transverse abdominis (TrA) and internal oblique (IO) muscle thickness at rest and during abdominal drawing-in maneuver (ADIM) were measured with ultrasound imaging in B-mode using a Logiq S7/Expert device and a 9-11 MHz linear transducer. Percentage change in thickness and contractile function of these muscles were also calculated.

RESULTS

No significant differences in the thickness of TrA and IO muscles at rest and during ADIM between the groups were found (p > 0.05). The percent change in thickness and contractile function of both right and left side TrA muscles and the right side IO muscle were lower in SUI group than control group (p < 0.05). The percentage change in thickness and the contractile function of the left side IO muscle did not change (p > 0.05).

CONCLUSION

Women with SUI had a smaller percentage change in thickness and contractile function of TrA and IO muscle than women without SUI. However, there was no difference in the morphological features of these muscles between the groups. Considering the lateral abdominal muscle, training may be important for management of SUI.

Morphometry of pyramidalis muscle and its role in reconstructive surgeries: A cadaveric study in South Indian population

Background

The pyramidalis muscle is a tiny triangular-shaped muscle that is located in the anterior abdominal wall, which originates from the body of the pubis and pubic symphysis and is inserted into linea alba. This study aimed to measure the different parameters of the pyramidalis muscle in adult cadavers.

Methods

This study was carried out on 31 adults (26 males and five females) 10% formalin embalmed cadavers of both sexes from the Department of Anatomy at Kasturba Medical College, Manipal.

Results

The mean length of the right pyramidalis muscle was 64.44 ± 12.52 mm and the left pyramidalis muscle was 64.73 ± 12.81 mm. The mean width of the muscle was 15 ± 4.18 mm and 15.03 ± 3.52 mm on the right and left sides, respectively. The mean thickness of the muscle was 1.32 ± 0.55 mm and 1.4 ± 0.80 mm on the right and left sides, respectively. The distance between the umbilicus to pubic symphysis ranged from 130-192 mm and their mean was calculated to be 159.77 ± 15.36. The distance between the umbilicus and the apex of the muscle ranged from 72-123 mm.

Conclusions

The measured parameters like length, width and thickness may help the surgeons to locate the muscle during infra umbilical surgeries.

Chronic low back pain and muscle activity in women during the sit-to-stand task: A cross-sectional study

INTRODUCTION

The ability to stand up and sit down is important. Due to the large number of repetitions of these activities during the day and the demand that the task requires, it is cited as painful in the presence of low back pain (LBP). Individuals with LBP present alterations in muscle activation, however, this statement needs to be verified during everyday situations like the sit-to-stand task (STST). Therefore, the objective was to evaluate the muscle recruitment of women with and without LBP during the STST.

METHODS

35 women were evaluated, and allocated into the control group (CG n = 15) and the low back pain group (LBPG n = 20). The protocol consisted of clinical evaluation and the sit-to-stand task (STST). Electromyographic signals of the lumbar multifidus (LM), internal oblique (IO) and external oblique (EO), rectus abdominis (RA), and lumbar iliocostalis (LI) were carried out concomitantly with the STST. To verify normality, the Shapiro-Wilk test was used. For the characterization of the sample, the MANOVA test was chosen and the MANCOVA test was also chosen to compare the characteristics of the participants.

RESULTS

Regarding the data analysis of the electromyographic signals, higher values were seen in the RA (moments 2 and 3) in the LBPG in the STST.

CONCLUSION

The present study showed that women with chronic LBP present higher muscle activation of the rectus abdominis in the sit-to-stand task.

Effect of verbal instructions on trunk muscle activity during volitional preemptive abdominal contraction

OBJECTIVE

This study investigated the effect of Verbal Instruction (VI) strategies on trunk muscle contraction among healthy subjects. The effect of three VI Abdominal Drawing-In Maneuver (ADIM) and two VI Abdominal Bracing Maneuver (ABM) strategies on left Internal (LIO) and External Oblique (LEO) and bilateral superficial Multifidi (sMf) activation was examined.

DESIGN

Within-subjects, repeated measure design.

METHODS

Surface EMG (sEMG) measured LIO, LEO, and sMf activity in 28 subjects (mean age 23.5 ± 5.5 years). Testing included five supine hook-lying and five quiet standing conditions.

RESULTS

One-way ANOVAs demonstrated no significant main effect for ADIM or ABM in supine or standing (p > .05). Muscle activation amplitudes during VPAC conditions demonstrated higher mean values for standing versus supine (p < .05) except for two conditions involving LEO. Friedman Tests for dominant strategy demonstrated a significant main effect for ADIM-VI and ABM-VI strategies. Post-hoc testing generally showed the dominant strategy to be significantly higher versus others.

CONCLUSION

No single preferred VI cue for ADIM or ABM was observed. Each subject's dominant strategy dictated the most suitable VI. Standing was preferred for LIO and sMf activation, whereas position did not change LEO activation. Non-significant correlations between all muscle pairings during all ADIM and ABM strategies were observed. These findings may suggest the need for healthcare providers who understand the intricacies of trunk stability to teach and monitor VPAC with either ADIM or ABM options.

Effect of strengthening and weakening of abdominal and dorsal muscles on lumbar spine loads in parents of disabled children

Pain in the lower part of the back is one of the most common chronic illnesses globally. This work aimed to determine the impact of the reinforcement of particular groups of abdominal and dorsal muscles on the loads exerted on the lumbar section of the spine in 30 mothers of children with motor disabilities. An optical Ariel Performance Analysis System recorded and processed the kinematics data of everyday activities. Tests investigating the effects of the strengthening or weakening of abdominal and dorsal muscles on loading in the lumbar section of the spine utilized the AnyBody Modelling System. Input data for the simulations included mean values of body positions, while the effects of strengthening or weakening of muscles were simulated in the muscle forces model by introducing different values for muscle physiological cross-sectional area (PCSA). Simulations used decreasing or increasing PCSA values of abdominal muscles and the erector spinae. The analysis involved component and resultant force values on the lumbosacral joint (L5-S1) of the spine and intra-abdominal pressure values. The highest reduction of the resultant reaction value in L5-S1 was observed in the simulations that increased the PCSA of the transverse abdominal (TrA). Indeed, a double increase in the TrA cross-section caused a reduction of the resultant reaction in L5-S1 by 30% and the anterior-posterior and proximal-distal forces by approximately 20-30%. Increased PCSA of the erector spinae exerted higher loads on the spine. These results indicate that strengthening weakened abdominal muscles, particularly TrA, in parents of children with motor disabilities reduces lower spinal loads during daily activities.

Ultrasound assessment of the abdominal, diaphragm, and pelvic floor muscles during the respiratory and postural tasks in women with and without postpartum lumbopelvic pain: a case-control study

INTRODUCTION AND HYPOTHESIS

Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks.

METHODS

Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration.

RESULTS

The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement.

CONCLUSION

The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP.

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) patients predominantly experience involuntary leakage during respiratory functions that induce a rapid increase in intra-abdominal pressure (IAP) such as coughing and sneezing. The abdominal muscles have an important role in the forced expiration and modulation of IAP. We hypothesized that SUI patients have different thickness changes in the abdominal muscles compared to healthy individuals during breathing maneuvers.

METHODS

This case-control study was conducted on 17 adult women with SUI and 20 continent women. Muscle thickness changes were measured by ultrasonography at the end of deep inspiration and expiration, and the expiratory phase of voluntary coughing for external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) muscles. The percent thickness changes of muscles were used and analyzed with a two-way mixed ANOVA test and post-hoc pairwise comparison at a confidence level of 95% (p < 0.05).

RESULTS

The percent thickness changes of TrA muscle were significantly lower in SUI patients at deep expiration (p < 0.001, Cohen's d = 2.055) and coughing (p < 0.001, Cohen's d=1.691). While, percent thickness changes for EO (p = 0.004, Cohen's d=0.996) and IO thickness (p < 0.001, Cohen's d=1.784) were greater at deep expiration and deep inspiration, respectively.

CONCLUSIONS

The percent thickness changes of abdominal muscles differed between women with and without SUI during breathing maneuvers. The present study provided information regarding the altered function of abdominal muscles during breathing maneuvers; therefore, it is important to consider the respiratory role of abdominal muscles for the rehabilitation of SUI patients.

Effects of axial extension on pelvic floor displacement and abdominal muscle activity during a pelvic floor muscle task

BACKGROUND

The effects of axial extension on pelvic floor displacement and abdominal muscle activity during pelvic floor muscle (PFM) exercises are not well known.

OBJECTIVE

To clarify the effect of sitting axial extension on pelvic floor displacement and abdominal muscle activity during a PFM task.

METHODS

Pelvic floor displacement, abdominal muscle activity, and subjective kinesthesia of the PFM were compared between the resting and axial-extended sitting positions during a pelvic floor task in 34 healthy young men.

RESULTS

No significant difference in pelvic floor displacement was observed between the resting and axial extension sitting position. Subjective kinesthesia was significantly easier to perform in axial extension than in resting sitting position during pelvic floor depression. Abdominal oblique muscle activity was higher in axial extension than in resting sitting position during pelvic floor depression. The changes in axial extension were significantly greater in the internal oblique muscles during elevation and in the internal and external oblique muscles during depression than in the lower rectus abdominis muscles.

CONCLUSION

Axial extension in the sitting position does not change pelvic floor displacement during the PFM task. However, axial extension may be effective in facilitating subjective kinesthesia of PFM and in increasing oblique abdominal muscle activity.

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.

Automated ultrasound measurements of lateral abdominal muscles under controlled breathing phases

BACKGROUND AND OBJECTIVES

A breathing phase during ultrasound measurements of the lateral abdominal muscles (LAMs) are usually indirectly controlled by visual inspection of the position of the transversus abdominis (TrA) muscle. This is due to the lack of devices to directly control airflow that are connected to the ultrasound in order to automatically and simultaneously freeze ultrasound images at the programmed breathing phase. Such indirect control may be related with potential measurement error because LAMs are respiratory muscles. Thus, the aim of this study was to present a newly developed and automatic measurement procedure to directly control airflow and at the same time automatically collect ultrasound images at the programed breathing phase. Additionally, it was decided to compare LAMs measurements obtained manually by the examiner and with an external device controlling the peak phase of tidal inspiration and expiration and compare the elasticity and thickness measurements between tidal inspiration and expiration in young participants.

METHODS

The study was carried out on 10 healthy youth. The thickness and shear modulus were measured by an Aixplorer ultrasound scanner. The measurements were obtained manually by the examiner and with a newly developed external device controlling the peak phases of tidal inspiration and expiration.

RESULTS

A significant difference in external/internal oblique thickness between the expiration and inspiration phases depended on the measurement procedure. The TrA thickness was similar during inspiration and expiration. During inspiration, the TrA shear modulus was higher than during expiration, and the TrA shear modulus depended on the measurement procedure.

CONCLUSION

Although the raw LAMs thickness and external/internal oblique thickness/shear modulus data were similar, the measurement procedure may affect the interpretation of the results. The TrA shear modulus is the most vulnerable to errors related to the measurement procedure. Construction of this study device controlling airflow and automatically collecting ultrasound images at the selected breathing phase seems to be promising in future studies considering measurements of respiratory muscles in a strictly defined breathing phase.

Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: A case-control study

BACKGROUND

In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure.

METHODS

Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18-28), body mass index (BMI): 20.70 (17.31-28.73) kg/m²) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19-23), BMI: 20.83 (17.31-27.10) kg/m²) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively.

FINDINGS

The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0-10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group.

INTERPRETATION

Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea.

Are preoperative CT variables associated with the success or failure of subsequent ventral hernia repair: nested case-control study

OBJECTIVES

Systematic review of CT measurements to predict the success or failure of subsequent ventral hernia repair has found limited data available in the indexed literature. To rectify this, we investigated multiple preoperative CT metrics to identify if any were associated with postoperative reherniation.

METHODS

Following ethical permission, we identified patients who had undergone ventral hernia repair and had preoperative CT scanning available. Two radiologists made multiple measurements of the hernia and abdominal musculature from these scans, including loss of domain. Patients were divided subsequently into two groups, defined by hernia recurrence at 1-year subsequent to surgery. Hypothesis testing investigated any differences between CT measurements from each group.

RESULTS

One hundred eighty-eight patients (95 male) were identified, 34 (18%) whose hernia had recurred by 1-year. Only three of 34 CT measurements were significantly different when patients whose hernia had recurred were compared to those who had not; these significant findings were assumed contingent on multiple testing. In particular, preoperative hernia volume (recurrence 155.3 cc [IQR 355.65] vs. no recurrence 78.2 [IQR 303.52], p = 0.26) nor loss of domain, whether calculated using the Tanaka (recurrence 0.02 [0.04] vs. no recurrence 0.009 [0.04], p = 0.33) or Sabbagh (recurrence 0.019 [0.05] vs. no recurrence 0.009 [0.04], p = 0.25) methods, differed between significantly between groups.

CONCLUSIONS

Preoperative CT measurements of ventral hernia morphology, including loss of domain, appear unrelated to postoperative recurrence. It is likely that the importance of such measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.

KEY POINTS

• Preoperative CT scanning is often performed for ventral hernia but systematic review revealed little data regarding whether CT variables predict postoperative reherniation. • We found that the large majority of CT measurements, including loss of domain, did not differ significantly between patients whose hernia did and did not recur. • It is likely that the importance of CT measurements to predict recurrence is outweighed by other patient factors and surgical reconstruction technique.

Trunk muscle size and function in volleyball players with and without injuries to the head, neck and upper limb

OBJECTIVE

To investigate trunk muscle size and function in elite and community volleyball players with and without a history of head, neck or upper limb injury.

DESIGN

Cross-sectional observational study.

SETTING

Volleyball training camp or training sessions.

PARTICIPANTS

86 volleyball players (elite = 29; community = 57).

MAIN OUTCOME MEASURES

Information regarding history of head, neck or upper limb injuries was collected by self-report questionnaires. Trunk muscle size (multifidus, transversus abdominis, internal oblique and quadratus lumborum) and voluntary contraction (multifidus, transversus abdominis, internal oblique) were assessed using ultrasound imaging.

RESULTS

For trunk muscle size, no significant differences were found between elite and community volleyball players with and without a history of injury (all p > 0.05). A significant difference was found for voluntary contraction of the multifidus and transversus abdominis muscles for elite and community volleyball players with and without a history of injury (all p < 0.05).

CONCLUSION

A difference in trunk muscle contraction but no change in trunk muscle size in players with a history of head, neck or upper limb injuries may represent an altered muscle recruitment pattern rather than a deficiency in trunk muscle strength. Prospective studies are required to determine if these adaptations are compensatory (and protective) or predispose players to further injuries.

Altered ultrasonographic activity of abdominal muscles during breathing in males with and without nonspecific chronic low back pain

PURPOSE

This study aimed to investigate the altered ultrasonographic activity of abdominal muscles during breathing in males with and without nonspecific chronic low back pain (NSCLBP).

DESIGN

Cross-sectional study.

METHODS

Twenty males with NSCLBP and 20 males without NSCLBP were recruited. Muscle thickness change was measured by ultrasonography during breathing in the end-inspiration and end-expiration phases for the transverse abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA) muscles. The data were normalized to the end-inspiration thickness. An independent t test was run to analyze the data at a confidence level of 95% (p < 0.05).

RESULTS

The participants with NSCLBP had thicker IO muscles in the end-inspiration (p = 0.030) and end-expiration (p = 0.017) phases as well as greater RA (p = 0.006) and smaller EO (p = 0.003) normalized thickness changes during breathing.

CONCLUSION

The normalized thickness changes during breathing differed between the participants with and without NSCLBP. Reduced EO and increased RA activity may predispose the spine to further injuries. Therefore, normalizing the breathing pattern should be considered in the management of people with NSCLBP.

Differences in Abdominal Body Composition According to Glycemic Status: An Inverse Probability Treatment Weighting Analysis

BACKGROUND

Several studies have reported that abdominal fat and muscle changes occur in diabetic patients. However, there are few studies about such changes among prediabetic patients. In this study, we evaluated the differences in abdominal fat and muscles based on abdominopelvic computed tomography in prediabetic and diabetic subjects compared to normal subjects.

METHODS

We performed a cross-sectional study using health examination data from March 2014 to June 2019 at Ulsan University Hospital and classified subjects into normal, prediabetic, and diabetic groups. We analyzed the body mass index corrected area of intra-abdominal components among the three groups using inverse probability treatment weighting (IPTW) analysis.

RESULTS

Overall, 8,030 subjects were enrolled; 5,137 (64.0%), 2,364 (29.4%), and 529 (6.6%) subjects were included in the normal, prediabetic, and diabetic groups, respectively. After IPTW adjustment of baseline characteristics, there were significant differences in log visceral adipose tissue index (VATI; 1.22±0.64 cm2/[kg/m2] vs. 1.30±0.63 cm2/[kg/m2] vs. 1.47±0.64 cm2/[kg/m2], P<0.001) and low-attenuation muscle index (LAMI; 1.02±0.36 cm2/[kg/m2] vs. 1.03±0.36 cm2/[kg/m2] vs. 1.09±0.36 cm2/[kg/m2], P<0.001) among the normal, prediabetic, and diabetic groups. Prediabetic subjects had higher log VATI (estimated coefficient= 0.082, P<0.001), and diabetic subjects had higher log VATI (estimated coefficient=0.248, P<0.001) and LAMI (estimated coefficient=0.078, P<0.001) compared to normal subjects.

CONCLUSION

Considering that VATI and LAMI represented visceral fat and lipid-rich skeletal muscle volumes, respectively, visceral obesity was identified in both prediabetic and diabetic subjects compared to normal subjects in this study. However, intra-muscular fat infiltration was observed in diabetic subjects only.

Clinical utility of ultrasonography imaging in musculoskeletal conditions: A Systematic review and Meta-analysis

Optimising ultrasonography imaging (UI) applications for clients is a highly specific and sensitive add-on method. The aim of this meta-analysis was to systematically evaluate the clinical utilisation of UI in musculoskeletal conditions by rehabilitation providers in the past decade. Two reviewers independently assessed relevant research articles from five databases electronically (Medline, Cochrane Library, EMBASE, ProQuest, EBSCO) and screened titles and abstracts based on predefined eligibility criteria (2010- 2020). A total of 147 articles were screened for eligibility by two reviewers independently, and any disagreements were resolved by another reviewer using Rayyan QCRI software. Ninety-seven duplicates were removed, and after excluding 21 studies, 16 randomized controlled trials were included and full texts retrieved. Data were synthesised using Revman 5.4 software for qualitative analysis and risk-of-bias assessment. Four similar studies were statistically analysed for heterogeneity of abdominal muscle contraction ratios. Two interventional studies were also analysed to assess the effect of feedback. The diagnostic application of UI was investigated using a consistent amount of literature, though from a rehabilitation perspective the literature is inconclusive. The clinical utility of UI in rehabilitation by physical therapists is conclusive and has potential to advance clinical practice. Further well-designed randomized controlled trials minimising selection biases will help improve the quality in this domain. Critical reflection, clinical reasoning, and mutual goal setting will help practising physical therapists to scrutinize the clinical practice more objectively.

Effect of photobiomodulation therapy on trunk flexor performance after incisional hernia repair: a randomized controlled trial

To investigate the effect of two photobiomodulation approaches on trunk flexor performance after incisional hernia repair and to compare the effects of both wavelengths. Forty-five patients were randomly distributed after isokinetic trunk flexor assessments into infrared laser, red laser, and placebo groups. Each patient received laser treatment followed by a traditional physical therapy program. In laser treatment, 24 points in both recti were irradiated by infrared or red laser light with the following parameters; 0.6 J per point, 214.28 J/cm² as energy density, and 17.85 W/cm² as intensity, while the control group received a placebo approach. All groups received clinical treatments at a rate of 3 sessions per week for 4 weeks; in addition, the physical therapy program was continued on other days for all groups. Isokinetic trunk flexor strength was measured before treatment and 4 weeks after treatment as in each measurement, fatigue protocol was designed, and the trunk flexor strength was measured before fatigue test while the trunk flexor resistance to fatigue was measured after fatigue test. After 4 weeks, pre-and post-fatigue trunk flexor strengths in both laser groups were significantly increased compared to pre-and post-fatigue trunk flexor strength in the placebo group, respectively, and there was no significant difference between the two laser groups. Photobiomodulation approaches enhance trunk flexor response to exercise after incisional hernia repair. This enhancement leads to greater strength and more fatigue resistance for the trunk flexors in photobiomodulation groups compared to the placebo group and no difference between the two photobiomodulation effects.

Transabdominal ultrasound to assess the displacement of the bladder base during abdominal and pelvic floor contractions in continent parous versus nulliparous women

INTRODUCTION AND HYPOTHESIS

The effect of different abdominal contractions on the position of pelvic organs in parous women during postpartum exercises has not been sufficiently assessed. The aim of this study was to evaluate the displacement of the bladder base (BB) during different pelvic floor and abdominal contractions in parous women compared to nulliparous women. We hypothesised that abdominal and perineal contractions will produce a disparate effect on the position of the BB between groups.

METHODS

Cross-sectional study including a convenience sample of 63 volunteers (35 nulliparous vs. 28 postpartum women). Transabdominal ultrasound was used in mode B to image the displacement of the BB. The protocol included six different pelvic floor and abdominal contractions commonly used in postpartum rehabilitation.

RESULTS

The BB elevated significantly more in the postpartum group compared to nulliparous women when performing submaximal contraction of pelvic floor and transversus abdominis muscles simultaneously with axial elongation of the back (0.93 ± 0.55 cm in parous women vs. 0.66 ± 0.46 cm in nulliparous women). In contrast, the BB was found to descend significantly during a curl-up contraction in both groups (0.93 ± 0.55 cm in parous women vs. 0.66 ± 0.46 cm in nulliparous women).

CONCLUSIONS

The overall results of this study showed that perineal and superficial abdominal contractions produced different immediate effects compared to deep abdominal contractions on the displacement of BB in parous and nulliparous women. Further research is required to assess the long-term effects of these contractions.

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.

The effects of curl-up exercise in terms of posture and muscle contraction direction on muscle activity and thickness of trunk muscles

BACKGROUND

The curl-up exercise is widely used in clinical practice for strengthening abdominal muscles, but has been applied without a systematic method.

OBJECTIVE

The purpose of this study was to determine the most effective method considering the angle and muscle contraction direction during the curl-up exercise.

METHODS

Fourteen healthy males performed the curl-up exercise according to contraction direction (concentric and eccentric) and angle (30∘, 60∘, and 90∘). The muscle activity of the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and iliopsoas (IP) was measured using electromyography (EMG), and the muscle thickness of transversus abdominis (TrA) was measured using ultrasonography.

RESULTS

The activities of the abdominal muscles (RA, EO, and IO) decreased with increasing angles (30∘, 60∘, and 90∘) (p< 0.05). There was no significant difference between eccentric and concentric contractions. The thickness ratio of TrA was the largest at an eccentric curl-up at 30∘, and the smallest at a concentric curl-up at 30∘ (p< 0.05).

CONCLUSIONS

The most effective angle for curl-up was 30∘. Although there is no difference in the direction of muscle contraction, eccentric curl-up at 30∘ could be considered the most effective posture for abdominal strengthening considering the importance of TrA.

Effects of whole body vibration exercise on lumbar-abdominal muscles activation for patients with chronic low back pain

Background

Whole body vibration (WBV) training as an intervention method can cure chronic low back pain (CLBP). Different WBV parameters exert different effects on lumbar-abdominal muscle performance. Currently, there is a lack of study researched the influence of WBV training on patients with CLBP by lumbar–abdominal muscle activity. Therefore, this study aimed to investigate how WBV and exercise and their interactions influence lumbar-abdominal muscle activity in patients with CLBP.

Methods

a group of ambulatory patients with chronic low back pain. Muscle activities of the multifidus (MF), erector spinae (ES), abdominal oblique externus muscle (AOE) and the rectus abdominis muscle (RA) were measured by surface electromyography, whereas participants performed 4 different exercises (single bridge, plank, side stay and V crunch) during three whole body vibration conditions and a no-vibration condition in a single experimental session.

Results

Compared with the same exercises without whole body vibration, muscle activity increased when whole body vibration was added to the exercises. MF; the WBV frequency (P = 0.002,) and exercise (P < 0.001) presented significant effects on the root mean square of MF, whereas exercise * frequency (P = 0.044) also resulted in significant interaction effects. ES: the significant differences were detected at WBV frequency (P < 0.001), exercise (P < 0.001), the interaction effect of exercise and frequency (P = 0.225) was no significant. RA: the significant difference was detected at WBV frequency (P = 0.018), the effect of exercise (P = 0.590) and the exercise * frequency interaction (P = 0.572) were no significant. AOE: the significant difference was detected at WBV frequency (P < 0.001), the effect of exercise (P = 0.152) and the exercise * frequency interaction (P = 0.380) were no significant.

Conclusion

Adding whole body vibration to exercise could increase muscle activation of lumbar–abdominal muscle in patients with CLBP. The optimum frequency for lumbar–abdominal muscles is 15 Hz. The best exercises include plank for multifidus and erector spinae, V crunch for rectus abdominis and single bridge for abdominal oblique externus.

Clinical registration

Trial registration: ChiCTR-TRC-13003708. Registered 19 October 2013.

The code of ethical approval

2014008.

The immediate effect of whole-body vibration on rectus abdominis muscle activity and cutaneous temperature: A randomized controlled trial

OBJECTIVES

To compare acute effects of isometric abdominal exercises performed with or without vibration on the electromyographic activity and cutaneous temperature in the abdominal region of physically active individuals.

METHODS

A randomized controlled crossover clinical trial was undertaken in thirty volunteers who completed one unique session of two different protocols of interventions apart from a week from each other, in a two-week study protocol. The subjects were randomly divided in to two groups of 15 volunteers; both were assigned to perform board exercise (30 s on the front, right and left lateral boards, with a rest interval of 2 min). The first group performed it on a vibrating platform at a frequency of 30 Hz for the first week, while the remaining participants executed the same exercise without stimulates vibration. In the second week the protocol was inverted. The outcome were surface electromyography (EMG) data for the rectus abdominis muscle (RAM) and cutaneous temperature (CT) of the abdominal region. Normality was accepted, and Student's t-tests were used to compare the measurements for dependents variables (P < 0.05).

RESULTS

There were no differences in RAM activation and CT between protocols with or without vibration (P > 0.05). CT increased (P = 0.001) after both the exercises with and without vibration.

CONCLUSION

The results suggest that there were no effects in cutaneous temperature or muscle activation through the use of vibration associated with isometric abdominal exercises.

Course of the thoracic nerves around the umbilicus within the posterior layer of the rectus sheath: a cadaver study

Rectus sheath block is used to anesthetize thoracic nerves around the umbilicus. However, the appropriate point for anesthetic injection during rectus sheath block has not been determined anatomically. Here, we examined the course of thoracic nerve T10 at the posterior layer of the rectus sheath and the anatomical relationship between the nerve and the rectus abdominis and transversus abdominis muscles in formalin-fixed adult cadavers. The cranio-caudal distance from a horizontal line running through the umbilicus to where the thoracic nerve T10 passes through the posterior layer of the rectus sheath was 33.8 ± 14.4 (mean ± standard deviation) mm, while that from the horizontal line running through the umbilicus to the position where the lateral edge of the rectus abdominis muscle and the medial border of the transversus abdominis muscle cross was 33.1 ± 17.1 mm. The position where the lateral edge of the rectus abdominis muscle and the medial border of the transversus abdominis muscle cross approximates the position where thoracic nerves T10 passes through the posterior layer of the rectus sheath. Our results identify effective landmarks to guide the performance of rectus sheath block.

Ultrasound Imaging of the Trunk Muscles in Acute Stroke Patients and Relations With Balance Scales

Objective

To examine the correlation between ultrasonographic trunk muscle parameters and balance scales in mild acute stroke patients.

Methods

A total of 55 stroke patients with hemiparesis and motor power grade ≥4 in the manual motor test were included. The Scale for the Assessment and Rating of Ataxia (SARA), Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and Trunk Control Test (TCT) were used to evaluate patient balance function. Ultrasonographic parameters were measured on both non-paretic and paretic sides of the rectus abdominis, external oblique, internal oblique, transversus abdominis, and erector spinae muscles. Resting thickness and contraction thickness were measured in all muscles, and contractility and contractility ratio were calculated based on measured thicknesses. The differences between paretic and non-paretic muscle parameters, and the correlation between ultrasonographic parameters and balance scales were analyzed. Stroke patients were divided into two groups according to their fall risk. Ultrasonographic measurements between the two groups were compared.

Results

All muscles’ contraction thickness and contractility were significantly different between paretic and non-paretic sides (p<0.001). Contractility ratios of all trunk muscles showed a significant correlation with SARA, BBS, TUG, and TCT (p<0.05). Contractility ratios of all muscles were significantly different between high- and low-risk fall groups (p<0.05).

Conclusion

The contractility ratio in stroke patients reflects their balance disturbance and fall risk and it may serve as a new parameter for ultrasound imaging of trunk muscles.

Does trunk and hip muscles strength predict performance during a core stability test?

BACKGROUND

A better understanding about the relationship between trunk and hip muscles strength and core stability may improve evaluation and interventions proposed to improve core stability.

OBJECTIVES

To investigate if trunk and hip muscles strength predict pelvic posterior rotation during the bridge test with unilateral knee extension.

METHODS

This is a cross-sectional study. Sixty-one healthy individuals of both sexes (age, 28±6.4 years, weight, 66.5±10.9kg, height, 167±9.5cm) performed the bridge test with unilateral knee extension. The pelvic posterior rotation during the bridge test was obtained with two-dimensional video analysis. Isometric strength of the trunk extensors and rotators, and hip abductors, external and internal rotators and extensors were measured with a hand-held dynamometer. Multiple linear regression analysis was performed to identify if the strength variables could explain the pelvic posterior rotation during the test.

RESULTS

Muscle strength predicted pelvic posterior rotation during the bridge test (r=0.54; p=0.003). Strength of the trunk rotators (p=0.045) and hip internal rotators (p=0.015) predicted reduced magnitude of pelvic posterior rotation during the bridge test, and strength of the hip extensors (p=0.003) predicted increased magnitude of pelvic posterior rotation.

CONCLUSIONS

Trunk rotators and hip internal rotators and extensors strength predict 29% of the performance during the bridge test with unilateral knee extension. The strength of these muscles should be evaluated in individuals with increased pelvic posterior rotation during the bridge test with unilateral knee extension.

Postoperative Complications and Patient Satisfaction After Abdominal Etching: Prospective Case Series of 25 Patients

INTRODUCTION

Conventional liposuction has provided good outcome for years. Abdominal etching (or abdominal high definition liposuction) allows the surgeon to shape and enhance the abdominal muscles by removing specific grooves of subcutaneous fat. The aim of this study is to describe the technique and the complications and to assess patients' satisfaction rate.

MATERIALS AND METHODS

Between January 2015 and January 2017, 25 patients (21 men and 4 women) underwent abdominal etching procedures in our department. The authors describe the technique and the specific key points of the procedure. All patients were seen at day 5, 10, 30, and 180. At day 180, everyone answered a modified Likert scale survey relating to their satisfaction.

RESULTS

No hematoma, infection, or seroma was reported. One patient experienced a superficial pressure wound caused by an improper positioning of the final dressing. Almost all patients (96%) were happy or very happy with the overall outcome of their abdominal etching.

CONCLUSION

The number of requests for abdominal liposculpture should increase in the coming years, and plastic surgeons specialized in silhouette surgery should be able to master this technique in order to add it to their therapeutic arsenal.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy and Safety of Abdominal Trunk Muscle Strengthening Using an Innovative Device in Elderly Patients With Chronic Low Back Pain: A Pilot Study

Objective

To examine the efficacy and safety of an innovative, device-driven abdominal trunk muscle strengthening program, with the ability to measure muscle strength, to treat chronic low back pain (LBP) in elderly participants.

Methods

Seven women with non-specific chronic LBP, lasting at least 3 months, were enrolled and treated with the prescribed exercise regimen. Patients participated in a 12-week device-driven exercise program which included abdominal trunk muscle strengthening and 4 types of stretches for the trunk and lower extremities. Primary outcomes were adverse events associated with the exercise program, improvement in abdominal trunk muscle strength, as measured by the device, and improvement in the numerical rating scale (NRS) scores of LBP with the exercise. Secondary outcomes were improvement in the Roland-Morris Disability Questionnaire (RDQ) score and the results of the locomotive syndrome risk test, including the stand-up and two-step tests.

Results

There were no reports of increased back pain or new-onset abdominal pain or discomfort during or after the device-driven exercise program. The mean abdominal trunk muscle strength, NRS, RDQ scores, and the stand-up and two-step test scores were significantly improved at the end of the trial compared to baseline.

Conclusion

No participants experienced adverse events during the 12-week strengthening program, which involved the use of our device and stretching, indicating the program was safe. Further, the program significantly improved various measures of LBP and physical function in elderly participants.

Abdominal muscle activation: An EMG study of the Sahrmann five-level core stability test

Background

Sahrmann five-level core stability test protocol has been used to evaluate the ability of the core muscles to stabilize the spine. However, validation studies on the Sahrmann protocol are limited.

Objective

The purpose of this study was to compare the different levels of Sahrmann five-level core stability (levels 1-5) on the muscle activity of rectus abdominis (RA), external oblique (EO), and transverse abdominis/internal oblique (TrA/IO).

Methods

Twenty-two asymptomatic male participants aged 21.3 6 ± 1 .59 years were recruited. Participants were instructed to perform maximum voluntary contraction (MVC) and five levels of Sahrmann five-level core stability test guided with a pressure biofeedback unit (PBU). The surface electromyography (EMG) data of each muscle during five levels of Sahrmann five-level core stability test were normalized as a percentage of MVC.

Results

Results showed significant differences in the normalized EMGs of RA [ χ 2 (4) = 64.80, p < 0 .001], EO [ χ 2 (4) = 58.11, p < 0 .001], and TrA/IO [ χ 2 (4) = 56.00, p < 0 .001] between the five levels of Sahrmann five-level core stability test. Post-hoc analysis revealed Sahrmann levels 5 and 3 have significantly higher abdominal EMG signals than levels 4, 2, and 1 ( p < 0 .001).

Conclusion

In conclusion, the Sahrmann five-level core stability test differs according to the level of Sahrmann tests. Significantly higher abdominal muscle activities were observed during levels 3 and 5. Therefore, the classification exchange in levels 3 and 4 of the Sahrmann five-level core stability test should be reconsidered in the future.

Correlation between peak expiratory flow and abdominal muscle activity in elderly women while holding maximum expiration and performing the side bridge exercise

INTRODUCTION

Expiratory flow is important to minimize the risk of infection by expelling foreign substances from the lungs. Abdominal muscle activities primarily produce expiratory flow. However, data on the association of abdominal muscle activity during expiratory effort and abdominal exercise posture with expiratory flow rate is limited. This study aimed to assess the correlation between expiratory flow and abdominal muscle activity while holding maximum expiration and performing the side bridge exercise in elderly women.

METHODS

Rectus abdominis (RA), external oblique (EO), and internal oblique (IO) muscle activity was measured using electromyography in 14 elderly women (82.8 ± 6.7 years), who could walk independently while performing 2 tasks: holding their breath after maximum expiration in the crook-lying position (maximum expiration), and performing the side bridge exercise on their knees without breathing instruction (side bridge). Peak expiratory flow (PEF) was obtained using a peak flow meter. Correlations between PEF and the abdominal muscle activity were determined using the Spearman rank correlation coefficient.

RESULTS

The correlation coefficients between PEF and RA, EO, and IO activity while holding maximum expiration were 0.407 (p = 0.149), -0.345 (p = 0.227), and 0.732 (p = 0.003), respectively. The correlation coefficients between PEF and RA, EO, and IO activity while performing the side bridge exercise were -0.297 (p = 0.303), -0.552 (p = 0.041), and 0.147 (p = 0.615), respectively.

CONCLUSIONS

Higher IO activity while holding maximum expiration or lower EO activity while performing the side bridge exercise was related to higher PEF. Thus, maximum expiration and abdominal exercise might be effective in the improvement or prevention of the decrease of expiratory flow.

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.

Anterior and posterior rectus abdominis sheath stiffness in relation to diastasis recti: Abdominal wall training or not?

INTRODUCTION

This study explores the anatomical relation of the rectus abdominis muscles with the anterior and posterior rectus sheaths. The elastic behavior of these fascial sheets is also assessed. Both of these analyses form an anatomic-biomechanical basis for diagnosis and treatment, especially in relation to diastasis recti abdominis (DRA).

METHOD

Fundamental observational, biomechanical study. Seven post-mortem, embalmed human specimens were dissected. The abdominal muscles and the fascial sheets of the abdominal wall were dissected. 4 × 4 cm samples of the anterior and posterior rectus sheaths were loaded in longitudinal and transverse direction, while recording elongation by means of a displacement sensor. The main outcome measures were anatomical descriptions and elongation of fascia samples in mm (mean and standard ± deviation).

RESULTS

In longitudinal direction the posterior rectus sheath samples stretched over 1.67 ± 0.48 mm, while in transverse direction the mean stretch was 0.29 ± 0.18 mm (p = 0.001). In contrast, no significant difference between longitudinal (0.78 ± 0.43 mm) and transversal displacement (0.50 ± 0.23 mm) was observed in the anterior rectus sheath (p = 0.56).

DISCUSSION AND CONCLUSION

The posterior rectus sheath is functionally more related to the transverse abdominis muscle than to the rectus abdominis muscle. From this connection, in combination with the specific stiffness of the posterior fascia in the lateral direction, it is assumed that the transverse abdominis muscles play an important role in the etiology but also in reduction of DRA. The transverse abdominis and rectus abdominis muscles collaborate in support of the abdominal wall.

The impact of dexmedetomidine added to ropivicaine for transversus abdominis plane block on stress response in laparoscopic surgery: a randomized controlled trial

BACKGROUND

Intravenous dexmedetomidine is known to attenuate stress response in patients undergoing laparoscopic surgery. We investigated whether the addition of the highly selective alpha-2 adrenergic agonist dexmedetomidine into ropivacaine for ultrasound-guided transversus abdominis plane block could inhibit stress response during laparoscopic surgery, and determined the optimal dose of dexmedetomidine in it.

METHODS

One hundred and twenty-five patients undergoing laparoscopic gynecological surgery were included in this prospective and randomized double-blind study. Patients received general anesthesia with or without a total of 60 ml of 0.2% ropivacaine in combination with low (0.25 μg/kg), medium (0.50 μg/kg) or high dose (1.0 μg/kg) of dexmedetomidine for the four-quadrant transversus abdominis plane block (n = 25). The primary outcomes were stress marker levels during the operation.

RESULTS

One hundred and twenty patients completed the study protocol. Dexmedetomidine added to ropivacaine for transversus abdominis plane block significantly reduced serum levels of cortisol, norepinephrine, epinephrine, interleukin-6, blood glucose, mean arterial pressure and heart rate in a dose-dependent manner (P < 0.05), accompanied with decreased anesthetic and opioid consumption during the operation (P < 0.05), but the high dose of dexmedetomidine induced higher incidences of bradycardia than low or medium dose of dexmedetomidine (P < 0.05).

CONCLUSION

The addition of dexmedetomidine at the dose of 0.5 μg/kg into ropivacaine for ultrasound-guided transversus abdominis plane block is the optimal dose to inhibit stress response with limited impact on blood pressure and heart rate in patients undergoing laparoscopy gynecological surgery.

TRIAL REGISTRATION

This study was registered at www.chictr.org.cn on November 6th, 2016 (ChiCTR-IOR-16009753).

Supersonic Shear Imaging for Quantification of Lateral Abdominal Muscle Shear Modulus in Pediatric Population with Scoliosis: A Reliability and Agreement Study

The aim of this study was to assess the intra- and inter-rater reliability/agreement of the lateral abdominal muscle (LAM) stiffness and thickness measurements at rest and during contraction and to determine the relationship between the superficial fat thickness and the LAM stiffness measurements. LAM stiffness and thickness were measured using supersonic shear wave elastography (SSI) in pediatric participants. The reliability of LAM stiffness and thickness measurements ranged from moderate to excellent. There was an inverse correlation between fat thickness and between-rater difference in the resting external oblique stiffness (r > -0.37) and the contracted external and internal oblique stiffness (r > -0.40). SSI is a reliable method for assessing LAM stiffness and thickness in pediatric populations. To remove potential systematic errors: (i) the first round of measurements should be performed to familiarize patients with procedures; (ii) the examiner should pay more attention while performing LAM measurements on the opposite side of the body.

Core stability and balance in patients with ankylosing spondylitis

The main purpose of this study was to compare core stability and balance between ankylosing spondylitis (AS) patients and healthy controls. AS patients diagnosed according to the Modified New York criteria and healthy age- and sex-matched controls were included in the study. Clinical status of AS patients was assessed using Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Spinal Mobility Index (BASMI). For evaluation of core stability, static and dynamic core endurance and hip strength were assessed. Trunk flexor and extensor endurance, lateral side bridge tests for static core endurance; modified sit-up test for dynamic core endurance were used. Hip strength was measured with a hand-held dynamometer. Biodex Balance System was used to assess static and dynamic balance. Bilateral standing static and dynamic postural stability, single leg standing postural stability and limits of stability test results were recorded. 64 AS patients (40 male, 24 female) and 64 healthy controls (39 male, 25 female) were assessed. Static and dynamic core endurance test results, hip abductor strength were significantly higher in control group than AS group (p < 0.05). Static postural stability and left leg postural stability test results were significantly better in control group than AS group (p < 0.05). Overall, forward, backward, and right, limits of stability test results were significantly higher in control group (p < 0.05). The results of our study demonstrate that AS has negative effects on core stability and balance. It would be beneficial to add core stability and balance training to AS patients' rehabilitation program.

Deformations of abdominal muscles under experimentally induced low back pain

PURPOSE

Low back pain (LBP) is associated with altered motor control and muscle activity; however, it remains unknown whether these changes predispose humans to injury and pain or are the consequence of ongoing nociceptive processes. In this experimental study, we aimed to use a novel ultrasound imaging technique for the measurement of lateral abdominal wall muscle activity: the tissue deformation index (TDI).

METHODS

Forty-two healthy subjects (22.30 ± 1.49 years of age) were exposed to postural perturbation induced by rapid arm movement. Activity of three muscles, the transversus abdominis (TrA) and the internal and external oblique (EO), was recorded by ultrasound imaging (M-mode) with and without induction of LBP. Pain was induced by electrical stimulation applied bilaterally to the lumbar spine.

RESULTS

No significant differences in the TDI between right and left sides of the body (p > 0.05) were found. Generally, muscles deformed slower with pain compared to non-painful conditions; however, only EO muscle displayed a statistically significant reduction in deformation velocity (p ≤ 0.00001). TDI for EO decreased from 0.065% per ms ( ± 0.038, 95% CI 0.057-0.074) to 0.053% per ms ( ± 0.035, 95% CI 0.046-0.061). Furthermore, characteristic inter-muscular TDI gradients were observed, directed from inner towards outer muscular layers, with TrA showing the lowest TDI and EO the highest.

CONCLUSION

Experimentally induced LBP suppresses deformation of the superficial abdominal muscles and increases the variability of local/deep muscles. Further research is required to confirm these observations. These slides can be retrieved under Electronic Supplementary Material.

Reliability of the lateral abdominal muscle thickness measurements in idiopathic scoliosis patients

BACKGROUND

To date, the reliability of ultrasound imaging (US) measures of the abdominal muscle thickness in idiopathic scoliosis (IS) patients during early stages of adolescence has not been confirmed.

OBJECTIVE

To assess the intra-rater reliability of US measures of the thickness of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) on convex and concave body sides in adolescents with IS.

DESIGN

One-way repeated-measures analysis of variance (ANOVA) and reliability study.

METHODS

Fifteen patients diagnosed IS were included between the ages of 9 and 14 years. Three repeated US measurements were recorded in the supine resting position over 2 sessions, 24 h apart.

RESULTS

By assessing the mean value from the first two measurements (ICC_3,2), the reliability was between .76 and .95 for all examined muscles on the convex and concave sides. The reliability for the mean values from three measurements (ICC_3,3) was between .81 and .96. The smallest detectable difference values for single measurements were twice as high on the convex side than on the concave side for all examined abdominal muscles.

CONCLUSION

US measurements of the thickness of the EO, IO, and TrA muscles in supine rest position in adolescent IS patients are reliable. In order to increase measurement reliability, and due to variability in reliability between concave and convex body side, we recommend using the mean of three consecutive measurements of the EO, IO, and TrA muscles for adolescents with IS.

Comparison Between Neuromuscular Electrical Stimulation to Abdominal and Back Muscles on Postural Balance in Post-stroke Hemiplegic Patients

Objective

To compare the effects of neuromuscular electrical stimulation (NMES) to abdominal muscles and back muscles on postural balance in post-stroke hemiplegic patients.

Methods

Thirty post-stroke hemiplegic patients were prospectively enrolled and randomly assigned to one of the three groups: core muscle-strengthening exercise (CME) with NMES to abdominal muscles (group A), CME with NMES to back muscles (group B), and CME alone (group C). All subjects underwent their targeted interventions for 30 minutes each day, 5 days per week for 3 weeks under a conventional stroke rehabilitation program. Subjects were evaluated using Korean version of Berg Balance Scale (K-BBS), Trunk Impairment Scale (TIS), Korean version of Modified Barthel Index (K-MBI), Weight Distribution Index (WDI), and Stability Index (SI) just before and 3 weeks after intervention.

Results

Changes in K-BBS (p<0.05) and TIS (p<0.05) were significantly higher in group A (18.5±8.10, 6.6±1.90) and group B (19.9±5.44, 7.0±2.26) than in group C (8.4±4.14, 3.1±0.99). However, K-MBI, WDI, and SI failed to show any significant difference. No significant difference in all outcomes was observed between groups A and B.

Conclusion

The effect of NMES to the abdominal muscles was similar to the effect on back muscles in terms of postural balance. This finding indicated that the NMES to the abdominal muscles may be an alternative for post-stroke hemiplegic patients contraindicated for NMES to the back muscles. Additional studies investigating the effects of NMES on abdominal and back muscles are needed.

Fatigability of the Lumbopelvic Stabilizing Muscles in Women 8 and 26 Weeks Postpartum

Background

Pregnancy and childbirth are associated with lumbopelvic pain and instability. Fatigability of the lumbopelvic stabilizing muscles after childbirth is unknown, and no clinical tests exist to assess this important metric of muscle function.

Objectives

To compare fatigability of the lumbopelvic stabilizing muscles in postpartum and nulligravid (control) women using the Active Straight Leg Raise (ASLR) Fatigue Task, and to determine if fatigability is associated with inter-recti distance (IRD), physical function, and pain/disability.

Study design

Longitudinal case-control study.

Methods

Twenty-nine nulligravid (25.4 ± 9.1 years) and 31 postpartum women (31.4 ± 5.2 years; vaginal delivery n=18) were tested at two time points, 16 weeks apart (postpartum women tested at 8-10 and 24-26 weeks postpartum). Muscular function was assessed with manual muscle testing (MMT), the ASLR Test, and a new ASLR Fatigue Task. Other measures included IRD, rectus abdominis thickness, physical activity, and six-minute walk distance.

Results

Postpartum women were 23% more fatigable (p=0.028) and were weaker (MMT) (p<0.001) than controls up to 26 weeks postpartum. The ASLR fatigue task (time-to-failure) was associated with smaller IRD, greater rectus abdominis thickness, higher physical activity levels, greater MMT strength, and further distance walked in six minutes (p<0.05).

Conclusion

Postpartum women (up to 6 months) had greater fatigability of the lumbopelvic stabilizing muscles and lower physical function than nulligravid women, suggesting core muscle function and fatigability should be assessed after pregnancy and childbirth. The ASLR Fatigue Task could be a clinically useful tool to determine fatigability of the lumbopelvic stabilizing muscles in women postpartum.

Volume change in the rectus abdominis muscle after deep inferior epigastric perforator flap harvest

Deep inferior epigastric perforator (DIEP) flap is associated with less donor site morbidity than transverse rectus abdominis myocutaneous flap. However, abdominal muscle atrophy and donor site complications caused by denervation during pedicle dissection cannot be avoided. This retrospective study investigated the change in the rectus abdominis muscle volume after DIEP flap harvest. Of 395 patients who underwent unilateral DIEP flap breast reconstruction between August 2007 and July 2017, 25 patients with >2-year postoperative abdominal computed tomography data were evaluated. Preoperative and postoperative images of the abdominal muscle after pedicle dissection and the nonoperated side were compared. The volume of the muscles from the lower margin to the umbilicus was determined by using OsiriX image analysis application. The muscle volumes on the side of pedicle dissection decreased from 72.63 ± 23.29 cm³ preoperation to 53.09 ± 16.93 cm³ postoperation (p < 0.001). The corresponding volumes on the side without dissection were 73.29 ± 19.25 cm³ and 60.89 ± 18.79 cm³ (p < 0.001). The percentage of postoperative retained volume relative to the preoperative retained volume was 75.65% ± 19.18% on the pedicle dissection side and 84.65% ± 19.00% on the contralateral side. The 9% difference was not statistically significant (p = 0.10). No major abdominal complications were observed. Despite nerve injury during DIEP flap surgery, the volume loss of the involved and contralateral muscles did not differ. More than 75% of the abdominal muscle volume was retained. Muscle integrity was well maintained without any postoperative complications.

An ultrasonographic analysis of the activation patterns of abdominal muscles in children with spastic type cerebral palsy and in typically developing individuals: a comparative study

Background

Abdominal muscles have stiffer appearance in individuals with spastic type cerebral palsy (STCP) than in their typically developing (TD) peers. This apparent stiffness has been implicated in pelvic instability, mal-rotation, poor gait and locomotion. This study was aimed at investigating whether abdominal muscles activation patterns from rest to activity differ in the two groups.

Method

From ultrasound images, abdominal muscles thickness during the resting and active stages was measured in 63 STCP and 82 TD children. The thickness at each stage and the change in thickness from rest to activity were compared between the two groups.

Results

Rectus abdominis (RA) muscle was the thickest muscle at rest as well as in active stage in both groups. At rest, all muscles were significantly thicker in the STCP children (p <  0.001). From rest to active stages muscle thickness significantly increased (p <  0.001) in the TD group and significantly decreased (p <  0.001) in the STCP children, except for RA, which became thicker during activity in both groups. In active stages, no significant differences in the thickness in the four abdominal muscles were found between the STCP and the TD children.

Conclusion

Apart from the RA muscle, the activation pattern of abdominal muscles in individuals with STCP differs from that of TD individuals. Further studies required for understanding the activation patterns of abdominal muscles prior to any physical fitness programmes aimed at improving the quality of life in individuals with STCP.

Trial registration

HREC REF: 490/2011. Human Research Ethics Committee, Faculty of Health Sciences, University of Cape Town, South Africa. November 17, 2011.

Synergistic Activities of Abdominal Muscles Are Required for Efficient Micturition in Anesthetized Female Mice

Purpose

To characterize the electromyographic activity of abdominal striated muscles during micturition in urethane-anesthetized female mice, and to quantitatively evaluate the contribution of abdominal responses to efficient voiding.

Methods

Cystometric and multichannel electromyographic recordings were integrated to enable a comprehensive evaluation during micturition in urethane-anesthetized female mice. Four major abdominal muscle domains were evaluated: the external oblique, internal oblique, and superior and inferior rectus abdominis. To further characterize the functionality of the abdominal muscles, pancuronium bromide (25 μg/mL or 50 μg/mL, abdominal surface) was applied as a blocking agent of neuromuscular junctions.

Results

We observed a robust activation of the abdominal muscles during voiding, with a consistent onset/offset concomitant with the bladder pressure threshold. Pancuronium was effective, in a dose-dependent fashion, for partial and complete blockage of abdominal activity. Electromyographic discharges during voiding were significantly inhibited by applying pancuronium. Decreased cystometric parameters were recorded, including the peak pressure, pressure threshold, intercontractile interval, and voiding duration, suggesting that the voiding efficiency was significantly compromised by abdominal muscle relaxation.

Conclusions

The relevance of the abdominal striated musculature for micturition has remained a topic of debate in human physiology. Although the study was performed on anesthetized mice, these results support the existence of synergistic abdominal electromyographic activity facilitating voiding in anesthetized mice. Further, our study presents a rodent model that can be used for future investigations into micturition-related abdominal activity.

Development of a pressure sensor system for unobtrusive monitoring of abdominal muscle activities

Surface electromyogram (sEMG) is often used by to objectively measure muscular activity during rehabilitation exercises. sEMG is accurate, but it is unsuitable for uses outside the clinic, and patients can benefit from an unobtrusive device which can be readily used to ubiquitously measure abdominal muscle activation. In this study, we present a pressure sensor system which can be latched onto a belt to measure abdominal muscle activation. sEMG and pressure sensor output were measured in 15 healthy young males during isometric trunk flexion exercise (public trials registration number, KCT0002351), and the results were highly correlated (median R > 0.939). As initial contact force can change the pressure sensor sensitivity, the experiment was performed at two different levels of belt tightness, but the correlations did not significantly improve after tightening the belt, suggesting that the system can be used to ubiquitously and unobtrusively monitor abdominal muscle activity with minimal discomfort.