Efficacy of Activation of Gluteus Maximus Versus Transversus Abdominis in Patients with Mechanical Low Back Pain: A Randomized Controlled Trial (original) (raw)
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2020
BACKGROUND: Low back pain and disc herniation are common problems in the world population, being characterized by discomfort in the region of the spine, resulting in functional capacity and quality of life reduced. Some of the causes of these conditions seem to be associated with the biomechanical imbalance of the muscles that act in the spine. There are methods to assess the level of activation and strength of the stabilizing muscles of the spine, such as the Pressure Biofeedback Unit (PBU). This study aims to compare the level of activation of the transverse abdomen muscle and back strength in healthy, low back pain and herniated disc individuals. METHODOS: a cross-sectional study was carried out with 30 men that were homogeneously distributed in three groups: healthy (HG), with low back pain (LBPG) and with herniated disc (HDG). The primary outcomes were the level of activation of the transversus abdominis, assessed by PBU, and back strength, assessed by dynamometry. Pain, flexib...
Journal of Bodywork and Movement Therapies, 2012
The Pressure Biofeedback Unit (PBU) is often used by clinicians and researchers to indirectly evaluate transversus abdominis (TrA) muscle activity. The purpose of this study was to evaluate the inter and intra-examiner reproducibility of the PBU in measuring TrA muscle activity in fifty patients with chronic nonspecific low back pain. This study was performed using a test-retest design with a seven day interval. An Intraclass Correlation Coefficient (ICC 2,1 ) of 0.74 (95% CI 0.54 to 0.85) and 0.76 (95% CI 0.58 to 0.86) was observed for the intra and inter-examiner reproducibility, respectively. The intra-examiner agreement (Limits of Agreement -LOA Z 2.1 to À1.8 mmHg) and the inter-examiner agreement (LOA Z 2.0 to À1.9 mmHg) were within the limits of agreement on 95% of occasions. The reproducibility of PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain ranged from satisfactory to excellent. ª
International Journal of Life Science and Pharma Research, 2021
Mechanical low back pain is the main common reason for referral to physiotherapy clinic, and a chief reason for people complains, and both men and women are equally reported to be affected by this condition. It is found that core stabilization exercises have got significant improvement when compared to conventional back care exercises in improving the function and in relieving pain. To see the effectiveness of core muscles activation over conventional exercises along with Interferential Therapy (IFT) in each group for the reduction of pain and to increase the range of motion and improve the disability in subjects with mechanical low back pain. This is an experimental study where pre and post design were used with 40 subjects with mechanical low back pain were taken considering the selection criteria and divided into two groups. 20 subjects in Group-A received Core muscles activation exercises and IFT with pre and post test analysis and 20 subjects in Group-B received Conv...
North American journal of sports physical therapy : NAJSPT, 2010
The transversus abdominis (TrA) is a spine stabilizer frequently targeted during rehabilitation exercises for individuals with low back pain (LBP). Performance of exercises on unstable surfaces is thought to increase muscle activation, however no research has investigated differences in TrA activation when stable or unstable surfaces are used. The purpose of this study was to investigate whether TrA activation in individuals with LBP is greater when performing bridging exercises on an unstable surface versus a stable surface. Fifty one adults (mean ± SD, age 23.1 ± 6.0 years, height 173.60 ± 10.5 cm, mass 74.7 ± 14.5 kg) with stabilization classification of LBP were randomly assigned to either exercise progression utilizing a sling bridge device or a traditional bridging exercise progression, each with 4 levels of increasing difficulty. TrA activation ratio (TrA contracted thickness/TrA resting thickness) was measured during each exercise using ultrasound imaging. The dependent vari...
Keywords: abdominal draw-in maneuver, irradiation, transverse abdominis, chronic non-specific low back pain, pressure biofeedback unit Abstract Introduction. Chronic non-specific low back pain (CNSLBP) is a disorder of frequently unknown etiology. Impairments in motor control (MC) have been frequently associated with CNSLBP disorder. The abdominal draw-in maneuver (ADIM) is commonly used during core stabilization techniques to restore neuromuscular control. Scope.This study was done to investigate effectiveness of ADIM along with resisted ankle dorsiflexion (RADF) on changes in activation score of transverse abdominis (TrA) muscle using pressure biofeedback unit (PBU) in CNSLBP patients. It was a single blind randomized controlled trial. Method. Sixty subjects with CNSLBP were randomly assigned into two groups. The subjects in Group-A (experimental group) performed ADIM along with RADF, and the subjects in Group-B (control group) performed ADIM alone. The activation score of TrA, pain and back related disability; were measured by PBU, Numeric Pain Rating scale (NPRS) and RolandMorris disability questionnaire (RMDQ) respectively. Resuls.Activation score of TrA, NPRS and RMDQ showed significant improvement in experimental group (p<0.05) than control group. Conclusion. The result of the study suggests the use of ADIM along with RADF for effective management of CNSLBP patients to restore neuromuscular control.
Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short-or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures.
Journal of Manual and Manipulative Therapy, 2014
"Objective: to review and update the evidence for different forms of manual therapy (MT) for patients with different stages of non-specific low back pain (LBP). Data sources: MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE. Method: A systematic review of MT with a literature search covering the period of January 2000 to April 2013 was conducted by two independent reviewers according to Cochrane and PRISMA guidelines. A total of 360 studies were evaluated using qualitative criteria. Two stages of LBP were categorized; combined acute–subacute and chronic. Further sub-classification was made according to MT intervention: MT1 (manipulation); MT2 (mobilization and soft-tissue-techniques); and MT3 (MT1 combined with MT2). In each sub-category, MT could be combined or not with exercise or usual medical care (UMC). Consequently, quantitative evaluation criteria were applied to 56 eligible randomized controlled trials (RCTs), and hence 23 low-risk of bias RCTs were identified for review. Only studies providing new updated information (11/23 RCTs) are presented here. Results: Acute–subacute LBP: STRONG-evidence in favour of MT1 when compared to sham for pain, function and health improvements in the short-term (1–3 months). MODERATE-evidence to support MT1 and MT3 combined with UMC in comparison to UMC alone for pain, function and health improvements in the short-term. Chronic LBP: MODERATE to STRONG-evidence in favour of MT1 in comparison to sham for pain, function and overall-health in the short-term. MODERATE-evidence in favour of MT3 combined with exercise or UMC in comparison to exercise and back-school was established for pain, function and quality-of-life in the short and long-term. LIMITED-evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone for pain and function from short to long-term. LIMITED-evidence of no effect for MT1 with extension-exercise compared to extension-exercise alone for pain in the short to long-term. Conclusion: This systematic review updates the evidence for MT with exercise or UMC for different stages of LBP and provides recommendations for future studies."
Journal of Pain, 2013
Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment and temporal changes in clinical outcomes. Candidate publications were identified from six electronic databases. Fifteen articles were included after scrutinization by two reviewers using the predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging or M-mode ultrasound) were unrelated to temporal changes in LBP/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements while the relation between multifidus changes and clinical improvements remains uncertain.
Journal of Physical Therapy Science, 2013
This study compared the effectiveness of stabilization and McKenzie exercises on pain, disability, and thickness of the transverse abdominis and multifidus muscles in patients with nonspecific chronic low back pain. [Subjects] Thirty patients were randomly assigned into two groups: the McKenzie and stabilization exercise groups. [Methods] Before and after intervention, pain, disability, and thickness of the transverse abdominis and multifidus muscles were evaluated by visual analogue scale, functional rating index, and sonography, respectively. The training program was 18 scheduled sessions of individual training for both groups. [Results] After interventions, the pain score decreased in both groups. The disability score decreased only in the stabilization group. The thickness of the left multifidus was significantly increased during resting and contracting states in the stabilization group. The thickness of the right transverse abdominis during the abdominal draw-in maneuver, and thickness of the left transverse abdominis during the active straight leg raising maneuver were significantly increased in the stabilization group. The intensity of pain, disability score, thickness of the right transverse abdominis during the abdominal draw-in manouver, and thickness of the left transverse abdominis during active straight leg raising in the stabilization group were greater than those on the Mackenzie. [Conclusion] Stabilization exercises are more effective than McKenzie exercises in improving the intensity of pain and function score and in increasing the thickness of the transverse abdominis muscle.
European Journal of Medical and Health Sciences, 2020
The study was designed to compare between the effect of strengthening exercises and mobilization techniques among patients with mechanical low back pain. Sixteen participants were included in this study, three patients for each group were excluded. They were classified into two groups. Group A, strengthening exercises, therapeutic massage, and group B, mobilization techniques, therapeutic massage. Each group had three sessions per week, for four weeks. The participants were assessed by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Independent samples were collected, t-test was used to study the similarity of demographic data between groups, Wilcoxon Signed Ranks Test was used to study the change between pre- and post-treatment. The Mann-Whitney test was used to study the comparison between the two treatments. The comparison revealed that for VAS there was a significant difference between groups in term of the strengthening exercises group (P >0.05). For ODI, t...