Immediate changes in trunk muscle activation patterns during a lifting task following an abdominal drawing-in exercise in subjects with recurrent low back pain

Abstract

BACKGROUND:

The abdominal drawing-in exercise could help improve delayed transversus abdominis (TrA) activation during limb movement in subjects with recurrent low back pain (rLBP). However, little is known about whether the same effect is observed during lifting tasks in subjects with rLBP.

OBJECTIVE:

This study aimed to clarify whether a single session of abdominal drawing-in exercise could correct the altered trunk muscle activation patterns during a lifting task in subjects with rLBP.

METHODS:

Fifteen subjects with rLBP performed lifting tasks before and immediately after three sets of 10 repetitions of isolated TrA voluntary contractions. The time of onset and activation amplitude during the lifting tasks were measured by surface electromyography (EMG) and compared between the trials before and immediately after exercise.

RESULTS:

During lifting, the onset of internal abdominal oblique/TrA (IO/TrA) and multifidus activation occurred earlier, the EMG amplitude of IO/TrA increased, and the EMG amplitude of erector spinae and multifidus decreased, compared with the pre-exercise data.

CONCLUSIONS:

These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP.

Keywords

Abdominal drawing-in exercise trunk muscle activation pattern lifting task recurrent low back pain

1. Introduction

Low back pain (LBP) has been found to have a lifetime prevalence of 75–85% and can significantly decrease an individual’s quality of life [1]. The economic burden of LBP, including direct and indirect costs, is massive and continues to be a problem [2]. Although 90% of low back pain episodes recover spontaneously within a month, between 42 and 75% of people, experience episodes of low back pain recurrence within 12 months [3]. People with recurrent low back pain (rLBP) had a longer total duration of work disability and higher indemnity and medical costs [4].

Trunk muscles have been classified as local and global muscles by Bergmark [5]. Activation of transversus abdominis (TrA) occurs before limb movement in healthy subjects [6], and local muscles such as TrA and lumbar multifidus are capable of contributing to the segmental lumbopelvic stability [7, 8, 9, 10]. Global muscles such as lumbar erector spinae (ES) and external oblique (EO) muscle contribute to the controlling spinal orientation, balancing extrinsic loads, and generating large torque for spinal movement [11, 12]

Altered trunk muscle activation patterns related to local muscle activation onset time and EMG activation of global muscles have been reported in subjects with LBP [13, 14, 15, 16]. It has been reported that in subjects with remitting LBP, the onset of TrA and multifidus activation was delayed during limb movement and lifting tasks, and EMG activation of ES and multifidus was greater [17, 18]. These changes in trunk muscle activation patterns have been theorized to lead to a recurrence of LBP [17] and to be caused by the reorganization of the motor cortex network [19, 20, 21]. Therefore, training interventions for correcting the altered muscle activation pattern in such patients have been tried [22, 23, 24, 25]. Co-contraction training, such as abdominal curl up, side bridge, and bird dog, as well as training with non-isolated voluntary contraction, such as sit-up and trunk extension training, have been identified as not effective in correcting muscle onset timing [22, 23, 24]. Conversely, the training with isolated voluntary contraction of TrA, called abdominal drawing-in exercise, has been reported to be effective in the immediate and persistent improvement of delayed muscle onset timing in subjects with rLBP [23, 24, 25]. However, previous studies assessing changes in trunk muscle onset timing induced by the abdominal drawing-in exercise have evaluated limb movement, which is not a functional task. People with rLBP show changes in trunk muscle activation pattern during lifting tasks, which are related to a high risk of LBP [18, 26], and changes in muscle activation pattern in people with LBP has been proposed to occur in a task-specific manner [27, 28]. Therefore, the effect of the abdominal drawing-in exercise on muscle activation patterns during a lifting task still needs to be established. However, little is known about whether an abdominal drawing-in exercise can correct delayed muscle onset in people with rLBP. The trunk muscle activation pattern is influenced by trunk motion during lifting motion [29]. When evaluating the effect of exercise intervention, if the motion of the trunk and lower limb motion cannot be controlled, it is impossible to know whether the change in muscle activity pattern is caused by the motion of the trunk and lower limb motion or the exercise intervention. Thus, there is a need to examine the trunk muscle activation pattern in lifting tasks with the trunk maintained in an upright posture to clarify the effect of abdominal drawing-in exercise.

The purpose of the present study was to clarify whether a single session of abdominal drawing-in exercise can correct altered trunk muscle activation patterns. We hypothesized that a session of abdominal drawing-in training would correct the trunk muscle activation pattern during a lifting task.

2. Methods

2.1 Participants

Fifteen subjects (six male and nine female, age 26.1 $\pm$ 8.1 years, height 162.4 $\pm$ 8.6 cm, weight 58.2 $\pm$ 11.4 kg) with rLBP were recruited through poster advertisements for the present study. The subject recruitment took place between June 19, 2018 and September 12, 2018. Inclusion criteria were a history of two or more episodes of pain, localized below the 12th thoracic vertebra and above the inferior gluteal folds occurring within a year that interfered with sports or work [30]. Exclusion criteria included circulatory, neurological, or respiratory disorders, history of surgery or fractures to the upper and lower extremities or spine, spinal deformities, pregnancy in the two previous years, and participation in trunk muscles’ motor training in the past year. Participants were in a period of remission from their LBP symptoms at the time of testing. Prior to participation, all subjects read the study protocol and provided written informed consent. All procedures were approved by the Ethics Committee of the Kawasaki University of Medical Welfare.

2.2 Data collection

EMG data were collected using surface electromyography with silver/silver-chloride electrodes (P-00-S; Mets Inc., Japan) with a 1000 Hz sampling frequency during a lifting task. Before fixing the electrodes, the skin area was shaved and wiped with alcohol. Electrodes had a 2.5 cm center-to-center distance and were placed parallel to muscle fibers. A reference electrode was placed on the anterior superior iliac spine (ASIS). Electrodes for the EO were placed 15 cm laterally to the umbilicus. Electrodes for the internal abdominal oblique/TrA (IO/TrA) were placed 2 cm medially and inferiorly to the ASIS. Electrodes for the ES were placed 3 cm laterally to the spinous process of first lumbar vertebra. The first lumbar vertebra was identified by counting up from the L5 spinous process. Electrodes for the lumbar multifidus were placed at the fifth lumbar vertebra level, 1 cm lateral from the midline. The fifth lumbar vertebra was identified as the first spinous process under the line connecting the right and left iliac crests [31]. Electrodes for the anterior deltoid were placed 3 cm anteriorly and distally to the acromion. Electrodes were placed at the trunk muscle of the more painful side in the low back region.

The angular velocities of shoulder movement during lifting were recorded with a 1000 Hz sampling frequency using the angular rate sensor attached to the wrist, and peak values were calculated.

2.3 Procedure

Subjects were asked to indicate the average LBP severity over the last week using a numeric rating scale (NRS). NRS is a subjective measure in which a person assesses their pain on an eleven points numerical scale from 0 to 10, where 0 $=$ no pain and 10 $=$ worst possible pain, and NRS has acceptable validity and reliability [32, 33]. NRS scale was administered to subjects verbally. Subjects were asked to indicate the intensity of pain by reporting a number that best represents it. In addition, LBP-related disability at time testing was measured using the Oswestry Disability Index (ODI). ODI has a 10 item questionnaire that assesses the level of LBP and interference with several physical activities [34].

Lifting tasks were performed three times before and immediately after abdominal drawing-in exercises. The participants grasped the handle portion of a 2.5-kg box put on the stand using both hands with 40 ${}^{\circ}$ of shoulder flexion and 0 ${}^{\circ}$ of elbow extension, in a standing position. A pressure sensor synchronized with the EMG device was installed on the bottom of the box to indicate when the box had been lifted from the stand. A target bar was placed, so that shoulder flexion was limited to 90 ${}^{\circ}$ . Participants were verbally instructed to lift the box as fast as possible until 90 ${}^{\circ}$ shoulder flexion while keeping the elbow extended and minimizing the trunk and pelvis when the light-emitting diode lamp placed in front of their eyes was turned on (Fig. 1) [18]. This position was held for three seconds. If visible trunk or pelvis motion was found during the test, the data were discarded and retested. Before testing, subjects were familiarized with the lifting tasks. Each participant performed lifting task three times before and after intervention respectively, with a two minute rest between repetitions.

Figure 1.

Participants lifted the box as fast as possible until 90 ${}^{\circ}$ shoulder flexion after the visual cue. I: Starting position. II: Final position.

2.4 Training intervention

The purpose of abdominal drawing-in exercise was to train the TrA contraction in isolation from rectus abdominis, EO, and IO. Participants were instructed to lay in crook lying position with their knees in 90 ${}^{\circ}$ flexion. Subjects were instructed to maintain normal breathing, as well as their pelvis and lumbar position, while gently drawing their lower abdomen toward the spine and contracting the pelvic floor. Feedback regarding shortening and thickening of TrA and IO was provided with real-time ultrasound imaging during the abdominal drawing-in exercise (Fig. 2). Three sets of 10 repetitions, maintaining each contraction for 10 seconds, were performed with two minutes of rest between sets.

Figure 2.

Subjects were instructed to maintain normal breathing, as well as their pelvis and lumbar position, while gently drawing their lower abdomen toward the spine and contracting the pelvic floor. Feedback regarding shortening and thickening of TrA and IO was provided with real-time ultrasound imaging during the abdominal drawing-in exercise.

2.5 Data analysis

For EMG data, bandpass filters (20–500 Hz) were used, and full-wave rectification was subsequently performed. The average amplitudes were determined over three seconds from the moment the box left the stand. EMG for each muscle was normalized to the maximum voluntary contraction (MVC) to calculate %MVC. To obtain the MVC of EO and IO/TrA, the participant was placed in a supine position with the legs straight and secured to the table with a belt. The participant attempted to rotate the upper trunk while the experimenter provided matched resistance to prevent motion [35]. To obtain the MVC of ES and multifidus, the participant was placed in prone position with the legs straight and secured to the table with a belt. The participant attempted to extend the upper trunk while the experimenter provided matched resistance to prevent motion.

Teager-Kaiser energy operator (TKEO) was applied after the EMG signal band-pass filtered in preparation for the decision to onset muscle activation because TKEO was reported to minimize erroneous onset detection [36]. The discrete TKEO $\Psi$ was defined as:

$\displaystyle\psi[x(t)]=x^{2}(t)-x(t+1)x(t+1)$

where $[x(t)]$ is the EMG value at the instant $t$ . The onset of muscle activation was identified by visual analysis. A graphical user interface was created in BIMUTUS II (Kissei Comtec, Nagano, Japan) which displayed individual EMG traces on the computer monitor. The researcher determined the onset of muscle activation by moving the mouse cursor (with 1 ms resolution) and identified the earliest rise of the EMG activity above the baseline [37, 38]. The onset of abdominal and back muscle activation relative to the prime mover (the anterior deltoid) was calculated using the following equation:

The relative onset of abdominal and back muscle activation $=$ onset of abdominal and back muscle activation – the onset of anterior deltoid activation.

Therefore, positive values indicated that abdominal muscle or back muscle fired after the deltoid muscle and negative values indicate the opposite.

2.6 Statistical analysis

All continuous variables were evaluated for distribution normality using the Shapiro-Wilk test. The angular velocity of shoulder movement, the onset of trunk muscle activation, and the EMG amplitude of trunk muscle during the lifting task were compared between trials before and immediately after the abdominal drawing-in exercise using a paired $t$ -test. When continuous variables were not normally distributed, Wilcoxon signed-rank test was employed. SPSS, version 22.0 (IBM Inc, Chicago, IL, USA) was used for statistical analyses. The significance level was set at $p<$ 0.05. The Holm’s Bonferroni method was used to control Type I error at the 0.05 level across all nine comparisons.

3. Results

The average severity of LBP over the previous week in the NRS score was 1.1 $\pm$ 1.4, and ODI score at the test was 14.8 $\pm$ 1.4 (Table 1). Subjects did not have an aggravation of symptoms during this study.

Table 1
Subjects’ demographics

Subject no.	Sex	Age (years)	Height (cm)	Weight (kg)	Last week average pain (NRS)	ODI (%)	Time since first onset of LBP (years)
1	F	20	153	48	5	17.8	5
2	F	41	151	48	0	22.2	9
3	F	20	158	51	0	11.1	3
4	M	37	170	68	2	11.1	11
5	F	21	155	45	0	8.9	3
6	F	21	157	52	1	8.9	4
7	F	20	153	50	0	11.1	5
8	F	37	157	53	0	6.7	8
9	M	26	174	74	2	20	3
10	M	30	171	71	1	17.8	8
11	F	21	162	48	0	11.1	4
12	M	20	173	62	3	15.6	4
13	M	38	175	76	1	24.4	3
14	F	20	159	53	0	17.8	1
15	M	20	169	75	1	17.8	4
Mean		26.1	162.4	58.2	1.1	14.8	5.0
SD		8.1	8.6	11.4	1.4	5.3	2.8

F: female; M: male; NRS: numeric rating scale; ODI: Oswestry Disability Index.

No difference in the speed of arm movement during lifting was found before and immediately after exercise (pre-exercise: 104.5 $\pm$ 29.2 degree/sec, post-exercise: 107.6 $\pm$ 32.7 degree/sec, $p=$ 0.53, effect size: Cohen’s dz $=$ 0.23, power $=$ 0.13). This fact indicates that the subjects lifted the box in a similar manner.

Table 2

Differences in the relative muscle onset time for between before and immediately after exercise

	Pre	Post	$P$ -value	95% CI		Effect size Cohen’s dz	Power
				Lower	Upper
External oblique	97.8 $\pm$ 31.3	96.4 $\pm$ 38.6	0.847	$-$ 14.1	17.0	0.05	0.05
IO/TrA	63.3 $\pm$ 19.4	40.4 $\pm$ 23.5	0.001 ${}^{\ast}$	11.8	33.9	1.15	0.98
Erector spinae	17.3 $\pm$ 10.9	12.3 $\pm$ 14.3	0.200	$-$ 2.9	12.8	0.35	0.24
Multifidus	13.1 $\pm$ 10.1	2.5 $\pm$ 11.5	0.002 ${}^{\ast}$	4.7	16.5	1.00	0.95

Values are mean $\pm$ SD. ${}^{*}p<\alpha$ . CI: confidence interval; IO/TrA: internal abdominal oblique/ transversus abdominis.

Figure 3.

Comparisons of trunk muscle activation onset relative to the onset of the anterior activation deltoid during lifting before and immediately after exercise. 0 millisecond indicates onset of anterior deltoid activation. Positive values indicated that the trunk muscle fired after the deltoid muscle. ${}^{**}p<$ 0.01.

Figure 3 and Table 2 show a comparison of the onset of trunk muscle activation relative to the onset of deltoid during lifting before and immediately after exercise. After exercise, the onset of IO/TrA and multifidus activation during lifting occurred earlier than that before exercise. No difference in the onset of EO and ES during lifting was found between before and after exercise.

Table 3

Differences in trunk muscle EMG amplitude for between before and immediately after exercise

	Pre	Post	$P$ -value	95% CI		Effect size Cohen’s dz	Power
				Lower	Upper
External oblique	12.2 $\pm$ 8.7	12.3 $\pm$ 7.9	0.909	$-$ 2.4	2.1	0.03	0.05
IO/TrA	22.3 $\pm$ 11.7	26.6 $\pm$ 15.9	0.028 ${}^{\ast}$	$-$ 8.2	$-$ 0.5	0.63	0.63
Erector spinae	31.7 $\pm$ 9.4	28.8 $\pm$ 7.5	0.032 ${}^{\ast}$	0.3	5.4	0.62	0.60
Multifidus	34.7 $\pm$ 12.5	29.7 $\pm$ 8.7	0.001 ${}^{\ast}$	2.3	7.7	1.02	0.96

Values are mean $\pm$ SD. ${}^{*}p<\alpha$ . CI: Confidence interval; IO/TrA: internal abdominal oblique/ transversus abdominis.

Figure 4.

Comparison of trunk muscle EMG amplitudes before and after exercise. ${}^{*}p<$ 0.05, ${}^{**}p<$ 0.01.

EMG amplitudes of the trunk muscle before and after exercise are compared in Fig. 4 and Table 3. After a single session of exercise, EMG amplitude of IO/TrA was greater compared to pre-exercise data during lifting, while EMG amplitude of ES and multifidus was lesser compared to pre-exercise data during lifting. No difference in the EMG amplitude of EO during lifting was found between before and after exercise.

4. Discussion

The purpose of this study was to clarify whether a single session of abdominal drawing-in exercise can correct changes in trunk muscle activation pattern. Our results demonstrate that after a single session of exercise, the onset of IO/TrA and multifidus activation occurred earlier, and the EMG amplitude of ES and multifidus decreased compared to pre-exercise data during lifting.

After exercise, the trunk muscle activation pattern changed compare with before exercise in this study. Muscle activation pattern has been reported to be affected by muscle fatigue and familiarization with the task [39, 40]. However, we believe that the familiarization effect had little effect on results in this study because subjects were familiarized with the lifting task before the test. Muscle fatigue during the lifting task has been reported to increase the EMG amplitude of ES [39]. In contrast, EMG amplitude of ES was lesser compared to pre-exercise data during lifting in our study. The abdominal drawing-in exercise involved the activity of IO/TrA muscles at low intensities, and the rest period between sets of exercises was enough taken. Therefore, we argue that the differences found in the muscle activation pattern between the tests performed before and after exercise were not likely to be due to muscle fatigue.

The mean ODI score at the test was 14.8 $\pm$ 5.8; almost all participants were classified as minimal disability. However, it has been reported that there was no relationship between ODI sore and the onset of IO/TrA [41]. The means onset time of the IO/TrA (63.3 $\pm$ 19.4 ms) and multifidus (13.1 $\pm$ 10.1 ms) activation before exercise in this study was delayed compared with previously reported onset timing of the IO/TrA (10.7 $\pm$ 19.9 ms) and multifidus ( $-$ 9.7 $\pm$ 12.2 ms) activation during lifting in healthy subjects [18]. In addition, the onset of IO/TrA and multifidus activation before exercise in this study was delayed to the same extent as previously reported onset timing of the IO/TrA (82.0 $\pm$ 50.8 ms) and multifidus (11.0 $\pm$ 23.0 ms) activation during lifting in individuals with rLBP [18]. In this study, the onsets of IO/TrA and multifidus activation during lifting after exercise were earlier than that before exercise. The onset timing of TrA activation has been reported to change according to the velocity of limb movement [42]. However, we believe that results in this study were not affected by the limb movement speed because there were no changes in arm speed during lifting from pre- to post-exercise. Thus, the onset of the IO/TrA and multifidus activation occurred earlier after the abdominal drawing-in exercise. This is in accordance with previous research, which showed improved onset of TrA activation during arm movement after abdominal drawing-in exercise [24, 25] or improved onset of IO/TrA during sudden release from trunk loading after abdominal drawing-in exercise in individuals with LBP [43]. The intervention with the abdominal drawing-in exercise for two weeks has been reported to induce motor cortical representation, which was correlated with improvement in delayed TrA activation during limb movement [44]. The mechanism underlying the relationship of abdominal drawing-in exercise and a plastic change in motor cortex remains unclear because the intervention of abdominal drawing-in exercise was provided in only a single session in this study. However, plastic changes in the motor cortex have been shown to occur within minutes to hours after exercise or after a single session of exercise [45, 46]. Tsao et al. have reported that after a single session of the abdominal drawing-in exercise, the onset of TrA activation was earlier than before exercise during rapid arm movement. This is consistent with the results obtained by intervention with a single session of exercise in the present study. Changes in the excitability of the motor cortex and motor neurons have been reported to be induced by repeated voluntary contraction [47]. Exercise of a skilled task has been shown to lead to greater plastic changes in the motor cortex than unskilled exercise [48]. In addition, perceptual and cognitive elements during exercise, such as attention, are crucial for increased performance [49, 50]. We believe that since abdominal drawing-in exercise, especially with real-time ultrasound feedback, needs perceptual strategies and great attention [24], the onset of the IO/TrA activation changed after exercise in this study.

There was an earlier onset of multifidus activation post-exercise during lifting in this study. A previous study demonstrated that isolated muscle training improves muscle activity onset timing [50]. Abdominal drawing-in exercise can facilitate multifidus activation [51, 52]. Therefore, the earlier onset of multifidus activation may have been caused by facilitation of multifidus activation associated with the abdominal drawing-in exercise.

The EMG amplitude of ES and multifidus decreased after exercise during lifting. People with LBP have been known to redistribute activation between local and global muscles and display delayed activation of local muscle and overactivation of global muscles. A decrease in the stability of the lumbopelvic region because of delayed activation of local muscles, which contributes to segmental spinal stability, has been reported to be compensated by overactivation of global muscles [27, 28]. Because an earlier onset of IO/TrA and multifidus activation and a greater EMG amplitude of IO/TrA occurred after exercise, ES and multifidus did not have to compensate for the decrease in the stability of the lumbopelvic region associated with delayed activation of TrA and multifidus. Thus, there was a decrease in the EMG amplitude of ES and multifidus compared to that before exercise during lifting in this study.

Our results demonstrate that a delayed onset of IO/TrA and multifidus and overactivation of ES and multifidus during the lifting task can be improved with the abdominal drawing-in exercise. These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP. However, because this study was not designed to test the effect on reducing LBP symptoms and recurrence, effects of the abdominal drawing-in exercise on reducing LBP symptoms and recurrence remain unclear, and this requires further investigations.

This study has some limitations. We aimed to determine whether improvements in the trunk muscle activation pattern could be caused by an abdominal drawing-in exercise. Therefore, in this study, the effect of an abdominal drawing-in exercise on the muscle activation pattern was not compared to that of other exercise methods. Therefore, the design of this study does not allow for conclusions about which is more effective, abdominal drawing-in exercise, or other methods. However, because sit-up training and co-contraction training (i.e., curl up, side bridge, and bird dog) have been shown not to improve TrA delayed activation [22, 24], we believe that the abdominal drawing-in exercise is more effective than those exercises. In addition, healthy subjects were not recruited in this study; nevertheless, we contended that whether the muscle activation pattern could be changed in asymptomatic people did not affect results in people with rLBP. This study investigated the immediate effect of abdominal drawing-in exercise on the muscle activation pattern. Future studies are necessary to examine the long-term effect of abdominal drawing-in exercise and whether changes are retained.

5. Conclusion

This study demonstrates that after a single session of exercise, the onset of IO/TrA and multifidus activation occurred earlier, and the EMG amplitude of ES and multifidus decreased compared to pre-exercise data during lifting. These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP. The effect of the abdominal drawing-in exercise on reducing LBP symptoms and recurrence remains unclear, and thus further investigations are needed.

Footnotes

Acknowledgments

This work was supported by JSPS KAKENHI under grant no. JP16K16454.

Conflict of interest

The authors have no conflict of interest to disclose.

References

Martin

Turner

Mirza

Lee

Comstock

Deyo

. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997–2006. Spine. 2009; 34(19): 2077-84. doi: 10.1097/BRS..

Dagenais

Caro

Haldeman

. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008; 8(1): 8-20. doi: 10.1016/j.spinee.2007.10.005.

Hestbaek

Leboeuf-Yde

Manniche

. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003; 12(2): 149-65. doi: 10.1007/s00586-002-0508-5.

Wasiak

Kim

Pransky

. Work disability and costs caused by recurrence of low back pain: longer and more costly than in first episodes. Spine. 2006; 31(2): 219-25. doi: 10.1097/01.brs.0000194774.85971.df.

Bergmark

. Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl. 1989; 230: 1-54.

Hodges

Richardson

. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997; 114(2): 362-70. doi: 10.1007/pl00005644.

MacDonald

Moseley

Hodges

. The lumbar multifidus: does the evidence support clinical beliefs? Man Ther. 2006; 11(4): 254-63. doi: 10.1016/j.math.2006.02.004.

Stanton

Kawchuk

. The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine. 2008; 33(6): 694-701. doi: 10.1097/BRS.0b013e318166e034.

Wilke

Wolf

Claes

Arand

Wiesend

. Stability increase of the lumbar spine with different muscle groups. A biomechanical in vitro study. Spine. 1995; 20(2): 192-8. doi: 10.1097/00007632-199501150-00011.

10.

Richardson

Hodges

Hides

. Therapeutic exercise for lumbopelvic stabilization. Edinburgh: Churchill Livingstone, 2004.

11.

Panjabi

. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord. 1992; 5(4): 390-7. doi: 10.1097/00002517-199212000-00002.

12.

Richardson

Jull

Hodges

Hides

. Therapeutic exercise for spinal segmental stabilization in low back pain: scientific basis and clinical approach. Sydney: Churchill Livingstone, 1999.

13.

Hodges

. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res. 2001; 141(2): 261-6. doi: 10.1007/s002210100873.

14.

Suehiro

Mizutani

Ishida

Kobara

Osaka

Watanabe

. Individuals with chronic low back pain demonstrate delayed onset of the back muscle activity during prone hip extension. J Electromyogr Kinesiol. 2015; 25(4): 675-80. doi: 10.1016/j.jelekin.2015.04.013.

15.

Radebold

Cholewicki

Panjabi

Patel

. Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine. 2000; 25(8): 947-54. doi: 10.1097/00007632-200004150-00009.

16.

Claus

Hides

Moseley

Hodges

. Different ways to balance the spine in sitting: Muscle activity in specific postures differs between individuals with and without a history of back pain in sitting. Clin Biomech (Bristol, Avon). 2018; 52: 25-32. doi: 10.1016/j.clinbiomech.2018.01.003.

17.

MacDonald

Moseley

Hodges

. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain. 2009; 142(3): 183-8. doi: 10.1016/j.pain.2008.12.002.

18.

Suehiro

Ishida

Kobara

Osaka

Watanabe

. Altered trunk muscle recruitment patterns during lifting in individuals in remission from recurrent low back pain. J Electromyogr Kinesiol. 2018; 39: 128-33. doi: 10.1016/j.jelekin.2018.02.008.

19.

Tsao

Galea

Hodges

. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008; 131(8): 2161-71. doi: 10.1093/brain/awn154.

20.

Tsao

Danneels

Hodges

. ISSLS prize winner: Smudging the motor brain in young adults with recurrent low back pain. Spine. 2011; 36(21): 1721-7. doi: 10.1097/BRS.0b013e31821c4267.

21.

Brumagne

Diers

Danneels

Moseley

Hodges

. Neuroplasticity of Sensorimotor Control in Low Back Pain. J Orthop Sports Phys Ther. 2019; 49(6): 402-14. doi: 10.2519/jospt.2019.8489.

22.

Hall

Tsao

MacDonald

Coppieters

Hodges

. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. J Electromyogr Kinesiol. 2009; 19(5): 763-73. doi: 10.1016/j.jelekin.2007.09.008.

23.

Tsao

Druitt

Schollum

Hodges

. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010; 11(11): 1120-8. doi: 10.1016/j.jpain.2010.02.004.

24.

Tsao

Hodges

. Immediate changes in feedforward postural adjustments following voluntary motor training. Exp Brain Res. 2007; 181(4): 537-46. doi: 10.1007/s00221-007-0950-z.

25.

Tsao

Hodges

. Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. J Electromyogr Kinesiol. 2008; 18(4): 559-67. doi: 10.1016/j.jelekin.2006.10.012.

26.

Heuch

Hagen

Zwart

. Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trondelag Health Study. PLoS One. 2017; 12(4): e0175086. doi: 10.1371/journal.pone.0175086.

27.

Hodges

Tucker

. Moving differently in pain: A new theory to explain the adaptation to pain. Pain. 2011; 152(3): S90-S8. doi: 10.1016/j.pain.2010.10.020.

28.

Hodges

Cholewicki

Van Dieën

. Spinal control: the rehabilitation of back pain: state of the art and science. Edinburgh: Elsevier Health Sciences, 2013.

29.

Butler

Hubley-Kozey

Kozey

. Electromyographic assessment of trunk muscle activation amplitudes during a simulated lifting task using pattern recognition techniques. J Electromyogr Kinesiol. 2009; 19(6): e505-12. doi: 10.1016/j.jelekin.2008.09.010.

30.

Macdonald

Dawson

Hodges

. Behavior of the lumbar multifidus during lower extremity movements in people with recurrent low back pain during symptom remission. J Orthop Sports Phys Ther. 2011; 41(3): 155-64. doi: 10.2519/jospt.2011.3410.

31.

Robinson

Bjorke

Kvale

. Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5. Man Ther. 2009; 14(4): 409-14. doi: 10.1016/j.math.2008.06.002.

32.

Lundeberg

Lund

Dahlin

Borg

Gustafsson

Sandin

, et al. Reliability and responsiveness of three different pain assessments. J Rehabil Med. 2001; 33(6): 279-83. doi: 10.1080/165019701753236473.

33.

Ferreira-Valente

Pais-Ribeiro

Jensen

. Validity of four pain intensity rating scales. Pain. 2011; 152(10): 2399-404. doi: 10.1016/j.pain.2011.07.005.

34.

Fairbank

Pynsent

. The Oswestry Disability Index. Spine. 2000; 25(22): 2940-52. doi: 10.1097/00007632-200011150-00017.

35.

Drysdale

Earl

Hertel

. Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises. J Athl Train. 2004; 39(1): 32-6.

36.

Solnik

Rider

Steinweg

DeVita

Hortobagyi

. Teager-Kaiser energy operator signal conditioning improves EMG onset detection. Eur J Appl Physiol. 2010; 110(3): 489-98. doi: 10.1007/s00421-010-1521-8.

37.

Horak

Esselman

Anderson

Lynch

. The effects of movement velocity, mass displaced, and task certainty on associated postural adjustments made by normal and hemiplegic individuals. J Neurol Neurosurg Psychiatry. 1984; 47(9): 1020-8. doi: 10.1136/jnnp.47.9.1020.

38.

Brown

Frank

. Influence of event anticipation on postural actions accompanying voluntary movement. Exp Brain Res. 1987; 67(3): 645-50. doi: 10.1007/bf00247295.

39.

Potvin

Norman

. Quantification of erector spinae muscle fatigue during prolonged, dynamic lifting tasks. Eur J Appl Physiol Occup Physiol. 1993; 67(6): 554-62. doi: 10.1007/bf00241654.

40.

Waldron

Highton

Gray

. Effects of familiarization on reliability of muscle-activation and gross efficiency in adolescents and adults. Cogent Med. 2016; 3(1): 1237606. doi: 10.1080/2331205X.2016.1237606.

41.

Marshall

Murphy

. Delayed abdominal muscle onsets and self-report measures of pain and disability in chronic low back pain. J Electromyogr Kinesiol. 2010; 20(5): 833-9. doi: 10.1016/j.jelekin.2009.09.005.

42.

Hodges

Richardson

. Relationship between limb movement speed and associated contraction of the trunk muscles. Ergonomics. 1997; 40(11): 1220-30. doi: 10.1080/001401397187469.

43.

Osuka

Ishida

Yamanaka

Chiba

Miura

Koshino

, et al. Abdominal draw-in maneuver changes neuromuscular responses to sudden release from trunk loading in patients with non-specific chronic low back pain. J Orthop Sci. 2019; doi: 10.1016/j.jos.2019.10.007.

44.

Tsao

Galea

Hodges

. Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain. 2010; 14(8): 832-9. doi: 10.1016/j.ejpain.2010.01.001.

45.

Classen

Liepert

Wise

Hallett

Cohen

. Rapid plasticity of human cortical movement representation induced by practice. J Neurophysiol. 1998; 79(2): 1117-23. doi: 10.1152/jn.1998.79.2.1117.

46.

Tsuchimoto

Shindo

Hotta

Hanakawa

Liu

Ushiba

. Sensorimotor Connectivity after Motor Exercise with Neurofeedback in Post-Stroke Patients with Hemiplegia. Neuroscience. 2019; 416: 109-25. doi: 10.1016/j.neuroscience.2019.07.037.

47.

Pascual-Leone

Nguyet

Cohen

Brasil-Neto

Cammarota

Hallett

. Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. J Neurophysiol. 1995; 74(3): 1037-45. doi: 10.1152/jn.1995.74.3.1037.

48.

Kleim

Barbay

Nudo

. Functional reorganization of the rat motor cortex following motor skill learning. J Neurophysiol. 1998; 80(6): 3321-5. doi: 10.1152/jn.1998.80.6.3321.

49.

Liu

Chan

Lee

Hui-Chan

. Mental imagery for promoting relearning for people after stroke: A randomized controlled trial1. Arch Phys Med Rehabil. 2004; 85(9): 1403-8. doi: 10.1016/j.apmr.2003.12.035.

50.

Crow

Pizzari

Buttifant

. Muscle onset can be improved by therapeutic exercise: a systematic review. Phys Ther Sport. 2011; 12(4): 199-209. doi: 10.1016/j.ptsp.2010.12.002.

51.

Matthijs

Dedrick

James

Brismee

Hooper

McGalliard

, et al. Co-contractive activation of the superficial multifidus during volitional preemptive abdominal contraction. PM R. 2014; 6(1): 13-21. doi: 10.1016/j.pmrj.2013.08.606.

52.

Cha

H-G

Kim

M-K

Shin

Y-J

. The effects of visual biofeedback using ultrasonograpy on deep trunk muscle activation. J Phys Ther Sci. 2016; 28(12): 3310-2. doi: 10.1589/jpts.28.3310.

Immediate changes in trunk muscle activation patterns during a lifting task following an abdominal drawing-in exercise in subjects with recurrent low back pain

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Keywords

1. Introduction

2. Methods

2.1 Participants

2.2 Data collection

2.3 Procedure

2.6 Statistical analysis

3. Results

Table 1 Subjects’ demographics

5. Conclusion

Footnotes

Acknowledgments

Conflict of interest

References

Table 1
Subjects’ demographics