Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain? A prospective study with 1-year follow-up

Unsgaard-Tøndel, Monica; Nilsen, Tom Ivar Lund; Magnussen, Jon; Vasseljen, Ottar

doi:10.1136/bjsm.2011.085506

Cited by 44 publications

(31 citation statements)

References 34 publications

(61 reference statements)

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“…11,[32][33][34] Q ualSyst scores ranged from 0.19 to 1. Most studies were found to have m oderate to high quality, 11,13,[32][33][34][35][36][37][38][39][40][41][42][43][44] with only 5 studies scoring below 0.75 31,[45][46][47][48] (Table 1 ). Results of the Q AREL ranged from three to seven (Table 2 ).…”

Section: Risk O F Bias Wit Hin St Udiesmentioning

confidence: 99%

Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review

Whittle

Flavell

Gordon

2017

Physical Therapy Reviews

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Bac kgr o und:Real tim e ultrasound im aging (RTUI) is used to m easure transversus abdom inis (TrA) thickness in low back pain (LBP ) populations. However, individuals with chronic low back pain (C LBP ) pose specific im aging challenges, such as older age and higher body m ass index, com pared to asym ptom atic populations or acute and sub-acute LBP groups. These challenges potentially increase m easurem ent error and m ay require different im aging m ethods. O bje c t ive s :This review describes the m ethodologies and reported reliability for RTUI m easurem ent of TrA specific to C LBP populations. Me t ho ds :A system atic database search of Medline, C INAHL, P EDro, the full C ochrane library, Scopus, and Inform it identified 20 studies that used RTUI to m easure TrA of C LBP participants. Two independent raters appraised the quality of the studies using the Q ualSyst and the Q AREL critical appraisal tools. Re s ult s :Methodological quality varied from low to high. Methods for patient and transducer positioning and m uscle m easurem ent were inconsistent between studies. Eight articles cited reliability results from past studies of non-C LBP populations. O nly two studies reported reliability in C LBP populations specifically and found higher Intraclass C orrelation C oefficients for thickness m easures at rest (0.63-0.97), com pared to thickness change over tim e or contraction ratios (0.28-0.80). Co nc lus io ns :Inconsistency of m ethodology, variable m ethodological quality, and lim ited and variable reliability reporting was highlighted in this review. This LBP subgroup poses challenges for RTUI, therefore future research should include standarized m ethods for im age acquisition. This will im prove the quality of study m ethods, reliability of TrA m easurem ent, and im prove the applicability and com paribility of research evidence available to clinicians. Ke ywo r ds Transversus abdom inis ReliabilityReal tim e ultrasound Back pain Int roduct ionReal tim e ultrasound im aging (RTUI) is used in research and clinical practice to m easure various m usculoskeletal structures. [1][2][3] In the last 20 years, a plethora of studies have m easured transversus abdom inis (TrA). 4-8 Through its attachm ent to the linear alba and thoracolum bar fascia, TrA provides spinal stability via m ultiple m echanism s, including feed-forward activation. 9 Hence it has been investigated in sports perform ance, and in relation to low back pain (LBP ). 10Several studies agree that TrA m orphology and function is altered in patients with low back pain. [11][12][13][14] When com pared to healthy populations, both delayed anticipatory activation and reduced m uscle thickness has been reported in individuals who had experienced at least one previous episode of LBP , but were asym ptom atic at the tim e of RTUI. 12 In part, this provides insight into the progression from acute to recurrent low back pain and then chronic pain via central sensitization. This system atic review identifies the current evidence for m easurem ent m...

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Section: Risk O F Bias Wit Hin St Udiesmentioning

confidence: 99%

Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review

Whittle

Flavell

Gordon

2017

Physical Therapy Reviews

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“…The findings from the studies in this thesis identified that the deep trunk muscles were the most likely to be affected by LBP in dancers. There is substantial evidence that training programs which target the transversus abdominis and multifidus muscles in people with LBP are successful in improving muscle function (Hides et al 2009, Tsao et al 2010a, Unsgaard-Tøndel et al 2012) and increasing muscle size (Danneels et al 2001, Hides et al 2008b. There is also evidence that exercise programs which target these muscles are associated with reduction of symptoms of LBP such as pain and disability (Ferreira et al 2010, O'Sullivan et al 1997, Unsgaard-Tøndel et al 2012, Vasseljen and Fladmark 2010.…”

Section: Implications For Motor Control Of the Trunk (Studies I-iv)mentioning

confidence: 99%

“…Furthermore, the changes in muscle morphology and behaviour associated with this intervention are linked to clinically meaningful outcomes such as reduced pain and disability in people with LBP. For example, improved contraction of transversus abdominis muscles in people who have chronic LBP and low baseline measures of contraction is associated with long-term pain reduction (Unsgaard-Tøndel et al 2012) and reduced disability (Ferreira et al 2010). The efficacy of motor control training to reduce pain and disability and recurrence (Hides et al 2001) associated with LBP has also been shown in specific groups such as: people with acute LBP (Hides et al 2001), people with spondylolisthesis (O'Sullivan et al 1997), and athletes with LBP (Hides et al 2008b).…”

Section: Hagins 2011mentioning

confidence: 99%

“…There is substantial evidence that training programs which target the transversus abdominis and multifidus muscles in people with LBP are successful in improving muscle function (Hides et al 2009, Tsao et al 2010a, Unsgaard-Tøndel et al 2012) and increasing muscle size (Danneels et al 2001, Hides et al 2008b. There is also evidence that exercise programs which target these muscles are associated with reduction of symptoms of LBP such as pain and disability (Ferreira et al 2010, O'Sullivan et al 1997, Unsgaard-Tøndel et al 2012, Vasseljen and Fladmark 2010. Furthermore, in a sporting population (elite footballers) an intervention program focussed on the deep trunk muscles was associated with; increased multifidus CSA; improved transversus abdominis function; fewer games missed due to injury , and reduced risk of severe lower limb injury (Hides and Stanton 2014).…”

Section: Implications For Motor Control Of the Trunk (Studies I-iv)mentioning

confidence: 99%

“…An ). There is also evidence that exercise programs which target these muscles are associated with reduction of symptoms of LBP such as pain and disability (Ferreira et al 2010, O'Sullivan et al 1997, Unsgaard-Tøndel et al 2012, Vasseljen and Fladmark 2010. Furthermore, in a sporting population (elite footballers) an intervention program focussed on the deep trunk muscles was associated with; increased multifidus CSA; improved transversus abdominis function; fewer games missed due to injury , and reduced risk of severe lower limb injury (Hides and Stanton 2014).…”

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Physiology and pathophysiology of low back pain in ballet dancers

Gildea¹

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Classical ballet dancers combine artistry and physical skills to perform graceful and exciting movements. Lengthy, exacting dance training potentially promotes unique adaptation of motor control to; execute these movements; maintain optimal physiological function, and provide stability to avoid injury and pain. Yet low back pain (LBP) is common in dancers. Differences in motor control are frequently observed between non-dancers with and without LBP. This often involves reduced and delayed activity of deep trunk muscles and augmented activity of superficial muscles. These changes are proposed to affect the control of movement and stiffness of the trunk. LBP is also associated with deficits in postural control, an aspect of motor control, which depends on control of the trunk. Some features of adaptation in motor control are relatively common; but there are some features that are specific to individuals or different populations. It is essential to understand how motor control is adapted in elite classical ballet dancers with LBP as less optimal motor control has potential to impair performance and limit the capacity to dance. The overall objective of this thesis was to investigate aspects of motor control in dancers with and without LBP, with specific attention to trunk muscle morphology and to postural stability.Studies I and II investigated trunk muscle size, symmetry and function, in dancers with and without LBP, at rest and during simple manoeuvres, with magnetic resonance imaging (MRI). Reduced size of the multifidus muscle was observed in dancers with LBP and dancers with both back and hip/pelvic region pain. This finding is similar to that for nondancers. Study II provided preliminary evidence of a behavioural change in transversus abdominis (the deepest abdominal muscle); expressed as reduced length change of this muscle measured with MRI, in dancers with LBP. Thickness of transversus abdominis, obliquus internus abdominis and multifidus muscles were asymmetrical in dancers but this was not related to LBP. This may be related to repetitive performance of asymmetrical movements. Studies III and IV investigated postural control. In Study III, the trunk was perturbed in order to measure the dynamic properties of stiffness, damping and mass as an indication of control of the trunk. Dancers with LBP had less damping (control of velocity) than dancers without LBP, but this could be changed with motor imagery in the dancers with LBP. Study IV used linear and non-linear measures of centre of pressure trajectories to investigate standing balance in dancers with and without LBP and nondancers. Balance was measured with the feet in parallel and the dance-specific turned out 'first' position; which increases the dependence on trunk motion for balance in the anteroposterior direction. Dancers without LBP used more movement to control balance iii than non-dancers. These findings suggest that "less" movement does not define optimal balance in dancers. Dancers with a history of LBP used strategies that were more s...

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Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain

Rahmani

Mohseni-Bandpei

Salavati

et al. 2017

J of Ultrasound Medicine

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Is activation of transversus abdominis and obliquus internus abdominis associated with long-term changes in chronic low back pain? A prospective study with 1-year follow-up

Cited by 44 publications

References 34 publications

Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review

Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review

Physiology and pathophysiology of low back pain in ballet dancers

Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain

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