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      Comparison of abdominal muscle thickness according to feedback method used during abdominal hollowing exercise

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          Abstract

          [Purpose] This study was intended to examine the most effective feedback method for contracting the musculus transversus abdominis muscle by using basic training, a pressure biofeedback unit, and real-time ultrasonographic imaging during abdominal hollowing exercise training. [Subjects and Methods] The subjects in this study were 30 healthy young students in their twenties. Thirty subjects were divided randomly and equally into the basic training, the pressure biofeedback unit, and real-time ultrasonographic imaging groups. All of the subjects received abdominal hollowing exercise training for 15 minutes. The subjects in the pressure biofeedback unit group were trained by using a pressure biofeedback unit. Those in the real-time ultrasonographic imaging group received training with monitoring of possible contraction of their musculus transversus abdominis muscles on ultrasonography. [Results] In all the three groups, the musculus transversus abdominis became significantly thicker, but more significantly in the real-time ultrasonographic imaging group than in the basic training group. [Conclusion] The feedback method using real-time ultrasonographic imaging may be more effective in thickening the musculus transversus abdominis muscle during exercise than the traditional feedback method with manual contact only. However, it is insufficient in terms of overall qualitative improvement of exercise outcome.

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          The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain.

          Two abdominal muscle patterns were tested in the same group of individuals, and their effects were compared in relation to sacroiliac joint laxity. One pattern was contraction of the transversus abdominis, independently of the other abdominals; the other was a bracing action that used all the lateral abdominal muscles. To demonstrate the biomechanical effect of the exercise for the transversus abdominis known to be effective in low back pain. Drawing in the abdominal wall is a specific exercise for the transversus abdominis muscle (in cocontraction with the multifidus), which is used in the treatment of back pain. Clinical effectiveness has been demonstrated to be a reduction of 3-year recurrence from 75% to 35%. To the authors' best knowledge, there is not yet in vivo proof of the biomechanical effect of this specific exercise. This study of a biomechanical model on the mechanics of the sacroiliac joint, however, predicted a significant effect of transversus abdominis muscle force. Thirteen healthy individuals who could perform the test patterns were included. Sacroiliac joint laxity values were recorded with study participants in the prone position during the two abdominal muscle patterns. The values were recorded by means of Doppler imaging of vibrations. Simultaneous electromyographic recordings and ultrasound imaging were used to verify the two muscle patterns. The range of sacroiliac joint laxity values observed in this study was comparable with levels found in earlier studies of healthy individuals. These values decreased significantly in all individuals during both muscle patterns (P < 0.001). The independent transversus abdominis contraction decreased sacroiliac joint laxity (or rather increased sacroiliac joint stiffness) to a significantly greater degree than the general abdominal exercise pattern (P < 0.0260). Contraction of the transversus abdominis significantly decreases the laxity of the sacroiliac joint. This decrease in laxity is larger than that caused by a bracing action using all the lateral abdominal muscles. These findings are in line with the authors' biomechanical model predictions and support the use of independent transversus abdominis contractions for the treatment of low back pain.
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            Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials.

            A systematic review of randomized controlled trials. To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long-term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions.
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              The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects.

              Randomized controlled trial. To determine if supplementing typical clinical instruction with real-time ultrasound feedback facilitates performance and retention of the abdominal hollowing exercise (AHE). Increasingly clinicians are using real-time ultrasound imaging as a form of feedback when teaching patients trunk stabilization exercises; however, there has been no justification for this practice. Forty-eight subjects were divided randomly into 3 groups that received different types of feedback: group 1 received minimal verbal feedback, group 2 received verbal and palpatory feedback, and group 3 received real-time ultrasound, verbal, and palpatory feedback. If the subject performed 3 consecutive correct AHEs during the initial session, she/he returned for a retention test. The performance of 3 consecutive, correct AHEs was the criterion measure; the number of trials to criterion was also recorded during the initial and retention test sessions. The ability to perform the AHE differed among groups (P<.001). During the initial session, 12.5% of subjects in group 1, 50.0% of subjects in group 2, and 87.5% of subjects in group 3 were able to perform 3 consecutive AHEs. Group 3 subjects achieved the criterion in fewer trials than the other 2 groups (P = .0006). No differences among groups were found for the retention testing; however, low power due to fewer subjects precluded a strong interpretation of this finding. Real-time ultrasound feedback can decrease the number of trials needed to consistently perform the AHE; however, the data are inconclusive with regard to retention of this skill.
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                Author and article information

                Journal
                J Phys Ther Sci
                J Phys Ther Sci
                JPTS
                Journal of Physical Therapy Science
                The Society of Physical Therapy Science
                0915-5287
                2187-5626
                29 September 2016
                September 2016
                : 28
                : 9
                : 2519-2521
                Affiliations
                [1) ] Department of Physical Therapy, U1 University, Republic of Korea
                Author notes
                [* ]Corresponding author. Daehee Lee, Department of Physical Therapy, U1 University: 12 Youngdong-eup, Youngdong-gun, Chungbuk 370-701, Republic of Korea. (E-mail: lovewisd@ 123456naver.com )
                Article
                jpts-2016-347
                10.1589/jpts.28.2519
                5080165
                505bf373-09e4-4064-be69-febb5459b0da
                2016©by the Society of Physical Therapy Science. Published by IPEC Inc.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                : 27 March 2016
                : 23 May 2016
                Categories
                Original Article

                transversus abdominis,real-time ultrasonographic imaging,pressure biofeedback unit

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