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      What is a Suitable Pressure for the Abdominal Drawing-in Maneuver in the Supine Position Using a Pressure Biofeedback Unit?

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          Abstract

          [Purpose] The aim of this study was to determine the appropriate pressure variation for performing a successful abdominal drawing-in maneuver (ADIM). The abdominal muscle thickness variations and contraction ratios were examined in relation to pressure variations using a Pressure Biofeedback Unit (PBU) during an ADIM in the supine position. [Methods] The PBU was placed identically between the lumbar lordosis of 20 healthy subjects (12 males and 8 females) and the pressure of the PBU was maintained at 40 mmHg. Then, while the subjects performed ADIM at four random pressure variations (0, 2, 4, or 6 mmHg), the thicknesses of the transversus abdominis (TrA), the internal oblique abdominal muscle (IO), and the external oblique abdominal muscle (EO) were measured using ultrasonography. [Results] Pressure increases of 0–2 mmHg resulted in significant decreases in IO and EO thicknesses compared to pressure increases of 6 mmHg. Increases of 0–2 mmHg also resulted in significant decreases in IO+EO and EO contraction ratios compared to pressure increases of 6 mmHg, while the preferential activation ratio of the TrA was significantly increased. [Conclusion] Compared to the other pressure increases, an increase of 0–2 mmHg effectively regulated the thicknesses and contraction ratios of superficial muscles such as IO and EO, rather than the thickness and contraction ratio of the TrA, showing high and indirect preferential activation ratios for TrA. Therefore, for successful ADIM, rather than using large PBU pressure increases, exercises that promote slight increases of around 0–2 mmHg from a baseline of 40 mmHg are desirable.

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          Most cited references 18

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          Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis.

          A randomized, controlled trial, test--retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up. To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised. Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner. After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up. A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.
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            Core strengthening.

            Core strengthening has become a major trend in rehabilitation. The term has been used to connote lumbar stabilization, motor control training, and other regimens. Core strengthening is, in essence, a description of the muscular control required around the lumbar spine to maintain functional stability. Despite its widespread use, core strengthening has had meager research. Core strengthening has been promoted as a preventive regimen, as a form of rehabilitation, and as a performance-enhancing program for various lumbar spine and musculoskeletal injuries. The intent of this review is to describe the available literature on core strengthening using a theoretical framework. To understand the concept of core strengthening.
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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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                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 June 2013
                May 2013
                : 25
                : 5
                : 527-530
                Affiliations
                [1) ] Department of Physical Therapy, Graduate School of Catholic University of Pusan
                [2) ] Department of Physical Therapy, Gimhae College
                Author notes
                Mailing address: Su-Kyoung Lee, Department of Physical Therapy, Gimhae College: Sambang-dong, Gimhae-si, Gyungnam 621-706, Republic of Korea. TEL: +82 55-320-1735, FAX: +82 55-336-6222 E-mail: holeintwo@ 123456naver.com
                Article
                jpts-2012-344
                10.1589/jpts.25.527
                3804982
                by the Society of Physical Therapy Science

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

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