Deep abdominal muscle activation lessens lower back pain

By Lucy Piper, Senior medwireNews Reporter

Improving transversus abdominis slide appears to be associated with clinically important long-term pain reduction in people experiencing lower back pain (LBP), researchers report.

They found that a combination of small baseline lateral slide in transverses abdominis combined with an increased slide after weekly exercises for 8 weeks significantly increased the odds for pain reduction.

"Reduced transversus abdominis activity can be interpreted as a biomarker for poor muscle control associated with LBP," say Monica Unsgaard-Tøndel (Norwegian University of Science and Technology, Trondheim) and colleagues.

The team now calls for further studies to "look into the degree of specificity needed to rehabilitate the automatic recruitment of transversus abdominis through exercises."

Using B- and M-mode ultrasound, the researchers recorded the recruitment of transversus abdominis and obliquus internus during the abdominal drawing-in maneuver and the anticipatory onset of deep abdominal muscle activity in 87 patients who had experienced LBP for at least 3 months.

The participants had a median transversus abdominis slide of 1.10 cm at baseline, and a small (below median) transversus abdominis lateral slide before intervention was marginally associated with a lower chance (odds ratio=0.76) for pain improvement (at least a 2-point reduction on a scale of 0-10) at 1 year.

But the chances of pain reduction at 1 year were greatly improved for patients with a small transversus abdominis slide at baseline whose slide increased after exercise intervention, at a significant 14.7 times greater than for those with a small slide but no improvement.

The researchers also note in the British Journal of Sports Medicine that "improved recruitment of transversus abdominis was moderately associated with reduced disability and with perceived recovery immediately after exercise intervention."

They found no associations between contraction thickness ratios in transversus abdominis or obliquus internus abdominis and pain at 1-year follow up, however.

Given that, in the present study, only improved transversus slide among persons with low slide at baseline was associated with long-term pain reduction, the team suggests that "recruitment per se is even more important than isolation of transverses abdominis."

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