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Effect of Core Stability Exercises on Feed-Forward Activation of Deep Abdominal Muscles in Chronic Low Back Pain: A Randomized Controlled Trial

Vasseljen, Ottar PhD, PT*; Unsgaard-Tøndel, Monica MSc, PT*; Westad, Christian PhD; Mork, Paul Jarle PhD

Spine:
doi: 10.1097/BRS.0b013e318241377c
Randomized Trial
Abstract

Study Design. A randomized controlled trial.

Objective. To investigate feed-forward activation or timing of abdominal muscle activation in response to rapid shoulder flexion after 8 weeks with core stability exercises, sling exercises, or general exercises in chronic nonspecific low back pain (LBP) patients.

Summary of Background Data. Delayed onset in abdominal muscles has been associated with LBP. Low load exercises to volitionally activate the transversus abdominis were introduced to restore trunk muscle activation deficits. More forceful co-contraction exercises have been advocated by others. This study explored whether abdominal muscle onset changed after low-load core stability exercises, high-load sling exercises, or general exercises.

Methods. Subjects (N = 109) with chronic nonspecific LBP of at least 3 months' duration were randomly assigned to 8 weekly treatments with low-load core stability exercises, high-load stabilizing exercises in slings, or general exercises in groups. Primary outcome was onset recorded bilaterally by m-mode ultrasound imaging in the deep abdominal muscles in response to rapid shoulder flexion.

Results. No or small changes were found in onset after treatment. Baseline adjusted between group differences showed a 15 ms (95% confidence interval [CI], 1–28; P = 0.03) and a 19 ms (95% CI, 5–33; P < 0.01) improvement with sling relative to core stability and general exercises, respectively, but on 1 side only. There was no association between changes in pain and onset over the intervention period (R2 ≤ 0.02).

Conclusion. Abdominal muscle onset was largely unaffected by 8 weeks of exercises in chronic LBP patients. There was no association between change in onset and LBP. Large individual variations in activation pattern of the deep abdominal muscles may justify exploration of differential effects in subgroups of LBP.

In Brief

Abdominal muscle feed-forward activation was largely unaffected by 8 weeks of core stability exercises in chronic low back pain (LBP) patients. There was no association between changes in onset and pain. Large individual variation in onset may justify further exploration of differential effects in subgroups of LBP patients.

Author Information

*Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Department of Human Movement Science, Faculty of Social Science and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.

Address correspondence and reprint requests to Ottar Vasseljen, PhD, PT, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, P.b. 8905, MTFS, 7491 Trondheim, Norway; E-mail: ottar.vasseljen@ntnu.no

Acknowledgment date: June 29, 2011. First revision date: September 30, 2011. Acceptance date: November 7, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Foundation funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.