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doi: 10.1097/BRS.0000000000000091

Effect of Recurrent Low Back Pain History on Volitional Pre-emptive Abdominal Activation During a Loaded Functional Reach Activity

Nagar, Vittal R. MD*; Hooper, Troy L. MPT, ATC*; Dedrick, Gregory S. PT, ScD; Brismée, Jean-Michel PT, ScD*; Sizer, Phillip S. Jr PT, PhD*

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Study Design. A 2 (group) × 2 (abdominal contraction) × 2 (reach activity) crossover mixed design with repeated measures for contraction and activity examined the effects of a loaded (4.6 kg) forward-reach activity and abdominal drawing-in maneuver (ADIM) on transversus abdominis (TrA) contraction in subjects with nonspecific low back pain (NSLBP) history versus controls.

Objective. We measured TrA contraction during a loaded forward-reach activity while using the ADIM and examined if a NSLBP history affects TrA activity.

Summary of Background Data. The ADIM supports trunk stability during function. Clinicians incorporate ADIM during patients' functional tasks. Pain-free individuals can sustain ADIM during function, such as forward-reach. However, this has not been tested in those with a NSLBP history.

Methods. Eighteen normal subjects and 18 subjects with a history of NSLBP participated. A blinded investigator recorded M-mode ultrasound imaging measurements of TrA thickness (mm) during 4 conditions as follows: (1) quiet standing without ADIM; (2) quiet standing with ADIM; (3) loaded forward-reach without ADIM; and (4) loaded forward-reach with ADIM.

Results. A mixed analysis of variance demonstrated a significant main effect for group (F [1, 34] = 5.404, P = 0.026; Figure 2), where TrA thickness was greater for NSLBP history (7.41 + 2.34 mm) versus controls (5.9 + 2.46 mm). A significant main effect was observed for abdominal contraction (F [1, 34] = 49.57, P < 0.0001; Figure 3), where TrA thickness was greater during ADIM (7.47 + 2.7 mm) versus without ADIM (5.84, 1.92 m). A significant main effect was observed for forward-reach activity (F [1, 34] = 12.79, P = 0.001; Figure 4), where TrA thickness was greater during a loaded forward-reach (7.04 + 2.6 mm) versus quiet standing (6.2 + 2.4 mm). There were no significant interactions.

Figure 2
Figure 2
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Figure 3
Figure 3
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Figure 4
Figure 4
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Conclusion. Individuals can use a volitional pre-emptive ADIM for trunk protection during loaded forward-reach, potentially reducing injury risk. A NSLBP history increases TrA activation during ADIM, suggesting an enhanced protective role.

Level of Evidence: 2

© 2014 by Lippincott Williams & Wilkins

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