Comparison of core stabilization techniques on ultrasound imaging of the diaphragm, and core muscle thickness and external abdominal oblique muscle electromyography activity

BACKGROUND: To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another. OBJECTIVE: The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude. METHODS: Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P< 0.05. RESULTS: Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P< 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS. CONCLUSIONS: DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.

Waist Circumference, a Clinical Measurement for the Activity of Transversus Abdominis

Objectives: Improving the timing and endurance of the deep abdominal muscles, notably transversus abdominis (TrA), is a known protocol for improving spinal stability. TrA is the deepest abdominal muscle, and monitoring its activity is a difficult task. Ultrasound and pressure biofeedback have been employed for monitoring the activity of TrA; however, these methods are expensive, not always available in all clinical settings, and their application requires formal training. The purpose of this study was to examine the use of a broadly known method, i.e., changes in the waist circumference, to monitor the activity of TrA. Methods: The study was carried out on 14 subjects following a pilot study of 5 participants. The thickness of TrA measured by ultrasound was considered the standard indicator for activity of TrA and was compared with simuObjectives: Improving the timing and endurance of the deep abdominal muscles, notably transversus abdominis (TrA), is a known protocol for improving spinal stability. TrA is the deepest abdominal muscle, and monitoring its activity is a difficult task. Ultrasound and pressure biofeedback have been employed for monitoring the activity of TrA; however, these methods are expensive, not always available in all clinical settings, and their application requires formal training. The purpose of this study was to examine the use of a broadly known method, i.e., changes in the waist circumference, to monitor the activity of TrA. Methods: The study was carried out on 14 subjects following a pilot study of 5 participants. The thickness of TrA measured by ultrasound was considered the standard indicator for activity of TrA and was compared with simultaneous measurement of waist circumference. Results: A significant criterion validity between the thickness of TrA and the waist circumference was established (Pearson correlation=-0.71, P=0.001), indicating an inverse relationship between changes in the thickness of the transversus abdominis muscle and waist circumference. Discussion: This result confirmed the hypothesis that changes in the waist circumference could be employed as a suitable indicator for the activity of TrA.ltaneous measurement of waist circumference. Results: A significant criterion validity between the thickness of TrA and the waist circumference was established (Pearson correlation=-0.71, P=0.001), indicating an inverse relationship between changes in the thickness of the transversus abdominis muscle and waist circumference. Discussion: This result confirmed the hypothesis that changes in the waist circumference could be employed as a suitable indicator for the activity of TrA.

Relationship between Transversus Abdominis Strength and Lumbar Lordosis in Young Adults

Background: The researchers and clinicians are emphasizing on function of Transverse Abdominis (TrA) which is a deepest abdominal muscles because there is an evidence that TrA is recruited independently of the other abdominal muscles in many different tasks and plays an important role in lumbar stability. Aim: The purpose of this study was to assess the relationship between TrA muscle strength and lumbar lordosis in young adults. Methods: Total 394 subjects were recruited from the constituent institutions of Sumandeep Vidyapeeth with the age range 18-35years. All the subjects, Lumbar lordosis angle and their TrA strength were measured with the Flexicurve and Pressure Biofeedback Unit respectively. Lumbar lordosis angle was calculated using established formula. Average of 03 trials was considered for TrA strength. Results: Pearson correlation coefficient was -0.18 on correlating Lumbar lordosis angle with TrA strength, -0.09 for age with TrA strength and 0.11 for age with lumbar lordosis angle. Conclusion: This study concludes that there is negative relationship between lumbar lordosis and TrA i.e. as the lumbar lordosis angle increases, the strength of TrA muscle decreases.

Effect of Deep Cervical Flexor Muscle Training Using Pressure Biofeedback on Pain and Forward Head Posture in School Teachers with Neck Pain: An Observational Study

Background. Teaching is one of the professions where incidence and prevalence of neck pain is high. Prolonged use of computers, which has further increased due to online teaching amid pandemic, is known to cause neck pain and alter posture, while people with forward head posture (FHP) are prone to develop neck pain and related disability. Research has shown that impairment of deep cervical flexor (DCF) muscles leads to insufficiency in coordination, activation, overload, and poor support on cervical structures that further lead to development of neck pain and altered neck posture. The objective of this study was to see the effect of DCF muscle training using pressure biofeedback on pain and FHP in school teachers with neck pain. Methods. This observational study was conducted at medical center in school premises. Fifty-five school teachers aged between 25 and 40 years with experience of more than 5 years were invited to participate in this study. Subjects were divided in two groups. Both the groups received conventional exercises while in experimental group DCF muscle training using pressure biofeedback was given additionally. Pain and FHP were assessed using NPRS and cranio-vertebral angle using digital photograph technique, respectively, at baseline and end of four weeks of treatment. Results. Although pain and FHP improved in both the groups, mean improvement in both the measures was more in the group that also received DCF training using pressure biofeedback. Conclusions. This study shows that although pain and FHP improved following conventional exercises in school teachers with neck pain, mean improvement was more significant among those who received additional DCF muscle training using pressure biofeedback.

Correlation between Hand Grip Strength and Core Muscle Activation in Physical Therapists of Gujarat

Background: Hand grip strength is of great significant parameter in evaluation of hand function and it is most reliable clinical assessment tool of human strength. It is very useful in various professions where people must work with their hand, like physiotherapy. The core serves at the center of functional kinetic chain in alternative medicine world; the core has been referred to as the “powerhouse”, the foundation or engine of all limb movements. So the purpose of this study is to find out correlation between hand grip strength and core muscle activation in physical therapists of age group 18 to 25. Methods: Two hundred physical therapists volunteered to participate in this study were assessed for height, weight, BMI, the hand grip strength of the dominant hand and the non-dominant hand and core muscle activation. The hand grip strength was assessed with Jamar dynamometer and the core muscle activation was assessed with Pressure Biofeedback Unit. Results: Pearson’s correlation coefficient was used. The results of this study shows that there was weak positive correlation(r=0.42) between the hand grip strength of dominant hand and non-dominant hand with core muscle activation. Conclusion: This study shows weak correlation between the hand grip strength with core muscle activation. Key words: Hand grip strength, Hand dynamometer, Core muscle strength, Pressure Biofeedback Unit.

INTERRATER AND INTRARATER RELIABILITY OF PRESSURE BIOFEEDBACK UNIT IN MEASUREMENT OF TRANSVERSES ABDOMINIS MUSCLE ACTIVATION IN ASYMPTOMATIC ADULTS

Background –The Transverse abdominis with its direct attachments to lumber vertebrae through thoracolumber fascia contributes as a local stabilizer of spine which have meaningful role for spinal stability. Transverse abdominis(TrA) activation is vital component in rehabilition of patients with Low back pain. The Pressure Biofeedback Unit (PBU) is a device designed to teach and measure Transverses abdominis activation by Abdominal draw-in maneuver which is often used by clinicians. Methods – 60 healthy male and female subjects were selected for study. The abdominal draw-in test was performed with the subject in a prone lying position, and the Pressure Biofeedback Unit (Chattanooga Stabilizer ) was utilized to evaluate the ability of the subject to perform this abdominal isolation test. For intrarater reliability, the examiner carried out the test twice at the interval of 2 days. For interrater reliability, 2 examiners did the test one after the other on the same day. Results – Intraclass Correlation Coefficient (ICC) were calculated to determine interrater and intrarater reliability.ICC value for inter-rater reliability is 0.87 with 95% confidence interval (0.78-0.92). ICC value for intra-rater reliability is 0.86 with 95% confidence interval (0.79 – 0.93). Conclusion - Pressure Biofeedback Unit shows good to excellent inter-rater and intra-rater reliability.