期刊论文详细信息
BMC Musculoskeletal Disorders
Effect of head and limb orientation on trunk muscle activation during abdominal hollowing in chronic low back pain
David G Behm3  Eric J Drinkwater1  Sean GT Gibbons2  Kevin Parfrey3 
[1] School of Exercise and Health Sciences, Edit Cowan University, Perth, Australia;Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada;School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
关键词: Stability exercise;    Primitive reflexes;    Abdominal hollowing;    Motor control;    Exercise therapy;    Chronic low back pain;   
Others  :  1128757
DOI  :  10.1186/1471-2474-15-52
 received in 2013-04-30, accepted in 2014-02-12,  发布年份 2014
PDF
【 摘 要 】

Background

Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre.

Methods

This study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter.

Results

Using magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA.

Conclusions

Individuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups.

【 授权许可】

   
2014 Parfrey et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20150225064603154.pdf 1477KB PDF download
Figure 3. 57KB Image download
Figure 2. 47KB Image download
Figure 1. 165KB Image download
【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】
  • [1]Waddell G: The Back Pain Revolution. 2nd edition. UK: Churchill Livingstone; 2004.
  • [2]Beith I, Synnott R, Newman S: Abdominal muscle activity during the abdominal hollowing manoeuvre in the four point kneeling and prone positions. Man Ther 2001, 6(2):82-87.
  • [3]Hodges P: Is there a role for transversus abdominis in lumbo-pelvic stability? Man Ther 1999, 4(2):74-86.
  • [4]O’Sullivan P, Twomey L, Allison G: Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention. J Orthop Sports Phys Ther 1998, 27(2):114-124.
  • [5]Ebenbichler G, Oddsson L, Kollmitzer J, Erim Z: Sensory-motor control of the lower back: implications for rehabilitation. Med Sci Sports Exerc 2001, 33(11):1889-1898.
  • [6]O’Sullivan P, Grahamslaw K, Kendell M, Lapenskie S, Moller N, Richards K: The effect of different standing and sitting postures on trunk muscle activity in a pain-free population. Spine 2002, 27(11):1238-1244.
  • [7]vanDieen J, Cholewicki J, Radebold A: Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine 2003, 28(8):834-841.
  • [8]Macdonald D, Moseley L, Hodges P: Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain 2009, 142(3):183-188.
  • [9]Hodges P, Tucker K: Moving differently in pain: a new theory to explain the adaptation to pain. Pain 2011, 152:S90-S98.
  • [10]Gibbons SGT: The role of proprioception & sensory motor function in rehabilitation, cognitive function & outcome prediction. In Proceedings of: The 7th National Symposium of the Kuwaiti Physical Therapy Association. Kuwait City, Kuwait; 2008:112-115.
  • [11]Richardson C, Jull G, Toppenberg R, Comerford : Techniques for active lumbar stabilization for spinal protection: a pilot study. Aust J Physiother 1992, 38(2):105-112.
  • [12]Gibbons S: Problems with the interpretation of abdominal hollowing in laboratory research and clinical trials: a discussion for the need of standardization and protocols. Neuromuscular Rehab Review 2014, 2:2-12.
  • [13]Comerford M, Mottram S, Gibbons : Diagnosis of Mechanical Back Pain sub Groups & Stability Retraining of the Lumbar Spine. Kinetic Control, Chichester, UK: Kinetic Control Movement Dysfunction Course; 2004.
  • [14]Richardson C, Hides J, Roll S: Advanced Instruction In Retraining Motor Control For Segmental Stabilization: Realtime Ultrasound For Biofeedback. Windsor Ontario, Canada: Human Kinetics Publishers; 1999. [Continuing Education Course]
  • [15]McGill S: Low Back Disorders: Evidence Based Prevention. 2nd edition. Edited by Robertson L, Mustain E, McCasky M, Cler C. Champaign, IL U.S.A: Human Kinetics; 2007.
  • [16]O’Sullivan P, Twomey L, Allison G, Sinclair J, Miller K: Altered patterns of abdominal muscle activation in patients with chronic low back pain. Aust J Physiother 1997, 43(2):91-98.
  • [17]Gibbons S: The development, initial reliability and construct validity of the motor control abilities questionnaire. Man Ther 2009, 14(S1):S22.
  • [18]Gibbons S: Neurocognitive and sensorimotor deficits represent an important sub-classification for musculoskeletal disorders – Central Nervous System Coordination. J Icelandic Phys Ther Assoc 2011, 38(1):10-12.
  • [19]Gibbons S: Retraining of asymmetry in recruitment of transversus abdominis. Orthop Div Rev 2008, 10:29-34.
  • [20]Breslau N, Chilcoat H, Johnson E, Andreski P, Lucia V: Neurologic soft signs and low birthweight: their association and neuropsychiatric implications. Biol Psychiatry 2000, 47:71-79.
  • [21]McPhillips M, Hepper P, Mulhern G: Effects of replicating primary-reflex movements on specific reading difficulties in children: a randomised, double-blind, controlled trial. Lancet 2000, 355(9203):537-541.
  • [22]McPhillips M, Sheehy N: Prevalence of persistent primary reflexes and motor problems in children with reading difficulties. Dyslexia 2004, 10(4):316-338.
  • [23]Zafeiriou D: Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatr Neurol 2004, 31(1):1-8.
  • [24]Teixeira F, Alonso E, Romero V, Ortiz A, Martinez C, Otero E: Clinico-pathological correlation in dementias. J Psychiatry Neurosci 1995, 20(4):276-282.
  • [25]VanBoxtel M, Bosma H, Jolles J, Vreeling F: Prevalence of primitive reflexes and the relationship with cognitive change in healthy adults: a report from the maastricht aging study. J Neurol 2006, 253(7):935-941.
  • [26]Apkarian A, Sosa Y, Sonty S, Levy R, Harden R, Parrish T, Gitelman D: Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci 2004, 24(46):10410-10415.
  • [27]Roland M, Fairbank J: The roland-morris disability questionnaire and the oswestry disability questionnaire. Spine 2000, 25(24):3115-3124.
  • [28]Gibbons S: Neurological soft signs are present more often and to a greater extent in adults with chronic low back pain with cognitive learning deficits. Man Ther 2009, 14(S1):S20.
  • [29]Turk DC, Okifuji A, et al.: Pain terms and taxonomies. In Bonica’s Management of Pain. 3rd edition. Edited by Loeser D, Butler SH, Chapman JJ. Philadelphia (PA): Lippincott, Williams & Wilkins; 2001:18-25. 2
  • [30]Von Garnier K, Koveker K, Rackwitz B, Kober U, Wilke S, Ewert T, Stucki G: Reliability of a test measuring transversus abdominus muscle recruitment with a pressure biofeedback unit. Physiotherapy 2009, 95(1):8-19.
  • [31]Anderson K, Behm D: Trunk muscle activity increases with unstable squat movements. Can J Appl Physiol 2005, 30(1):33-45.
  • [32]Behm D, Anderson K: The role of instability with resistance training. J Strength Cond Res 2006, 20(3):716-722.
  • [33]Hamlyn N, Behm D, Young W: Trunk muscle activation during dynamic weight-training exercises and isometric instability activities. J Strength Cond Res 2007, 21(4):1108-1112.
  • [34]Parfrey K, Docherty D, Workman C, Behm D: The effects of different sit- and curl-up positions on activation of abdominal and hip flexor musculature. Appl Physiol Nutr Metab 2008, 33(5):888-895.
  • [35]Workman C, Docherty D, Parfrey K, Behm D: Influence of pelvis position on the activation of abdominal and hip flexor muscles. J Strength Cond Res 2008, 22(5):1563-1569.
  • [36]Goddard S: Reflexes, Learning and Behavior. Eugene, Oregon. USA: Fern Ridge Press; 2005.
  • [37]Beimborn D, Morrissey M: A review of the literature related to trunk muscle performance. Spine 1988, 13(6):655-660.
  • [38]Allen M, Capute A: The evolution of primitive reflexes in extremely premature infants. Pediatr Res 1986, 20(12):1284-1289.
  • [39]Hopkin W, Marshall S, Batterham A, Hanin J: Progressive statistic for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009, 41(1):3-13.
  • [40]Cohen J: Statistical power analysis for the behavioural sciences. 2nd edition. Hillsdale, New Jersey: Lawrence Erlaum Associates; 1988.
  • [41]Hopkins W: A spreadsheet for deriving a confidence interval, mechanistic inference and clinical inference from a p value. Sportscience 2007, 2007(11):16-20.
  • [42]Liow D, Hopkins W: Velocity specificity of weight training for kayak sprint performance. Med Sci Sports Exerc 2003, 35(7):1232-1237.
  • [43]Hodges P, Richardson C: Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine 1996, 21(22):2640-2650.
  • [44]Hodges P: Pain and motor control: from the laboratory to rehabilitation. J Electromyogr Kinesiol 2011, 21:220-228.
  • [45]Jull G, Richardson C: Motor control problems in patients with spinal pain: a new direction for therapeutic exercise. J Manipulative Physiol Ther 2000, 23(2):115-117.
  • [46]Hodges P, Richardson C, Jull G: Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function. Physiother Res Int 1996, 1(1):30-40.
  • [47]Hanada E, Johnson M, Hubley-Kozey C: A comparison of trunk muscle activation amplitudes during gait in older adults with and without chronic low back pain. PMR 2011, 3(10):920-928.
  • [48]Ng K, Richardson C, Parianpour M, Kippers V: EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls. J Orthop Res 2002, 20(1):112-121.
  • [49]Ershad N, Kahrizi S, Abadi M, Zadeh S: Evaluation of trunk muscle activity in chronic low back pain patients and healthy individuals during holding loads. J Back Musculoskelet Rehabil 2009, 22(3):165-172.
  • [50]Hungerford B, Gilleard W, Hodges P: Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine 2003, 28(14):1593-1600.
  • [51]Shadmehr A, Jafarian Z, Talebian S: Changes in recruitment of pelvic stabilizer muscles in people with and without sacroiliac joint pain during the active straight-leg-raise test. J Back Musculoskelet Rehabil 2012, 25(1):27-32.
  • [52]Hodges P, van den Hoorn W, Dawson A, Cholewicki J: Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. J Biomech 2009, 42:61-66.
  • [53]Fookson O, Smetanin B, Berkinblit M, Adamovich S, Feldman G, Poizner H: Azimuth errors in pointing to remembered targets under extreme head rotations. Neuroreport 1994, 5:885-888.
  • [54]Guerraz M, Blouin J, Vercher J: From head orientation to hand control: evidence of both neck and vestibular involvement in hand drawing. Exp Brain Res 2003, 150:40-49.
  • [55]Knox J, Hodges P: Changes in head and neck position affect elbow joint position sense. Exp Brain Res 2005, 165:107-113.
  • [56]Knox J, Beilstein D, Charles S, Aarseth G, Rayer S, Treleaven J, Hodges P: Changes in head and neck position have a greater effect on elbow joint position sense in people with whiplash-associated disorders. Clin J Pain 2006, 22:512-518.
  • [57]Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S: The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine 2000, 25(8):989-994.
  • [58]Deutsch H, Kilani H, Moustafa E, Hamilton N, Hebert JP: Effect of head-neck position on elbow flexor muscle torque production. Phys Ther 1987, 67:517-521.
  • [59]Le Pellec A, Maton B: The influence of tonic neck reflexes on voluntary fatiguing elbow movements in humans. Eur J Appl Physiol 1993, 67:231-238.
  • [60]Aiello I, Rosati G, Sau GF, Patraskakis S, Bissakou M, Traccis S: Tonic neck reflexes on upper limb flexor tone in man. Exp Neurol 1988, 101(1):41-49.
  • [61]Baliki M, Geha P, Apkarian A, Chialvo D: Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. J Neurosci 2008, 28(6):1398-1403.
  • [62]Tsao H, Galea M, Hodges P: Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008, 131:2161-2171.
  • [63]Tsao H, Galea M, Hodges P: Driving plasticity in the motor cortex in recurrent low back pain. Eur J Pain 2010, 14(8):832-839.
  • [64]Sudo K, Matsuyama T, Goto Y, Matsumoto A, Tashiro K: Elbow flexion response as another primitive reflex. Psychiatry Clin Neurosci 2002, 56(2):131-137.
  • [65]Odenheimer G, Funkenstein H, Beckett L, Chown M, Pilgrim D, Evans D, Albert M: Comparison of neurologic changes in ‘successfully aging’ persons vs the total aging population. Arch Neurol 1994, 51(6):573-580.
  • [66]Wand B, Parkitny L, O’Connell N, Luomajoki H, Thacker M, Moseley G: Cortical changes in chronic low back pain: current state of the art and implications for clinical practice. Man Ther 2011, 16(1):15-20.
  • [67]McGill S, Juker D, Kropf P: Appropriately placed surface EMG electrodes reflect deep muscle activity (psoas, quadratus lumborum, abdominal wall) in the lumbar spine. J Biomech 1996, 29(11):1503-1507.
  • [68]Ng J, Kippers V, Richardson C: Muscle fibre orientation of abdominal muscles and suggested surface EMG electrode positions. Electromyogr Clin Neurophysiol 1998, 38:51-58.
  • [69]Urquhart D, Barker P, Hodges P, Story I, Briggs C: Regional morphology of the transversus abdominis and obliquusinternus and externus abdominis muscles. Clin Biomech 2005, 20(3):233-241.
  • [70]Urquhart D, Hodges P: Differential activity of regions of transversus abdominis during trunk rotation. Eur Spine J 2005, 14(4):393-400.
  • [71]Monfort-Pañego M, Vera-García J, Sánchez-Zuriaga D, Sarti-Martínez A: Electromyographic studies in abdominal exercise: a literature synthesis. J Manipulative Physiol Ther 2009, 32(3):232-244.
  • [72]Gibbons SGT: Integrating the psoas major and deep sacral guteus maximus muscles into the lumbar cylinder model. Rome, Italy: Proceedings of: “The Spine”: World Congress on Manual Therapy; 2005.
  • [73]Gibbons S, Clark J: Specific motor control exercise for lumbo-pelvic pain of articular origin: a systematic review. Man Ther 2009, 14(S1):S16-S17.
  • [74]Richardson C, Jull G, Hodges P, Hides J: Therapeutic exercises for spinal segmental stabilization in low back pain: scientific basis and clinical approach. London, England: Churchill Linvingstone; 1999.
  • [75]Gorbet N, Selkow L, Joseph M, Susan S: No difference in transverse abdominis activation ratio between healthy and asymptomatic low back pain patients during therapeutic exercise. Rehabil Res Pract 2010, 18:1-6.
  • [76]Park D, Lee H: Activation of abdominal muscles during abdominal hollowing in four different positions. J Phys Ther Sci 2010, 22:203-207.
  • [77]Gibbons S: Primitive reflex inhibition and sensory motor training improves cognitive learning function and symptoms in chronic disabling low back pain: a case series. Man Ther 2009, 14(S1):S24.
  • [78]Byström G, Rasmussen-Barr E, Grooten W: Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine 2013, 38(6):E350-E358.
  文献评价指标  
  下载次数:17次 浏览次数:31次