Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function

Mannion, Anne F.; Caporaso, F.; Pulkovski, N.; Sprott, Haiko

doi:10.1007/s00586-012-2155-9

Cited by 76 publications

(72 citation statements)

References 64 publications

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“…However, the reported result does not support the hypothesis of associated involuntary recruitment of TrA fibers and the degree of functional disability, pain severity, and prognosis risk. A recent study (2012) 29 and a systematic review 28 also demonstrate the lack of relationship between change in thickness of the transversus abdominis and the improvement of disability and pain intensity in patients with chronic low back pain.…”

Section: Discussionmentioning

confidence: 98%

Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar

et al. 2016

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RESUMO Este estudo investigou a associação entre testes clínicos, desfechos clínicos e risco prognóstico de pacientes com dor lombar crônica não específica. Para esta pesquisa, 20 pacientes, maiores de 18 anos, foram selecionados por conveniência e submetidos à avaliação dos desfechos clínicos por meio de Escala numérica de dor e Questionário de incapacidade. Para classificação de risco prognóstico utilizou-se o questionário STarT Back, e para avaliar o recrutamento do músculo transverso do abdome foram utilizados os seguintes testes clínicos: Escala de classificação clínica (ECC); e medida da espessura dos músculos do abdome por meio de imagens ultrassonográficas (MEM-US). Os testes foram realizados em um único dia por avaliador treinado, e a ordem dos testes foi aleatória. Os coeficientes de correlação de Pearson (r) e Spearman (rS) foram utilizados para investigar a associação. Os resultados mostraram que as associações entre o risco prognóstico de dor lombar com os desfechos clínicos, dor e incapacidade foram moderadas (r=0,68 e r=0,57, respectivamente). Para ECC, as associações com incapacidade e risco prognóstico foram consideradas razoáveis (r=-0,34 e r=-0,36, respectivamente). Não houve associações com a MEM-US. Na amostra de baixo risco prognóstico, a relação do ECC com a incapacidade foi considerada moderada para boa, enquanto para dor a correlação foi razoável (rS=-0,62 e rS=-0,24, respectivamente). Concluímos que existe associação entre ECC com desfechos clínicos e risco prognóstico, e a estratificação, segundo o risco prognóstico, aumenta a relação observada. Futuros estudos devem ser conduzidos com novas medidas para avaliação do recrutamento muscular abdominal com amostras maiores.

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Section: Discussionmentioning

confidence: 98%

Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar

et al. 2016

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“…Landm arks used for transducer placem ent included bony or palpable landm arks, 11, 13, 31, 32, 34-38, 40 -48 visual landm arks such as the um bilicus 33,38,39 and theoretical landm arks, such as axillary lines. 11, 34, 35, 38, 39 , 42, 47, 48 Increased difficulties in palpation of landm arks in people with higher BMI 51 is likely to influence reliability of TrA RTUI in the C LBP population.…”

Section: Discussionmentioning

confidence: 99%

“…11,[32][33][34] Q ualSyst scores ranged from 0.19 to 1. Most studies were found to have m oderate to high quality, 11,13,[32][33][34][35][36][37][38][39][40][41][42][43][44] with only 5 studies scoring below 0.75 31,[45][46][47][48] (Table 1 ). Results of the Q AREL ranged from three to seven (Table 2 ).…”

Section: Risk O F Bias Wit Hin St Udiesmentioning

confidence: 99%

“…13,33,34,38,[42][43][44]47 Three studies used on-screen calipers 11, 39 , 44 for this purpose and four placed a grid over the im age. 32, 36 , 40 , 41 Four studies took thickness m easures in the m iddle of the im age and at set distances either side 33, 36 , 40 , 41 and others reported taking m easures at varying distances from the TrA aponeurosis.…”

Section: Measurementmentioning

confidence: 99%

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Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review

Whittle

Flavell

Gordon

2017

Physical Therapy Reviews

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Bac kgr o und:Real tim e ultrasound im aging (RTUI) is used to m easure transversus abdom inis (TrA) thickness in low back pain (LBP ) populations. However, individuals with chronic low back pain (C LBP ) pose specific im aging challenges, such as older age and higher body m ass index, com pared to asym ptom atic populations or acute and sub-acute LBP groups. These challenges potentially increase m easurem ent error and m ay require different im aging m ethods. O bje c t ive s :This review describes the m ethodologies and reported reliability for RTUI m easurem ent of TrA specific to C LBP populations. Me t ho ds :A system atic database search of Medline, C INAHL, P EDro, the full C ochrane library, Scopus, and Inform it identified 20 studies that used RTUI to m easure TrA of C LBP participants. Two independent raters appraised the quality of the studies using the Q ualSyst and the Q AREL critical appraisal tools. Re s ult s :Methodological quality varied from low to high. Methods for patient and transducer positioning and m uscle m easurem ent were inconsistent between studies. Eight articles cited reliability results from past studies of non-C LBP populations. O nly two studies reported reliability in C LBP populations specifically and found higher Intraclass C orrelation C oefficients for thickness m easures at rest (0.63-0.97), com pared to thickness change over tim e or contraction ratios (0.28-0.80). Co nc lus io ns :Inconsistency of m ethodology, variable m ethodological quality, and lim ited and variable reliability reporting was highlighted in this review. This LBP subgroup poses challenges for RTUI, therefore future research should include standarized m ethods for im age acquisition. This will im prove the quality of study m ethods, reliability of TrA m easurem ent, and im prove the applicability and com paribility of research evidence available to clinicians. Ke ywo r ds Transversus abdom inis ReliabilityReal tim e ultrasound Back pain Int roduct ionReal tim e ultrasound im aging (RTUI) is used in research and clinical practice to m easure various m usculoskeletal structures. [1][2][3] In the last 20 years, a plethora of studies have m easured transversus abdom inis (TrA). 4-8 Through its attachm ent to the linear alba and thoracolum bar fascia, TrA provides spinal stability via m ultiple m echanism s, including feed-forward activation. 9 Hence it has been investigated in sports perform ance, and in relation to low back pain (LBP ). 10Several studies agree that TrA m orphology and function is altered in patients with low back pain. [11][12][13][14] When com pared to healthy populations, both delayed anticipatory activation and reduced m uscle thickness has been reported in individuals who had experienced at least one previous episode of LBP , but were asym ptom atic at the tim e of RTUI. 12 In part, this provides insight into the progression from acute to recurrent low back pain and then chronic pain via central sensitization. This system atic review identifies the current evidence for m easurem ent m...

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“…However, the mechanisms of action generating improved clinical outcome are not elucidated. In the July issue, the article by Mannion et al [22] examines whether clinical improvement is greater in patients with an initial functional deficit of the abdominal muscles implicated in this type of exercises, and whether the clinical results can be attributed to the effects of the exercises on the trunk muscles. Pain intensity and disability (Roland-Morris) were evaluated pre and post 9 weeks of SSE along with psychological questionnaires.…”

Section: Modic Changesmentioning

confidence: 99%

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

Benoist

2013

Eur Spine J

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Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function

Cited by 76 publications

References 64 publications

Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar

Associação entre recrutamento de músculos abdominais com desfechos clínicos e risco prognóstico em indivíduos com dor lombar crônica não específica: estudo preliminar

Methodological consistency and measurement reliability of transversus abdominis real time ultrasound imaging in chronic low back pain populations: a systematic review

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

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