Ultrasound assessment of the abdominal, diaphragm, and pelvic floor muscles during the respiratory and postural tasks in women with and without postpartum lumbopelvic pain: a case-control study.

INTRODUCTION AND HYPOTHESIS: Postpartum lumbopelvic pain (PLPP) is common among women. Abdominal, diaphragm, and pelvic floor muscles (PFMs) modulate intraabdominal pressure as a part of the force closure mechanism. These muscles are exposed to changes during pregnancy that compromise the force closure mechanism. It was hypothesized that abdominal and PFMs activity, the direction of bladder base displacement, diaphragm thickness, and excursion might differ between women with and without PLPP during respiratory and postural tasks. METHODS: Thirty women with and 30 women without PLPP participated in this case-control study. Ultrasound imaging was used to assess the abdominal, diaphragm, and PFMs during rest, active straight leg raising (ASLR) with and without a pelvic belt, and deep respiration. RESULTS: The bladder base descent was significantly greater in the PLPP group than in the controls during deep respiration and ASLR without a belt (p = 0.026; Chi-squared = 6.40). No significant differences were observed between the groups in the abdominal muscles activity and diaphragm muscle thickness. There was a significant interaction effect of the group and the task for diaphragm excursion (F (2, 116) = 6.08; p = 0.00) and PFM activity (F (2, 116) = 5.22; p = 0.00). In the PLPP group, wearing a belt compromised altered PFM activation and direction of bladder base displacement. CONCLUSION: The PFM activity, direction of bladder base displacement, and diaphragm excursion differed between groups during postural and respiratory tasks. Therefore, it is recommended to involve retraining of the PFMs and diaphragm muscle in the rehabilitation of women with PLPP.

Ultrasound Assessment of Abdominal Muscle Thickness With and Without Lumbopelvic Pain in Pregnant Women.

OBJECTIVES: Lumbopelvic pain (LPP) is a very common cause of discomfort during pregnancy, but its etiology remains unclear. The association between abdominal muscle thickness and LPP in pregnant women has not been studied extensively, despite the significant abdominal changes that occur during pregnancy. This study aimed to examine the relationship between abdominal muscle thickness and LPP in pregnant women. METHODS: In this study, 49 pregnant women in their second trimester participated. The intensity of LPP was assessed using a numerical rating scale. Ultrasound imaging was used to measure the thickness of abdominal muscles, including the rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles. Participants were classified into two groups, the LPP group and non-LPP group, and the abdominal muscle thickness was compared between the two groups. The statistical significance level was set at P < .05. RESULTS: There were 24 and 25 participants in the LPP and non-LPP groups, respectively. Internal oblique (IO) thickness was significantly thinner in the LPP group than in the non-LPP group (5.4 ± 0.2 mm versus 6.1 ± 0.2 mm; P = .042). Multivariate logistic regression analysis showed that IO thickness was significantly associated with LPP (odds ratio, 0.516; 95% confidence interval, 0.284-0.935; P = .019). CONCLUSIONS: This study suggested that LPP in second trimester pregnancy might be related to IO thickness. Further longitudinal studies are needed to understand the role of this muscle as an LPP risk factor for pregnant women.

Ultrasound imaging assessment of the diaphragm and abdominal muscles in people with a recent history of moderate Covid-19 infection and healthy participants: A cross-sectional pilot study.

Coronavirus disease (Covid-19) is a highly infectious disease caused by the SARS-CoV-2 virus and is associated with a decrease of respiratory, physical, and psychological function, subsequently affecting quality of life. The aim of the present pilot study was to use ultrasound imaging (USI) to evaluate and compare the thickness of the diaphragm and abdominal muscles between individuals recently diagnosed with moderate Covid-19 infection and healthy individuals. METHODS: A cross-sectional observational pilot study was performed. A total sample of 24 participants were recruited from a private medical center (Madrid, Spain): Covid-19 (n = 12) and healthy controls (n = 12). The external oblique (EO), internal oblique (IO), transversus abdominis (TrA), rectus abdominis (RA), interrecti distance (IRD) and diaphragm thickness were assessed using USI during inspiration, expiration and during contraction. RESULTS: USI measurements of the thickness of EO, IO, TrA, RA, IRD and the diaphragm did not differ significantly between groups during inspiration, expiration or during contraction (all P > 0.05). CONCLUSIONS: These preliminary results suggest that the morphology of the abdominal muscles and diaphragm is not altered in people with a recent history of moderate Covid-19 infection.

Assessment of the influence of global and local exercises on core stabilization mechanisms: randomized controlled trial.

BACKGROUND: Over the last few years, various concepts of applying core stabilization mechanisms in the formation of human motor function have come to existence. The objective of the research was to assess the influence of two types of core stability training on deep abdominal muscle thickness and on global trunk mobility. METHODS: The study involved 108 individuals divided into 3 groups: LT (local training), performing the stability training based on locally isolated work of the transversus abdominis muscle; GT (global training), performing the training based on global movement patterns; and CG (control group), who did not undergo the training. The workout programs comprised 4 weeks of the exercise, 4 times a week. The measurement of the observed muscle thickness was carried out by means of ultrasound imaging. Trunk mobility was evaluated based on the toe-touch test, as well as the measurement of lateral flexion ranges. All the measurements were performed before the workout programs, right after finishing and 2 weeks after the end of the training cycle. RESULTS: Both training concepts have an impact on deep abdominal muscle thickness; however, in the LT group, significant improvement was noted with regard to the transversus abdominis, whereas in the GT group the improvement concerned the external oblique muscle. Both training methods also improved trunk mobility in the sagittal and frontal plane. CONCLUSIONS: The results we have obtained imply that both concepts of core stability training affect the human body at a structural as well as functional level. The application of the described training methods may not only provide measurable benefits in the field of clinical physiotherapy, for instance in the treatment of spine-related back pain, but also in motor training designed to improve athletes' performance and to minimize the risk of injury.

[Assessment of the nutritional status and physical condition of basic education students in Chile]. / Valoración del estado nutricional y la condición física de estudiantes de educación básica de Chile.

INTRODUCTION: Introduction: currently, regular physical exercise is the best tool available to promote people's well-being and improve their health. Objective: the objective of the study was to determine the level of physical condition and nutritional status, as well as the relationship between them, in elementary school students in the city of Chillán. Methods: the study is of the descriptive, cross-sectional, relational type. A total of 2500 students participated. To evaluate physical condition, the followingtests were used: Wells and Dillons (flexibility), Sargent Test (lower limb power), AAPHARD's 1-Mile Test (cardiorespiratory resistance), and Sit-ups in 30 seconds (localized muscular resistance). Results: when comparing by sex, men presented significant statistical differences in the physical variables of aerobic capacity (p = 0.00), sit-ups (p = 0.00) and jumping (p = 0.00); only in the case of flexibility did women present better results (p = 0.01). When relating BMI to physical capacity a negative relationship is observed in both sexes-that is, the higher the BMI, the lower the amount of sit-ups (r = -0.032; r = -0.084, women and men, respectively) and aerobic capacity (r = -0.063 and r = -0.023, women and men, respectively). In flexibility and jump a positive though negligible correlation was observed. Conclusion: normal-weight men and women have a better physical condition as compared to those with overweight or obesity. As for sex, men have a better physical condition except for the flexibility test, where women obtain the best results. In addition, a negative relationship is observed in both sexes between physical condition and body composition, where a high BMI results in a low level of physical performance.

INTRODUCCIÓN: Introducción: actualmente, el ejercicio físico practicado de manera regular es la mejor herramienta disponible para fomentar el bienestar de las personas y una mejor salud. Objetivo: el objetivo del estudio fue determinar el nivel de condición física y el estado nutricional, así como la relación entre estos, en estudiantes de enseñanza básica de la ciudad de Chillán. Métodos: el estudio es de tipo descriptivo, de corte transversal y relacional. Participaron 2500 estudiantes. Para evaluar la condición física se utilizaron los siguientes test: Wells y Dillons (flexibilidad), Sargent Test (potencia miembros inferiores), Test de 1 Milla de la AAPHARD (capacidad aeróbica) y Abdominales en 30 segundos (capacidad muscular localizada). Resultados: al comparar por sexos, los hombres presentaron diferencias estadísticas significativas en las variables físicas de capacidad aeróbica (p = 0,00), abdominales (p = 0,00) y salto (p = 0,00); solo en el caso de la flexibilidad las mujeres presentaron mejores resultados (p = 0,01). Al relacionar el IMC con la capacidad física se observa una relación negativa en ambos sexos, es decir: a mayor IMC, menor es la cantidad de abdominales realizados (r = -0,032; r = -0,084, mujeres y hombres, respectivamente) y la capacidad aeróbica (r = -0,063 y r = -0,023, mujeres y hombres, respectivamente). En flexibilidad y salto se observa una correlación positiva, aunque esta es insignificante. Conclusión: los hombres y las mujeres con normopeso presentan una mejor condición física en comparación con quienes presentan sobrepeso u obesidad. En cuanto al sexo, los hombres presentan una mejor condición física salvo en la prueba de flexibilidad, donde las mujeres presentan los mejores resultados. Además, se observa una relación negativa en ambos sexos entre la condición física y la composición corporal, donde un IMC elevado se traduce en un bajo nivel de rendimiento físico.

Assessment and application of the Bunkie test in college students.

INTRODUCTION: The 'Bunkie test' is a functional performance test consisting of five different plank positions held bilaterally. No current literature has established appropriate rest intervals for in-between plank positions nor termination criteria. PURPOSE: The current study examined rest interval duration and test termination criteria for the Bunkie test. METHODS: Forty college students participated in the study, completing three Bunkie test sessions separated by at least 48 h. Positions included the anterior power line (APL), lateral stabilizing line (LSL), posterior power line (PPL), posterior stabilizing line (PSL), and medial stabilizing line (MSL). Positions were held for as long as possible with proper form. Each session utilized a different rest interval of either 30s, 1min, or 2min between each of the plank positions. RESULTS: A repeated measures ANOVA revealed significant differences bilaterally among rest intervals for APL (p = .009; p = .001) whereas, no significant differences (p < .05) were observed for PPL. LSL and MSL and PSL had significant differences among rest intervals on one side (LSL left, p = .002; MSL right, p = .006; PSL right p=.005)). Post hoc analysis with a Bonferroni adjustment revealed less variability among times between the 1min and 2min rest intervals between plank positions. CONCLUSIONS: The current study revealed that utilizing a shorter rest interval time frame (30s) appears to create greater variability in performance outcomes. Since no differences were found between using a 1min or 2min rest interval for both the final hold times and tension times, a rest interval of at least 1min will allow for more dependable data.

Can a Standardized Visual Assessment of Squatting Technique and Core Stability Predict Injury?

O'Connor, S, McCaffrey, N, Whyte, EF, and Moran, KA. Can a standardized visual assessment of squatting technique and core stability predict injury? J Strength Cond Res 34(1): 26-36, 2020-This study examined whether a standardized visual assessment of squatting technique and core stability can predict injury. Male adolescent and collegiate Gaelic players (n = 627) were assessed using the alternative core/trunk stability push-up test and a developed scoring system for the overhead squat and single-leg squat (SLS) that examined both overall impression and segmental criteria. A single summative score from the overall impression scores of all 3 tests was calculated. Sustained injuries were examined over a season. Results indicated that the single summative score did not predict those that sustained a lower-extremity injury, trunk injury, or whole-body injury, and receiver operating characteristic curves were also unable to generate an optimal cutoff point for prediction. When segmental criteria were included in multivariate analyses, the tests were able to predict whole-body injury (p < 0.0001) and lower-extremity injury (p < 0.0001). However, although specificity was high (80.6%, 76.5%), sensitivity of the models was low (40.2%, 44.2%). The most common score was "good" for the overhead squat (46.4%) and SLS (47.6%), and "good" and "excellent" for the alternative core stability push-up test (33.5%, 49.1%), with "poor" core stability increasing the odds of sustaining a lower-extremity injury (odds ratio = 1.52 [0.92-2.51]). The findings suggest that although segmental scoring could be incorporated by strength and conditioning coaches and clinicians, they should be used predominantly as a preliminary screening tool to highlight players requiring a more thorough assessment.

Application of Ultrasonography in the Assessment of Abdominal and Lumbar Trunk Muscle Activity in Participants With and Without Low Back Pain: A Systematic Review.

OBJECTIVE: The purpose of this study was to systematically review the literature regarding which condition (task, position, or contraction type), changes in muscle thickness could be interpreted as muscle activity of trunk muscles. METHODS: Studies that assessed the correlation between changes in muscle thickness measured with ultrasonography (US) and electromyography (EMG) activity were included. Only the data related to abdominal and lumbar trunk muscles in participants with or without low back pain were extracted. The PubMed, ScienceDirect, Ovid MEDLINE, Scopus, Springer, and Cumulative Index to Nursing and Allied Health Literature databases were searched from inception to August 2018. Two independent raters appraised the quality of the included studies using the Critical Appraisal Skills Program checklist. RESULTS: Fourteen studies were included. The results revealed significant correlations between US and EMG measures for the lumbar multifidus and erector spinae muscle during most contraction levels and postures. For transverse abdominis and internal oblique, US and EMG measures were correlated during low load abdominal drawing or bracing. The correlations were influenced by trunk position for higher intensities of contraction. For the external oblique muscle, correlation was observed only during trunk rotation. CONCLUSION: Changes in muscle thickness should not be interpreted as muscle activity for all tasks, positions, and contraction types. Only during prime movement tasks performed with isometric contraction could muscle thickness change be considered as muscle activity. Also, upright postures influenced the relationship between changes in muscle thickness and muscle activity for abdominal muscles.

Deep learning enables automatic quantitative assessment of puborectalis muscle and urogenital hiatus in plane of minimal hiatal dimensions.

OBJECTIVES: To measure the length, width and area of the urogenital hiatus (UH), and the length and mean echogenicity (MEP) of the puborectalis muscle (PRM), automatically and observer-independently, in the plane of minimal hiatal dimensions on transperineal ultrasound (TPUS) images, by automatic segmentation of the UH and the PRM using deep learning. METHODS: In 1318 three- and four-dimensional (3D/4D) TPUS volume datasets from 253 nulliparae at 12 and 36 weeks' gestation, two-dimensional (2D) images in the plane of minimal hiatal dimensions with the PRM at rest, on maximum contraction and on maximum Valsalva maneuver, were obtained manually and the UH and PRM were segmented manually. In total, 713 of the images were used to train a convolutional neural network (CNN) to segment automatically the UH and PRM in the plane of minimal hiatal dimensions. In the remainder of the dataset (test set 1 (TS1); 601 images, four having been excluded), the performance of the CNN was evaluated by comparing automatic and manual segmentations. The performance of the CNN was also tested on 117 images from an independent dataset (test set 2 (TS2); two images having been excluded) from 40 nulliparae at 12 weeks' gestation, which were acquired and segmented manually by a different observer. The success of automatic segmentation was assessed visually. Based on the CNN segmentations, the following clinically relevant parameters were measured: the length, width and area of the UH, the length of the PRM and MEP. The overlap (Dice similarity index (DSI)) and surface distance (mean absolute distance (MAD) and Hausdorff distance (HDD)) between manual and CNN segmentations were measured to investigate their similarity. For the measured clinically relevant parameters, the intraclass correlation coefficients (ICCs) between manual and CNN results were determined. RESULTS: Fully automatic CNN segmentation was successful in 99.0% and 93.2% of images in TS1 and TS2, respectively. DSI, MAD and HDD showed good overlap and distance between manual and CNN segmentations in both test sets. This was reflected in the respective ICC values in TS1 and TS2 for the length (0.96 and 0.95), width (0.77 and 0.87) and area (0.96 and 0.91) of the UH, the length of the PRM (0.87 and 0.73) and MEP (0.95 and 0.97), which showed good to very good agreement. CONCLUSION: Deep learning can be used to segment automatically and reliably the PRM and UH on 2D ultrasound images of the nulliparous pelvic floor in the plane of minimal hiatal dimensions. These segmentations can be used to measure reliably UH dimensions as well as PRM length and MEP. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Ultrasound Assessment of the Transverse Abdominis During Functional Movement.

OBJECTIVES: The traditional activation ratio divides contracted muscle thickness by resting muscle thickness while an abdominal draw-in maneuver is performed during hook lying. Ultrasound imaging during function, such as standing or gait, or peak knee flexion in a single-leg squat allows for further visualization of muscle activity. The goal of this study was to examine activation ratio calculations for transverse abdominis function in supine versus loaded conditions to determine the most informative normalization strategy for muscle activity based on thickness values. METHODS: Transverse abdominis thickness was measured via ultrasound in 35 healthy participants under 4 different conditions. Comparisons were made between the traditional activation ratio tabletop, standing activation ratio (standing abdominal draw-in maneuver thickness/quiet standing thickness), and functional activation ratio (single-leg squat thickness/quiet standing thickness). Additionally, a cued activation ratio (single-leg squat with cued abdominal draw-in maneuver thickness/single-leg squat thickness) during the single-leg squat was obtained. Activation ratios of greater than 1.0 indicated that participants could activate the muscle during activity, and values were compared by analysis of variance. RESULTS: The participants included 23 women and 12 men with a mean age ± SD of 21.3 ± 2.7 years, mass of 66.1 ± 14.4 kg, and height of 168.5 ± 10.1 cm. Activation ratios exceeded 1.0 in 94.3% for the traditional activation ratio, 85.7% for the standing activation ratio, 82.9% for the cued activation ratio, and 82.9% for the functional activation ratio. With groups defined as tabletop activated or not, the standing, cued, and functional activation ratios were all significantly different (all P < .05). CONCLUSIONS: Normalizing muscle thickness to the corresponding functional position quiet value provides a useful functional activation ratio and may help clinicians better understand the transverse abdominis role during complex functional tasks. Assessment techniques using various formulas for activation ratios reveal that the muscle functions differently during weight bearing compared to traditional measures.

Evaluating abdominal core muscle fatigue: Assessment of the validity and reliability of the prone bridging test.

The aims of this study were to research the amplitude and median frequency characteristics of selected abdominal, back, and hip muscles of healthy subjects during a prone bridging endurance test, based on surface electromyography (sEMG), (a) to determine if the prone bridging test is a valid field test to measure abdominal muscle fatigue, and (b) to evaluate if the current method of administrating the prone bridging test is reliable. Thirty healthy subjects participated in this experiment. The sEMG activity of seven abdominal, back, and hip muscles was bilaterally measured. Normalized median frequencies were computed from the EMG power spectra. The prone bridging tests were repeated on separate days to evaluate inter and intratester reliability. Significant differences in normalized median frequency slope (NMFslope ) values between several abdominal, back, and hip muscles could be demonstrated. Moderate-to-high correlation coefficients were shown between NMFslope values and endurance time. Multiple backward linear regression revealed that the test endurance time could only be significantly predicted by the NMFslope of the rectus abdominis. Statistical analysis showed excellent reliability (ICC=0.87-0.89). The findings of this study support the validity and reliability of the prone bridging test for evaluating abdominal muscle fatigue.

The assessment of abdominal and multifidus muscles and their role in physical function in older adults: a systematic review.

BACKGROUND: Age-related changes in the trunk (abdominal and lumbar multifidus) muscles and their impact on physical function of older adults are not clearly understood. OBJECTIVES: To systematically summarise studies of these trunk muscles in older adults. DATA SOURCES: Cochrane Library, Pubmed, EMBASE and CINAHL were searched using terms for abdominal and MF muscles and measurement methods. STUDY SELECTION: Two reviewers independently assessed studies and included those reporting measurements of abdominal muscles and/or MF by ultrasound, computed tomography, magnetic resonance imaging or electromyography of adults aged ≥50 years. DATA SYNTHESIS: A best evidence synthesis was performed. RESULTS: Best evidence synthesis revealed limited evidence for detrimental effects of ageing or spinal conditions on trunk muscles, and conflicting evidence for decreased physical activity or stroke having detrimental effects on trunk muscles. Thicknesses of rectus abdominis, internal oblique and external oblique muscles were 36% to 48% smaller for older than younger adults. Muscle quality was poorer among people with moderate-extreme low back pain and predicted physical function outcomes. LIMITATIONS: Study heterogeneity precluded meta-analysis. CONCLUSION: Overall, the evidence base in older people has significant limitations, so the role of physiotherapy interventions aimed at these muscles remains unclear. The results point to areas in which further research could lead to clinically useful outcomes. These include determining the role of the trunk muscles in the physical function of older adults and disease; developing and testing rehabilitation programmes for older people with spinal conditions and lower back pain; and identifying modifiable factors that could mitigate age-related changes.

Isometric abdominal wall muscle strength assessment in individuals with incisional hernia: a prospective reliability study.

PURPOSE: To determine the reliability of measurements obtained by the Good Strength dynamometer, determining isometric abdominal wall and back muscle strength in patients with ventral incisional hernia (VIH) and healthy volunteers with an intact abdominal wall. METHODS: Ten patients with VIH and ten healthy volunteers with an intact abdominal wall were each examined twice with a 1 week interval. Examination included the assessment of truncal flexion and extension as measured with the Good Strength dynamometer, the completion of the International Physical Activity Questionnaire (IPAQ) and the self-assessment of truncal strength on a visual analogue scale (SATS). The test-retest reliability of truncal flexion and extension was assessed by interclass correlation coefficient (ICC), and Bland and Altman graphs. Finally, correlations between truncal strength, and IPAQ and SATS were examined. RESULTS: Truncal flexion and extension showed excellent test-retest reliability for both patients with VIH (ICC 0.91 and 0.99) and healthy controls (ICC 0.97 and 0.96). Bland and Altman plots showed that no systematic bias was present for neither truncal flexion nor extension when assessing reliability. For patients with VIH, no significant correlations between objective measures of truncal strength and IPAQ or SATS were found. For healthy controls, both truncal flexion (τ 0.58, p = 0.025) and extension (τ 0.58, p = 0.025) correlated significantly with SATS, while no other significant correlation between truncal strength measures and IPAQ was found. CONCLUSIONS: The Good Strength dynamometer provided a reliable, low-cost measure of truncal flexion and extension in patients with VIH.

Ultrasound Assessment of Abdominal Muscle Thickness in Postpartum vs Nulliparous Women.

OBJECTIVE: The purpose of this study was to determine the effect size in measurable change of abdominal musculature morphology using ultrasonography in postpartum women within 1 month of a healthy, vaginal delivery. METHODS: One hundred fifty-six participants were recruited for this study. B-mode ultrasound imaging was used to measure abdominal muscle thickness on 80 nulliparous women and 76 mothers who had delivered within the past 4 weeks. Measures were taken for the upper and lower rectus abdominus, external and internal obliques, and transversus abdominus at rest. RESULTS: Statistically significant differences were found in the thickness of the rectus abdominus muscle at both sites; upper (P < .0001) and lower (P < .0001) as well as the internal oblique (P < .0001). All 3 muscles were thinner in postpartum participants (8.29 ± 1.83 mm, 8.89 ± 2.29 mm, and 7.06 ± 1.82 mm, respectively) within the first month of delivery than in controls (10.82 ± 1.93 mm, 11.13 ± 2.38 mm, and 8.36 ± 1.87 mm, respectively). Large effect sizes were found for the influence of pregnancy on the rectus muscle segments (1.35 for the upper rectus abdominus and 1.00 for the lower rectus abdominus) and a medium effect size for the internal oblique (0.71). No significant differences were observed in the remaining 2 muscles. CONCLUSION: This study showed that there are differences in morphology of the abdominal muscles in pregnant women vs nonpregnant controls. The large effect sizes reported may provide the basis for future studies examining relationships between morphology, functional change, and back pain during pregnancy.

Ultrasound assessment of trunk muscles and back flexibility, strength and endurance in off-road cyclists with and without low back pain.

OBJECTIVES: To compare the thickness of lateral abdominal muscles and Cross Sectional Area (CSA) of lumbar Multifidus Spinae (LM) muscles of competitive off-road cyclists with and without Low Back Pain (LBP). We also aimed to compare the maximum isometric back strength and endurance, as well as flexibility of lower back in cyclists with LBP and in the controls. METHODS: The thickness of Transversus Abdominis (TrA), Internal Oblique (IO) and External Oblique (EO) along with the CSA of LM muscles of 14 professional competitive off-road cyclists with LBP and 24 controls were measured by ultrasound (US) in hook-lying position on the examination table, and mounted on the bicycle. In addition, the back strength and endurance of the subjects and the flexibility of the participants were measured. RESULTS: Data showed a significantly lower thickness of Transversus Abdominis (TrA) and CSA of LM muscles in cyclists with LBP comparing to controls in all positions. No significant result regarding the flexibility of the subjects in case group comparing with the controls was found (p= 0.674). In addition, it was found that there is no significant difference in isometric back strength of the subjects between the groups (p= 0.105). However, we found that subjects with LBP have a lower endurance in back dynamometry with 50% of their maximum isometric back strength (p= 0.016). CONCLUSION: In this study, useful information regarding possible factors associated with low back pain in off- road cyclists was found (lower thickness of TrA and LM muscles and decreased back endurance).

Comparison between muscle activation measured by electromyography and muscle thickness measured using ultrasonography for effective muscle assessment.

In this study, we aimed to compare the intrarater reliability and validity of muscle thickness measured using ultrasonography (US) and muscle activity via electromyography (EMG) during manual muscle testing (MMT) of the external oblique (EO) and lumbar multifidus (MF) muscles. The study subjects were 30 healthy individuals who underwent MMT at different grades. EMG was used to measure the muscle activity in terms of ratio to maximum voluntary contraction (MVC) and root mean square (RMS) metrics. US was used to measure the raw muscle thickness, the ratio of muscle thickness at MVC, and the ratio of muscle thickness at rest. One examiner performed measurements on each subject in 3 trials. The intrarater reliabilities of the % MVC RMS and raw RMS metrics for EMG and the % MVC thickness metrics for US were excellent (ICC=0.81-0.98). There was a significant difference between all the grades measured using the % MVC thickness metric (p<0.01). Further, this % MVC thickness metric of US showed a significantly higher correlation with the EMG measurement methods than with the others (r=0.51-0.61). Our findings suggest that the % MVC thickness determined by US was the most sensitive of all methods for assessing the MMT grade.

Electromyographic assessment of trunk and shoulder muscles during a Pilates pull-up exercise / Avaliação eletromiográfica de músculos do tronco e do ombro durante um exercício Pilates de pull-up / Evaluación electromiográfica de los músculos del tronco y del hombro durante un ejercicio Pilates de pull-up

This study compares surface electromyographic activity of the internal oblique, rectus abdominis, multifidus, iliocostalis, anterior deltoids during the pull-up on a lower and on a higher difficulty level. We assessed nine adults with previous experience in Pilates. The root mean square (RMS) values were normalized by maximum isometric contraction for each participant. During the ascent phase, the low spring position showed a significantly higher RMS than the high spring position of 8.9% for deltoid, 17.2% for internal oblique, 22.3% for rectus abdominis, 4.1% for iliocostalis, and 5.6% for multifidus, and in the descent phase, the RMS in the lower spring exceeded significantly the high spring position in 1.6% for the deltoid, 10% for internal oblique, 31.4% for rectus abdominis and 11.4% for iliocostalis. There was no predominance of abdominal muscles over the shoulder muscle in any spring position. The pull-up exercise can be a useful choice for the core and anterior deltoid muscles strengthening...

Este estudo compara a atividade eletromiográfica de superfície dos músculos oblíquo interno, reto abdominal, multífidos, iliocostal e deltóide anterior durante o pull-up em dois níveis de dificuldade (mola alta e mola baixa). Foram avaliadas nove adultos com experiência anterior em Pilates. Os valores RMS foram normalizados pela contração isométrica máxima. Durante a fase de subida, a posição de mola baixa mostrou RMS significativamente maiores em relação a alta de 8,9% para deltóide, 17,2% para o oblíquo interno, 22,3% para o reto abdominal, 4,1% para iliocostal, e 5,6% para o multífido, e na fase de descida, em 1,6% para o deltóide, 10% para oblíquo interno, 31,4% para o reto abdominal e 11,4% para o iliocostal. Não houve predomínio dos músculos abdominais sob o músculo do ombro em qualquer posição de mola. O exercício de pull-up pode ser ferramenta útil para o fortalecimento da musculatura do core e do músculo deltóide anterior...

Este estudio compara la EMG superficial de los músculos recto del abdomen, oblicuo interno, multifidos, ilio-costal y deltoides anterior durante el ejercicio pull-up en dos niveles de dificultad. Se evaluaron a nueve adultos experimentados en Pilates. Los valores de RMS se normalizaron por la contracción isométrica máxima. Durante la fase de ascenso, la posición baja del resorte mostró valores significativamente majores de RMS que la posición alta de 8,9% para lo deltoides, 17,2% para oblicuo interno, 22,3% para recto abdominal, 4,1% para ilio-costalis, y 5,6% para multifidos. En la fase de descenso, el RMS, en el muelle inferior, excede significativamente la posición alta del resorte en 1,6% para el deltoides, 10% para oblicuo interno, 31,4% para recto abdominal y 11,4% para ilio-costalis. No hubo predominio de los músculos abdominales bajo los deltoides anteriores. Pull-up puede ser una herramienta útil para el trabajo del core y para la fortificación del deltoides anterior...

Relationship between ultrasonography and electromyography measurement of abdominal muscles when activated with and without pelvis floor muscles contraction.

AIM: The importance of the abdominal musculature in spine stability, has promoted the development of a variety of studies. Ultrasound imaging (UI) is a valuable tool which, when applied appropriately, has the potential to provide significant insight into abdominal muscle contraction. Limited studies have been taken place regarding the relationship between ultrasound measures of muscle thickening and electromyography (EMG) measures of activation. Inconsistent results, however, have been reported. Based on previous studies association between abdominal muscle activation and thickening may be affected by contraction level. The aims of this study were to measure the relationship between abdominal muscle thickness and abdominal muscles amplitude in different levels of abdominal muscles contraction. METHODS: The research was carried on with a convenience sampling at the Physical Therapy Department of University of Social Welfare and Rehabilitation Sciences. Thirty healthy participants volunteered for this study. Muscle thickness right transversus abdominis (TrA) and obliqus internus (OI) muscles in abdominal hallowing maneuvers with and without pelvic floor muscle (PFM) contraction has been measured. Additionally, surface EMG of the right TrA/IO muscles was recorded. A hardware electrical part that acts as trigger system was used to record the activities of abdominal muscles in UI and EMG synchronously. Thickness change, normalized thickness and maximum amplitude abdominal muscles were used for statistical analysis. RESULTS: Correlations between the thickness change and amplitude measures were -0.03 -- 0.38 for TrA/IO. The Correlations between the normalized thickness and amplitude measures were -0.04--0.26 for TrA/IO. CONCLUSION: There is not clear relationship between increases in abdominal muscle activation and corresponding measures of thickening during abdominal muscle contraction. Changes in thickness of deep abdominal muscle cannot be used to indicate changes in the electrical activity in this muscle.

Pelvic floor muscle training in treatment of female stress urinary incontinence, pelvic organ prolapse and sexual dysfunction.

OBJECTIVES: The objectives of the present review was to present and discuss evidence for pelvic floor muscle (PFM) training on female stress urinary incontinence (SUI), pelvic organ prolapse (POP) and sexual dysfunction. METHODS: This manuscript is based on conclusions and data presented in systematic reviews on PFM training for SUI, POP and sexual dysfunction. Cochrane reviews, the 4th International Consultation on Incontinence, the NICE guidelines and the Health Technology Assessment were used as data sources. In addition, a new search on Pubmed was done from 2008 to 2011. Only data from randomized controlled trials (RCTs) published in English language is presented and discussed. RESULTS: There is Level 1, Grade A evidence that PFM training is effective in treatment of SUI. Short-term cure rates assessed as <2 g of leakage on pad testing vary between 35 and 80%. To date there are 5 RCTs showing significant effect of PFM training on either POP stage, symptoms or PFM morphology. Supervised and more intensive training is more effective than unsupervised training. There are no adverse effects. There is a lack of RCTs addressing the effect of PFM training on sexual dysfunction. CONCLUSIONS: PFM training should be first line treatment for SUI and POP, but the training needs proper instruction and close follow-up to be effective. More high quality RCTs are warranted on PFM training to treat sexual dysfunction.

Ultrasound assessment of transversus abdominis muscle contraction ratio during abdominal hollowing: a useful tool to distinguish between patients with chronic low back pain and healthy controls?

Spine stabilisation exercises, in which patients are taught to preferentially activate the transversus abdominus (TrA) during "abdominal hollowing" (AH), are a popular treatment for chronic low back pain (cLBP). The present study investigated whether performance during AH differed between cLBP patients and controls to an extent that would render it useful diagnostic tool. 50 patients with cLBP (46.3 ± 12.5 years) and 50 healthy controls (43.6 ± 12.7 years) participated in this case-control study. They performed AH in hook-lying. Using M-mode ultrasound, thicknesses of TrA, and obliquus internus and externus were determined at rest and during 5 s AH (5 measures each body side). The TrA contraction-ratio (TrA-CR) (TrA contracted/rest) and the ability to sustain the contraction [standard deviation (SD) of TrA thickness during the stable phase of the hold] were investigated. There were no significant group differences for the absolute muscle thicknesses at rest or during AH, or for the SD of TrA thickness. There was a small but significant difference between the groups for TrA-CR: cLBP 1.35 ± 0.14, controls 1.44 ± 0.24 (p < 0.05). However, Receiver Operator Characteristics (ROC) analysis revealed a poor and non-significant ability of TrA-CR to discriminate between cLBP patients and controls on an individual basis (ROC area under the curve, 0.60 [95% CI 0.495; 0.695], p = 0.08). In the patient group, TrA-CR showed a low but significant correlation with Roland Morris score (Spearman Rho = 0.328; p = 0.02). In conclusion, the difference in group mean values for TrA-CR was small and of uncertain clinical relevance. Moreover, TrA-CR showed a poor ability to discriminate between control and cLBP subjects on an individual basis. We conclude that the TrA-CR during abdominal hollowing does not distinguish well between patients with chronic low back pain and healthy controls.