Inter-rater reliability of the dynamic neuromuscular stabilization diaphragm tests among individuals with non-specific low back pain and neck pain.

BACKGROUND: The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm. OBJECTIVE: Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain. METHODS: Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria. RESULTS: Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001). CONCLUSIONS: The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions.

BACKGROUND: Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles. OBJECTIVE: To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles. METHODS: In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles. RESULTS: AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < .01; Cohen's d = -1.13 to -2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position. CONCLUSION: The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.

Intra-abdominal pressure correlates with abdominal wall tension during clinical evaluation tests.

BACKGROUND: The abdominal muscles play an important respiratory and stabilization role, and in coordination with other muscles regulate the intra-abdominal pressure stabilizing the spine. The evaluation of postural trunk muscle function is critical in clinical assessments of patients with musculoskeletal pain and dysfunction. This study evaluates the relationship between intra-abdominal pressure measured as anorectal pressure with objective abdominal wall tension recorded by mechanical-pneumatic-electronic sensors. METHODS: In a cross-sectional observational study, thirty-one asymptomatic participants (mean age = 26.77 ± 3.01 years) underwent testing to measure intra-abdominal pressure via anorectal manometry, along with abdominal wall tension measured by sensors attached to a trunk brace (DNS Brace). They were evaluated in five different standing postural-respiratory situations: resting breathing, Valsalva maneuver, Müller's maneuver, instructed breathing, loaded breathing when holding a dumbbell. FINDINGS: Strong correlations were demonstrated between anorectal manometry and DNS Brace measurements in all scenarios; and DNS Brace values significantly predicted intra-abdominal pressure values for all scenarios: resting breathing (r = 0.735, r2 = 0.541, p < 0.001), Valsalva maneuver (r = 0.836, r2 = 0.699, p < 0.001), Müller's maneuver (r = 0.651, r2 = 0.423, p < 0.001), instructed breathing (r = 0.708, r2 = 0.501, p < 0.001), and loaded breathing (r = 0.921, r2 = 0.848, p < 0.001). INTERPRETATION: Intra-abdominal pressure is strongly correlated with, and predicted by abdominal wall tension monitored above the inguinal ligament and in the area of superior trigonum lumbale. This study demonstrates that intra-abdominal pressure can be evaluated indirectly by monitoring the abdominal wall tension.