Association of fear of falling with performance-based physical function and low back pain in older adults: a cross-sectional study in Iran.

OBJECTIVES: This study investigated the association of fear of falling with performance-based physical function and low back pain (LBP) among older adults. DESIGN: Cross-sectional study. SETTING: Participants were selected via convenient sampling from Iran University orthopaedic and/or physiotherapy outpatient clinics, between March 2022 and April 2023. PARTICIPANTS: 140 subjects with and without LBP, aged over 60 years, were included. OUTCOME MEASURES: The Falls Efficacy Scale International was used to measure fear of falling. A baseline questionnaire inquired about LBP. Participants performed the Timed Up and Go, 30 s Sit-To-Stand (30s-STS), single leg stance with open and closed eyes and gait speed tests to assess performance-based physical function. Demographic variables including age, gender and body mass index were considered as potential covariates. Bivariate and multivariable linear regression analyses were used to investigate the associations. RESULTS: A significant association between fear of falling and the 30s-STS test score (ß=-0.30, 95% CI -1.27 to -0.28; p=0.00) and the sex (ß=0.31, 95% CI 1.53 to 4.83; p=0.00) was confirmed in multivariable analyses. LBP and other performance-based physical function tests were not associated with a fear of falling. CONCLUSION: Fear of falling was significantly associated with lower extremity muscle function, measured by the 30s-STS test and female gender. Older adults with a fear of falling could benefit from interventions that improve lower extremity muscle function. Also, the observed association between the fear of falling and the female sex confirms the need for effective interventions to reduce the fear of falling among older women.

The association between disability and physical performance, pain intensity, and pain-related anxiety in patients after lumbar decompression surgery: a cross-sectional study.

BACKGROUND: Most patients with lumbar spinal stenosis improve significantly within 6 months of lumbar decompression surgery, however, unfavorable long-term disability may persist in some patients. It was unclear which potential influencing factors were more likely to be associated with disability. This study aimed to assess the association between disability and physical performance, pain, and pain-related anxiety in patients after lumbar decompression surgery. METHODS: Patients who underwent decompression for lumbar spinal stenosis were included. Participants completed the visual analog scale, Oswestry Disability Index, and Pain Anxiety Symptoms Scale-20 to collect pain intensity, disability, and pain-related anxiety information. For physical performance assessment, participants performed timed up and go (TUG), functional reach test (FRT), 6-min walking test, and modified Sorensen test, 6-12 months after lumbar decompression surgery. The associations were examined with bivariate and multivariable linear regression analyses. RESULTS: A total of 80 patients were included. A significant association between disability and pain-related anxiety, the FRT, and the modified Sorensen test scores was confirmed in multivariable analyses. Both bivariate (r = - 0.75) and multivariable (ß = 0.60, 95% CI, 0.24, 0.54; P = 0.00) analyses confirmed that pain-related anxiety was the strongest indicator of disability. The association between disability and pain intensity, TUG, and 6-min walking test scores was not confirmed. CONCLUSION: Pain-related anxiety should be considered in the rehabilitation programs after lumbar decompression surgery. The evaluation of all aspects of physical performance following lumbar decompression surgery is also recommended.

Dynamic postural control in women athletes with and without nonspecific low back pain with high and low pain-related anxiety- A case-control study.

BACKGROUND: Low back pain is common among athletes and it has been shown that postural control is altered in the general population with nonspecific low back pain (NSLBP). Psychological factors may also predispose individuals to risk of altered postural control. Dynamic postural control is essential to the performance of athletes. This study aimed to compare the dynamic postural control between women athletes with and without NSLBP with high and low pain-related anxiety. METHODS: Forty-five female athletes (15 NSLBP with high pain-related anxiety, 15 NSLBP with low pain-related anxiety, and 15 healthy (control)) were included. Pain-related anxiety was assessed using the Pain Anxiety Symptom Scale-20 (PASS-20). Based on the cut-off score of 30 for the total score of PASS-20, NSLBP patients were classified into two groups of low and high pain-related anxiety. Participants performed double-leg vertical drop jump (DVJ) and single-leg vertical jump (SVJ) tests on a Kistler force plate (type 9260AA6, Kistler Instruments Inc, Switzerland). The total root mean square (RMS) of the center of pressure (COP), COP displacement in the anteroposterior (AP), and mediolateral (ML) directions, COP mean velocity, and time to stabilization (TTS) in vertical, AP, and total directions were extracted from COP and ground reaction force data using MATLAB software. One-way Analysis of variance (ANOVA) and Welch's ANOVA were employed to compare the groups. In case of significant findings, post hoc tests were performed. RESULTS: The results showed that during DJV, athletes with high pain-related anxiety had significantly greater TTS in all total, AP, and ML directions than other groups (P < 0.05). Also, the control group showed greater total RMS distance during DJV than either NSLBP group. However, no significant differences in TTS and COP parameters were found between the groups during SVJ (P > 0.05). CONCLUSIONS: The findings suggest that pain-related anxiety may contribute to athletes' postural control strategies. Therefore, it is important to consider the level of pain-related anxiety during planning postural control exercises for women athletes with NSLBP.

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.

Lateral abdominal muscle thickness during breathing maneuvers in women with and without stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) patients predominantly experience involuntary leakage during respiratory functions that induce a rapid increase in intra-abdominal pressure (IAP) such as coughing and sneezing. The abdominal muscles have an important role in the forced expiration and modulation of IAP. We hypothesized that SUI patients have different thickness changes in the abdominal muscles compared to healthy individuals during breathing maneuvers. METHODS: This case-control study was conducted on 17 adult women with SUI and 20 continent women. Muscle thickness changes were measured by ultrasonography at the end of deep inspiration and expiration, and the expiratory phase of voluntary coughing for external oblique (EO), internal oblique (IO), and transverse abdominis (TrA) muscles. The percent thickness changes of muscles were used and analyzed with a two-way mixed ANOVA test and post-hoc pairwise comparison at a confidence level of 95% (p < 0.05). RESULTS: The percent thickness changes of TrA muscle were significantly lower in SUI patients at deep expiration (p < 0.001, Cohen's d = 2.055) and coughing (p < 0.001, Cohen's d=1.691). While, percent thickness changes for EO (p = 0.004, Cohen's d=0.996) and IO thickness (p < 0.001, Cohen's d=1.784) were greater at deep expiration and deep inspiration, respectively. CONCLUSIONS: The percent thickness changes of abdominal muscles differed between women with and without SUI during breathing maneuvers. The present study provided information regarding the altered function of abdominal muscles during breathing maneuvers; therefore, it is important to consider the respiratory role of abdominal muscles for the rehabilitation of SUI patients.

Supervised versus unsupervised pelvic floor muscle training in the treatment of women with urinary incontinence - a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: This study synthesized the effects of supervised and unsupervised pelvic floor muscle training (PFMT) programs on outcomes relevant to women's urinary incontinence (UI). METHODS: Five databases were searched from inception to December 2021, and the search was updated until June 28, 2022. Randomized and non-randomized control trials (RCTs and NRCTs) comparing supervised and unsupervised PFMT in women with UI and reported urinary symptoms, quality of life (QoL), pelvic floor muscles (PFM) function/ strength, the severity of UI, and patient satisfaction outcomes were included. Risk of bias assessment of eligible studies was performed by two authors through Cochrane risk of bias assessment tools. The meta-analysis was conducted using a random effects model with the mean difference or standardized mean difference. RESULTS: Six RCTs and one NRCT study were included. All RCTs were assessed as "high risk of bias", and the NRCT study was rated as "serious risk of bias" for almost all domains. The results showed that supervised PFMT is better than unsupervised for QoL and PFM function of women with UI. There was no difference between supervised and unsupervised PFMT for urinary symptoms and improvement of the severity of UI. Results of patient satisfaction were inconclusive due to the sparse literature. However, supervised and unsupervised PFMT with thorough education and regular reassessment showed better results than those for unsupervised PFMT without educating patients about correct PFM contractions. CONCLUSIONS: Supervised and unsupervised PFMT programs can both be effective in treating women's UI if training sessions and regular reassessments are provided.

Association between long COVID, functional activity, and health-related quality of life in older adults.

BACKGROUND: Older adults experience persistent symptoms post-COVID-19, termed as Long COVID, affecting their physical and mental health. This study aimed to evaluate the effects of Long COVID, level of physical activity, and functional decline on older adults' health-related quality of life post-COVID-19. METHODS: This cross-sectional study was conducted on 121 older adults with 60 to 90 years old post-coronavirus infection. The standardized metrics used in the study were Fatigue Severity Scale, Physical Activity Elderly, SF12, Post-COVID-19 functional status scale, and COVID-19 Yorkshire rehabilitation screening scale. The severity of coronavirus infection was evaluated by changes in chest CT scan images and O2 saturation at hospital admission. Data were analyzed using linear regression analyses. RESULTS: The results of regression analysis revealed six factors to be predictors of physical health at 6 months post-COVID-19 (F = 9.046, P < 0.001; explained variance 63%), which the significant factors were fatigue, level of physical activity, worsened pain, difficulties in activities of daily living and cognitive-communication problems. Among these factors, greater fatigue and worsened pain intensity were the strongest predictors. Mental health was associated with days of hospitalization and cognitive-communication problems (F = 2.866, P < 0.001; explained variance 35%). CONCLUSIONS: Considering the negative impact of fatigue, pain, low physical activity, and cognitive-communication problems on health-related quality of life, early and accurate evaluation and management are required for recovered older adults post-COVID-19.

Occupational Performance Coaching for Adults with Heart Failure: Randomized Controlled Trial Protocol.

Background: Patients with heart failure (HF) usually experience functional disabilities and face participation challenges. Self-care behavior is an essential component of long-term management of HF. Purpose: This study aims to investigate the effect of occupational performance coaching (OPC) on self-care behaviors and participation in people with HF. Method: This study is a parallel group, single-blind, randomized controlled trial of 44 adults with HF, to evaluate the efficacy of OPC. Patients will be randomly allocated (1:1) into two groups. Both groups will receive usual self-care education and the intervention group will receive eight weekly sessions of OPC as well. We will measure the primary and secondary outcomes at baseline, 8, and 12 weeks after the intervention initiation. Implications: If OPC is superior to usual self-care education on improving self-care behavior and participation, the finding will support the integration of OPC into practice to improve participation and self-care behaviors of HF patients.

Comparison of Isometric Strength of the Trunk and Hip Muscle Groups in Female Athletes with and without Low Back Pain: A Cross-Sectional Study.

Background: Low back pain (LBP) is a common musculoskeletal disorder in athletes. Reduced strength in hip and trunk muscles has been observed among non-athletes with low back pain. This study aimed to compare the strength of trunk and hip muscles between female athletes with and without LBP and to investigate strength association with disability level in female athletes with LBP. Methods: This cross-sectional study was conducted on 26 female athletes with LBP and 30 female athletes without LBP. The strength of the trunk and hip muscles was measured using a hand-held dynamometer and the impact of LBP on the sports activities and activities of daily living was measured using the Athletes Disability Index (ADI). Data analysis was done using an independent sample t test and the Pearson correlation coefficient. Results: There were no significant differences between groups for trunk and hip muscles strength (p > 0.05). A fair to moderate correlation was seen between the strength of the trunk, hip abductors, flexor and extensors muscles and the scores of the ADI questionnaire in the LBP group (r = -0.26 to -0.48). However, there was no significant correlation between the strength of hip adductor muscles and the scores on the ADI questionnaire. Conclusion: Based on the results, the strength of trunk and hip muscles was not different between athletes with and without LBP. It is recommended that athletes' training be done during functional tasks rather than strengthening a single muscle group.

Effect of Motor Control Training on Trunk Muscle Morphometry, Pain, and Disability in People With Chronic Low Back Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis was to study the effects of motor control training (MCT) on trunk muscle morphometry measured by ultrasound imaging and pain and disability in individuals with chronic low back pain. METHODS: PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from study inception until January 2021. Randomized control trials evaluating both muscle morphometry and pain or disability in individuals with chronic low back pain were included. Study selection, data extraction, and quality assessment were performed by 2 reviewers independently. Modified Downs and Black tool and the Grading of Recommendations Assessment, Development and Evaluation approach were used to assess the risk of bias and quality of evidence, respectively. A meta-analysis was performed using a random effects model with mean difference or standardized mean difference (SMD). RESULTS: Of 3459 studies initially identified, 15 studies were included, and 13 studies were selected for meta-analysis. The results revealed no differences in the resting thickness of the transversus abdominis, internal and external oblique, and lumbar multifidus muscles in studies that compared MCT with other interventions. The transversus abdominis muscles contraction ratio was greater (SMD = 0.93; 95% confidence interval [CI], -0.0 to 1.85) and lower pain (weighted mean difference: -1.07 cm; 95% CI, -1.91 to -0.22 cm; P = .01) and disability (SMD = -0.86; 95% CI, -1.42 to -0. 29; P < .01) scores were found in the groups who underwent MCT compared with other interventions. CONCLUSION: This systematic review and meta-analysis found that motor control exercise training increased the transverse abdominis contraction ratio (muscle activation) and improved the level of pain and disability compared to other interventions in people with chronic low back pain. However, motor control exercise training was not superior to other interventions in increasing the resting thickness of deep abdominal and lumbar multifidus muscles in intervention times less than 12 weeks.

Reliability of Center of Pressure measures of Postural Stability in Anterior Cruciate Ligament Reconstructed Athletes: Effect of Vibration and Cognitive Load.

Background: To evaluate intra and intersession reliability of the Center of Pressure (COP) parameters in Anterior Cruciate Ligament Reconstructed (ACLR) athletes with and without ankle vibration using a dual-task paradigm. Methods: Postural sway of 14 ACLR individuals was assessed during a single-leg stance on a force platform. COP parameters were assessed with manipulating sensory inputs via vision and ankle vibration under single and dual-task conditions. The outcome variables included COP displacement in medial-lateral (ML) and anterior-posterior (AP) range, mean velocity (mV), and area. During dual-task conditions, the auditory Stroop Task was applied. Intraclass correlation coefficient (ICC) values and standard error of measurement (SEM) were assessed for relative and absolute reliability. Results: The COP measures had moderate to very high intrasession reliability (ICC range: 0.51-0.93) for conditions with vibration and cognitive task, with the highest ICCs for mV and the lowest for area, regardless of eyes being open or closed. The intersession reliability was moderate to high for mV (ICC range: 0.60-0.82) and little to very high (ICC range: 0.21-0.97) for the range of ML and AP, as well as an area in conditions with vibration and cognitive task. Conclusion: The mV is the most reliable COP parameter for assessing postural control under ankle vibration and dual-task conditions for both operated and non-operated sides. During closed-eye conditions, the application of vibration affected the intersession reliability with decreased ICCs on the operated side and increased ICCs on the non-operated side.

Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis.

PURPOSE: Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP. METHOD: Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size. RESULT: Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = - 0.31, p < 0.01, 95% CI: - 0.39, - 0.24) and disability (r = - 0.24, p < 0.01, 95% CI: - 0.40, - 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed. CONCLUSION: Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Psychometric properties of the Persian version of the pain anxiety symptom scale (PASS-20) in chronic non-specific neck pain patients.

OBJECTIVES: Pain-related anxiety has been linked to avoidance behaviour, maintenance of pain and disability. A valid and reliable tool is required to evaluate pain-related anxiety among Persian speaking adults with chronic non-specific neck pain (CNSNP). This study aimed to evaluate psychometric properties of the Persian pain anxiety symptom scale-20 (PASS-20) according to the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist in Iranian adults with CNSNP. METHODS: 198 individuals with CNSNP completed the PASS-20. The factorial structure (confirmatory factor analysis (CFA), exploratory factor analysis (EFA)), test-retest reliability (intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC)), internal consistency (Cronbach's alpha), and construct validity (convergent and known-group validity) were assessed. The correlation between PASS-20 with pain catastrophizing scale (PCS), Tampa Scale for Kinesiophobia (TSK), neck disability index (NDI), Beck Depression Inventory (BDI), visual analog scale (VAS) (Spearman's rank correlation) were examined. Known-group validity of PASS-20 was evaluated by comparing the difference between the PASS-20 scores of the known groups based on level of disability, pain intensity and gender using non-parametric tests. RESULTS: The CFA showed almost the best fit with the original version. The subscales and total score demonstrated good internal consistency (Cronbach's α: 0.70-0.92) and high test-retest reliability (ICC: 0.94-0.97). PASS-20 had significant moderate correlations with PCS, TSK, NDI, VAS and a significant low correlation with BDI. Regarding known-group validity, the total score of Persian PASS-20 was higher in CNSNP with higher levels of pain and disability and in the female gender. CONCLUSIONS: The Persian PASS-20 has acceptable psychometric properties in adults with CNSNP. The results of the factor analysis supported the four-factor structure comparable to the original version. ETHICAL COMMITTEE NUMBER: 921672004.

Physical and mental health complications post-COVID-19: Scoping review.

OBJECTIVE: Several long-lasting health complications have been reported in previous coronavirus infections. Therefore, the aim of this study was to review studies that evaluated physical and mental health problems post-COVID-19. METHODS: Articles for inclusion in this scoping review were identified by searching the PubMed, Scopus, Web of Science and Google Scholar databases for items dated from 1 January to 7 November 2020. Observational studies evaluating physical health (musculoskeletal symptoms, functional status) or mental health status with a follow-up period longer than 1 month after discharge or after the onset of symptoms were included. RESULTS: This scoping review included 34 studies with follow-up periods of up to 3 months post-COVID-19. The most commonly reported physical health problems were fatigue (range 28% to 87%), pain (myalgia 4.5% to 36%), arthralgia (6.0% to 27%), reduced physical capacity (six-minute walking test range 180 to 561 m), and declines in physical role functioning, usual care and daily activities (reduced in 15% to 54% of patients). Common mental health problems were anxiety (range 6.5% to 63%), depression (4% to 31%) and post-traumatic stress disorder (12.1% to 46.9%). Greater fatigue, pain, anxiety and depression were reported in female patients and individuals admitted to intensive care. An overall lower quality of life was seen up to 3 months post-COVID-19. CONCLUSIONS: This review highlights the presence of several physical and mental health problems up to 3 months post-COVID-19. The findings point to the need for comprehensive evaluation and rehabilitation post-COVID-19 to promote quality of life.

The Effect of Respiratory Phase on Abdominal Muscle Activity During Stable and Unstable Sitting Positions in Individuals With and Without Chronic Low Back Pain.

OBJECTIVE: The aim was to assess the abdominal muscle activities during inspiration and expiration at different sitting positions in individuals with and without chronic low back pain (CLBP). METHODS: This study was conducted on 36 participants (18 with CLBP and 18 healthy controls). Ultrasound imaging was used to assess thickness changes of the transverse abdominis, internal oblique, rectus abdominis, and external oblique muscles. Muscle thickness was measured during inspiration and expiration under 3 different stability levels: sitting on a chair, sitting on a gym ball, and sitting on a gym ball with lifting the left foot. The muscle thickness measured in these positions was normalized to the actual muscle thickness at rest in supine lying and presented as a percentage of thickness change. RESULTS: Both groups displayed greater abdominal muscle activities as the stability of the surface decreased during both respiratory phases. However, compared with the healthy controls, the CLBP group showed smaller muscle thickness changes in all abdominal muscles, except the external oblique, in both respiration phases while sitting on a gym ball with lifting the left foot. The CLBP group displayed overactivity of the rectus abdominis muscle relative to the healthy controls while sitting on a chair in both respiratory phases. CONCLUSION: The findings of the study indicate that as the stability of the support surface decreases, individuals with CLBP had more difficulty activating all abdominal muscles in a similar manner compared to healthy controls in both respiratory phases, which might affect both respiration and postural stability.

Discriminative ability of fall efficacy scale international in Iranian people with multiple sclerosis.

BACKGROUND: The discriminative validity of fall efficacy scale international (FES-I) in differentiating between fallers and non-fallers, levels of functional mobility, dynamic balance and disability has not been assessed in Persian speaking people with multiple sclerosis (MS). OBJECTIVE: To assess reliability, factor structure, construct and known group validity, sensitivity and specificity of FES-I for differentiating individuals with and without a history of fall and determining a cutoff point of the Persian version of the FES-I in people with MS. METHOD: One hundred thirty people with all subtypes of MS were included. The ability of FES-I in differentiating fall history was assessed using receiver operating characteristic (ROC). Also the FES-I score of groups based on expanded disability status scale (EDSS) 1-3.5 low and 4-6 moderate, time up and go (TUG) ≥14 sec and functional reach test (FRT) ≥25 cm were compared. The correlation between FES-I with EDSS, TUG, FRT and short form health survey (SF-36) was assessed. RESULTS: The ROC curve analysis revealed that the FES-I could differentiate people with MS based on fall history at a cutoff score of 35.5. The area under the curve (AUC) was 0.86 (sensitivity 76%; specificity 95%). Significant difference was observed between the FES-I score of groups with moderate and low EDSS scores (d = 2.98), higher than 14 sec TUG (d = 2.18) and lower than 25 cm FRT(d = 2.53). Significant high correlation was observed between FES-I with TUG (r = 0.88), EDSS (r = 0.91), FRT (r = -0.83), SF-36 physical (r =  -0.87) and mental (r =  -0.70) subscales. CONCLUSIONS: The Persian versions of the FES-I could differentiate people with MS with fall history, higher disability, lower functional mobility and balance deficiency.

Stabilization exercise affects function of transverse abdominis and pelvic floor muscles in women with postpartum lumbo-pelvic pain: a double-blinded randomized clinical trial study.

INTRODUCTION AND HYPOTHESIS: Lumbo-pelvic pain (LPP) is a common disorder in women after pregnancy due to ligament laxity and postural changes. Transverse abdominis (TrA) and pelvic floor muscle (PFM) activity is important for lumbo-pelvic stability. The purpose of this study was to compare the effect of stabilization exercise (SE) and general exercise (GE) on TrA and PFM muscle activity and pain intensity in women with postpartum LPP. METHODS: A randomized controlled trial study was conducted on 68 women with postpartum LPP. Patients were randomly divided into two groups of stabilization exercise (SE) and general exercise (GE) and received either SE or GE exercise for 8 weeks three times a week. Ultrasound imaging was utilized to measure the thickness change of TrA muscles during abdominal hollowing (AH) and bladder base displacement. These measurements were used as an indicator of TrA and PFM muscle activity. Pain intensity, thickness changes of the TrA muscle and bladder base displacement were measured pre- and post-intervention. RESULTS: The results showed that there was no significant difference in pain relief after intervention between groups. The differences in TrA and PFM activity between groups were significant (P < 0.05). PFM and TrA muscle activity was significantly increased after SE in women with postpartum LPP (P < 0.05). CONCLUSIONS: SE improved both PFM and TrA muscle function more than GE in women with postpartum LPP. However, the clinical outcome of pain relief was not greater in the SE group.

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.

Automatic activity of deep and superficial abdominal muscles during stable and unstable sitting positions in individuals with chronic low back pain.

OBJECTIVE: The purpose of this study was to assess muscle thickness changes in the deep and superficial abdominal muscles, during sitting on stable and unstable surfaces in subjects with and without chronic low back pain (CLBP). METHOD: A cross-sectional study was conducted involving 40 participants (20 CLBP and 20 healthy). Ultrasound imaging was used to assess changes in the thickness of the Transversus abdominis (TrA), Internal Oblique (IO), Rectus abdominis (RA) and External oblique (EO) muscles. Muscle thickness under two different sitting postures; (sitting on a chair and sitting on a Swiss ball), was normalized to actual muscle thickness at rest in the supine lying position and was expressed as a percentage of thickness change of muscles. RESULT: The results showed significantly greater thickness changes in RA muscle in the CLBP patients compared to the healthy subjects, during both stable and unstable sitting positions. Also, significantly lower thickness changes in TrA muscle was observed in subjects with CLBP compared to those without CLBP, during unstable sitting position. CONCLUSION: There was an imbalance between the automatic activity of TrA and RA muscles in the subjects with CLBP, compared to the pain-free controls, during an unstable sitting position. Therefore, it is necessary to pay attention, to the altered automatic activity of the abdominal muscles while utilizing a Swiss ball, for rehabilitation of subjects with CLBP.