Background: Chronic LowBack Pain (LBP) is a common musculoskeletal problem with high prevalence and recurrence. Specific stabilization exercises with feedback, which aim to restore the function of deep trunk muscles such as transversus abdominis (TrA), have been suggested to modify motor control deficits but the quantitative effects of such exercises is lacking. Purpose: 1. To examine the performance of the TrA after 6-week ultrasonography (US) biofeedback guided specific stabilization exercises, for patients with recurrent chronic LBP; 2. To examine the effects on TrA contraction, pain and disability. Methods: Subjects with recurrent chronic LBP were included in the study. Real-time ultrasound images were viewed in B-mode with 5-12MHz linear-array transducer (Teroson t3000). Specific stabilization exercise with US biofeedback to confirm the TrA contraction was conducted by physical therapists once a week for six weeks. The architecture of the anterior and posterior sites of the TrA was measured during the abdominal draw-in maneuver (ADIM), prone ipsilateral hip extension (IE) and prone contralateral hip extension (CE). Outcome measurements included pain (current and most pain, VAS), disability (Oswestry disability index, self-efficient score), resting thickness (Thr), contracted thickness (Thc), change of thickness (ΔT) and sliding of the muscle-fascial junctions of the TrA (ΔX). Paired-t test was used to assess the effect of exercise training. Results: Eleven participants (male: 8, age: 40.5±9.4) with recurrent chronic LBP were enrolled in the study. The current pain and self-efficient score were improved (P < 0.05) after 6-week exercise training. ΔT and ΔX of the TrA were all improved after training (P < 0.05). Thc only increased in the abdominal draw-in maneuver and prone ipsilateral hip extension (P < 0.05). Thr was unaltered. Conclusion(s): 6-week specific stabilization exercises with ultrasound biofeedback improve pain, disability and muscle contraction pattern of the TrA in subjects with recurrent chronic LBP. Using this training protocol may helps patients with LBP to contract their core muscle more specifically and accurately, consequently, pain and function improved. Implications: Specific stabilization exercise with US feedback benefited patients with recurrent LBP in both pain and function. US image provided the visual feedback and quantitative measurement to enhance the accurate contraction of deep core muscles.
Chen, Y.-H., Huang, Y.-C., Tsai, Y.-C., Chen, H.-Y., Chang, C.-C., Liu, S.-S., & Wang, S.-F. (2015). Effect of six-week specific stabilization exercise with ultrasound biofeedback for patients with recurrent LBP. Physiotherapy, 101, e230. https://doi.org/10.1016/j.physio.2015.03.403