Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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The Effects of Intentional Abdominal Muscle Contraction Through Real-Time Feedback on Sensed Changes in Waist Circumference on Pain, Functional Capacity and Neuromuscular Control in Adults With Lumbar Spinal Stenosis

허리둘레변화 감지의 실시간 되먹임을 통한 의도적인 복근수축이 요추관 협착증 환자의 골반경사와 기능적 능력 그리고 신경근 조절에 미치는 영향

  • Seong, Jae-hyeon (Dept. of Physical Therapy, The Graduate School, Daejeon University) ;
  • Kim, Chang-beom (Dept. of Physical Therapy, The Graduate School, Daejeon University) ;
  • Choi, Jong-duk (Dept. of Physical Therapy, College of Health & Medical Science, Daejeon University)
  • 성재현 (대전대학교 대학원 물리치료학과) ;
  • 김창범 (대전대학교 대학원 물리치료학과) ;
  • 최종덕 (대전대학교 보건의료과학대학 물리치료학과)
  • Received : 2017.08.18
  • Accepted : 2017.09.27
  • Published : 2018.02.19
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Abstract

Background: The continuous co-contraction of the trunk muscles through trunk stabilization exercises is important to patients with lumbar spinal stenosis (LSS). However, intentional abdominal muscle contraction (IAMC) for trunk stabilization has been used only for specific training in the treatment room. Objects: The purpose of this study was to provide feedback to adults with LSS to enable IAMC during activities of daily living (ADLs). Methods: The participants with spinal stenosis were divided into an experimental group of 15 adults and a control group of 16 adults. Electromyographic signals were measured while the subjects kept their both hands held up at $90^{\circ}$. The measured muscles were the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES). Pelvic tilt was measured using a digital pelvic inclinometer. The degree of pain was measured using the visual analogue scale (VAS) and functional capacity was measured using the Korean version of the Oswestry disability index (KODI). Results: While the experimental group showed statistically significantly higher activities in the RA, EO, and IO after the intervention compared with the control group. Pelvic tilt was significantly decreased only in the experimental group. Both the experimental and control groups exhibited statistically significant declines in the VAS and KODI (p<.01). In terms of the levels of changes, the experimental group exhibited a statistically significant larger decline only in the VAS and the pelvic tilt when compared with the control group (p<.05). Conclusions: The subjects could stabilize their trunks, and relieve their pain and dysfunctions and reduce pelvic tilt by learning abdominal muscle contraction during ADLs. The combination of therapeutic exercises and IAMC may have greater effects on patients with LSS.

Keywords

References

  1. Akyol Y, Durmus D, Alayli G, et al. Effectiveness of physical therapy agents in patients with lumbar spinal stenosis. Turkish J Phys Med Rehabil. 2009;55(4):141-146.
  2. Arab AM, Chehrehrazi M. Ultrasound measurement of abdominal muscles activity during abdominal hollowing and bracing in women with and without stress urinary incontinence. Man Ther. 2011;16(6):596-601. https://doi.org/10.1016/j.math.2011.06.002
  3. Arokoski JP, Valta T, Airaksinen O, et al. Back and abdominal muscle function during stabilization exercises. Arch Phys Med Rehabil. 2001;82(8):1089-1098. https://doi.org/10.1053/apmr.2001.23819
  4. Beith ID, Synnott RE, Newman SA. Abdominal muscle activity during the abdominal hollowing manoeuvre in the four point kneeling and prone positions. Man Ther. 2001;6(2):82-87. https://doi.org/10.1054/math.2000.0376
  5. Binder DK, Schmidt MH, Weinstein PR. Lumbar spinal stenosis. Semin Neurol. 2002;22(2):157-166. https://doi.org/10.1055/s-2002-36539
  6. Bjerkefors A, Ekblom MM, Josefsson K, et al. Deep and superficial abdominal muscle activation during trunk stabilization exercises with and without instruction to hollow. Man Ther. 2010;15:502-507. https://doi.org/10.1016/j.math.2010.05.006
  7. Bodack MP, Monteiro M. Therapeutic exercise in the treatment of patients with lumbar spinal stenosis. Clin Orthop Related Res. 2001;384:144-152. https://doi.org/10.1097/00003086-200103000-00017
  8. Brokelman RB, Haverkamp D, van Loon C, et al. The validation of the visual analogue scale for patient satisfaction after total hip arthroplasty. Eur Orthop Traumatol. 2012;3(2):101-105. https://doi.org/10.1007/s12570-012-0100-3
  9. Chaleat-Valayer E, Mac-Thiong JM, Paquet J, et al. Sagittal spino-pelvic alignment in chronic low back pain. Eur Spine J. 2011;20(suppl5):634-640. https://doi.org/10.1007/s00586-011-1931-2
  10. Chanthapetch P, Kanlayanaphotporn R, Gaogasigam C, et al. Abdominal muscle activity during abdominal hollowing in four starting positions. Man Ther. 2009;14(6):642-646. https://doi.org/10.1016/j.math.2008.12.009
  11. Cottingham JT, Porges SW, Richmond K. Shifts in pelvic inclination angle and parasympathetic tone produced by rolfing soft tissue manipulation. Phys Ther. 1988;68(9):1364-1370. https://doi.org/10.1093/ptj/68.9.1364
  12. Jung DE, Kim K, Lee SK. Comparison of muscle activities using a pressure biofeedback unit during abdominal muscle training performed by normal adults in the standing and supine positions. J Phys Ther Sci. 2014;26(2):191-193. https://doi.org/10.1589/jpts.26.191
  13. Dayan E, Cohen LG. Neuroplasticity subserving motor skill learning. Neuron. 2011;72(3):443-454. https://doi.org/10.1016/j.neuron.2011.10.008
  14. DiBenedetto M, Innes KE, Taylor AG, et al. Effect of a gentle iyengar yoga program on gait in the elderly: An exploratory study. Arch Phys Med Rehabil. 2005;86(9):1830-1837. https://doi.org/10.1016/j.apmr.2005.03.011
  15. Kim DY. Lee SM, Lee HY, et al. Validation of the korean version of the oswestry disability index. Spine(Phila Pa 1976). 2005;30(5):E123-127. https://doi.org/10.1097/01.brs.0000157172.00635.3a
  16. Dozza M, Chiari L, Peterka RJ, et al. What is the most effective type of audio-biofeedback for postural motor learning? Gait Posture. 2011;34(3):313-319. https://doi.org/10.1016/j.gaitpost.2011.05.016
  17. Farooque M, Salzman MM, Ye Z. Effectiveness of bilateral transforaminal epidural steroid injections in degenerative lumbar spinal stenosis patients with neurogenic claudication: A case series. PM R. 2017;9(1):26-31. https://doi.org/10.1016/j.pmrj.2016.06.002
  18. Ferreira PH, Ferreira ML, Maher CG, et al. Specific stabilisation exercise for spinal and pelvic pain: A systematic review. Aust J Physiother. 2006;52(2):79-88. https://doi.org/10.1016/S0004-9514(06)70043-5
  19. Herrington L. Assessment of the degree of pelvic tilt within a normal asymptomatic population. Man Ther. 2011;16(6):646-648. https://doi.org/10.1016/j.math.2011.04.006
  20. Hootman JM, Helmick CG, Brady TJ. A public health approach to addressing arthritis in older adults: The most common cause of disability. Am J Public Health. 2012;102(3):426-433. https://doi.org/10.2105/AJPH.2011.300423
  21. Imai A, Kaneoka K, Okubo Y, et al. Trunk muscle activity during lumbar stabilization exercises on both a stable and unstable surface. J Orthop Sports Phys Ther. 2010;40(6):369-375. https://doi.org/10.2519/jospt.2010.3211
  22. Jensen MP, Smith DG, Ehde DM, et al. Pain site and the effects of amputation pain: Further clarification of the meaning of mild, moderate, and severe pain. Pain. 2001;91(3):317-322. https://doi.org/10.1016/S0304-3959(00)00459-0
  23. Kent P, Laird R, Haines T. The effect of changing movement and posture using motion-sensor biofeedback, versus guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskelet Disord. 2015;16:131. https://doi.org/10.1186/s12891-015-0591-5
  24. Kisner C, Colby LA. Therapeutic Exercise: Foundation and techniques, 5th ed. Philadelpia, F.A. Davis. 2007:392.
  25. Koc Z, Ozcakir S, Sivrioglu K, et al. Effectiveness of physical therapy and epidural steroid injections in lumbar spinal stenosis. Spine(Phila Pa 1976). 2009;34(10):985-989. https://doi.org/10.1097/BRS.0b013e31819c0a6b
  26. Krawiec CJ, Denegar CR, Hertel J, et al. Static innominate asymmetry and leg length discrepancy in asymptomatic collegiate athletes. Man Ther. 2003;8(4):207-213. https://doi.org/10.1016/S1356-689X(03)00012-2
  27. Lee SC, Lee DT. Effects of exercise therapy on lower back pain patients. Health and Sports Medicine. 2007;9(2):69-78.
  28. Levine D, Walker JR, Tillman L. The effect of abdominal muscle strengthening on pelvic tilt and lumbar lordosis. Physiother Theory Pract. 1997;13(3):217-226. https://doi.org/10.3109/09593989709036465
  29. Lim HS, Roh SY, Lee SM. The relationship between pelvic tilt angle and disability associated with low back pain. J Phys Ther Sci. 2013;25(1):65-68. https://doi.org/10.1589/jpts.25.65
  30. Mew R. Comparison of changes in abdominal muscle thickness between standing and crook lying during active abdominal hollowing using ultrasound imaging. Man Ther. 2009;14(6):690-695. https://doi.org/10.1016/j.math.2009.05.003
  31. Muyor JM, Lopez-Minarro PA, Casimiro AJ. Effect of stretching program in an industrial workplace on hamstring flexibility and sagittal spinal posture of adult women workers: A randomized controlled trial. J Back Musculoskelet Rehabil. 2012;25(3):161-169. https://doi.org/10.3233/BMR-2012-0323
  32. Nanhoe-Mahabier W, Allum JH, Pasman EP, et al. The effects of vibrotactile biofeedback training on trunk sway in parkinson's disease patients. Parkinsonism Relat Disord. 2012;18(9):1017-1021. https://doi.org/10.1016/j.parkreldis.2012.05.018
  33. Pua YH, Cai CC, Lim KC. Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: A randomised controlled trial. Aust J Physiother. 2007;53(2):83-89. https://doi.org/10.1016/S0004-9514(07)70040-5
  34. Queiroz BC, Cagliari MF, Amorim CF, et al. Muscle activation during four pilates core stability exercises in quadruped position. Arch Phys Med Rehabil. 2010;91(1):86-92. https://doi.org/10.1016/j.apmr.2009.09.016.
  35. Reeves NP, Cholewicki J. Modeling the human lumbar spine for assessing spinal loads, stability, and risk of injury. Crit Rev Biomed Eng. 2003;31(1-2):73-139.
  36. Sahin F, Yilmaz F, Kotevoglu N, et al. The efficacy of physical therapy and physical therapy plus calcitonin in the treatment of lumbar spinal stenosis. Yonsei Med J. 2009;50(5):683-688. https://doi.org/10.3349/ymj.2009.50.5.683
  37. Schizas C, Theumann N, Burn A, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976). 2010;35(21):1919-1924. https://doi.org/10.1097/BRS.0b013e3181d359bd
  38. Schneider M, Ammendolia C, Murphy D, et al. Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: Protocol for a randomized controlled trial. Chiropr Man Ther. 2014;22:19. https://doi.org/10.1186/2045-709X-22-19
  39. Sielski R, Ridf W, Glombiewski JA. Efficacy of biofeedback in chronic back pain: A meta-analysis. Int J Behav Med. 2017;24(1):25-41. https://doi.org/10.1007/s12529-016-9572-9
  40. Souza GM, Baker LL, Powers CM. Electromyographic activity of selected trunk muscles during dynamic spine stabilization exercises. Arch Phys Med Rehabil. 2001;82(11):1551-1557. https://doi.org/10.1053/apmr.2001.26082
  41. Thompson JA, O'Sullivan PB, Briffa NK, et al. Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and valsalva manouevre. Neurourol Urodyn. 2006;25(3):268-276. https://doi.org/10.1002/nau.20183
  42. Urquhart DM, Hodges PW, Allen TJ, et al. Abdominal muscle recruitment during a range of voluntary exercises. Man Ther. 2005;10(2):144-153. https://doi.org/10.1016/j.math.2004.08.011
  43. Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: A randomized clinical trial. Spine(Phila Pa 1976). 2006;31(22):2541-2549. https://doi.org/10.1097/01.brs.0000241136.98159.8c
  44. Wong AY, Parent EC, Kawchuk GN. Reliability of 2 ultrasonic imaging analysis methods in quantifying lumbar multifidus thickness. J Orthop Sports Phys Ther. 2013;43(4):251-262. https://doi.org/10.2519/jospt.2013.4478
  45. Yoo WG. Effect of the individual strengthening exercises for posterior pelvic tilt muscles on back pain, pelvic angle, and lumbar ROM of a LBP patient with excessive lordosis: A case study. J Phys Ther Sci. 2014;26(2):319-312. https://doi.org/10.1589/jpts.26.319
  46. Youdas JW, Garrett TR, Egan KS, et al. Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther. 2000;80(3):261-275.

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