Department of Physical Therapy, Konyang University, Seo-Gu, Daejeon, Republic of South Korea.
J Athl Train. 2012 Jul-Aug;47(4):379-89. doi: 10.4085/1062-6050-47.4.12.
The abdominal draw-in maneuver (ADIM) with cocontraction has been shown to be a more effective method of activating the transversus abdominis (TrA) in healthy adults than the ADIM alone. Whether such an augmented core stabilization exercise is effective in managing low back pain (LBP) remains uncertain.
To determine the effect of 2 weeks of ADIM and cocontraction training on abdominal muscle thickness and activation timing and to monitor pain and function in patients with LBP.
Case-control study.
Local orthopaedic clinic and research laboratory.
Twenty patients with mechanical LBP (age = 27.20 ± 6.46 years, height = 166.25 ± 8.70 cm, mass = 58.10 ± 11.81 kg) and 20 healthy, age-matched people (age = 24.25 ± 1.59 years, height = 168.00 ± 8.89 cm, mass = 60.65 ± 11.99 kg) volunteered for the study.
INTERVENTION(S): Both the LBP and control groups received ten 30-minute sessions of ADIM and cocontraction training of the tibialis anterior (TA) and rectus femoris (RF) muscles over a 2-week period.
MAIN OUTCOME MEASURE(S): A separate, mixed-model analysis of variance was computed for the thicknesses of the TrA, internal oblique (IO), and external oblique muscles. The differences in mean and peak electromyographic (EMG) amplitudes, onset time, and latency were compared between the groups. The visual analog pain scale, Pain Disability Index, and LBP rating scale were used to assess pain in the LBP group before and after the intervention.
We found an interaction between the LBP and control groups and a main effect from pretest to posttest for only TrA muscle thickness change (F₁,₃₈ = 6.57, P = .01). Reductions in all pain measures were observed after training (P < .05). Group differences in peak and mean EMG amplitudes and onset time values for TrA/IO and TA were achieved (P < .05). The RF peak (t₃₈ = 3.12, P = .003) and mean (t₃₈ = 4.12, P = .001) EMG amplitudes were different, but no group difference was observed in RF onset time (t₃₈ = 1.63, P = .11) or the cocontracted TrA/IO peak (t₃₈ = 1.90, P = .07) and mean (t₃₈ = 1.81, P = .08). The test-retest reliability for the muscle thickness measure revealed excellent correlations (intraclass correlation coefficient range, 0.95-0.99).
We are the first to demonstrate that a cocontraction of the ankle dorsiflexors with ADIM training might result in a thickness change in the TrA muscle and associated pain management in patients with chronic LBP.
与单独使用腹部内收动作（ADIM）相比，腹部内收动作与协同收缩已被证明是一种更有效的激活腹横肌（TrA）的方法，在健康成年人中。然而，这种增强的核心稳定性练习是否能有效治疗慢性下腰痛（LBP）仍不确定。
确定 ADIM 和协同收缩训练对腹部肌肉厚度和激活时间的影响，并监测 LBP 患者的疼痛和功能。
病例对照研究。
当地骨科诊所和研究实验室。
20 名患有机械性 LBP（年龄=27.20±6.46 岁，身高=166.25±8.70cm，体重=58.10±11.81kg）和 20 名健康、年龄匹配的人（年龄=24.25±1.59 岁，身高=168.00±8.89cm，体重=60.65±11.99kg）自愿参加了这项研究。
LBP 和对照组均接受了 10 次 30 分钟的 ADIM 和协同收缩训练，包括胫骨前肌（TA）和股直肌（RF），共 2 周。
分别对 TrA、内斜肌（IO）和外斜肌的厚度进行混合模型方差分析。比较组间平均和峰值肌电图（EMG）幅度、起始时间和潜伏期的差异。视觉模拟疼痛量表、疼痛残疾指数和 LBP 评分量表用于评估干预前后 LBP 组的疼痛。
我们发现 LBP 组和对照组之间存在交互作用，并且仅在 TrA 肌肉厚度变化方面存在从预测试到后测试的主要效应（F₁,₃₈=6.57，P=0.01）。训练后所有疼痛指标均有下降（P<0.05）。TrA/IO 和 TA 的峰值和平均 EMG 幅度以及起始时间值的组间差异达到统计学意义（P<0.05）。RF 的峰值（t₃₈=3.12，P=0.003）和平均（t₃₈=4.12，P=0.001）EMG 幅度不同，但 RF 起始时间（t₃₈=1.63，P=0.11）或协同收缩 TrA/IO 的峰值（t₃₈=1.90，P=0.07）和平均（t₃₈=1.81，P=0.08）没有组间差异。肌肉厚度测量的测试-重测信度显示出极好的相关性（组内相关系数范围，0.95-0.99）。
我们是第一个证明，与 ADIM 训练相结合的踝关节背屈肌协同收缩可能导致慢性 LBP 患者 TrA 肌肉厚度的变化，并与疼痛管理相关。
