Southwell Daniel J, Hills Nicole F, McLean Linda, Graham Ryan B
School of Physical and Health Education, Nipissing University, 100 College Drive, Box 5002, North Bay, ON, P1B 8L7, Canada.
School of Rehabilitation Therapy, Queen's University, 31 George Street, Kingston, ON, K7L 3N6, Canada.
J Neuroeng Rehabil. 2016 Feb 27;13:19. doi: 10.1186/s12984-016-0126-9.
Targeted activation of the transversus abdominis (TrA) muscle through the abdominal drawing-in maneuver (ADIM) is a frequently prescribed exercise for the prevention and rehabilitation of low back pain. However, there is still debate over the role the ADIM plays in maintaining a stable spine during movement. Thus, a single cohort pre/post-intervention protocol was used to examine whether 5 min of ADIM training prior to a dynamic movement task alters dynamic spine stability and control.
Thirteen healthy participants performed a repetitive spine flexion task twice, once before and once after they received biofeedback training on how to correctly perform the ADIM in standing. Abdominal and back muscle activation (indwelling and surface electromyography, EMG) and 3D kinematic data were recorded during all trials. EMG activation (percent maximum) and local dynamic stability of spine movement [maximum finite-time Lyapunov exponent (λmax)] were compared before and after the training using Friedman's rank test and repeated-measures ANOVA, respectively. To assess the moderating effects of absolute changes in EMG (∆EMG) of each muscle after training on changes in stability, the ∆EMG (peak and mean) were added to the ANOVA as separate covariates (ANCOVA).
Following ADIM training, there were greater peak and mean levels of activation in all tested abdominal muscles, including TrA, (p < 0.05), but not in the back muscles. The ANOVA showed no significant change in λmax following training (p = 0.633). However, after considering the moderating effects of the ∆EMG seen in each muscle with training, it was found that only changes in TrA EMG significantly influenced stability. The ANCOVA revealed a significant main effect of training on stability as well as a significant interaction effect between training and ∆EMG recorded from TrA (p < 0.05); those with larger increases in TrA activation demonstrated larger improvements in stability.
As a group, 5 min of ADIM training did not change spine stability during dynamic movement. However, those who were most successful in improving TrA activation with a 5-min ADIM training session showed the greatest improvements in local dynamic spine stability after training. As such, dynamic spine stability in some individuals may benefit from ADIM training.
通过收腹动作（ADIM）针对性激活腹横肌（TrA）是预防和康复下背痛时常用的一项训练。然而，对于ADIM在运动过程中维持脊柱稳定所起的作用仍存在争议。因此，采用单队列干预前后方案来研究在动态运动任务前进行5分钟的ADIM训练是否会改变动态脊柱稳定性和控制能力。
13名健康参与者进行了两次重复性脊柱前屈任务，一次是在接受关于如何在站立位正确进行ADIM的生物反馈训练之前，一次是在之后。在所有试验过程中记录腹部和背部肌肉激活情况（植入式和表面肌电图，EMG）以及三维运动学数据。分别使用弗里德曼秩和检验以及重复测量方差分析比较训练前后的EMG激活（最大百分比）和脊柱运动的局部动态稳定性[最大有限时间李雅普诺夫指数（λmax）]。为了评估训练后各肌肉EMG绝对变化量（∆EMG）对稳定性变化的调节作用，将∆EMG（峰值和平均值）作为单独的协变量添加到方差分析中（协方差分析）。
ADIM训练后，所有测试的腹部肌肉（包括TrA）的激活峰值和平均水平均有所提高（p < 0.05），但背部肌肉没有。方差分析显示训练后λmax没有显著变化（p = 0.633）。然而，在考虑了训练后各肌肉中观察到的∆EMG 的调节作用后，发现只有TrA的EMG变化对稳定性有显著影响。协方差分析显示训练对稳定性有显著的主效应，以及训练与TrA记录的∆EMG之间有显著的交互效应（p < 0.05）；TrA激活增加幅度较大的人在稳定性方面有更大的改善。
总体而言，5分钟的ADIM训练在动态运动过程中并未改变脊柱稳定性。然而，那些在5分钟的ADIM训练中最成功地提高TrA激活的人在训练后局部动态脊柱稳定性改善最大。因此，一些人的动态脊柱稳定性可能受益于ADIM训练。
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