The Effects of Stabilization Exercise on the Thickness of Lateral Abdominal Muscles During Standing Tasks in Women With Chronic Low Back Pain: A Randomized Triple-Blinded Clinical Trial Study

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: Chronic low back pain (CLBP) often presents with a dysfunction in deep abdominal muscles activity during standing tasks. Although some studies indicated that deep abdominal muscle activity improved during some functional tasks following stabilization exercise (SE), there is no study to evaluate the effect of SE on lateral abdominal muscles thickness during standing postural tasks. Objective: The purpose of this study was (1) to evaluate the lateral abdominal muscles thickness in the participants with CLBP while standing on a balance board and (2) to compare the effects of SE and a general exercise (GE) program on the lateral muscles thickness changes. Methods: This was a between-groups, triple-blinded randomized controlled trial design. In total, 40 females with CLBP were randomly assigned into 2 groups:  GE (control group) and supervised progressive SE (experimental group). Diagnostic ultrasound imaging was used before and after the intervention to measure lateral abdominal muscles thickness during standing on 2 different levels of platform in the Biodex Balance System. Visual analog scale and Roland–Morris Disability Questionnaire were used to evaluate changes in pain intensity and disability. Results: The results indicated significant increases in transverse abdominis muscle thickness during all standing tasks (P = .02) and significant decreases in pain intensity and disability following SE intervention (P < .001). However, the lateral abdominal muscle thicknesses were not changed after GE intervention while standing postural tasks (P > .05). The GE group revealed only significant decreases in pain intensity after intervention (P = .03). Conclusion: Supervised progressive SE improved the activity of deep abdominal muscles in standing postural tasks in the patients with CLBP.

Ehsani, Hedayati, and Bagheri are with the Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran. Jaberzadeh is with the Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.

Hedayati (rosehed@yahoo.com) is corresponding author.
  • 1.

    Ehrlich GE. Low back pain. Bull World Health Organ. 2003;81(9):671672. PubMed ID: 14710509

  • 2.

    Gourmelen J, Chastang JF, Ozguler A, Lanoe JL, Ravaud JF, Leclerc A. Frequency of low back pain among men and women aged 30 to 64 years in France. Results of two national surveys. Ann Readapt Med Phys. 2007;50(8):640644, 633–649.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Bandpei MAM, Ehsani F, Behtash H, Ghanipour M. Occupational low back pain in primary and high school teachers: prevalence and associated factors. J Manipulative Physiol Ther. 2014;37(9):702708. doi:10.1016/j.jmpt.2014.09.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Borenstein DG. Chronic low back pain. Rheum Dis Clin North Am. 1996;22(3):439456. PubMed ID: 8844907 doi:10.1016/S0889-857X(05)70281-7

  • 5.

    Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(9178):581585. PubMed ID: 10470716 doi:10.1016/S0140-6736(99)01312-4

  • 6.

    Weiner BK. Spine update: the biopsychosocial model and spine care. Spine. 2008;33(2):219223. PubMed ID: 18197110 doi:10.1097/BRS.0b013e3181604572

  • 7.

    Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord Tech. 1998;11(1):4656.

    • Search Google Scholar
    • Export Citation
  • 8.

    Hodges PW. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res. 2001;141(2):261266. PubMed ID: 11713638 doi:10.1007/s002210100873

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Experimental muscle pain changes feed forward postural responses of the trunk muscles. Exp Brain Res. 2003;151(2):262271. PubMed ID: 12783146 doi:10.1007/s00221-003-1457-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Ferreira PH, Ferreira ML, Hodges PW. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine. 2004;29(22):25602566. PubMed ID: 15543074 doi:10.1097/01.brs.0000144410.89182.f9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Hides JA, Belavý DL, Cassar L, Williams M, Wilson SJ, Richardson CA. Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain. Eur Spine J. 2009;18(3):410418. PubMed ID: 19015895 doi:10.1007/s00586-008-0827-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Jull GA, Richardson CA. Motor control problems in patients with spinal pain: a new direction for therapeutic exercise. J Manipulative Physiol Ther. 2000;23(2):115117. PubMed ID: 10714539 doi:10.1016/S0161-4754(00)90079-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    O’sullivan PB, Phyty GDM, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine. 1997;22(24):29592967. doi:10.1097/00007632-199712150-00020

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Pourahmadi MR, Ebrahimi Takamjani I, Jaberzadeh S, et al. The effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit in patients with chronic nonspecific low back pain (COSCIOUS): study protocol for a randomized double-blind controlled trial. JMIR Res Protoc. 2017;6(6):e109. PubMed ID: 28572078 doi:10.2196/resprot.7378

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Shamsi MB, Sarrafzadeh J, Jamshidi A. Comparing core stability and traditional trunk exercise on chronic low back pain patients using three functional lumbopelvic stability tests. Physiother Theory Pract. 2014;31(2):8998. PubMed ID: 25317504 doi:10.3109/09593985.2014.959144

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    França FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study. Clinics. 2010;65(10):10131017. doi:10.1590/S1807-59322010001000015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Vasseljen O, Fladmark AM. Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients. Man Ther. 2010;15(5):482489. PubMed ID: 20621545 doi:10.1016/j.math.2010.04.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Chung S, Lee J, Yoon J. Effects of stabilization exercise using a ball on mutifidus cross-sectional area in patients with chronic low back pain. J Sports Sci Med. 2013;12(3):533. PubMed ID: 24149162

    • Search Google Scholar
    • Export Citation
  • 19.

    Hosseinifar M, Akbari M, Behtash H, Amiri M, Sarrafzadeh J. The effects of stabilization and McKenzie exercises on transverse abdominis and multifidus muscle thickness, pain, and disability: a randomized controlled trial in nonspecific chronic low back pain. J Phys Ther Sci. 2013;25(12):15411545. PubMed ID: 24409016 doi:10.1589/jpts.25.1541

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Tsao H, Hodges PW. Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. J Electromyogr Kinesiol. 2008;18(4):559567. PubMed ID: 17336546 doi:10.1016/j.jelekin.2006.10.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Ferreira P, Ferreira M, Maher C, Refshauge K, Herbert R, Hodges P. Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med. 2010;44(16):11661172. doi:10.1136/bjsm.2009.061515

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Ehsani F, Shanbehzadeh S. The effect of stabilization exercises on objective outcome measures in patients with chronic non-specific low back pain: a systematic review with particular emphasis on randomized controlled clinical trial. J Rehabil. 2013;14(2):821.

    • Search Google Scholar
    • Export Citation
  • 23.

    Akbari A, Khorashadizadeh S, Abdi G. The effect of motor control exercise versus general exercise on lumbar local stabilizing muscles thickness: randomized controlled trial of patients with chronic low back pain. J Back Musculoskelet Rehabil. 2008;21(2):105112. doi:10.3233/BMR-2008-21206

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Vasseljen O, Unsgaard-Tøndel M, Westad C, Mork PJ. Effect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: a randomized controlled trial. Spine. 2012;37(13):11011108. PubMed ID: 22146280 doi:10.1097/BRS.0b013e318241377c

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Shamsi M, Sarrafzadeh J, Jamshidi A, Zarabi V, Pourahmadi MR. The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging. Physiother Theory Pract. 2016;32(4):277283. PubMed ID: 27253335 doi:10.3109/09593985.2016.1138559

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Nabavi N, Mohseni Bandpei MA, Mosallanezhad Z, Rahgozar M, Jaberzadeh S. The effect of 2 different exercise programs on pain intensity and muscle dimensions in patients with chronic low back pain: a randomized controlled trial. J Manipulative Physiol Ther. 2018;41(2):102110. doi:10.1016/j.jmpt.2017.03.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Ehsani F, Arab AM, Jaberzadeh S, Salavati M. Ultrasound measurement of deep and superficial abdominal muscles thickness during standing postural tasks in participants with and without chronic low back pain. Man Ther. 2016;23:98105. PubMed ID: 26842677 doi:10.1016/j.math.2016.01.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    van Emmerik RE, van Wegen EE. On variability and stability in human movement. J Appl Biomech. 2000;16(4):394406. doi:10.1123/jab.16.4.394

  • 29.

    Seay J, Van Emmerik R, Hamill J. Low back pain status affects pelvis-trunk coordination and variability during walking and running. Clinic Biomech. 2011;26(6):572578. doi:10.1016/j.clinbiomech.2010.11.012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Bagheri R, Takamjani IE, Dadgoo M, et al. A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain. Chiropr Man Therap. 2017;25:31. PubMed ID: 29177031 doi:10.1186/s12998-017-0162-y

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Boudreau S, Farina D, Kongstad L, et al. The relative timing of trunk muscle activation is retained in response to unanticipated postural-perturbations during acute low back pain. Exp Brain Res. 2011;210(2):259267. PubMed ID: 21442223 doi:10.1007/s00221-011-2629-8

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol. 2011;106(5):25062514. PubMed ID: 21795622 doi:10.1152/jn.00296.2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13(4):361370. PubMed ID: 12832166 doi:10.1016/S1050-6411(03)00042-7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Ehsani F, Arab AM, Salavati M, Jaberzadeh S, Hajihasani A. Ultrasound measurement of abdominal muscle thickness with and without transducer fixation during standing postural tasks in participants with and without chronic low back pain: intrasession and intersession reliability. PM R. 2016;8(12):11591167. doi:10.1016/j.pmrj.2016.05.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Noguchi T, Demura S. Relationship between abdominal strength measured by a newly developed device and abdominal muscle thickness. Adv Phys Educ. 2014;4(2):7076. doi:10.4236/ape.2014.42010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002;32(9):447460. PubMed ID: 12322811 doi:10.2519/jospt.2002.32.9.447

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Moon HJ, Choi KH, Kim DH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Ann Rehabil Med. 2013;37(1):110117. PubMed ID: 23525973 doi:10.5535/arm.2013.37.1.110

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Roland M, Fairbank J. The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25(24):31153124. PubMed ID: 11124727 doi:10.1097/00007632-200012150-00006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and the Quebec Back Pain Disability Scale: translation and validation studies of the Iranian versions. Spine. 2006;31(14):E454E459. PubMed ID: 16778675 doi:10.1097/01.brs.0000222141.61424.f7

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    McMeeken J, Beith I, Newham D, Milligan P, Critchley D. The relationship between EMG and change in thickness of transversus abdominis. Clinic Biomech. 2004;19(4):337342. doi:10.1016/j.clinbiomech.2004.01.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Teyhen DS, Gill NW, Whittaker JL, Henry SM, Hides JA, Hodges P. Rehabilitative ultrasound imaging of the abdominal muscles. J Orthop Sports Phys Ther. 2007;37(8):450466. PubMed ID: 17877281 doi:10.2519/jospt.2007.2558

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Costa LOP, Maher CG, Latimer J, Hodges PW, Shirley D. An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain. Eur Spine J. 2009;18(7):10591065. PubMed ID: 19415347 doi:10.1007/s00586-009-1018-5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Bunce SM, Hough AD, Moore AP. Measurement of abdominal muscle thickness using M-mode ultrasound imaging during functional activities. Man Ther. 2004;9(1):4144. PubMed ID: 14723861 doi:10.1016/S1356-689X(03)00069-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Klimstra M, Dowling J, Durkin JL, MacDonald M. The effect of ultrasound probe orientation on muscle architecture measurement. J Electromyogr Kinesiol. 2007;17(4):504514. PubMed ID: 16919969 doi:10.1016/j.jelekin.2006.04.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Teyhen DS, Williamson JN, Carlson NH, et al. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch Phys Med Rehabil. 2009;90(5):761767. PubMed ID: 19406295 doi:10.1016/j.apmr.2008.11.011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Rasouli O, Arab AM, Amiri M, Jaberzadeh S. Ultrasound measurement of deep abdominal muscle activity in sitting positions with different stability levels in subjects with and without chronic low back pain. Man Ther. 2011;16(4):388393. PubMed ID: 21330182 doi:10.1016/j.math.2011.01.009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc; 1988.

  • 48.

    Chung SH, You YY, Lee HJ, Sim SH. Effects of stabilization exercise using flexi-bar on functional disability and transverse abdominis thickness in patients with chronic low back pain. J Phys Ther Sci. 2018;30(3):400404. PubMed ID: 29581659 doi:10.1589/jpts.30.400

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13(4):371379. PubMed ID: 12832167 doi:10.1016/S1050-6411(03)00044-0

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Andrusaitis SF, Brech GC, Vitale GF, Greve JM. Trunk stabilization among women with chronic lower back pain: a randomized, controlled, and blinded pilot study. Clinics. 2011;66(9):16451650. PubMed ID: 22179174 doi:10.1590/S1807-59322011000900024

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Muthukrishnan R, Shenoy SD, Jaspal SS, Nellikunja S, Fernandes S. The differential effects of core stabilization exercise regime and conventional physiotherapy regime on postural control parameters during perturbation in patients with movement and control impairment chronic low back pain. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:13. PubMed ID: 20515453

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Med Sci Monit. 2012;18(3):CR174CR181. PubMed ID: 22367128 doi:10.12659/MSM.882522

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53.

    Marshall PW, Murphy BA. Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: a pilot study. J Manipulative Physiol Ther. 2006;29(7):550560. PubMed ID: 16949944 doi:10.1016/j.jmpt.2006.06.025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Marshall P, Murphy B. Self-report measures best explain changes in disability compared with physical measures after exercise rehabilitation for chronic low back pain. Spine. 2008;33(3):326338. PubMed ID: 18303467 doi:10.1097/BRS.0b013e31816233eb

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55.

    Gatti R, Faccendini S, Tettamanti A, Barbero M, Balestri A, Calori G. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):542552. PubMed ID: 21654092 doi:10.2519/jospt.2011.3413

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    França FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial. J Manipulative Physiol Ther. 2012;35(4):279285. doi:10.1016/j.jmpt.2012.04.012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Stuge B, Lærum E, Kirkesola G, Vøllestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine. 2004;29(4):351359. PubMed ID: 15094530 doi:10.1097/01.BRS.0000090827.16926.1D

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58.

    Laird RA, Kent P, Keating JL. Modifying patterns of movement in people with low back pain—does it help? A systematic review. BMC Musculoskelet Disord. 2012;13:169. PubMed ID: 22958597 doi:10.1186/1471-2474-13-169

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 59.

    Wong AY, Parent EC, Funabashi M, Kawchuk GN. Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to nonspecific low back pain? A systematic review. J Pain. 2013;15(4):377.e1377.e35. PubMed ID: 24184573 doi:10.1016/j.jpain.2013.10.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    Wong AY, Parent EC, Funabashi M, Stanton TR, Kawchuk GN. Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in nonspecific low back pain? A systematic review. Pain®. 2014;154(12):25892602. PubMed ID: 31569295

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 278 278 54
Full Text Views 17 17 0
PDF Downloads 11 11 0