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BMC Musculoskeletal Disorders

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Open Access 01-12-2017 | Research article

The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study

Authors: Jan M. A. Mens, Annelies Pool-Goudzwaard

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Abstract

Background

Many studies suggest that impairment of motor control is the mechanical component of the pathogenesis of painful disorders in the lumbo-sacral region; however, this theory is still unproven and the results and recommendations for intervention remain questionable. The need for a force to compress both innominate bones against the sacrum is the basis for treatment of pregnancy-related pelvic girdle pain (PGP). Therefore, it is advised to use a pelvic belt and do exercises to enhance contraction of the muscles which provide this compression. However, our clinical experience is that contraction of those muscles appears to be excessive in PGP. Therefore, in patients with long-lasting pregnancy-related posterior PGP, there is a need to investigate the contraction pattern of an important muscle that provides a compressive force, i.e. the transverse abdominal muscle (TrA), during a load transfer test, such as active straight leg raising (ASLR).

Methods

TrA thickness was measured by means of ultrasound imaging at rest and during ASLR in 43 non-pregnant women with ongoing posterior PGP that started during a pregnancy or delivery, and in 39 women of the same age group who had delivered at least once and had no current PGP (healthy controls).

Results

In participants with PGP, the median TrA thickness increase with respect to rest during ipsilateral and contralateral ASLR was 31% (SD 46%) and 31% (SD 57%), respectively. In healthy controls, these values were 11% (SD 25%) and 13% (SD 22%), respectively.

Conclusions

Significant excessive contraction of the TrA is present during ASLR in patients with long-lasting pregnancy-related posterior PGP. The present findings do not support the idea that contraction of the TrA is decreased in long-lasting pregnancy-related PGP. This implies that there is no rationale for the prescription of exercises to enhance contraction of TrA in patients with long-lasting pregnancy-related PGP.

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Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-Relat Pelvic Girdle Pain: An Update. BMC Med. 2011;9:15. doi:10.1186/1741-7015-9-15.CrossRefPubMedPubMedCentral

Bysrtröm MG, Rasmussen-Barr E, Grooten WJ (2013) Motor control exercises reduces pain and disability in chronic and recurrent low back pain: a meta-analysis. Spine 15;38(6):E350-E358. doi:10.1097/BRS.0b013e31828435fb.

Pel JJ, Spoor CW, Goossens RH, Pool-Goudzwaard AL. Biomechanical model study of pelvic belt influence on muscle and ligament forces. J Biomech. 2008;41:1878–84.CrossRefPubMed

Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part I—biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech. 1993;8:285–94.CrossRef

Snijders CJ, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. Part II – loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech. 1993;8:295–301.CrossRef

Snijders CH, Vleeming A, Stoeckart R, Mens JMA, Kleinrensink GJ. Biomechanics of the interface between spine and pelvis in different postures. In: Vleeming A, Mooney V, Snijders CJ, Dorman TA, Stoeckart R, editors. Movement, stability, and low back pain: the essential role of the pelvis. New York: Churchill Livingstone; 1997. p. 103–14.

Koppenhaver SL, Hebert JJ, Parent EC, Fritz JM. Rehabilitative ultrasound imaging is a valid measure of trunk muscle size and activation during most isometric sub-maximal contractions: a systematic review. Aust J Physiother. 2009;55:153–69.CrossRefPubMed

Beazell JR, Grindstaff TL, Hart JM, Magrum EM, Cullaty M, Shen FH. Changes in lateral abdominal muscle thickness during an abdominal drawing-in maneuver in individuals with and without low back pain. Res Sports Med. 2011;19:271–82. doi:10.1080/15438627.2011.608053.PubMed

Himes ME, Selkow NM, Gore MA, Hart JM, Saliba SA. Transversus abdominis activation during a side-bridge exercise progression is similar in people with recurrent low back pain and healthy controls. J Strength Cond Res. 2012;26:3106–12. doi:10.1519/JSC.0b013e318247300f.CrossRefPubMed

10.

Pinto RZ, Ferreira PH, Franco MR, Ferreira MC, Ferreira ML, Teixeira-Salmela LF, et al. The effect of lumbar posture on abdominal muscle thickness during an isometric leg task in people with and without non-specific low back pain. Man Ther. 2011;16:578–84. doi:10.1016/j.math.2011.05.010.CrossRefPubMed

11.

Pinto RZ, Ferreira PH, Franco MR, Ferreira ML, Ferreira MC, Teixeira-Salmela LF, et al. Effect of 2 lumbar spine postures on transversus abdominis muscle thickness during a voluntary contraction in people with and without low back pain. J Manip Physiol Ther. 2011;34:164–72. doi:10.1016/j.jmpt.2011.02.009.CrossRef

12.

Teyhen DS, Williamson JN, Carlson NH, Suttles ST, O’Laughlin SJ, Whittaker JL, et al. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch Phys Med Rehabil. 2009;90:761–7. doi:10.1016/j.apmr.2008.11.011.CrossRefPubMed

13.

O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders. Part 1: a mechanism based approach within a biopsychosocial framework. Man Ther. 2007;12:86–97.CrossRefPubMed

14.

O’Sullivan PB, Beales DJ. Diagnosis and classification of pelvic girdle pain disorders. Part 2: illustration of the utility of a classification system via case studies. Man Ther. 2007;12:e1–12.CrossRefPubMed

15.

Mens JM, Huis in ‘t Veld YH, Pool-Goudzwaard A. Severity of signs and symptoms in lumbopelvic pain during pregnancy. Man Ther. 2012;17:175–9. doi:10.1016/j.math.2011.12.012.CrossRefPubMed

16.

Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Prac. 2003;3:310–6.CrossRef

17.

Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, et al. The Quebec Back Pain Disability Scale: Measurement properties. Spine. 1995;20:341–52.CrossRefPubMed

18.

Schoppink LE, van Tulder MW, Koes BW, Beurskens SA, de Bie RA. Reliability and validity of the Dutch adaptation of the Quebec Back Pain Disability Scale. Phys Ther. 1996;76:268–75.CrossRefPubMed

19.

Vleeming A, Albert HB, Östgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17:794–819. doi:10.1007/s00586-008-0602-4.CrossRefPubMedPubMedCentral

20.

Chang WJ. Active straight leg raise. J Physiother. 2012;58:132. doi:10.1016/S1836-9553(12)70098-X.CrossRefPubMed

21.

Mens JM, Huis in ‘t Veld YH, Pool-Goudzwaard A. The Active Straight Leg Raise test in lumbopelvic pain during pregnancy. Man Ther. 2012;17:364–8. doi:10.1016/j.math.2012.01.007.CrossRefPubMed

22.

Östgaard HC, Zetherstrom G, Roos-Hansson E. The posterior pelvic pain provocation test in pregnant women. Eur Spine J. 1994;3:258–60.CrossRefPubMed

23.

Hebert JJ, Koppenhaver SL, Parent EC, Fritz JM. A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine. 2009;34:E848–56. doi:10.1097/BRS.0b013e3181ae625c.CrossRefPubMed

24.

Fleiss J. The design and analysis of clinical experiments. New York: Wiley; 1986.

25.

De Groot M, Pool-Goudzwaard AL, Spoor CW, Snijders CJ. The active straight leg raising test (ASLR) in pregnant women: differences in muscle activity and force between patients and healthy subjects. Man Ther. 2008;13:68–74.CrossRefPubMed

26.

Stuge B, Sætre K, Brækken IH. The automatic pelvic floor muscle response to the active straight leg raise in cases with pelvic girdle pain and matched controls. Man Ther. 2013;18:327–32. doi:10.1016/j.math.2012.12.004.CrossRefPubMed

27.

Shadmehr A, Jafarian Z, Talebian S. Changes in recruitment of pelvic stabilizer muscles in people with and without sacroiliac joint pain during the active straight-leg-raise test. J Back Musculoskelet Rehab. 2012;25:27–32. doi:10.3233/BMR-2012-0307.CrossRef

28.

Mens JM, Pool-Goudzwaard A, Stam HJ. Mobility of the pelvic joints in pregnancy-related Lumbopelvic pain: A Systematic Review. Obstet Gynecol Surv. 2009;64:200–8. doi:10.1097/OGX.0b013e3181950f1b.CrossRefPubMed

29.

Hodges P, Richardson C, Jull G. Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function. Physiother Res Int. 1996;1:30–40.CrossRefPubMed

30.

Cowan SM, Schache AG, Brukner P, Bennell KL, Hodges PW, Cobum P, et al. Delayed onset of transversus abdominis in long-standing groin pain. Med Sci Sports Exerc. 2004;36:2040–5.CrossRefPubMed

31.

Sjödahl J, Gutke A, Ghaffari G, Strömberg T, Öberg B. Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the active straight leg raise in women with and without pelvic girdle pain: an experimental study. Clin Biomech. 2016;35:49–55. doi:10.1016/j.clinbiomech.2016.04.007.CrossRef

32.

Mens JM, Vleeming A, Snijders CJ, Stam HJ, Ginai AZ. The active straight leg raise test and mobility of the pelvic joints. Eur Spine J. 1999;8:468–73.CrossRefPubMedPubMedCentral

33.

Palsson TS, Hirata RP, Graven-Nielsen T. Experimental pelvic pain impairs the performance during the active straight leg raise test and causes excessive muscle stabilization. Clin J Pain. 2015;31:642–51. doi:10.1097/AJP.0000000000000139.CrossRefPubMed

34.

Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27:399–405.CrossRefPubMed

35.

Urquhart DM, Hodges PW, Allen TJ, Story IH. Abdominal muscle recruitment during a range of voluntary exercises. Man Ther. 2005;10:144–53.CrossRefPubMed

36.

Urquhart DM, Hodges PW. Differential activity of regions of transversus abdominis during trunk rotation. Eur Spine J. 2005;14:393–400.CrossRefPubMed

37.

Beales DJ, O’Sullivan PB, Briffa NK. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. Spine. 2009;34:861–70. doi:10.1097/BRS.0b013e318198d212.CrossRefPubMed

38.

Mens J, Hoek van Dijke G, Pool-Goudzwaard A, van der Hulst V, Stam HJ. Possible harmful effects of high intra-abdominal pressure on the pelvic girdle. J Biomech. 2006;39:627–35.CrossRefPubMed

39.

Whittaker JL, Mclean L, Hodder J, Warner MB, Stokes MJ. Association between changes in electromyographic signal amplitude and abdominal muscle thickness in individuals with and without lumbopelvic pain. J Orthop Sports Phys Ther. 2013;43:466–77. doi:10.2519/jospt.2013.4440.CrossRefPubMed

Title: The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study
Authors: Jan M. A. Mens
Annelies Pool-Goudzwaard
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-017-1732-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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