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Published in: European Spine Journal 4/2008

01-04-2008 | Original Article

Muscle thickness changes during abdominal hollowing: an assessment of between-day measurement error in controls and patients with chronic low back pain

Authors: Anne F. Mannion, Natascha Pulkovski, Deborah Gubler, Mark Gorelick, David O’Riordan, Thanasis Loupas, Peter Schenk, Hans Gerber, Haiko Sprott

Published in: European Spine Journal | Issue 4/2008

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Abstract

Spine stabilization exercises, in which patients are taught to perform isolated contractions of the transverses abdominus (TrA) during “abdominal hollowing”, are a popular physiotherapeutic treatment for low back pain (LBP). Successful performance is typically judged by the relative increase in TrA thickness compared with that of the internal (OI) and external (OE) oblique muscles, measured using ultrasound. The day-to-day measurement error (imprecision) associated with these indices of preferential activation has not been assessed but is important to know since it influences the interpretation of changes after treatment. On 2 separate days, 14 controls and 14 patients with chronic LBP (cLBP) performed abdominal hollowing exercises in hook-lying, while M-mode ultrasound images superimposed with tissue Doppler imaging (TDI) data were recorded from the abdominal muscles (N = 5 on each side). The fascial lines bordering the TrA, OI and OE were digitized, and muscle thicknesses were calculated. The between-day error (intra-observer) was expressed as the standard error of measurement, SEM; SEM as a percentage of the mean gave the coefficient of variation (CV). There were no significant between-day differences for the mean values of resting or maximal thickness for any muscle, in either group (P > 0.05). The median SEM and CV of all thickness variables was 0.71 mm and 10.9%, respectively for the controls and 0.80 mm or 11.3%, respectively for the cLBP patients. For the contraction ratios (muscle thickness contracted/thickness at rest), the CVs were 3–11% (controls) and 5–12% (patients). The CVs were unacceptably high (30–50%, both groups) for the TrA preferential activation ratio (TrA proportion of the total lateral abdominal muscle thickness when contracted minus at rest). In both the controls and patients, the precision of measurement of absolute muscle thickness and relative change in thickness during abdominal hollowing was acceptable, and commensurate with that typical of biological measurements. The TrA preferential activation ratio is too imprecise to be of clinical use. Knowledge of the SEM for these indices is essential for interpreting the clinical relevance of any changes observed following physiotherapy.
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Metadata
Title
Muscle thickness changes during abdominal hollowing: an assessment of between-day measurement error in controls and patients with chronic low back pain
Authors
Anne F. Mannion
Natascha Pulkovski
Deborah Gubler
Mark Gorelick
David O’Riordan
Thanasis Loupas
Peter Schenk
Hans Gerber
Haiko Sprott
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 4/2008
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-008-0589-x

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