Reciprocal activation changes of lower extremity muscles caused by the abdominal hollowing maneuver in patients with unilateral lumbar disc herniation: an electromyography study

Year 2023, , 59 - 65, 12.01.2023

Ceyhun Türkmen , Ayşenur Özcan , Zehra Karahan , İsmail Bozkurt

https://doi.org/10.32322/jhsm.1193371

Cited By: 1

Abstract

Aim: Decreased or delayed multifidus and transversus abdominis (TrA) activity, transition of the TrA from tonic to phasic activity, and increased activity in the more superficial erector spinae muscles are behaviors unique to people with lumbar disc herniation (LDH). This study investigates whether the abdominal hollowing maneuver (AHM), which activates the TrA, can improve the rates of impaired muscle reciprocal activation of the lower extremities due to unilateral LDH during walking, tandem walking, and stair climbing activities.
Material and Method: The healthy and affected lower extremities of 17 patients with unilateral LDH were analyzed. The participants performed three activities and three times without the AHM. For the walking activity, the participants took a total of eight steps without deviating from their normal gait pattern. For the tandem walking activity, the participants covered the eight-step distance by performing heel-to-toe walking. For the stair climbing activity, the participants climbed a total of four steps without support from their upper extremities. The researchers visually checked the postures of the participants during all stages of the activities. The ratio of tibialis anterior (TA) and medial gastrocnemius (MGC) electromyographic values that emerged during the activities to the maximum voluntary isometric contraction (MVIC) values of these muscles was called MVIC%. Then the MVIC% values of the TA and MGC were matched, and the muscle reciprocal activation ratio ("MVIC%"-TA/"MVIC%"-MGC) was determined. While the activities were being performed, the MVIC% values of both muscles were measured separately without and with the AHM.
Results: Reliability values ranged from 0.87 to 0.99, with an SEM of 2.22 to 11.98. The ICC3,1 was considered “good” or “excellent” for all muscle surface electromyography measurements. During the tandem walking activity performed with the AHM, the reciprocal activation rates of TA: MGC on the affected and healthy legs converged (p=0.010, d=0.71). However, TA: MGC reciprocal activation rates did not differ between the affected and healthy extremities in the walking (p=0.519, d=0.16) or stair climbing (p=0.180, d=0.35) activities performed with the AHM.
Conclusion: According to the results of the study, integration of the AHM into tandem walking activity brought the reciprocal activation rates of both legs closer to each other and enabled them to exhibit similar behaviors, even without adherence to any exercise protocol. Therefore, tandem walking can be selected as an appropriate activity to combine with spinal stabilization exercises performed by unilateral L4-L5 radiculopathy patients using the AHM along with the task.

Keywords

Abdominal hollowing maneuver, disc herniation, lower extremity muscles, surface electromyography, tandem walking

References

• Pourahmadi MR, Taghipour M, Takamjani IE, Sanjari MA, Mohseni-Bandpei MA, Keshtkar AA. Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis. BMJ Open 2016; 6: e012426.
• Özsoy G, İlçin N. The impact of non-specific low back pain on postural control, balance, fall, mobility and physical activity in elderly individuals: a comparative study. Turk J Physiother Rehabil 2021; 32: 67-73.
• Paoloni M, Di Sante L, Cacchio A, et al. Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection. Spine (Phila Pa 1976) 2009; 34: 1337-44.
• Lee JH, Choi KH, Kang S, et al. Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation. Spine J 2019; 19: 1478-89.
• Bakhtiary AH, Safavi-Farokhi Z, Rezasoltani A. Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation. J Back Musculoskelet Rehabil 2005; 18: 55-60.
• Prasad KS, Gregson BA, Hargreaves G, Byrnes T, Winburn P, Mendelow AD. Inversion therapy in patients with pure single level lumbar discogenic disease: a pilot randomized trial. Disabil Rehabil 2012; 34: 1473-80.
• López-Díaz JV, Arias-Buría JL, Lopez-Gordo E, Lopez Gordo S, Oyarzún AP. Effectiveness of continuous vertebral resonant oscillation using the POLD method in the treatment of lumbar disc hernia. A randomized controlled pilot study. Man Ther 2015; 20: 481-6.
• Sherry E, Kitchener P, Smart R. A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain. Neurol Res 2001; 23: 780-4.
• Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther 2008; 31: 191-8.
• 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 :110-7.
• Kahlaee AH, Ghamkhar L, Arab AM. Effect of the abdominal hollowing and bracing maneuvers on activity pattern of the lumbopelvic muscles during prone hip extension in subjects with or without chronic low back pain: a preliminary study. J Manipulative Physiol Ther 2017; 40: 106-17.
• Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976) 1996; 21: 2640-50.
• Sánchez-Zuriaga D, López-Pascual J, Garrido-Jaén D, García-Mas MA. A comparison of lumbopelvic motion patterns and erector spinae behavior between asymptomatic subjects and patients with recurrent low back pain during pain-free periods. J Manipulative Physiol Ther 2015; 38: 130-7.
• Kim DW, Kim TH. Effects of abdominal hollowing and abdominal bracing during side-lying hip abduction on the lateral rotation and muscle activity of the pelvis. J Exerc Rehabil 2018; 14: 226-30.
• Jung E, Sung J, Uh I, Oh J. The effects of abdominal hollowing and bracing on abdominal muscle thicknesses and pelvic rotation during active straight leg raise. Isokinet Exerc Sci 2022; 30: 1-6.
• Jull GA, Richardson CA. Motor control problems in patients with spinal pain: a new direction for therapeutic exercise. J Manipulative Physiol Ther 2000; 23: 115-7.
• Lee W-h. Effects of the abdominal hollowing and abdominal bracing maneuvers on the pelvic rotation angle during leg movement. J Musculoskelet Sci Technol 2020; 4: 70-5.
• Harput G, Calık M, Erdem MM, Cigercioglu N, Gunduz S, Cınar N. The effects of enhanced abdominal activation on quadriceps muscle activity levels during selected unilateral lower extremity exercises. Hum Mov Sci 2020; 70: 102597.
• Park D, Lee M, Chung Y. Effect of the abdominal bracing maneuver on muscle activity of the trunk and legs during walking in healthy adults. Phys Ther Rehabil Sci 2022; 11: 119-26.
• Ennis K, Sizer PS, Sargent E, et al. Abdominal bracing changes lower quarter muscle activity but not reach distances during active forward reach on an unstable surface. Bodyw Mov Ther 2021; 28: 391-6.
• Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39: 175-91.
• Nelson-Wong E, Callaghan JP. Changes in muscle activation patterns and subjective low back pain ratings during prolonged standing in response to an exercise intervention. J Electromyogr Kinesiol 2010; 20: 1125-33.
• Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol 2000; 10: 361-74.
• Lahey MA, Downey RG, Saal FE. Intraclass correlations: There's more there than meets the eye. Psychol Bull 1983; 93: 586-95.
• Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res 2005; 19: 231-40.
• Bussey MD, Kennedy JE, Kennedy G. Gluteus medius coactivation response in field hockey players with and without low back pain. Phys Ther Sport 2016; 17: 24-9.
• Lemos T, Imbiriba LA, Vargas CD, Vieira TM. Modulation of tibialis anterior muscle activity changes with upright stance width. J Electromyogr Kinesiol 2015; 25: 168-74.
• Boudreau SA, Farina D, Falla D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Man Ther 2010; 15: 410-4.
• França FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study. Clinics (Sao Paulo) 2010; 65: 1013-7.
• Hauggaard A, Persson AL. Specific spinal stabilisation exercises in patients with low back pain – a systematic review. Phys Ther Rev 2007; 12: 233-48.
• Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol 2007; 17: 556-67.
• Grenier SG, McGill SM. Quantification of lumbar stability by using 2 different abdominal activation strategies. Arch Phys Med Rehabil 2007; 88: 54-62.
• Liebenson C, Karpowicz AM, Brown SH, Howarth SJ, McGill SM. The active straight leg raise test and lumbar spine stability. PM R 2009; 1: 530-5.
• Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015; 29: 1155-67.
• 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: 279-85.
• França FJR, Callegari B, Ramos LAV, et al. Motor control training compared with transcutaneous electrical nerve stimulation in patients with disc herniation with associated radiculopathy: a randomized controlled trial. Am J Phys Med Rehabil 2019; 98: 207-14.