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Br J Sports Med doi:10.1136/bjsm.2009.061515

Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain

  1. Paulo Ferreira (p.ferreira{at}usyd.edu.au)
  1. Discipline of Physiotherapy, Faculty of Health Sciences,The University of Sydney, Sydney, Australia
    1. Manuela Ferreira
    1. Discipline of Physiotherapy, Faculty of Health Sciences,The University of Sydney, Sydney, Australia
      1. Christopher Maher
      1. The George Institute for International Health, The University of Sydney, Sydney, Australia
        1. Kathryn Refshauge
        1. Discipline of Physiotherapy, Faculty of Health Sciences,The University of Sydney, Sydney, Australia
          1. Robert Herbert
          1. The George Institute for International Health, The University of Sydney, Sydney, Australia
            1. Paul Hodges
            1. Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Reh, Australia
              • Published Online First 26 May 2009

              Abstract

              Objectives: Although motor control exercises have been shown to be effective in the management of low back pain (LBP) the mechanism of action is unclear. The current study investigated the relationship between ability to recruit transversus abdominis and clinical outcomes of participants in a clinical trial.

              Methods: Ultrasonography was used to assess the ability to recruit transversus abdominis in a nested design: a sample of 34 participants with chronic low back pain was recruited from participants in a randomised controlled trial comparing efficacy of motor control exercise, general exercise and spinal manipulative therapy. Perceived recovery, function, disability and pain were also assessed.

              Results: Participants with chronic LBP receiving motor control exercise had greater improvement in recruitment of transversus abdominis (7.8%) than participants receiving general exercise (4.9% reduction) or spinal manipulative therapy (3.7% reduction). The effect of motor control exercise on pain reduction was greater in participants who had a poor ability to recruit transversus abdominis at baseline. There was a significant, moderate correlation between improved recruitment of transversus abdominis and reduction in disability (r= -0.35; 95%CI 0.02 to 0.62).

              Conclusion: These data provide some support for the hypothesised mechanism of action of motor control exercise and suggest that the treatment may be more effective in those with a poor ability to recruit transversus abdominis.

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