• 한국전문물리치료학회지
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• 제25권1호
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• pp.1-11
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• 2018

Background: The continuous co-contraction of the trunk muscles through trunk stabilization exercises is important to patients with lumbar spinal stenosis (LSS). However, intentional abdominal muscle contraction (IAMC) for trunk stabilization has been used only for specific training in the treatment room. Objects: The purpose of this study was to provide feedback to adults with LSS to enable IAMC during activities of daily living (ADLs). Methods: The participants with spinal stenosis were divided into an experimental group of 15 adults and a control group of 16 adults. Electromyographic signals were measured while the subjects kept their both hands held up at $90^{\circ}$. The measured muscles were the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and erector spinae (ES). Pelvic tilt was measured using a digital pelvic inclinometer. The degree of pain was measured using the visual analogue scale (VAS) and functional capacity was measured using the Korean version of the Oswestry disability index (KODI). Results: While the experimental group showed statistically significantly higher activities in the RA, EO, and IO after the intervention compared with the control group. Pelvic tilt was significantly decreased only in the experimental group. Both the experimental and control groups exhibited statistically significant declines in the VAS and KODI (p<.01). In terms of the levels of changes, the experimental group exhibited a statistically significant larger decline only in the VAS and the pelvic tilt when compared with the control group (p<.05). Conclusions: The subjects could stabilize their trunks, and relieve their pain and dysfunctions and reduce pelvic tilt by learning abdominal muscle contraction during ADLs. The combination of therapeutic exercises and IAMC may have greater effects on patients with LSS.

• 한국전문물리치료학회지
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• 제20권3호
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• pp.81-88
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• 2013

Active straight-leg raise (ASLR) is a physical evaluation procedure to test lumbar spine stability. Several previous studies have reported various methods to control the activation of abdominal muscles during ASLR. We investigated the effects of three different hip positions in frontal plane on abdominal muscles to increase or decrease the difficulty level of lumbar spine stability exercise during ASLR in pain free subjects. Eleven young and healthy subjects voluntarily participated in this study (6 men, 5 women; mean age=$24.0{\pm}1.2$ years, height=$160.0{\pm}7.3cm$, weight=$55.0{\pm}10.6kg$, body mass index=$21.5{\pm}2.3kg/m^2$). The subjects had three trials on each ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction. Separate repeated-measures analysis of variance (ANOVA) and the post hoc Bonferroni tests (with ${\alpha}$=.05/3=.017) were performed for each muscle among the three different hip positions in frontal plane (ASLR with hip $10^{\circ}$ adduction, neutral hip, and hip $30^{\circ}$ abduction). The ipsilateral external oblique (EO), contralateral EO, ipsilateral internal oblique/transverse abdominis (IO/TrA), and contralateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with hip $10^{\circ}$ adduction. Also, the ipsilateral EO, contralateral EO, and ipsilateral IO/TrA were significantly greater in ASLR with hip $30^{\circ}$ abduction compared with ASLR with neutral hip. These results suggest that ASLR with hip $30^{\circ}$ abduction and neutral would be useful method to strengthen the EO and IO/TrA. And, ASLR with hip $10^{\circ}$ adduction would be effective in early stages of lumbar stabilization program due to low activation of EO and IO/TrA during maintaining of ASLR position with low load.

• 한국전문물리치료학회지
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• 제24권1호
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• pp.71-78
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• 2017

Background: Muscle weakness and impaired trunk muscle control are common in stroke patients. The bridging exercise (BE) is generally used for trunk stabilization and improving the overall function of stroke patients. The effectiveness of the BE with hip adductor contraction (BEHA) in facilitating trunk muscle activation has been well studied in healthy adults. However, the impact of BEHA in sub-acute stroke patients has not yet been investigated. Objects: The purpose of this study was to determine the effects of BEHA on the electromyography (EMG) activities and the asymmetry of the rectus abdominis (RA), external oblique (EO) and internal oblique (IO) abdominal muscles. Methods: Twenty participants with sub-acute stroke (11 males and 9 females) were recruited. Each participant was asked to perform bridging exercises for five seconds under three different conditions: BE in a neutral position (BEN), BEHA with a large ball (BEHAL) and BEHA with a small ball (BEHAS). The EMG amplitudes of the bilateral RA, EO and IO and the asymmetry of the EMG activity between the sound and affected sides were compared among the conditions. The significance level was set at ${\alpha}=.05$. Results: The EMG activities of RA, EO and IO were significantly greater during BEHAL and BEHAS than during BEN (p<.05); the asymmetry of the RA, EO and IO decreased significantly during BEHAL and BEHAS compared to BEN (p<.05). However, no measured variables showed any significant differences between BEHAL and BEHAS (p>.05). Conclusion: This study compared the EMG activities of the RA, EO and IO on both sides and the asymmetry of the RA, EO and IO during BEN, BEHAL and BEHAS. Our findings suggest that BEHA was more effective for individuals with hemiplegic stroke at facilitating and normalizing abdominal muscle control than BEN.

• 대한물리의학회지
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• 제16권1호
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• pp.111-121
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• 2021

PURPOSE: This study examined the effects of core stability exercise on the strength, activation of the trunk muscle, and pulmonary function in a Guillain-Barre syndrome (GBS) patient. METHODS: A 38-year-old male with GBS was enrolled in the study. A core stability exercise program was implemented for four weeks with a duration of 30 min/day and a frequency of three days/week. The program consisted of abdominal crunch, Swiss ball crunch, bicycle crunch, medicine ball sit-up with a toss, medicine ball rotational chest pass, raised upper body and lower body, and dead bug. Measurements of the strength of the trunk muscle (trunk flexion and hip flexion), activation of trunk muscles (rectus femoris; RA, external oblique abdominal; EOA, internal oblique abdominal; IOA, erector spinae; ES), and pulmonary function (forced expiratory capacity; FVC, forced expiratory volume at one second; FEV1) were taken before and after four weeks of core stability exercise. RESULTS: The strength of trunk muscles increased in the trunk and hip flexion after four weeks of core stability exercise, respectively, compared to the baseline levels. Activation of the trunk muscles increased in RA, EOA, and IOA after four weeks of core stability exercise compared to baseline levels, but decreased in ES after four weeks of core stability exercise compared to the baseline levels. The pulmonary function increased in FVC and FEV1 after four weeks of core stability exercise compared to the baseline levels. CONCLUSION: These results suggest that core stability exercise improves strength, Activation of the trunk muscle, And pulmonary function in patients with GBS.

• PNF and Movement
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• 제19권2호
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• pp.215-223
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• 2021

Purpose: This study aimed to compare the contraction ratios of the abdominal muscles and the preferential activation ratios of the transversus abdominis muscle (TrA) during the abdominal drawing-in maneuver (ADIM) in the hook-lying, sitting, and standing positions. Methods: This study included 30 healthy participants. The thicknesses of the TrA, internal oblique muscle (IO), and external oblique muscle (EO) were measured at rest and during the ADIM in the hook-lying, sitting, and standing positions using B-mode ultrasound imaging. The contraction ratios of these muscles and the preferential activation ratios of the TrA were calculated for each position. Results: The contraction ratio of the TrA and preferential activation ratio of the TrA during the ADIM in the hook-lying position were significantly higher than those in the sitting and standing positions (p < 0.05). The contraction ratio of the TrA during the ADIM in the sitting position was significantly higher than that in the standing position (p < 0.05). Conclusion: The hook-lying position tended to facilitate TrA activity better than the sitting position. Furthermore, the sitting position tended to facilitate TrA activity better than the standing position. These findings suggest that the ADIM in the hook-lying position should be implemented before that in the sitting position and that the ADIM in the sitting position should be implemented before that in the standing position.

• PNF and Movement
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• 제18권3호
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• pp.415-424
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• 2020

Purpose: This study aimed to compare changes in abdominal muscle thickness in different standing postures with a handheld load between subjects with and without chronic low back pain (CLBP). Methods: Twenty subjects with CLBP and 20 controls participated in this study. Ultrasound imaging was used to assess the changes in the thickness of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles. Muscle thickness in three different standing postures (standing at rest, standing with loads, standing with lifting loads) was compared with the muscle thickness at rest in the supine position and was expressed as a percentage of change in the thickness of the muscle. Results: While standing with loads, the change in IO muscle thickness in the CLBP patients increased more significantly than in the pain-free controls (p < 0.05). The standing with lifting loads posture showed a significant increase in the change in thickness of the TrA compared with the standing with loads posture (p < 0.05). In addition, the standing with lifting loads posture showed a significant decrease in the change in the thickness of the EO when compared with the standing with loads posture (p < 0.05). Conclusion: The automatic activity of the IO muscle in subjects with CLBP increased more than that of the pain-free controls in the standing with loads posture. These findings suggest that IO muscle function may be altered in those with CLBP while standing with loads. Additionally, TrA the activation level was found to be associated with increased postural demand caused by an elevated center of mass.

• 한국전문물리치료학회지
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• 제18권4호
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• pp.60-67
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• 2011

Ultrasonography (US) is a recent technique that has proven to be useful for assessing muscle thickness and guiding the rehabilitation decision-making of clinicians and researchers. The purpose of this study was to determine the inter-rater reliability of the US measurement of transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) thicknesses for different probe locations and measurement techniques. Twenty healthy volunteers were recruited in this study. Muscle thicknesses of the transversus TrA, IO, and EO were measured three times in the hook-lying position. The three different probe locations were as follows: 1) Probe location 1 (PL1) was below the rib cage in direct vertical alignment with the anterior superior iliac spine (ASIS). 2) Probe location 2 (PL2) was halfway between the ASIS and the ribcage along the mid-axillary line. 3) Probe location 3 (PL3) was halfway between the iliac crest and the inferior angle of the rib cage, with adjustment to ensure the medial edge of the TrA. The two different techniques of thickness measurement from the captured images were as follows: 1) Muscle thickness was measured in the middle of the muscle belly, which was centered within the captured image (technique A; TA). 2) Muscle thickness was measured along a horizontal reference line located 2 cm apart from the medial edge of the TrA in the captured image (technique B; TB). The intraclass correlation coefficient (ICC [3,k]) was used to calculate the inter-rater reliability of the thickness measurement of TrA, IO and EO using the values from both the first and second examiner. In all three muscles, moderate to excellent reliability was found for all conditions (probe locations and measurement techniques) (ICC=.70~.97). In the PL1-TA condition, inter-rater reliability in the three muscle thicknesses was good to excellent (ICC=.85~.96). The reliability of all measurement conditions was excellent in IO (ICC=.95~.97). Therefore, the findings of this study suggest that TA can be applied to PL1 by clinicians and researchers in order to measure the thickness of abdominal muscles.

• 한국전문물리치료학회지
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• 제25권1호
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• pp.22-30
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• 2018

Background: Improvement of lumbo-pelvic stability can reduce the compensatory action of the quadratus lumborum (QL) and selectively strengthen the gluteus medius (GM) during side-lying hip abduction (SHA). There are abdominal draw-in maneuver (ADIM) and abdominal bracing (AB) as active ways, and pelvic compression belt (PCB) as a passive way to increase of lumbo-pelvic stability. It is necessary to compare how these stabilization methods affect the selective strengthening of the GM. Objects: To investigate the effects of ADIM, AB, and PCB during SHA on the electromyography (EMG) activity of the GM, QL, external oblique (EO) and internal oblique (IO), and the GM/QL EMG activity ratio. Methods: A total of 20 healthy male adults participated in the study. The subjects performed three conditions in side-lying in random order: SHA with ADIM (SHA-ADIM), SHA with AB (SHA-AB), and SHA with PCB (SHA-PCB). To compare the differences among the three conditions, the EMG activities of the GM, QL, EO and IO, and GM/QL EMG activity ratio were analyzed using one-way repeated ANOVA. Results: The EMG activity of the QL was significantly higher in SHA-AB than in SHA-ADIM and SHA-PCB. The GM/QL activity ratio was significantly higher in SHA-PCB than in SHA-ADIM and SHA-AB. In addition, the figure for SHA-ADIM was significantly higher than that for SHA-AB. In the case of the EO, the figure for SHA-AB was significantly higher than corresponding values for the other two conditions. The figure for SHA-ADIM was significantly higher than that for SHA-PCB. The EMG activity of the IO was significantly higher in SHA-AH than in SHA-PCB. Conclusion: It can be suggested that wearing the PCB can more selectively strengthen the GM than to perform ADIM and AB during SHA. In addition, the ADIM can be recommended when there is a need to strengthen abdominal muscles during SHA.

• 한국전문물리치료학회지
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• 제22권1호
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• pp.37-48
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• 2015

This study aimed to investigate the effect of the abdominal drawing-in maneuver (ADIM) and abdominal expansion maneuver (AEM) on trunk stabilization, as well as trunk muscle activities and differences in quadruple visual analogue scale, Korean Oswestry Disability Index, and Fear Avoidance Beliefs Questionnaire scores, in patients with chronic low back pain and lumbar spine instability. To increase intra-abdominal pressure during the trunk stabilization exercise, the technique of pushing the abdomen out using diaphragmatic abdominal breathing suggested by Pavel Koral was used, which we termed the AEM. Fifty patients who tested positive on more than three of the five lumbar spine instability tests were separated from 138 patients with chronic low back pain of these patients, 16 were placed in the control group (trunk stabilization exercise), 17 were placed in the ADIM group (trunk stabilization exercise with ADIM), and 17 were placed in the AEM group (trunk stabilization exercise with AEM). Each group participated in the study for 30 minutes three times weekly for 4 weeks. Surface electromyography was used to measure the trunk muscle activities during the kneeling forward and supine bridging positions, and one-way repeated analysis of variance was used to determine the statistical significance of the trunk muscle activities in the rectus abdominis, internal oblique (IO), erector spinae, and multifidus (MF) muscles. The ADIM and AEM groups showed relatively larger improvements in psychosocial and functional disability level than control group. There were significant changes among the three groups, those from the measured values of the AEM group was significantly higher than the other two groups in changes in IO and MF trunk muscle activities (p<.05). This finding demonstrates that trunk stabilization exercises with AEM is more effective than ADIM for increasing trunk deep muscle activity of chronic low back pain patients with lumbar spine instability.

• 대한물리의학회지
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• 제14권3호
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• pp.13-20
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• 2019

PURPOSE: Sitting with crossed legs may have an effect on maintaining a healthy body posture and proper functioning of the respiratory system. Thus, this study's objective was to identify whether or not sitting with crossed legs affects the vertebral angle, chest wall mobility, the pulmonary function, and the activity of the respiratory muscles. METHODS: Thirty healthy subjects were recruited for this study (16 males and 14 females). The vertebral angle, chest wall mobility, pulmonary function, and the activity of the respiratory muscle were measured while the subjects sat in the correct posture and these factors were again measured with the subjects seated with their legs crossed. Three-dimensional motion analysis was used to determine the trunk and lumbar vertebral angles. Surface electromyography was employed to measure the sternocleidomastoid, the rectus abdominis, and the external and internal oblique abdominis muscles. A tapeline was utilized to evaluate the subjects' chest wall mobility. Spirometry was assessed to determine the forced vital capacity and forced expiratory volume in one second. Paired t-tests were then performed (p<.05). RESULTS: There were significant differences in the trunk and lumbar flexion angles, the chest wall mobility, the activity of the right external oblique muscle, and the left internal oblique abdominis muscle. However, the difference in pulmonary function did not reach statistical significance. CONCLUSION: A crossed leg posture caused slight thoracic extension and lumbar flexion, which may lead to a decrease of the chest wall mobility and also to an imbalance of the abdominal muscles. Therefore, sitting with a crossed leg posture should be avoided. Yet a crossed leg posture did not have any clinical effect on the pulmonary function of healthy people. It may be necessary to study the effects of sitting with crossed legs over an extended period of time for patients suffering with impaired respiratory function.