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Open Access Highly Accessed Research article

Effect of head and limb orientation on trunk muscle activation during abdominal hollowing in chronic low back pain

Kevin Parfrey1, Sean GT Gibbons2, Eric J Drinkwater13 and David G Behm1*

Author Affiliations

1 School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada

2 Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada

3 School of Exercise and Health Sciences, Edit Cowan University, Perth, Australia

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BMC Musculoskeletal Disorders 2014, 15:52  doi:10.1186/1471-2474-15-52

Published: 22 February 2014

Abstract

Background

Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre.

Methods

This study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter.

Results

Using magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA.

Conclusions

Individuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups.

Keywords:
Chronic low back pain; Exercise therapy; Motor control; Abdominal hollowing; Primitive reflexes; Stability exercise