Chronic Low Back Pain and the Transversus Abdominis
Training for therapeutic purposes is the most commonly used treatment for people with chronic low back pain (CLBP), and the use of pressure biofeedback units performed in transversus abdominis (TrA) training is one of the core muscle training methods.
The purpose of this study will be to investigate the effects of different intensities of TrA strength training (sham training, low intensity, and high intensity) on people with CLBP at pressure pain threshold (PPT).
A total of 45 CLBP patients will be included in the study.
A total of 45 CLBP patients were included in the analysis, of which 44 were included in the study. A pressure biofeedback unit was used to perform a one-time TrA training intervention consisting of 30 10-minute 180 mmHg TrA contraction training sessions at high intensity and 15 5-minute 100 mmHg TrA contraction training sessions at low intensity.
The sham training group completed the exercise comfortably and did not receive any training. Assessment measures were measured with PPT, the short form McGill Pain Questionnaire, and body surface pain radiography.
Results.
High-intensity training may activate more abdominal core units than low-intensity training. Immediately after high-intensity training, significant changes in PPT (unit: kgf) were observed in the following four muscles
iliopsoas muscle [0.69 (0.13-1.25) 95% CI, p = 0.020].
Quadratus lumborum muscle [0.84 (0.23-1.45) 95% CI, p = 0.012].
erector spinae muscle [0.66 (0.18-1.15) 95% CI, p = 0.011].
Transversus abdominis [0.70 (0.26-1.14) 95% CI, p = 0.004].
In the three muscles after low-intensity training
Quadratus lumborum muscle [0.61 (0.17-1.05) 95% CI, p = 0.009].
Transversus abdominis [0.14 (-0.15 to 0.43) 95% CI, p = 0.022].
Pear-shaped muscle [0.55 (0.13-0.98) 95% CI, p = 0.014].
The change in pain radiations on the body surface immediately after exercise was [-] in high-intensity training and [-] in low-intensity training.
The change in the radiation of pain on the body surface immediately after exercise was -10.87 (-17.51 to -4.22) 95% CI, p = 0.003 in high-intensity training.
In low-intensity training, the change in pain radiations was [-5.21 (-9.40 to -1.03) 95% CI, p = 0.019].
From these results, we can conclude that training aimed at activating the transversus abdominis decreases lumbar tenderness and that high-intensity training is more beneficial.
Xu, C., Fu, Z. & Wang, X. Effect of transversus abdominis muscle training on pressure-pain threshold in patients with chronic low back pain. BMC Sports Sci Med Rehabil 13, 35 (2021). Available at: https://doi.org/10.1186/s13102-021-00262-8
Summary
The training performed in this intervention consisted of a common exercise called drawing with an air cushion in the lower back.
The results from this intervention suggest that the reduction in tender points that can be achieved with high intensity training can be used clinically, and some studies have suggested that it is more significant than spinal manipulation or regular exercise. I must say that the results from the studies are limited due to the small sample size and other factors, but I think it is something that we can try to put into practice.
