title: Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure.
abstract: The increased intra-abdominal pressure (IAP) commonly observed when the spine is loaded during physical activities is hypothesized to increase lumbar spine stability. The mechanical stability of the lumbar spine is an important consideration in low back injury prevention and rehabilitation strategies. This study examined the effects of raised IAP and an abdominal belt on lumbar spine stability. Two hypotheses were tested: (1) An increase in IAP leads to increased lumbar spine stability, (2) Wearing an abdominal belt increases spine stability. Ten volunteers were placed in a semi-seated position in a jig that restricted hip motion leaving the upper torso free to move in any direction. The determination of lumbar spine stability was accomplished by measuring the instantaneous trunk stiffness in response to a sudden load release. The quick release method was applied in isometric trunk flexion, extension, and lateral bending. Activity of 12 major trunk muscles was monitored with electromyography and the IAP was measured with an intra-gastric pressure transducer. A two-factor repeated measures design was used (P < 0.05), in which the spine stability was evaluated under combinations of the following two factors: belt or no belt and three levels of IAP (0, 40, and 80% of maximum). The belt and raised IAP increased trunk stiffness in all directions, but the results in extension lacked statistical significance. In flexion, trunk stiffness increased by 21% and 42% due to 40% and 80% IAP levels respectively; in lateral bending, trunk stiffness increased by 16% and 30%. The belt added between 9% and 57% to the trunk stiffness depending on the IAP level and the direction of exertion. In all three directions, the EMG activity of all 12 trunk muscles increased significantly due to the elevated IAP. The belt had no effect on the activity of any of the muscles with the exception of the thoracic erector spinae in extension and the lumbar erector spinae in flexion, whose activities decreased. The results indicate that both wearing an abdominal belt and raised IAP can each independently, or in combination, increase lumbar spine stability. However, the benefits of the belt must be interpreted with caution in the context of the decreased activation of a few trunk extensor muscles.
authors.affiliation: Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, P.O. Box 208071, New Haven, CT 06520-8071, USA. cholewicki@biomed.med.yale.edu
authors.forename: J
authors.initials: J
authors.lastname: Cholewicki
authors.forename: K
authors.initials: K
authors.lastname: Juluru
authors.forename: A
authors.initials: A
authors.lastname: Radebold
authors.forename: M M
authors.initials: MM
authors.lastname: Panjabi
authors.forename: S M
authors.initials: SM
authors.lastname: McGill
mesh_terms: D000005:Abdomen / Q000503:physiopathology; D000009:Abdominal Muscles / Q000503:physiopathology; D000328:Adult; D001696:Biomechanical Phenomena; D004576:Electromyography; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000628:therapy*; D008161:Lumbosacral Region; D008954:Models, Biological; D009989:Orthotic Devices; D011312:Pressure; D013122:Spinal Diseases / Q000503:physiopathology / Q000628:therapy*; D013131:Spine / Q000503:physiopathology*; D016896:Treatment Outcome; D014636:Valsalva Maneuver