title: Effect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: a randomized controlled trial.
abstract: METHODS
  A randomized controlled trial.
  
  
  OBJECTIVE
  To investigate feed-forward activation or timing of abdominal muscle activation in response to rapid shoulder flexion after 8 weeks with core stability exercises, sling exercises, or general exercises in chronic nonspecific low back pain (LBP) patients.
  
  
  BACKGROUND
  Delayed onset in abdominal muscles has been associated with LBP. Low load exercises to volitionally activate the transversus abdominis were introduced to restore trunk muscle activation deficits. More forceful co-contraction exercises have been advocated by others. This study explored whether abdominal muscle onset changed after low-load core stability exercises, high-load sling exercises, or general exercises.
  
  
  METHODS
  Subjects (N = 109) with chronic nonspecific LBP of at least 3 months' duration were randomly assigned to 8 weekly treatments with low-load core stability exercises, high-load stabilizing exercises in slings, or general exercises in groups. Primary outcome was onset recorded bilaterally by m-mode ultrasound imaging in the deep abdominal muscles in response to rapid shoulder flexion.
  
  
  RESULTS
  No or small changes were found in onset after treatment. Baseline adjusted between group differences showed a 15 ms (95% confidence interval [CI], 1-28; P = 0.03) and a 19 ms (95% CI, 5-33; P < 0.01) improvement with sling relative to core stability and general exercises, respectively, but on 1 side only. There was no association between changes in pain and onset over the intervention period (R ≤ 0.02).
  
  
  CONCLUSIONS
  Abdominal muscle onset was largely unaffected by 8 weeks of exercises in chronic LBP patients. There was no association between change in onset and LBP. Large individual variations in activation pattern of the deep abdominal muscles may justify exploration of differential effects in subgroups of LBP.
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. ottar.vasseljen@ntnu.no
authors.forename: Ottar
authors.initials: O
authors.lastname: Vasseljen
authors.forename: Monica
authors.initials: M
authors.lastname: Unsgaard-Tøndel
authors.forename: Christian
authors.initials: C
authors.lastname: Westad
authors.forename: Paul Jarle
authors.initials: PJ
authors.lastname: Mork
mesh_terms: D000009:Abdominal Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000328:Adult; D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D004185:Disability Evaluation; D004576:Electromyography; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D053580:Muscle Strength; D009664:Norway; D016017:Odds Ratio; D010147:Pain Measurement; D004856:Postural Balance; D011237:Predictive Value of Tests; D012782:Shoulder / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014836:Volition