title: Changes in deep lumbar stabilizing muscle thickness by transcutaneous neuromuscular electrical stimulation in patients with low back pain.
abstract: Transcutaneous neuromuscular electrical stimulation (NMES) is known to stimulate contraction of deep lumbar stabilizing muscles.
  The purpose of this study was to investigate changes in deep lumbar stabilizing muscle thickness during transcutaneous NMES on specific abdominal wall and paraspinal regions.
  Thirty patients with low back pain (LBP) were recruited. Three sessions were preformed: Session 1: NMES on abdominal wall, Session 2: NMES on lumbar paraspinal area, and Session 3: concurrent NMES on abdominal wall and lumbar paraspinal area. Real time ultrasound imaging (RUSI) of three abdominal stabilizing muscles; transverse abdominis (TrA), obliquus internus (OI), obliquus externus (OE) muscles and one posterior stabilizer, the lumbar multifidus muscles (LM) was captured.
  All studied muscles of TrA, OI, OE, and LM were found to have significant thickness increases during all three sessions compared to resting state (p < 0.05). Thicknesses changes of TrA, OI, and LM were significant during simultaneous NMES of both abdominal wall and lumbar paraspinal regions (Session 3) (p < 0.05).
  Our results indicate that concurrent NMES on abdominal wall and lumbar paraspinal area is most effective to maximally activate deep lumbar stabilizers. Rehabilitative efforts for patients with LBP may benefit from simultaneous transcutaneous NMES of abdominal and lumbar regions.
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyung-Dong, Nam-Gu, Daegu, Korea.
authors.forename: Seung Ok
authors.initials: SO
authors.lastname: Baek
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Catholic University, Daegu, Korea.
authors.forename: Hee Kyung
authors.initials: HK
authors.lastname: Cho
authors.affiliation: Research Institute of Medical Engineering, Yeungnam University, Daegu, Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Anesthesia, University of Kansas School of Medicine, Wichita, KS, USA.
authors.forename: Rodney
authors.initials: R
authors.lastname: Jones
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyung-Dong, Nam-Gu, Daegu, Korea.
authors.forename: Yun Woo
authors.initials: YW
authors.lastname: Cho
authors.affiliation: Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyung-Dong, Nam-Gu, Daegu, Korea.
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Ahn
keywords: Neuromuscular electrical stimulation; low back pain; lumbar stabilizing muscle; real time ultrasound imaging