Abdominal Muscles Are the Front Side of the Low Back
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Hollis H. King
Arab AM, Rasouli O, Amiri M, Tahan N. Reliability of ultrasound measurement of anatomic activity of the abdominal muscle in participants with and without chronic low back pain. Chiropr Man Therap.2013;21:37. doi:10.1186/2045-709X-21-37.
I frequently tell my patients with low back pain—particularly those carrying extra weight in the abdominal area—that the abdominal muscles are the front side of their low back, and that they need to do abdominal strengthening exercises to reduce their low back pain. This perspective is a mainstay of physical therapy; core strengthening exercises have been prescribed for every patient I have referred to a physical therapist for low back pain (I also provide these patients with osteopathic manipulative treatment, of course, as appropriate).
Interestingly, in my 20 years of cumulative experience on the faculty of 3 different osteopathic medical schools, I had never seen this notion presented in osteopathic manipulative medicine curriculum. Recently, however, I attended an osteopathic conference where Frank H. Willard, PhD, presented his work on the anatomy related to this concept.1,2 I selected this article by Arab et al because it relates to the practical application of Dr Willard's work and may further the process of “thinking osteopathically” in regard to low back pain.
Researchers in Iran used ultrasonography to measure abdominal wall thickness with participants in 4 positions: (1) lying supine, (2) sitting on a chair, (3) sitting on a gym ball with both feet on the ground, and (4) sitting on a gym ball with both feet on ground and then lifting 1 foot off the floor. The study included 10 healthy participants and 10 participants with low back pain of more than 6 weeks duration. Ultrasonography of the abdomen was performed with participants in each of the 4 positions. Each image was frozen at the end of expiration.
The reliability of ultrasonography as a measure of absolute abdominal muscle thickness was found to be very high. Intraclass correlation coefficients ranged from 0.88 to 0.95 for within-days comparisons and from 0.85 to 0.94 for between-days comparisons. A clinically useful finding was that the minimal detectable change measure showed a much thicker abdominal muscle wall in low back pain participants compared with that of healthy participants when 1 foot was lifted. The authors suggested, and I agree, that such an easily obtained measurement can be used to assess progress in the management of low back pain, as well as for research purposes.
References
1 Willard FH . Anatomy and neurology of the lumbar spine: overview. Lecture presented at: International Congress of Osteopathy: Structure & Function—Principles, Models, Evidence; 1115, 2013; Milan, Italy.Search in Google Scholar
2 Schuenke MD Vleeming A Van Hoof T Willard FH . A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia[published online May 15, 2012]. J Anat.2012;221(6): 568-576. doi:10.1111/j.1469-7580.2012.01517.x.10.1111/j.1469-7580.2012.01517.xSearch in Google Scholar PubMed PubMed Central
© 2014 The American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in the same Issue
- Abstracts
- 2013 SOMA Abstracts and Poster Competition
- 2013 BIOM Abstracts and Poster Competition
- Editorial
- Our Past, Present, and Future Are in Our Hands
- Letters
- Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion
- Original Contribution
- The Persistence of Lumbar Somatic Dysfunction and Its Association With Bone Mineral Density
- Medical Education
- Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
- Special Communication
- A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
- A Research Primer, Part 2: Guidelines for Developing a Research Project
- Case Report
- A Case of Seasonal Recurrent Myopericarditis
- A Case of Idiopathic Colonic Varices
- The Somatic Connection
- OMT Relieves Severe Chronic Low Back Pain
- Abdominal Muscles Are the Front Side of the Low Back
- Systematic Review Paints Incomplete Picture of OMT Research
- Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
- Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
- A Chiropractic Perspective: Spinal Manipulative Therapy Is Not Causally Related to Stroke
- Clinical Images
- Abducens Palsy
- In Your Words
- No Place Like HOME
Articles in the same Issue
- Abstracts
- 2013 SOMA Abstracts and Poster Competition
- 2013 BIOM Abstracts and Poster Competition
- Editorial
- Our Past, Present, and Future Are in Our Hands
- Letters
- Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion
- Original Contribution
- The Persistence of Lumbar Somatic Dysfunction and Its Association With Bone Mineral Density
- Medical Education
- Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
- Special Communication
- A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
- A Research Primer, Part 2: Guidelines for Developing a Research Project
- Case Report
- A Case of Seasonal Recurrent Myopericarditis
- A Case of Idiopathic Colonic Varices
- The Somatic Connection
- OMT Relieves Severe Chronic Low Back Pain
- Abdominal Muscles Are the Front Side of the Low Back
- Systematic Review Paints Incomplete Picture of OMT Research
- Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
- Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
- A Chiropractic Perspective: Spinal Manipulative Therapy Is Not Causally Related to Stroke
- Clinical Images
- Abducens Palsy
- In Your Words
- No Place Like HOME
