I got the new JOSPT in the mail the other day and lo and behold, there was yet another article on the activation of TrA with lumbopelvic pain. Hasn’t this been studied enough (Ferrera 2004, Hides 2008, Hodges 1998 & 1999, Teyhen 2005 to name a few!), with SIMILAR findings. I get the idea and have read it 100 times;
“these findings are consistent with previous research that has identified a diminished or delayed activation of the TrA in those with lumbopelvic pain (pg. 795)”.
Why is this studied so frequently and monotonously? Are authors going to come up with a different conclusion and actually thinking “gently drawing in your lower abdomen” will change how we treat low back pain?
What I found interesting in the study was that the relative difference of change in TrA thickness between symptomatics and asymptomatics was 20.9%, however, this is less than 0.5 mm difference and it is unclear if this thickness change reflects a clinically important difference.
Who cares if there was 20.9% difference in TrA activation, this means nothing clinically to me and as you read above, not too much to the authors either.
They also concluded that this study “provides an element of construct validity for the ADIM in its use for assessing muscle function of the Tra & IO muscles”.
Unless you have a ultrasound imaging scanner beside you while with a patient, I don’t know how much this study increased the construct validity of testing TrA in my daily practice. I was not convinced prior to this study to assess TrA muscle function (as if I am going to really determine it by palpating medial and inferior to ASIS) and still not.
Heart of the matter, if there is pain, there will most likely be alterations in TrA muscle function. How much longer do we have to study this?
Teyhen DS, Blemle LN, Dolbeer JA et al. Changes in Lateral Abdominal Muscle Thickness During the Abdominal Drawing-in Maneuver in Those with Lumbopelvic Pain. JOSPT. 2009 November. Volume 39. Number 11. 791-798.