The effect of an abdominal drawing-in maneuver with real-time visual biofeedback on muscle activity in young adults

DOI: https://doi.org/10.21203/rs.3.rs-2024724/v1

Abstract

Background

The abdominal drawing-in maneuver (ADIM) is a core stability exercise through the activation of the transversus abdominis and internal abdominal oblique (TrA/IO). However, controlling muscle activity of TrA/IO is difficult, especially when combined with other exercises. It has been proposed that real-time visual biofeedback (RVBF) can increase muscle activation but it has not been investigated in standing and lunge positions.

Objectives

This study aimed to investigate the effect of ADIM with RVBF on muscle activity during standing and lunge positions.

Methods

Twelve young adults (21.5 ± 2.1 years) were recruited for this study. Surface electromyography (EMG) was attached to 1) TrA/IO; 2) lumbar multifidus (LM); 3) lumbar erector spinae (LES); 4) gluteus medius (GMed); and 5) gluteus maximus (GMax) during ADIM and without ADIM (no-ADIM). Those data were processed and reported as a percentage of maximal voluntary isometric contraction (%MVIC). The RVBF was used to provide feedback to participants during ADIM in both standing and lunge positions.

Results

During standing position, the ADIM of about 24.92%MVIC of TrA/IO can increase the muscle activity of LM (p < 0.01), LES (p < 0.01), and GMed (p = 0.02) when compared to no-ADIM. During lunge position, the ADIM of about 25.48%MVIC of TrA/IO can increase the muscle activity of GMax (p < 0.01) when compared to no-ADIM.

Conclusions

ADIM of about 25%MVIC of TrA/IO is sufficient to improve back and hip muscle activity. Therefore, we recommended ADIM with RVBF when exercising in the standing and lunge positions.

Introduction

The abdominal drawing-in maneuver (ADIM) is a core stability exercise in which the abdominal walls are pulled inwards to increase abdominal pressure(1, 2). The ADIM can provide lumbar stability by activating transversus abdominis and internal abdominal oblique (TrA/IO)(3). This exercise has been recommended to improve lumbar stability for preventing or reducing the risk of injury to the lumbar spine (4). However, controlling and performing consistent intensity of muscle activity of TrA/IO was difficult, especially when combined with other exercises that require motor control(2, 5). Therefore, it has been suggested to use some tools for providing feedback to participants when performing ADIM(2, 6).

Real-time visual biofeedback (RVBF) has been proposed as an effective tool for motor control and learning(7). RVBF can provide feedback through the visual input that is demonstrated on the screen during exercise(7, 8). Thus, participants can either increase motor control when performing the difficult task or decrease the time required to learn the new task(8, 9). Recently, electromyography-based (EMG-based) RVBF has the potential to be used in monitoring muscle activity(8, 9). The EMG-based RVBF was used to consistently control muscle activity during exercise(8, 9). Hence, EMG-based RVBF has been recommended for use to control the consistency of muscle activity(7–9).

Muscle activity is a result of the force generated in a muscle to stabilize posture or move the body(10). Muscle activity is recruited increasingly when people do physical activities such as exercise(11). During exercise, the muscle activities of agonist and antagonist muscles have to work together in coordination, known as muscle co-activation(10, 12). For instance, it has been found that the back and hip muscles are co-activated with the TrA/IO(6). Therefore, an increase in muscle activity of TrA/IO increases back and hip muscle activity(6). Muscle co-activation is usually found when people are kept in an upright position, such as standing, or performing exercises(13–16). Consequently, studies on muscle activity have become important to determine how people’s muscles are activated during exercise(17, 18).

The lunge position is a functional exercise that is commonly used to strengthen the hip and knee muscles(17, 19). Functional exercise is important in the rehabilitation field for improving the functional activities of daily life(18, 20). To challenge participants, the lunge position has been widely combined with other exercises to increase hip and knee muscle activity(15, 16). For example, the resistance exercise, holding a dumbbell, was combined with the lunge position(15, 16). Hip and knee muscle activities were increased in the lunge position with resistance exercise more than in the lunge position alone(15, 16). Thus, the lunge position has been recommended to be combined with other exercises to provide additional benefits.

To our knowledge, EMG-based biofeedback has the potential to be used in monitoring muscle activity(9). Hence, our study was to use EMG-based RVBF to monitor muscle activity of TrA/IO and guide participants while performing the ADIM. Furthermore, the ADIM with RVBF has not been investigated in the upright position, standing position, functional position, or lunge position, which are common starting positions for exercise. Therefore, the purpose of this study was to investigate the effect of ADIM with RVBF on back and hip muscle activities in the standing and lunge positions. We hypothesized that the ADIM would improve the muscle activity of the back and hip during holding in the positions. Our findings might provide beneficial information about the use of ADIM with RVBF for improving back and hip muscle activation during exercise.

Methods

Participants

The eligibility of participants was assessed based on inclusion and exclusion criteria. The inclusion criteria were as follows: 1) between the ages of 20 and 30; 2) no experience of ADIM or RVBF. Participants were excluded based on the following criteria: 1) history of musculoskeletal disorders over the past year, such as low back pain; 2) history of neurological disorders, such as stroke. This study was ethically approved by Mahidol University-Central Institutional Review Board (MU-CIRB), all methods were carried out in accordance with the Declaration of Helsinki as a statement of ethical principles for medical research involving human participants, the Certificate of Approval (COA) numbered: MU-CIRB 2017/156.2010. We obtained the informed consent from all participants before participation.

Procedures

Surface electromyography (EMG), Telemyo 2400 G2 (Noraxon Inc. Scottsdale, AZ, USA), was used to collect muscle activity. The sampling frequency was set at 1,000 Hz. The skin was shaved and cleaned with fine sandpaper and alcohol until the impedance of the skin was less than five kilo-ohms (21). The Ag/AgCl surface electrodes (blue sensor, disc shape, diameter 34 mm, and sensor area of 13.2 mm2) were placed parallel to muscle fibers, with a 2 cm inter-electrode distance. The EMG electrodes were attached to the following muscles of the right leg: 1) transversus abdominis/internal abdominal oblique (TrA/IO); 2) lumbar multifidus (LM); 3) lumbar erector spinae (LES); 4) gluteus medius (GMed); and 5) gluteus maximus (GMax)(21). Then, each participant was asked to perform a maximal voluntary isometric contraction (MVIC) of the TrA/IO, LM, LES, GMed, and GMax muscles(19, 21).

For the practice trial, the researcher taught the participants to perform the ADIM with RVBF in both standing and lunge positions. In a standing position, participants stood quietly with their arms relaxed. In a lunge position, the participants stepped their right leg forward with their hips and knees flexed 90 degrees. The participant's trunk had to be straight and upright with arms akimbo. The instruction of ADIM was to pull the navel inwards and maintain the muscle contraction of TrA/IO without holding a breath(2, 5).

We used the EMG-based RVBF to provide feedback on TrA/IO muscle activity. The screen showed a gauge level that represented the muscle activity of TrA/IO in the %MVIC units. Participants were instructed to perform the ADIM between 10 and 25%MVIC of TrA/IO(1, 6). In each position, participants held in the position without ADIM (no-ADIM) for the first five seconds and then held in the position with ADIM for the last five seconds, as shown in Fig. 1. The practice trials were provided until participants were familiar with the experiment and performed the experiment correctly. For data collection, the RVBF was used to monitor whether participants performed the ADIM in both standing and lunge positions correctly and completely, holding the ADIM within the range of 10–25%MVIC of TrA/IO throughout the data collection.

Data processing

All EMG data were processed using Noraxon software (Noraxon Inc., Scottsdale, AZ, USA). For the setting in the software, the data was processed by a 4th order Butterworth filter with bandpass and notch filters at 30–350 Hz and 50 Hz, respectively(21). The common-mode rejection ratio was set at > 95 decibels (21). The filtered data were full-wave rectified (using a root mean square) and smoothed (using a moving average). The processed data was normalized using the MVIC of each muscle and reported as a %MVIC. The middle three seconds of no-ADIM and ADIM were analyzed and chosen for statistical analysis.

Statistical analysis

Statistical analysis was conducted using SPSS Statistic 23.0 (IBM SPSS Statistics for Windows, Version 23.0, IBM Corp., Armonk, New York). The normality of all variables was determined using the Shapiro–Wilk test. Nonetheless, the data was not normally distributed. Therefore, the non-parametric Wilcoxon signed-rank test was used to compare the variables between no-ADIM and ADIM in both standing and lunge positions. The alpha level was set at 0.05.

Results

A total of twelve healthy adults were recruited. The descriptive characteristics of the participants are shown in Table 1.

Table 1

Descriptive characteristics of the participants
 

Mean ± SD

(n = 12)

Age (years)

21.5 ± 2.1

Sex (male/female)

8/4

Weight (kg)

53.7 ± 7.3

Height (cm)

161.7 ± 8.3

Body mass index (kg/m2)

20.4 ± 1.6

 

In the standing position, as shown in Fig. 2, the RVBF was used to control the muscle activity of TrA/IO from 9.87 ± 5.37%MVIC during the no-ADIM to 24.92 ± 7.02%MVIC during the ADIM, which was statistically significantly increased by 15.05%MVIC (p < 0.01). The muscle activity of LM increased statistically significantly from 6.33 ± 5.59%MVIC during no-ADIM to 7.92 ± 6.03%MVIC during ADIM (p < 0.01). Moreover, the muscle activity of LES increased statistically significantly from 3.97 ± 3.19%MVIC during no-ADIM to 5.29 ± 3.78%MVIC during ADIM (p < 0.01). In addition, the muscle activity of GMed also increased statistically significantly from 2.03 ± 1.50%MVIC during no-ADIM to 3.70 ± 4.02%MVIC during ADIM (p = 0.02). However, there was no statistically significant difference in muscle activity of GMax between no-ADIM and ADIM (p = 0.09).

In the lunge position, as shown in Fig. 3, the RVBF was used to control the muscle activity of TrA/IO from 12.62 ± 5.91%MVIC during the no-ADIM to 25.48 ± 13.50%MVIC during the ADIM, which was statistically significantly increased by 12.86%MVIC (p < 0.01). There was no statistically significant difference in muscle activity of LM (p = 0.34), LES (p = 0.34), nor GMed (p = 0.48) between no-ADIM and ADIM. However, the muscle activity of GMax increased statistically significantly from 15.18 ± 7.11%MVIC during no-ADIM to 18.75 ± 7.27%MVIC during ADIM (p = 0.04).

Discussion

Our results support the hypothesis that ADIM with RVBF can increase the muscle activity of the back and hips in the standing position as well as the muscle activity of the hip in the lunge position. Specifically, an increase in TrA/IO by 15.05%MVIC during ADIM can increase the muscle activity of LM, LES, and GMed in the standing position. Meanwhile, an increase in TrA/IO by 12.86%MVIC during ADIM can increase the muscle activity of GMax in the lunge position. Therefore, we recommend performing ADIM with RVBF to improve back and hip muscle activities both in the standing and lunge positions.

Our findings demonstrate that the performing of ADIM in the standing position can increase the muscle activity of back extensors, LES and LM, as well as hip abductors, GMed. According to the results of the previous studies(4, 8), ADIM has been found to increase the muscle activity of the back and hips in the lying position. Although this study did the ADIM in the standing position, the results were similar to the previous study. It is well known that the back extensor and hip abductor are the muscle coactivation of TrA/IO(22). For this reason, the back and hip muscle activities in our study might have been increased following the muscle contraction of TrA/IO. Hence, the ADIM was suggested to be performed in the standing position to improve the muscle activity of the back extensor and hip abductor.

As a result, ADIM only improved the muscle activity of GMax in the lunge position. In the previous squat studies(15, 16), core stability exercise can increase hip muscle activity, which is consistent with our results. Muscle activity is generally increased when the muscle contraction is in the same direction as the muscle fiber(23). In this study, in the lunge position, the hip joint was primarily moved along the sagittal plane, which is similar to the muscle fiber of GMax. In addition, the TrA/IO and GMax have an anatomical correlation with pelvic rotation such that the contraction of these two muscles induces the posterior tilt of the pelvis(24). As aforementioned, this explains why our results show only the muscle activity of GMax increased significantly when performing ADIM. Thus, the ADIM might be a useful exercise for improving the muscle activity of the hip extensor in the lunge position.

Previous studies found that RVBF can improve motor control and learning in participants who are learning a new task(7, 8). In our study, participants had no experience with ADIM. Hence, we used the EMG-based RVBF to guide participants in this study to correctly perform ADIM. Although the ADIM was found in the previous study(2, 25) to be difficult to combine with the other exercises, the use of EMG-based RVBF in our study helped participants to consistently control the muscle activity of the TrA/IO when combined with the standing and lunge positions. Therefore, we also highly recommended RVBF for monitoring the ADIM with other starting positions for exercise because of the difference in abdominal and back muscle activation(26).

Limitations

Firstly, this study did not have data from a force platform. Participants might distribute body weight to their legs differently, which might result in different muscle activities. Secondly, the EMG was attached to the participant’s right leg only. The muscle activity in the left leg, which might have different muscle activity from the right leg, would be limited. However, this study focused on how ADIM with RVBF affects muscle activity in the lunge position. In the lunge position, participants usually shift their body weight to the stepping leg (i.e., right leg). Thus, the muscle activity of both legs might not be needed.

Conclusions

Our findings show that the ADIM with RVBF is an effective exercise for improving back and hip muscle activity both in standing and lunge positions. The results demonstrated that the ADIM of about 25%MVIC of TrA/IO is sufficient to improve muscle activity during exercise. Moreover, we also suggest that beginners should use the RVBF to guide the muscle activity of the TrA/IO when performing ADIM in both the standing and lunge positions. Consequently, ADIM with RVBF is a beneficial exercise to combine with standing and lunging positions.

Declarations

Ethics approval and consent to participate

This study was ethically approved by Mahidol University-Central Institutional Review Board (MU-CIRB), all methods were carried out in accordance with the Declaration of Helsinki as a statement of ethical principles for medical research involving human participants, the Certificate of Approval (COA) numbered: MU-CIRB 2017/156.2010. We obtained the informed consent from all participants before participation.

Consent for publication

Not Applicable

Availability of data and materials

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Competing interests

We declared no competing interests regarding this study.

Funding

We received no fund for this study.

Authors' contributions

Phunsuk Kantha: Concepts and design of the work, data collection, data analysis and interpretation, write the manuscript, final approval of the manuscript

Prasert Sakulsriprasert: Concepts and design of the work, data analysis and interpretation, write the manuscript, revision, final approval of the manuscript

Peemongkon Wattananon: Concepts and design of the work, revision, final approval of the manuscript

Acknowledgements

We would like to express our thanks to Faculty of Physical Therapy, Mahidol University and all participants joining this study.

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