The Influence Of Abdominal Drawing-in Maneuver With Dififerent Types Of Biofeedback On Patients With Chronic Low Back Pain

Purpose: To investigate the influence of abdominal drawing-in maneuver(ADIM)with different types of biofeedback(verbal biofeedback,pressure biofeedback and ultrasound imaging biofeedback)on patients with chronic low back pain who belong to stabilization-deficit subgroup.Subjective perception of pain,fear-avoidance beliefs,functional ability and change of Transversus Abdominis(Tr A)activation during supine and upright loaded functional tasks were tested in this study.Method: 30 subjects(13men,17women)with chronic low back pain who met stabilization-deficit classification criteria were divided randomly into verbal biofeedback group(n=9),pressure biofeedback group(n=11)and ultrasound imaging biofeedback group(n=10).Subjects received ADIM with verbal biofeedback,pressure biofeedback and ultrasound imaging biofeedback respectively for four times and last for four weeks.Percentage change of Tr A thickness during supine(external rotation of lower-extremity,hip and knee flexion and straight leg raising)and upright loaded(lifting task,loaded forward reach activity,stepping stair)position were tested before intervention,after one time intervention,seven days after first intervention and after four-time intervention.The score of Visual Analogue Scale(VAS),Fear-avoidance Beliefs Questionnaire(FABQ)and Roland-Morris Disability Questionnaire(RMDQ)were test before intervention and after four-week intervention.Result: After four-week intervention,no difference was observed for the score of VAS,FABQ and RMDQ in all three groups(p>0.05).During supine and upright loaded functional tasks with abdominal drawing-in maneuver,a short session of ADIM training resulted in significant increase of percentage change of Tr A thickness in all three groups(p<0.05);there was no significant difference between the data after first intervention and the data of retention test(p>0.05);during most functional tasks,percentage change of Tr A thickness increased significantly in three groups(p<0.05)after four-time intervention compared with one intervention.During supine and uploaded functional tasks without abdominal drawing-in maneuver,the percentage of Tr A thickness remained the same in all three groups(p>0.05)after one intervention,while the percentage of Tr A thickness increased significantly in all three groups(p<0.05)after four-time intervention.Conclusion:(1)Adding pressure biofeedback or ultrasound imaging biofeedback in ADIM doesn't have better influence on Tr A activation level.(2)Single ADIM training doesn't improve pain index,fear-avoidance beliefs and functional ability.(3)For patients with chronic low back pain who belong to stabilization-deficit subgroup,adding ADIM to functional tasks increases the level of Tr A activation.(4)As a motor learning process,ADIM has excellent persistence and adaptability.(5)With the increase of intervention time,Tr A activation level during functional tasks increases.