![]() compared respiratory rate and diaphragm and pelvic floor movement using real time ultrasound during a task that required load transfer through the lumbo-pelvic region (the active straight leg raise test). 21 studied subjects with LBP attributed to the sacroiliac joints and compared them to control subjects without pain. 6 Thus, it is also possible that faulty posture such as over lengthened abdominals and excessive lordosis could reduce the coordination of the diaphragm and transversus abdominis during respiration and stabilization activities. noted that during respiratory disease the coordinating function between the transversus abdominis and diaphragm was reduced. The muscles function in reverse during exhalation with the diaphragm contracting eccentrically while the transversus abdominis contracts concentrically. During inspiration, the diaphragm contracts concentrically, whereas the transversus abdominis contracts eccentrically. 27 describe coordination of the Transversus abdominis and the diaphragm in respiration during tasks in which stability is maintained by tonic activity of these muscles. Perhaps stabilization exercises that encourage an optimal ZOA of the diaphragm which in turn promotes optimal activation of the transversus abdominis may further help to address suboptimal respiration and posture which may be associated with LBP. Traditional stabilization exercises that have included transversus abdominis, multifidi and/or paraspinal activation are not always sufficient to prevent future episodes of pain. 26 In spite of decreasing LBP with stabilization exercises, the rate of recurrence of LBP, 15 suggests that there may be a missing component to traditional stabilization exercise programs. 25 Stabilization exercises have also included co-contraction exercises of the abdominals and lumbar extensor muscles. ![]() 23, 24 These stabilization exercises utilize verbal and tactile cuing in order to educate the patient to voluntarily contract the transversus abdominis and multifidi via the abdominal drawing in maneuver (ADIM) in a variety of positions such as supine, sitting, sit to stand, standing and single leg standing. Rehabilitation programs prescribed by physical therapists with the goal of decreasing lumbar-pelvic instability via specific stabilization exercises have been shown to decrease LBP. 18– 20 Poor neuromuscular control of core muscles (transversus abdominis, internal oblique, pelvic floor and diaphragm) has been described in individuals with SIJ pain 21 and in individuals with lumbar segmental instability, potentially adversely affecting respiration. 16– 18 Excessive lumbar lordosis may be associated with over lengthened and weak abdominal musculature. 15 Low back pain is frequently correlated with faulty posture such as an excessive lumbar lordosis. 16 The incidence of LBP has been documented to be as high as 30% in the athletic population, and in many cases pain may persist for years. This region includes the osseous structures and soft tissue of the lumbar segments and the sacroiliac joints (SIJs). 14, 15 Low back pain is defined as pain that occurs between the 12 th rib and the gluteal fold. ![]() In an athletic population, low back pain (LBP) is one of the most common reasons for missed playing time by professional athletes. Diminished activation of the transversus abdominis which is important for both respiration and lumbar stabilization.
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