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Changes in transversus abdominis muscle thickness after lumbo-pelvic core stabilization training among chronic low back pain individuals

Leonard JH, Paungmali A, Sitilertpisan P, Pirunsan U, Uthaikhup S

Clin Ter, 2015;166(5):e312-6.
PMID: 26550815 DOI: 10.7417/T.2015.1884

OBJECTIVE: Lumbo-pelvic core stabilization training (LPST) is one of the therapeutic exercises common in practice for rehabilitation of patients with chronic low back pain. This study was carried out to examine the therapeutic effects of LPST on the muscle thickness of transversus abdominis (TrA) at rest and during contraction among patients with chronic non-specific low back pain.
MATERIALS AND METHODS: A total of 25 participants (7 males and 18 females) with chronic non-specific low back pain participated in a within-subject, repeated measures, double-blinded, placebo-controlled comparisons trial. The participants received three different types of experimental therapeutic training conditions which includes the lumbo-pelvic core stabilization training (LPST), the placebo treatment with passive cycling (PC) and a controlled intervention with rest (CI). The interventions were carried out by randomization with 48 hours between the sessions. The effectiveness of interventions was studied by measuring the changes in muscle thickness of TrA at rest and during contraction using a real time ultrasonography.
RESULTS: Repeated measures ANOVA demonstrated that the LPST provided significant therapeutic benefits as measured by an increase in the muscle thickness of the TrA at rest (p<0.05) and during contraction (p<0.01). The percentage change of the muscle thickness observed during LPST was significantly higher (p<0.01) when compared to the other two experimental training conditions.
CONCLUSIONS: The findings indicated that the LPST might provide therapeutic benefits by increasing the muscle thickness and function of TrA. Therefore, it is suggested that LPST technique should be considered as part of management program for treatment of low back pain.
KEYWORDS: Back pain; Core stabilization; Lumbo-pelvic exercise; Rehabilitation; Transversus abdominis
Altered breathing pattern valuation relatively to dyspnea assessment and treatment for low back pain: Effects of clinical practice

Mohan V, Paungmali A, Sitilertpisan P

Musculoskelet Sci Pract, 2017 02;27:e1-e2.
PMID: 27697391 DOI: 10.1016/j.math.2016.09.004
Letter to Editor: Application of neuroplasticity theory through the use of the Feldenkrais Method with a runner with scoliosis and lower quarter pain: Additional respiratory mechanics principle, implication of the Feldenkrais method for clinical practice in neuro-musculoskeletal rehabilitation

Mohan V, Paungmali A, Sitilertpisan P

J Bodyw Mov Ther, 2017 07;21(3):470-471.
PMID: 28750952 DOI: 10.1016/j.jbmt.2016.08.008
The science of respiratory characteristics in individuals with chronic low back pain: Interpreting through statistical perspective

Mohan V, Paungmali A, Sitilertpisan P

J Bodyw Mov Ther, 2018 01;22(1):11-12.
PMID: 29332732 DOI: 10.1016/j.jbmt.2017.03.017
Fulltext Improvements in tissue blood flow and lumbopelvic stability after lumbopelvic core stabilization training in patients with chronic non-specific low back pain

Paungmali A, Henry LJ, Sitilertpisan P, Pirunsan U, Uthaikhup S

J Phys Ther Sci, 2016 Jan;28(2):635-40.
PMID: 27064327 DOI: 10.1589/jpts.28.635

[Purpose] This study investigated the effects of lumbopelvic stabilization training on tissue blood flow changes in the lumbopelvic region and lumbopelvic stability compared to placebo treatment and controlled intervention among patients with chronic non-specific low back pain. [Subjects and Methods] A total of 25 participants (7 males, 18 females; mean age, 33.3 ± 14.4 years) participated in this within-subject, repeated-measures, double-blind, placebo-controlled comparison trial. The participants randomly underwent three types of interventions that included lumbopelvic stabilization training, placebo treatment, and controlled intervention with 48 hours between sessions. Lumbopelvic stability and tissue blood flow were measured using a pressure biofeedback device and a laser Doppler flow meter before and after the interventions. [Results] The repeated-measures analysis of variance results demonstrated a significant increase in tissue blood flow over the lumbopelvic region tissues for post- versus pre-lumbopelvic stabilization training and compared to placebo and control interventions. A significant increase in lumbopelvic stability before and after lumbopelvic stabilization training was noted, as well as upon comparison to placebo and control interventions. [Conclusion] The current study supports an increase in tissue blood flow in the lumbopelvic region and improved lumbopelvic stability after core training among patients with chronic non-specific low back pain.
Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain

Paungmali A, Joseph LH, Sitilertpisan P, Pirunsan U, Uthaikhup S

Pain Pract, 2017 11;17(8):1008-1014.
PMID: 28042685 DOI: 10.1111/papr.12552

BACKGROUND: Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain.
METHODS: A within-subject, repeated-measures, crossover randomized controlled design was conducted among 25 participants (7 males and 18 females) with chronic nonspecific low back pain. All the participants received 3 different types of experimental interventions, which included LPST, the passive automated cycling intervention, and the control intervention randomly, with 48 hours between the sessions. The pressure pain threshold (PPT), hot-cold pain threshold, and pain intensity were estimated before and after the interventions.
RESULTS: Repeated-measures analysis of variance showed that LPST provided therapeutic effects as it improved the PPT beyond the placebo and control interventions (P < 0.01). The pain intensity under the LPST condition was significantly better than that under the passive automated cycling intervention and controlled intervention (P < 0.001). Heat pain threshold under the LPST condition also showed a significant trend of improvement beyond the control (P < 0.05), but no significant effects on cold pain threshold were evident.
CONCLUSIONS: Lumbopelvic stabilization training may provide therapeutic effects by inducing pain modulation through an improvement in the pain threshold and reduction in pain intensity. LPST may be considered as part of the management programs for treatment of chronic low back pain.
The effect of core stability training with ball and balloon exercise on respiratory variables in chronic non-specific low back pain: An experimental study

Mohan V, Paungmali A, Sitilertpisan P, Henry LJ, Omar FA, Azhar FZ

J Bodyw Mov Ther, 2020 Oct;24(4):196-202.
PMID: 33218511 DOI: 10.1016/j.jbmt.2020.07.007

BACKGROUND: Studies have shown the involvement of respiratory characteristics and their relationship with impairments in non-specific low back pain (NS-LBP). The effects of core stability with a combined ball and balloon exercise (CBB) on respiratory variables had not been investigated.
OBJECTIVE: To evaluate the effectiveness of CBB on respiratory variables among NS-LBP patients.
STUDY DESIGN: pre- and post-experimental study.
PARTICIPANTS: Forty participants were assigned to an experimental group (EG) [n = 20] and control group (CG) [n = 20] based on the study criteria.
INTERVENTIONS: The EG received CBB together with routine physiotherapy and the CG received routine physiotherapy over a period of 8 weeks. Participants were instructed to carry out the exercises for 3 days per week. The training was evaluated once a week and the exercises progressed based on the level of pain.
OUTCOME MEASURES: Primary outcomes were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV). The secondary outcomes were measured in the numeric rating scale (NRS), total faulty breathing scale (TFBS), cloth tape measure (CTM) and lumbo-pelvic stability.
RESULTS: The MIP increased significantly among the EG when compared with that in the CG (p > 0.05).The EG showed a significant increase in MVV (p = 0.04) when compared to the CG (p = 0.0001). There was a significant reduction in pain for both groups. The MEP, TFBS, chest expansion and core stability showed no changes in either group.
CONCLUSION: CBB was effective in improving respiratory variables among NS-LBP patients.
Intra-rater and inter-rater reliability of total faulty breathing scale using visual observation and videogrammetry methods

Mohan V, Perri M, Paungmali A, Sitilertpisan P, Joseph LH, Jathin R, et al.

J Bodyw Mov Ther, 2017 Jul;21(3):694-698.
PMID: 28750986 DOI: 10.1016/j.jbmt.2016.10.007

Faulty breathing is an aspect of alteration in the normal fundamental pattern of breathing. The available existence of scales in assessing faulty breathing has not frequently been used. Measurement errors in assessing and quantifying breathing patterns may originate from unclear directions and variation between observers. This study determined the measure reliability of the Total Faulty Breathing Scale (TFBS) for quantifying breathing patterns. Twenty seven participants were recruited comprising healthy and unhealthy subjects. Two examiners assessed their breathing patterns using the TFBS on two different occasions with visual observation and a videogrammetry method. Evaluation of the observational breathing pattern method for intra-rater and inter-rater showed agreement of 96.30% and a kappa score of greater than 0.78, which indicated substantial agreements. The videogrammetry method showed a percent agreement of (100%) with a kappa score of (1.00). This study indicates that the TFBS is a considerably reliable tool for evaluating breathing patterns with both visual observation and a videogrammetry method.