Lumbar spine stability can be augmented with an abdominal belt and/or increased intra-abdominal pressure

Cholewicki, J.; Juluru, Krishna; Radebold, Andrea; Panjabi, Manohar M.; McGill, Stuart M.

Affiliations

¹Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, P.O. Box 208071, New Haven, CT 06520-8071, USA

²Occupational Biomechanics Laboratories, Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada

Abstract and keywords

The increased intra-abdominal pressure (IAP) commonly observed when the spine is loaded during physical activities is hypothsized to increase lumbar spine stability.The mechanical stability of the lumbar spine is an important consideration in low back injury prevention and rehabilitation strategies. This study examined the effects of raised IAP and an abdominal belt on lumbar spine stability. Two hypotheses were tested: (1) An increase in IAP leads to increased lumbar spine stability, (2) Wearing an abdominal belt increases spine stability. Ten volunteers were placed in a semi-seated position in a jig that restricted hip motion leaving the upper torso free to move in any direction. The determination of lumbar spine stability was accomplished by measuring the instantaneous trunk stiffness in response to a sudden load release. The quick release method was applied in isometric trunk flexion, extension, and lateral bending. Activity of 12 major trunk muscles was monitored with electromyography and the IAP was measured with an intra-gastric pressure transducer. A two-factor repeated measures design was used (P < 0.05), in which the spine stability was evaluated under combinations of the following two factors: belt or no belt and three levels of IAP (0, 40, and 80% of maximum). The belt and raised IAP increased trunk stiffness in all directions, but the results in extension lacked statistical significance. In flexion, trunk stiffness increased by 21% and 42% due to 40% and 80% IAP levels respectively; in lateral bending, trunk stiffness increased by 16% and 30%. The belt added between 9% and 57% to the trunk stiffness depending on the IAP level and the direction of exertion. In all three directions, the EMG activity of all 12 trunk muscles increased significantly due to the elevated IAP. The belt had no effect on the activity of any of the muscles with the exception of the thoracic erector spinae in extension and the lumbar erector spinae in flexion, whose activities decreased. The results indicate that both wearing an abdominal belt and raised IAP can each independently, or in combination, increase lumbar spine stability. However, the benefits of the belt must be interpreted with caution in the context of the decreased activation of a few trunk extensor muscles.

Keywords: Lumbar spine, stability; Lumbar spine, intra-abdominal pressure; Lumbar spine, abdominal belts; Lumbar spine, electromyography

Links

DOI: 10.1007/s005860050192

PubMed: 10552322

PubMedCentral: PMC3611203

WoS: 000083622200009

History

Received: 1998-08-17

Revised: 1999-3-01

Accepted: 1999-03-18

Cited Works (11)

Year	Entry
1999	Cholewicki J, Juluru K, McGill SM. Intra-abdominal pressure mechanism for stabilizing the lumbar spine. J Biomech. January 1999;32(1):13-17.
1994	McGill S, Seguin J, Bennett G. Passive stiffness of the lumber torso in flexion, extension, lateral bending, and axial roatation: effect of belt wearing and breath holding. Spine. March 15, 1994;19(6):696-704.
1990	Winter DA. Biomechanics and Motor Control of Human Movement. 2nd ed. New York, NY: Inc., John Wiley & Sons; 1990.
1992	Panjabi MM. The stabilizing system of the spine, II: neutral zone and instability hypothesis. J Spinal Disord. December 1992;5(4):390-396.
1996	Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clin Biomech (Bristol, Avon). January 1996;11(1):1-15.
1990	Crisco JJ III, Panjabi MM. Postural biomechanical stability and gross muscular architecture in the spine. In: Winters JM, Woo SL-Y, eds. Multiple Muscle Systems: Biomechanics and Movement Organization. New York, NY: Springer-Verlag; 1990:438-450.
1957	Bartelink DL. The role of abdominal pressure in relieving the pressure on the lumbar intervertebral discs. J Bone Joint Surg. November 1957;39B(4):718-725.
1992	Oxland TR, Panjabi MM. The onset and progression of spinal injury: a demonstration of neutral zone sensitivity. J Biomech. October 1992;25(10):1165-1172.
1992	Panjabi MM. The stabilizing system of the spine, I: function, dysfunction, adaptation, and enhancement. J Spinal Disord. December 1992;5(4):383-389.
1990	Hogan N. Mechanical impedance of single- and multi-articular systems. In: Winters JM, Woo SL-Y, eds. Multiple Muscle Systems: Biomechanics and Movement Organization. New York, NY: Springer-Verlag; 1990:149-164.
1961	Morris JM, Lucas DB, Bresler B. Role of the trunk in stability of the spine. J Bone Joint Surg. April 1961;43A(3):327-351.

Cited By (12)

Year	Entry
2023	Bernier E, Driscoll M. Numerical investigation of intra-abdominal pressure and spinal load-sharing upon the application of an abdominal belt. J Biomech. December 1, 2023;161:111863.
2019	Beaucage-Gauvreau E. Brace for it: Assessing Lumbar Spinal Loads for a Braced Arm-to-Thigh Lifting and Bending Technique Using a Musculoskeletal Modelling Approach [PhD thesis]. University of Adelaide; June 2019.
2022	El Bojairami I. Assessment of Static Spinal Stability and Muscle Activation Strategies: A Comprehensive Approach Via a Novel Validated Finite Elements Spine Model Inclusive of Thoracolumbar Fascia, Intramuscular Pressure, and Intra-Abdominal Pressure [PhD thesis]. McGill University; April 2022.
2006	Arjmand N. Computational Biomechanics of the Human Spine in Static Lifting Tasks [PhD thesis]. École polytechnique de Montréal; October 2006.
2007	Bazrgari B. Biodynamic of the Human Spine [PhD thesis]. École polytechnique de Montréal; February 2007.
2006	Abdoli-Eramaki M. Design and Instrumentation of a Mechanical Personal Lift Augmentation Device (PLAD) for Manual Lifting Tasks [PhD thesis]. Queen's University; January 2006.
2008	Agnew MJ. Kinetic and Kinematic Adaptations to Use of a Personal Lift Assist Device [PhD thesis]. Queen's University; September 2008.
2012	Graham RB. Assessing Dynamic Spinal Stability Using Maximum Finite-Time Lyapunov Exponents [PhD thesis]. Queen's University; July 2012.
2005	Sran MM. Manual Therapy and the Osteoporotic Spine [PhD thesis]. Vancouver, BC: University of British Columbia; March 2005.
2002	Grenier SG. Stabilization Strategies of the Lumbar Spine in Vivo [PhD thesis]. University of Waterloo; 2002.
2008	Brown SHM. Examining the Neuromuscular and Mechanical Characteristics of the Abdominal Musculature and Connective Tissues: Implications for Stiffening the Lumbar Spine [PhD thesis]. University of Waterloo; 2008.
2007	Reeves NP. Tuning-Out Instability: The Importance of Feedback Control in the Spine [PhD thesis]. Yale University; December 2007.