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Background: The serratus anterior (SA) is a muscle that performs protraction of the scapulothoracic joint and plays a role in stabilizing the scapula. Imbalances or weaknesses in SA activation are associated with a variety of shoulder dysfunctions, making selective SA strengthening important for rehabilitation. Objects: We aimed to compare the muscle activation of the pectoralis major (PM), SA, external oblique (EO), and internal oblique (IO) during the push-up plus (PUP) exercise with isometric hip adduction (HA) and abdominal drawing-in maneuver (ADIM). Methods: Nineteen healthy male participants performed three PUP exercises: standard PUP, PUP with ADIM, and PUP with HA. Surface electromyography was used to measure and analyze the muscle activity for PM, SA, EO, and IO. Results: PUP with HA showed the lowest PM activity and highest SA activity, and no significant difference was observed between PUP and PUP with ADIM. PUP with ADIM showed significantly the highest EO and IO activity, followed by PUP with HA and PUP. Additionally, PUP with HA showed the lowest PM/SA ratio, and no significant difference was noted between PUP and PUP with ADIM. Conclusion: PUP with HA was able to show high SA muscle activity while reducing PM muscle activity. In addition, PUP with HA can lead to higher EO and IO muscle activity than standard PUP. This exercise could be used as a practical exercise method to selectively strengthen SA and improve scapular muscle stability during early shoulder rehabilitation.

Objective: The goal of this article is to compile relevant literature that proposes that perhaps the abdominal drawing-in maneuver (ADIM), also known as the “abdominal hollowing maneuver” (AHM), should not be applied as a general rule during the core training. Methods and Materials: Based on current evidence, this paper evaluates whether general use of this ADIM is beneficial for the core training. In this regard, we have searched for related scientific evidence in PubMed and Google Scholar. The keywords used were: abdominal hollowing maneuver, abdominal drawing-in maneuver, lumbo-pelvic stability, core stability. Results: The literature shows us that the application of ADIM during core strengthening exercises does not meet the requirements for isolated TrA-specific retraining, can increase Inter-Rectus Distance, may be incompatible with postural stability goals, and could interfere the Rectus Abdominis input impairing the lumbo-pelvic stability during high-load exercises. Conclusion: It can be concluded that if the goal is to train core stability and strength with high-load scenarios we should not use the ADIM. [ABSTRACT FROM AUTHOR]

the transversus abdominis muscle (TrA) has a fundamental role in the segmental control of lumbosacral spine. Some strategies have been reported to facilitate TrA activation, such as ADIM (abdominal drawing-in maneuver), biofeedback systems or expiration against resistance. The latest, despite being a promising therapy, is still scarcely studied. Objectives: to compare TrA thickness during two contraction techniques, ADIM versus ADIM combined with TheraPEP®, and secondarily, to evaluate the subjective perception of contraction difficulty. Material and method: a cross-sectional pilot study was performed with 11 healthy female volunteers (20.09 ± 2.43 years), who were asked to perform 2 ADIM maneuvers (with/without TheraPEP) in 3 different conditions (static, right leg raise and left leg raise). The thickness of the TrA was evaluated by ultrasound and the perception of difficulty levelof contraction with a Likert-type scale. The images were analyzed with AutoCAD software and data analysis with IBM SPSS 22.0 software. Descriptive statistics and comparison of means for related samples were calculated. Results: statistically significant mean differences were observed in TrA contraction fraction in favor of the maneuvers performed with TheraPEP®: ADIM (0.69; p = 0.013), ADIM right leg (0.40; p = 0.026) and ADIM left leg (0.29; p = 0.016). Regarding the perception of contraction difficulty, no significant differences were found between the different maneuvers. Conclusions: TrA thickness increases significantly more in the ADIM maneuver combined with TheraPEP® compared to the ADIM maneuver. [ABSTRACT FROM AUTHOR]

BACKGROUND: To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another. OBJECTIVE: The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude. METHODS: Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P < 0.05. RESULTS: Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P < 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS. CONCLUSIONS: DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization. [ABSTRACT FROM AUTHOR]

one of the most frequent determinants of long-term disability in the adults is Stroke which may affect the normal functioning of trunk and hence may disturb balance. to assess the effects of "Abdominal Drawing-in Maneuver" and "Diaphragmatic Breathing Maneuver" in improving the stability of trunk in stroke patients. A quasi-experimental study including 36 patients with confirmed diagnosis of the first incident of stroke was conducted. Patients were assigned randomly in two groups ADIM and DBM. Outcome measurements were evaluated using the "Trunk Impairment Scale". after 4 weeks of training; "Trunk Impairment Scale" score improved significantly. Between groups comparison shows that trunk stability significantly improved in the group DBM as compared those in the group ADIM. it may be concluded that Diaphragmatic Breathing Maneuver can be an effective technique in improving trunk stability in stroke patients. [ABSTRACT FROM AUTHOR]

To measure the thickness of transversus abdominis(TrA), internal oblique(IO), external oblique(EO) and multifidus(MF) and compare the effects on trunk stability according to the performing abdominal drawing-in manuever during plank exercises. Thirty healthy male and female adults were recruited. Subjects perform the plank exercises after measuring thickness of TrA, IO, EO and MF in resting position. When performing the General plank(GP), General plank with abdominal drawing-in maneuver(GPA), Unstable surface of plank(USP) and Unstable surface of the plank with abdominal drawing-in maneuver(USPA), we measured three times and used the value of measurements. All measurements were used in One way repeated ANOVA. The results of study, resting time and each plank exercises showed significant differences in TrA, IO, MF muscles. In the comparison between each plank exercises, the TrA, IO, MF activation increased because that muscle were thicker than other plank exercises when performing GPA and USPA. These findings suggest that a plank exercise with abdominal drawing-in maneuver is useful way in trunk stability. [ABSTRACT FROM AUTHOR]

* BACKGROUND: Two potential interventions for enhancing lumbar stability are to actively increase abdominal muscle activity, either through the abdominal drawing-in maneuver (ADIM) or bracing, and passively increase lumbar stiffness using a lumbosacral orthosis (LSO), * OBJECTIVE: To compare the increase in lumbar stiffness after 2 active interventions (ADIM versus bracing) and 1 passive intervention (LSO), and to evaluate the combined effect of active (abdominal bracing) and passive interventions. * METHODS: In this experimental and comparative study, lumbar stiffness, a surrogate measure of lumbar stability, was estimated in 25 healthy individuals during 7 trunk perturbation conditions: (1) control, (2) ADIM, (3) bracing at 5% of right external oblique maximal voluntary activation (5% bracing), (4) bracing at 10% of right external oblique maximal voluntary activation (10% bracing), (5) LSO, (5) LSO plus 5% bracing, and (7) LSO plus 10% bracing. Electromyographic biofeedback of the external oblique was provided on a monitor, while ultrasound was used for the ADIM to ensure a sustained contraction of the transversus abdominis. * RESULTS: The ADIM, 5% bracing, and 10% bracing active interventions generated comparable lumbar stiffness. However, considering that bracing can range from 10% to 20%, it may be superior to hollowing, as further estimated with a mixed-effect statistical model. Combining bracing and an LSO resulted in an additive effect on lumbar stiffness. * CONCLUSION: Bracing and ADIM produced comparable lumbar stiffness, as they were performed at the same overall abdominal activation levels (5% and 10% maximal voluntary activation). The independent effects of bracing and LSO raises the possibility of combining these interventions in some circumstances. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lateral abdominal muscles control the lumbar region and this manages the stability of the trunk through co-contraction. Abdominal drawing-in maneuver (ADIM) is the basis method for spine stabilization to restore proper neuromuscular control. OBJECTIVE: To investigate the effect of therapeutic abdominal drawing-in maneuver on abdominal muscle thickness and balance. METHODS: Twenty healthy adults were divided into 2 groups. The experimental group performed a bridging exercise with ADIM whereas the control group performed a bridging exercise without ADIM. The exercise was conducted 3 times a week for 4 weeks. Ultrasonography was used to measure the thickness of abdominal muscles. Balance ability was evaluated using Tetrax device. The Wilcoxon signed ranks test for comparison of pre and post values and Mann Whitney U test for comparison between groups were used. RESULTS: After 4 weeks, there was a significant difference in the thickness of TrA between groups (p < 0.05) whereas no significant difference in IO and EO (p > 0.05). In stability values, the experimental group showed significant changes in stability indexes of standing with eyes open (NO) and standing on the pillow with eyes closed (PC) after the exercise period and there was a significant difference in NO between two groups. CONCLUSIONS: Performing the bridging exercise with abdominal drawing-in maneuver is a more effective way to strengthen the abdominal muscles and stabilize the body than bridging exercise only. [ABSTRACT FROM AUTHOR]

Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). Materials and Methods: A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Results: Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA (p = 0.001) and IO (p = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM (p = 0.001, Cohen’s d = 2.183) and at rest and with the EFCD (p = 0.001, Cohen’s d = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found (p = 0.055, Cohen’s d = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest (p = 0.038), Cohen’s d = 0.081). Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA.

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Based on previous studies indicating that core stabilization exercises accompanied by abdominal drawing-in maneuvers increase the thickness of the transversus abdominis muscle. OBJECTIVE: The purpose of this study was to compare the measurements of abdominal muscle thicknesses during running in place in a limited area with the abdominal drawing-in maneuver. METHODS: The study classified the subjects into two experimental groups: the training group (M = 2, F = 13), and the control group (M = 2, F = 13). The training group performed three sets of running in place in a limited area with abdominal drawing-in maneuvers each time, three times a week for six weeks. The abdominal muscle thicknesses of the subjects were measured using ultrasonography. RESULTS: Comparing the training group's abdominal muscle thickness before and after this study, there was a statistical significance in all of the external obliquus abdominis, the internal obliquus abdominis, and the transversus abdominis. In particular, thicknesses of external obliquus abdominis and internal obliquus increased remarkably. CONCLUSIONS: Running in place in a limited area accompanied by abdominal drawing-in maneuvers increased the thickness of the deep abdominal muscles that are the basis of trunk stabilization. [ABSTRACT FROM AUTHOR]

To compare effects of verbal, tactile-verbal and visual feedback on muscle activation of the trunk stabilizers relative to trunk-extremity movers during Abdominal Drawing-In Maneuver (ADIM). The study employed a quasi-experimental pre-post intervention design. The study was conducted at School of Health Professions, SUNY Health Sciences University. A convenience sample of 54 healthy participants between18-49 years of age were equally divided among three feedback groups: Verbal, Tactile-Verbal and Visual. All participants were instructed similarly to perform the ADIM prior to receiving intervention 2x/week over a four-week period. The feedback provided during interventions was delivered concurrently but feedback types differed amongst the groups. Verbal group received intermittent feedback based upon observance of substitution patterns. Tactile-verbal group received feedback every trial upon palpation of Transverse Abdominis. Lastly, Visual group received feedback every trial using a pressure biofeedback unit. The percentage of maximum voluntary isometric contraction of rectus abdominis (RA), multifidus (MF), erector spinae (ES), and hamstrings (HS) as outcome measures were acquired using surface electromyography. A two-way factorial ANOVA with bootstrapping allowed comparison of pre-post difference scores across the interaction of feedback and muscle groups. HS activation decreased in the tactile-verbal group, relative to an increase in subjects given visual feedback. Furthermore, in the verbal group, HS activity increased relative to a decline in RA; and in the visual group, HS activity increased relative to a decrease in MF. However, no pre-post changes were seen across muscles with tactile-verbal feedback. Although tactile-verbal feedback did not increase MF recruitment, it recruited less HS activity than verbal and especially visual feedback. Increases in HS recruitment may reflect boredom of simple task or feedback dependency. The authors have no disclosures. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the reliability of sonographic measurements of the transversus abdominis of adults without low back pain during upright loaded functional tasks in real time, without relying on delayed recorded images. Methods: A single‐group repeated‐measures reliability study was conducted on 12 healthy participants without low back pain. Six of these adults reported a prior history of abdominal drawing‐in maneuver training without sonographic measurement. The participants performed 3 trials of neutral standing, a loaded forward reach, and a loaded box lift under rest and with abdominal drawing‐in maneuver instructions; task order was randomized. Transversus abdominis thickness measurements were obtained by an experienced rater using B‐mode sonography in real‐time via electronic calipers twice on the same static image during all trials by a rater. The rater was masked to group assignment and on‐screen measurement output and required to respond to trivia questions between repeated measurements. Results: The participants included 6 male and 6 female adults with a mean age ± SD of 26.3 ± 3.7 years. Intra‐rater intraclass correlation coefficients (2,3) were high and precise for the rater's first and second measurements for all tasks and instruction conditions for mean transversus abdominis thickness and percent change in thickness measurements (eg, ranges were 0.968–0.997 for intraclass correlation coefficients, 0.01–0.21 mm for standard errors of the measurement, and 0.01–0.58 mm for minimal detectable changes). Calipers cleared by the rater or a research assistant produced similar findings of excellent reliability and precision. Conclusions: High intra‐rater reliability and precision of transversus abdominis thickness measurements were obtained by a physical therapist in real time from asymptomatic adults performing upright loaded functional tasks under rest and with abdominal drawing‐in maneuver instructions. [ABSTRACT FROM AUTHOR]

Purpose Recent evidence suggested the significance of integrity of the tension balance of the muscle-fascia corset system in spinal stability, particularly the posterior musculofascial junction which is adjacent to dorsal located paraspinal muscles joining each other at lateral raphe (LR). The purpose of this study was to compare the contraction of the transversus abdominis (TrA) at both anterior and posterior musculofascial muscle-fascia junctions in patients with low back pain (LBP) and asymptomatic participants before and immediately after a sustained manual pressure to LR. Methods The present observational cohort study used a single-instance, test-retest design. The outcome variables included the resting thickness (Tr), the thickness during contraction (Tc), change in thickness (ΔT), sliding of musculofascial junction (ΔX), muscle length at rest (L) and displacement pattern (ΔD) of the TrA using ultrasonography. Vertical tolerable pressure at the LR was applied manual for 1 min. Tr, Tc, ΔT, and ΔX were analyzed by three-way ANOVA (musculofascial junction sites*group* pre-post manual release). ΔL and ΔD were analyzed by two-way ANOVA (group* pre-post manual release). Results Participants with LBP revealed less Tc, ΔT and ΔX at both sites ( p < 0.005). After myofascial release, LBP group demonstrated a positive ΔD of the musculofascial junctions at both end ( p < 0.001). Nevertheless, both groups increased the ΔT and ΔX at both sites ( p < 0.001 and 0.001, respectively). Conclusion The result indicated immediately effect of sustained manual pressure on musculofascial junction of TrA and supported the concept that the possible imbalanced tension of the myofascia corset of TrA in patients with LBP. [ABSTRACT FROM AUTHOR]

Purpose: No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia. Methods: Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15 minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1 second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity. Results: Our results showed that changes between the pre- and post-test values of FVC (F=12.50, P=0.02) and FEV1 (F=12.81, P=0.01) (P<0.05) in the ITG were significantly (P<0.05) greater. Changes in EMG activation of the diaphragm (F=13.75, P=0.003) and external intercostal (F=14.33, P=0.002) (P<0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P<0.05) greater than those in patients of the RMTG and the CG at post-test. Conclusions: Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia. [ABSTRACT FROM AUTHOR]

Purpose: No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia. Methods: Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15 minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1 second (FEV-i). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity. Results: Our results showed that changes between the pre- and post-test values of FVC (F= 12.50, P= 0.02) and FEV-i (F=12.81, P=0.01) (P<0.05) in the ITG were significantly (P<0.05) greater. Changes in EMG activation of the diaphragm (F= 13.75, P= 0.003) and external intercostal (F= 14.33, P=0.002) (P<0.01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (P< 0.05) greater than those in patients of the RMTG and the CG at post-test. Conclusions: Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia. [ABSTRACT FROM AUTHOR]

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The abdominal drawing-in maneuver (ADIM) is used to prevent abnormal movements of the lumbar spine and pelvis during therapeutic exercises. This study compared the effects of ADIM on the muscle onset time of the hamstring, gluteus maximus, and erector spinae muscles during prone hip extension exercise in subjects with or without hyperlordotic lumbar angle. Forty healthy adults (18 male, 22 female) were recruited for this study. Methods: The lumbar lordotic angles and pelvic tilt angles of the subjects were measured using the Avaliação postural analysis software. The subjects were divided into two groups: the lumbar hyperlordotic angle (LHLA) and lumbar normal lordotic angle (LNLA) groups. The muscle contraction onset time of the hamstring, gluteus maximus, and erector spinae were assessed using surface electromyography. Results: During ADIM application, the muscle contraction onset time of the gluteus maximus was significantly increased in the LHLA group compared with the LNLA group. Conclusions: ADIM application during prone hip extension was more effective for gluteus maximus onset time in the LHLA group. Therefore, ADIM during prone hip extension may be useful for gluteus maximus training in individuals with lumbar hyperlordosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of novel augmented abdominal drawing-in maneuver (ADIM) training using rehabilitative ultrasound imaging (RUSI) and electromyography (EMG) in adults with core instability. Methods: A convenience sample of 20 young adults with core instability (female =4; mean age ± standard deviation=24.4 ± 2.9 years) was recruited. Core instability was determined by the formal test. All subjects underwent an intensive ADIM that was augmented by comprehensive visual feedback via a pressure biofeedback unit, RUSI, and EMG. The intervention was provided for 20 minutes a day, 7 days a week, over a two-week period. Results: The paired t-test showed that both transverse abdominal (TrA) and internal oblique (IO) muscle thickness during ADIM were significantly greater than at rest (p= 0.000). However, external oblique (EO) muscle thickness remained relatively unchanged. The mean EMG amplitudes of the EO and erector spinae (ES) muscles were significantly decreased after the intervention (p=0.001, p=0.008). The intra-class correlation coefficient (ICC_{1,2}) showed the excellent test-retest reliability for muscle thickness (ranging from 0.90 to 0.98 in the prone position). Conclusion: This is the first evidence to demonstrate that the novel augmented ADIM training can effectively improve the lumbo-pelvic stabilization in adults with core instability. [ABSTRACT FROM AUTHOR]

[Purpose] There have been many studies on ipsilateral erector spinae in regard of prone hip extension (PHE). However, mediating methods have been focusing on the reinforcement of gluteus. Hereupon, this study is intended to identify how an increase of abdominal drawing-in maneuver influences on posterior oblique sling (POS) and suggest a mediating method to effectively reinforce them. [Participants and Methods] This study has been conducted on normal male (10) and female (10), and participants were asked to prove PHE exercise and abdominal drawing-in maneuver prone hip extension exercise (ADIM PHE). Surface electromyography (EMG) was recorded from the contralateral latissimus dorsi, ipsilateral erector spinae, ipsilateral gluteus maximus, and ipsilateral biceps femoris. A pared t-test was used to compare muscle activity POS. [Results] EMG activity of the contralateral latissimus dorsi, ipsilateral gluteus maximus was significantly greater performed ADIM PHE than PHE. As for ipsilateral erector spinae muscle, ipsilateral biceps femoris activation was lower in ADIM PHE than PHE. [Conclusion] According to the results of this study, abdominal drawing-in maneuver seems to be an important factor that influences on muscular activation of POS., Competing Interests: None., (2020©by the Society of Physical Therapy Science. Published by IPEC Inc.)

Background and Objectives: The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). Materials and Methods: A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Results: Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA ( p = 0.001) and IO ( p = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM ( p = 0.001, Cohen's d = 2.183) and at rest and with the EFCD ( p = 0.001, Cohen's d = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found ( p = 0.055, Cohen's d = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest ( p = 0.038), Cohen's d = 0.081). Conclusions: Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA.

The abdominal drawing-in maneuver (ADIM) exercise has been commonly applied to recover lumbopelvic stability and normal movement in the clinical field. Although many researchers investigated its effects using several methods, there is further need for comparing those methods. The purpose of this study was to assess the effects of ADIM with three different methods including a pressure biofeedback unit, a foam-roller, and the quadruped posture on lumbopelvic rotation and muscle activities. Twenty-five healthy participants (14 males, 11 females) who volunteered for this study were randomly divided into three intervention groups. We obtained pre- and postintervention data through application of a three-dimensional motion analysis system and a surface electromyography. Results showed that lumbopelvic rotation degree was significantly decreased in all groups ( P <0.05). The muscle activities of external oblique, internal oblique of left side, and gluteus maximus were significantly increased ( P <0.05). The muscle activities of erector spinae and biceps femoris were not significantly different ( P >0.05). The muscle activity of internal oblique of the right side showed significant differences ( P <0.05), between ADIM with pressure biofeedback group and ADIM with foam-roller group, and ADIM with foam-roller group and ADIM with quadruped group. Three kinds of ADIM were effective to recover lumbopelvic stability. This study suggests that the proper method of ADIM should be applied to a given patient considering abilities to maintain equilibrium and to control muscular strength., Competing Interests: CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

The present study aimed to investigate lumbar multifidus (LM) thickness and perceived exertion during graded superman exercises (GSE) or GSE with an abdominal drawing-in maneuver (GSE-AD) in young adults. Twelve young adult males and females, who were informed of the purpose and procedures of this study and then gave their voluntary consent to participate, were included in this study. All subjects randomly performed three GSE and GSE-AD over 3 days. Ultrasonography was used to measure the LM thickness to the left and right of the L5 region. Additionally, the issue of whole-body fatigue felt by the subject while performing the GSE or GSE-AD was measured using the Borg scale. The intrarater reliability of the LM measurement was found to be intraclass correlation coefficient (ICC[3,1])=0.97 (0.87-0.99) at resting and ICC(3,1)=0.94 (0.78-0.99) at contraction. Both the left and right LM showed significantly higher contraction during the grade 3 GSE ( P < 0.05). The whole-body fatigue was significantly greater following GSE 2 and 3 than following GSE-AD 2 and 3 ( P <0.05). In particular, GSE-AD had a significantly lower Borg score compared to GSE ( P <0.05) and did not show any significant difference in muscle thickness ( P >0.05). It is recommended that the abdominal drawing-in maneuver be applied with grade 3 GSE to enhance stability and reduce spinal fatigue., Competing Interests: CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.

[Purpose] The purpose of this study was to investigate the differential effects of fixation of the thoracolumbar junction on the activity of the thoracic and lumbar muscle groups with and without the abdominal drawing-in maneuver (ADIM). [Subjects and Methods] The participants were 40 healthy adults. During trunk extension, thoracic and lumbar muscle activities were assessed using surface electromyography when fixing the pelvic and popliteal areas and the thoracolumbar junction, with and without the ADIM. [Results] The activity of the thoracic extensors at the T9 level applying thoracolumbar fixation with ADIM was significantly higher than with only pelvic fixation or pelvic fixation with ADIM during prone trunk extension. However, the activity of the lumbar extensors at the L3 level with pelvic fixation alone, without ADIM, was significantly higher than pelvic fixation with ADIM or additional thoracolumbar fixation with ADIM during prone trunk extension [Conclusion] This study demonstrated that fixation of the thoracolumbar junction with ADIM during trunk extension was more effective at eliciting thoracic extensor and minimising lumbar extensor activity than other conventional fixation methods.

Objective: To investigate the effects of respiratory muscle training (RMT) combined with the abdominal drawing-in maneuver (ADIM) on the pulmonary function in patients with chronic spinal cord injury (SCI)., Methods: Thirty-seven subjects with SCI (level of injury: C4-T6, time since injury: 4-5 years) were randomly allocated to three groups; the integrated training group (ITG), the RMT group (RMTG), and the control group (CG). The ITG performed RMT using an incentive respiratory spirometer (IRS) and the ADIM using a stabilizer. The RMTG received only RMT using an IRS. Subjects in the CG received alternative and routine physical therapy or usual care. The interventions were conducted over an eight-week period. Pulmonary function was evaluated using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1 )., Results: The differences between the pre- and post-test values for FVC (0.47 ± 0.05 versus 0.15 ± 0.06 versus -0.03 ± 0.01) and FEV 1 (0.74 ± 0.07 versus 0.27 ± 0.17 versus 0.02 ± 0.67)were significant among the groups. Post-test, in the ITG, the FVC and FEV 1 values showed significant differences from those in the RMTG and CG (F = 11.48 and 11.49, P = 0.002 and 0.001). Furthermore, following the 8-week intervention, the change ratio values of the FVC and FEV 1 of the ITG were increased further by an average of 9.75% and 7.91%, respectively, compared with those of the RMTG., Conclusion: These findings suggest positive evidence that RMT with additional ADIM training can improve pulmonary function in SCI pulmonary rehabilitation.

Background: Based on previous studies indicating that core stabilization exercises accompanied by abdominal drawing-in maneuvers increase the thickness of the transversus abdominis muscle., Objective: The purpose of this study was to compare the measurements of abdominal muscle thicknesses during running in place in a limited area with the abdominal drawing-in maneuver., Methods: The study classified the subjects into two experimental groups: the training group (M = 2, F = 13), and the control group (M = 2, F = 13). The training group performed three sets of running in place in a limited area with abdominal drawing-in maneuvers each time, three times a week for six weeks. The abdominal muscle thicknesses of the subjects were measured using ultrasonography., Results: Comparing the training group's abdominal muscle thickness before and after this study, there was a statistical significance in all of the external obliquus abdominis, the internal obliquus abdominis, and the transversus abdominis. In particular, thicknesses of external obliquus abdominis and internal obliquus increased remarkably., Conclusions: Running in place in a limited area accompanied by abdominal drawing-in maneuvers increased the thickness of the deep abdominal muscles that are the basis of trunk stabilization.

[Purpose] This study aimed to determine the effect of abdominal muscle activities and the activation ratio related to trunk stabilization to compare the effects between the abdominal drawing-in maneuver and lumbar stabilization exercises on an unstable base of support. [Subjects and Methods] Study subjects were 20 male and 10 female adults in their 20s without lumbar pain, who were equally and randomly assigned to either the abdominal drawing-in maneuver group and the lumbar stabilization exercise group. Abdominal muscle activation and ratio was measured using a wireless TeleMyo DTS during right leg raise exercises while sitting on a Swiss ball. [Results] Differences in rectus abdominis, external oblique abdominis, and internal oblique abdominis muscle activation were observed before and after treatment. Significant differences were observed between the groups in the muscle activation of the external oblique abdominis and internal oblique abdominis, and the muscle activation ratio of external oblique abdominis/rectus abdominis and internal oblique abdominis/rectus abdominis. [Conclusion] Consequently trunk stability exercise enhances internal oblique abdominis activity and increases trunk stabilization. In addition, the abdominal drawing-in maneuver facilitates the deep muscle more than LSE in abdominal muscle. Therefore, abdominal drawing-in maneuver is more effective than lumbar stabilization exercises in facilitating trunk stabilization.

[Purpose] The purpose of this study was to compare changes in the mobility of the pelvic floor muscle during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. [Subjects] Thirty healthy adults participated in this study (15 men and 15 women). [Methods] All participants performed a bridge exercise and abdominal curl-up during the abdominal drawing-in maneuver, maximal expiration, and pelvic floor muscle maximal contraction. Pelvic floor mobility was evaluated as the distance from the bladder base using ultrasound. [Results] According to exercise method, bridge exercise and abdominal curl-ups led to significantly different pelvic floor mobility. The pelvic floor muscle was elevated during the abdominal drawing-in maneuver and descended during maximal expiration. Finally, pelvic floor muscle mobility was greater during abdominal curl-up than during the bridge exercise. [Conclusion] According to these results, the abdominal drawing-in maneuver induced pelvic floor muscle contraction, and pelvic floor muscle contraction was greater during the abdominal curl-up than during the bridge exercise.

[Purpose] The purpose of this study was to compare the effects of an abdominal drawing-in maneuver (ADIM), measured using a pressure bio-feedback unit, on the activities of the hamstring, gluteus maximus, and erector spinae muscles during prone hip extension. [Subjects and Methods] Thirty healthy adult subjects (14 male, 16 female), were recruited. Subjects' lumbar lordosis and pelvic tilt angles were measured, and based on the results, the subjects were divided into two groups: a hyperlordotic lumbar angle (HLLA) group (n=15) and a normal lordotic lumbar angle (NLLA) group (n=15). The muscle activities of the hamstring and gluteus maximus, and of the erector spinae on the right side of the body, were recorded using surface electromyography. [Results] When performing ADIM with prone hip extension, the muscle activity of the gluteus maximus of the HLLA group significantly improved compared with that the NLLA group. [Conclusion] This study demonstrated that ADIM with prone hip extension was more effective at eliciting gluteus maximus activity in the HLLA group than in the NLLA group. Therefore, ADIM with prone hip extension may be useful for increasing the gluteus maximus activity of individuals with lumbar hyperlordosis.

[Purpose] The purpose of this study was to determine the impact of a bridge exercise with an abdominal drawing-in maneuver (ADIM) performed with different surface conditions on abdominal muscle thickness. [Subjects] Thirty subjects were randomly divided into an unstable bridge exercise group (UBE group, n=15) and a stable bridge exercise group (SBE group, n=15). [Methods] After 6 weeks of performing bridge exercises accompanied by ADIM, the change in the muscle thicknesses of the transverse abdominis (TrA) and internal oblique abdominis (IOA) muscles was assessed using ultrasonography. [Results] After 6 weeks of exercise, the TrA was significantly altered in the SBEG, and the TrA and IOA were both significantly changed in the UBEG. [Conclusion] When performing bridge exercises to increase the Tra and the IO muscle thicknesses, exercising on an unstable surface is recommended.

[Purpose] The present study sought to investigate the influence on static and dynamic lumbar stability of bridge exercise accompanied by an abdominal drawing-in maneuver (ADIM) performed on an uneven support surface. [Subjects] A total of 30 participants were divided into an experimental group (15 participants) and a control group (15 participants). [Methods] The experimental group performed bridge exercise on an unstable surface, whereas the control group performed bridge exercise on a stable surface. The respective bridge exercises were performed for 30 minutes, 3 times per week, for 6 weeks. The static lumbar stability (SLS) and dynamic lumbar stability (DLS) of both the experimental group and the control group were measured using a pressure biofeedback unit. [Results] In the comparison of the initial and final results of the experimental and control groups, only the SLS and DLS of the experimental group were found to be statistically significant. [Conclusion] The results of the present study show that when using bridge exercise to improve SLS and DLS, performing the bridge exercise accompanied by ADIM on an uneven surface is more effective than performing the exercise on a stable surface.

This study investigated the reliability of ultrasound in combination with surface electromyogram (EMG) for evaluating the activity of the abdominal muscles in individuals with and without low back pain during the abdominal drawing-in maneuver (ADIM). The study recruited ten individuals with or without low back pain, respectively. While the participants were performing the ADIM, the activities of the transversus abdominis (TrA) and the internal oblique (IO) were measured using ultra-sound, while the activities of the external oblique (EO) and the rectus abdominis (RA) were measured using surface EMG. Intra-class correlation coefficients (ICC) were used to verify the inter-rater reliability of ultrasound in combination with surface EMG at rest and during the ADIM, and Bland-Altman plots were used to verify intra-rater reliability. The inter-rater reliability for the two groups at rest and during the ADIM was excellent (ICC2,1 = 0.77-0.95). In the Bland-Altman plots, the mean differences and 95% limits of agreement in the abdominal muscles of the two groups at rest were -0.03∼0.03 mm (-0.66 to 0.60 mm) and -0.12∼ -0.05 (-0.58 to 0.48% MVIC), respectively. The mean differences and 95% limits of agreement in the abdominal muscles of the two groups during the ADIM were -0.04∼0.02 mm (-0.73 to 0.65 mm) and -0.19∼0.05% MVIC (-1.24 to 1.34% MVIC), respectively. The ultrasound in combination with surface EMG showed excellent inter-rater and intra-rater reliability at rest and during the ADIM.

The objective of this study was to determine appropriate knee angles for the abdominal drawing-in maneuver (ADIM) through evaluation of changes in contraction ratios of the abdominal muscles and activity of quadriceps muscle in relation to changes in knee angles occurring while the ADIM is performed in the wall support standing (WSS). 20 subjects performed the ADIM at different knee angles (0°, 20°, 40°, 60°) in random order, standing at a point 6 inches away from the wall with the spine maintained in the neutral position. The WSS with knee flexion at 20° showed significantly higher preferential contraction ratio (PCR) of transversus abdominis (TrA) compared to other positions (0°, 40°, 60°). Therefore, performing the ADIM in the WSS with knee flexion at 20° appears to be the most appropriate position for TrA PCR.

[Purpose] The purpose of this study was to investigate the reliability of ultrasound imaging (USI) measurements of muscle thicknesses of patients with low back pain (LBP) performing the abdominal drawing-in maneuver (ADIM) [Subjects] Twenty patients with LBP were the subjects. [Methods] Muscle thickness measurements of transversus abdominis (Tra), internal obliques (IO), and external obliques (EO) muscles were measured using ultrasound imaging at rest and during performance of the ADIM. [Results] The intra-examiner reliability estimates ranged from 0.55 to 0.97 in the rest position, and from 0.82 to 0.95 during ADIM. The inter-examiner reliability estimates ranged from 0.77 to 0.98 in the rest position, and from 0.86 to 0.98 during ADIM. [Conclusion] ADIM thickness measurements of the TrA, IO, and EO muscles in patients with LBP based on the mean of 2 measures are highly reliable when taken by a single examiner and adequately reliable when taken by different examiners.