Comparison of Real-time Ultrasound Imaging and Pressure Biofeedback training for performing Abdominal Drawing-in Maneuver in low back pain

Researches are being undertaken worldwide to understand the muscle related dysfunctions present in LBP sufferers. It is an established fact that LBP is associated with impaired function of transversus abdominis (TrA) and multifidus muscles. The abdominal drawing-in maneuver (ADIM) is commonly used as a foundational component of lumbar stabilization training program. This exercise involves a motor learning approach, for preferential activation of TrA, which is facilitated with the use of augmented sensory feedback such as pressure biofeedback unit and rehabilitative ultrasound imaging. The purpose of the study was to compare the two feedback tools used for teaching patients ADIM and to derive a faster and efficient tool to help patients acquire the skill in a timely fashion.

Twenty two patients with chronic low back pain having transverse abdominis muscle weakness were randomized in two groups for feedback training, one with real-time ultrasound imaging and second with pressure biofeedback training. Number of trials and number of days required for learning the correct maneuver were noted as outcome measures for the two groups. To evaluate the patient s learning a retention test was conducted after 2 days.

Number of trials and number of days required for learning the correct maneuver were significantly less with patients receiving feedback training with real-time ultrasound as compared to training with pressure biofeedback (p<0.01). Patients learnt efficiently with ultrasound feedback as indicated by 100% results on retention testing done after 2 days.

RUSI provides an efficient, extrinsic visual feedback tool for learning ADIM in patients with chronic recurrent low back pain making it a useful and specific clinical teaching tool for physiotherapists.