Citation: Gibbon, Karl (2017) Lumbopelvic muscle function during low impact weight-bearing exercise: development of the functional re-adaptive exercise device. Doctoral thesis, Northumbria University. This version was downloaded from Northumbria Research Link: http://nrl.northumbria.ac.uk/32567/ Northumbria University has developed Northumbria Research Link (NRL) to enable users to access the University’s research output. Copyright © and moral rights for items on NRL are retained by the individual author(s) and/or other copyright owners. Single copies of full items can be reproduced, displayed or performed, and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided the authors, title and full bibliographic details are given, as well as a hyperlink and/or URL to the original metadata page. The content must not be changed in any way. Full items must not be sold commercially in any format or medium without formal permission of the copyright holder. The full policy is available online: http://nrl.northumbria.ac.uk/policies.html LUMBOPELVIC MUSCLE FUNCTION DURING LOW IMPACT WEIGHT- BEARING EXERCISE: DEVELOPMENT OF THE FUNCTIONAL RE-ADAPTIVE EXERCISE DEVICE Karl Christian Gibbon PhD 2017 LUMBOPELVIC MUSCLE FUNCTION DURING LOW IMPACT WEIGHT- BEARING EXERCISE: DEVELOPMENT OF THE FUNCTIONAL RE-ADAPTIVE EXERCISE DEVICE Karl Christian Gibbon A thesis submitted in partial fulfilment of the requirements of the University of Northumbria at Newcastle for the degree of Doctor of Philosophy Research undertaken in the Department of Sport, Exercise, and Rehabilitation Faculty of Health and Life Sciences Northumbria University Newcastle upon Tyne NE1 8ST Publications and Presentations Arising from this Thesis Peer-reviewed Manuscripts Gibbon, K. C., Debuse, D., Hibbs, A., & Caplan, N. (2017). Reliability and Precision of Sonography of the Lumbar Multifidus and Transversus Abdominis During Dynamic Activities. Journal of Ultrasound in Medicine, 36(3), 571-581. Caplan, N., Gibbon, K.C., Hibbs, A., Evetts, S., & Debuse, D. (2014). Phasic-to-tonic shift in trunk muscle activity relative to walking during low-impact weight bearing exercise. Acta Astronautica, 104(1), 388-395. Gibbon, K.C., Debuse, D., & Caplan, N. (2013). Low impact weight-bearing exercise in an upright posture achieves greater lumbopelvic stability than overground walking. Journal of Bodywork and Movement Therapies, 17(4), 462-468. Conference Presentations Gibbon, K.C., Debuse, D., Hibbs, A., & Caplan, N. (2015). Interday Reliability and Precision of Lumbar Multifidus and Transversus Abdominis Thickness Change During Dynamic Activities. Medicine and Science in Sports and Exercise, 47(S1), 256. Gibbon, K.C., Debuse, D., & Caplan, N. (2012). ‘Kinematic comparison of overground walking and exercise using a functional re-adaptive exercise device’, Presented at UK Space Biomedicine Association (UKSBA) Space Environments Conference, Aberdeen, Scotland, UK. i ABSTRACT The aim of this thesis was to develop our understanding of the Functional Re-adaptive Exercise Device (FRED): a novel prototype exercise device proposed to facilitate the activation the deep paraspinal and anterolateral abdominal wall musculature in a manner consistent with the requirements of motor control training in people with low back pain. Firstly, the intra- and interday reliability and precision of measurement of ultrasound imaging of the lumbar multifidus (LM) and transversus abdominis (TrA) were established. LM and TrA demonstrated good (ICC ≥ 0.75) to excellent (ICC ≥ 0.9) intrarater reliability for both intra- and interday measurements of absolute linear muscle thickness across all conditions. Normalised thickness change, expressed relative to resting values, also demonstrated good reliability between days, with ICCs in excess of 0.75 across all conditions. Secondly, the typical nature of LM and TrA function during this mode of exercise was evaluated in relation to commonly used assessment techniques such as the abdominal drawing-in manoeuvre, active straight-leg raise, and contralateral arm-lift. All contraction conditions successfully resulted in active relative thickness change of LM and TrA. Relative thickness change of the LM when using the FRED was favourable in that it was lower than that observed in loaded contralateral arm raise and walking conditions, suggesting that one of the key features of specific motor control training (contraction intensity of 30-40 % MVC) has been met. Thirdly, activity of the LM and TrA during this mode of exercise and other commonly used corrective/rehabilitative techniques based on relatively static challenges to stability was compared (gym ball, balance board). All stability challenges successfully ii induced non-volitional concomitant activation of both the LM and TrA. Additionally, it was observed that the LM followed a pattern where all standing conditions elicited greater recruitment than seated conditions, with no additional effect of surface lability. Contrastingly, the TrA only demonstrated an effect of surface instability during FRED conditions. The preferential contraction ratio of the TrA in comparison to IO and EO was greatest during use of the exercise device in the standing position. Fourthly, the intrinsic kinematic stability of the lumbopelvic region whilst using the exercise device was examined, revealing further evidence of the underlying mechanisms facilitating LM and TrA contraction. Key differences between FRED exercise and overground walking included reduced axial rotation of the trunk with respect to the pelvis (i.e. increased lumbopelvic stability) and a more anteriorly tilted pelvis. FRED exercise potentially moved the pelvis into a more advantageous position for the recruitment of TrA and LM. However, the unstable base of support afforded by FRED exercise would seem to add a challenge to movement control that could result in greater TrA and LM activity than overground walking. Finally, the pattern of global muscle activation during this exercise was examined, and provided evidence as to the tonic nature of FRED mediated muscle activity of the lumbar paraspinal and anterolateral abdominal muscles. FRED exercise a) promoted more tonic activity of the lumbopelvic musculature compared to overground walking, b) resulted in greater spinal extensor activity than spinal flexor muscles compared with overground walking, and c) resulted in greater knee extensor activity compared with overground walking. iii TABLE OF CONTENTS LIST OF TABLES .................................................................................................. viii LIST OF FIGURES .................................................................................................. ix LIST OF ABBREVIATIONS ................................................................................ xiii ACKNOWLEDGEMENTS .................................................................................... xiv AUTHOR DECLARATION ................................................................................... xv CHAPTER I - Introduction ...................................................................................... 1 1.1 Topic Overview .................................................................................................. 2 1.2 Aims of Thesis and Research Questions ............................................................ 6 CHAPTER II - Literature Review ........................................................................... 9 2.1 Literature Review Organisation & Search Strategy ......................................... 10 2.2 Structural and Functional Anatomy of the Spine ............................................. 10 2.2.1 The Osteoligamentous Subsystem ............................................................. 11 2.2.2 The Musculotendinous Subsystem ............................................................ 19 2.3 Musculoskeletal Conditions and Back Pain ..................................................... 32 2.3.1 Low Back Pain Prevalence ........................................................................ 33 2.3.2 The Natural History and Time Course of Low Back Pain ......................... 35 2.3.3 Recurrence and Chronicity of Low Back Pain .......................................... 38 2.4 The Muscle Capacity and Control Model ........................................................ 40 2.4.1 Roles of Lumbar Multifidus and Transversus Abdominis in Spinal Stability ............................................................................................................................ 41 2.5 Treatment Strategies for Low Back Pain.......................................................... 52 2.5.1 Exercise Therapy ....................................................................................... 52 2.5.2 Exercise Using the Functional Re-adaptive Exercise Device .................... 61 2.5.3 Summary .................................................................................................... 64 CHAPTER III - Lumbar Multifidus and Transversus Abdominis Thickness during Dynamic Activities – Reliability and Precision of Measurement of Ultrasound Images ....................................................................................................................... 65 3.1 Introduction ...................................................................................................... 66 3.2 Method .............................................................................................................