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Concept: Muscles of the torso


[Purpose] It has been reported that exercises focusing upon the transversus abdominis (TrA) ameliorate low back pain (LBP). We investigated whether expiratory muscle training (EMT) can promote activity of the TrA to the same degree as the abdominal drawing-in manoeuvre (ADIM) in elderly individuals. [Subjects and Methods] Twenty-one elderly subjects (9 males, 12 females; mean age, 84.9 ± 6.6 years) without LBP symptoms were included. Using ultrasound imaging we measured changes in thickness of the lateral abdominal muscles, TrA, internal oblique muscle (IO), and external oblique muscle (EO) during ADIM and EMT. The load in EMT was set to 15% of maximal expiratory pressure. [Results] TrA showed a significant increase in muscle thickness during ADIM and EMT compared with at rest. A significant increase in muscle thickness was noted for EMT in comparison with ADIM. No significant differences were found for IO and EO. [Conclusion] In elderly people, EMT may be an effective alternative to ADIM for promoting activity of the TrA and can be used as an exercise to maintain TrA function.

Concepts: Physical exercise, Transversus abdominis muscle, Abdomen, Iliac crest, Abdominal external oblique muscle, Muscles of the torso, Iliohypogastric nerve, Abdominal internal oblique muscle


BACKGROUND:: Slipping rib syndrome (SRS) is a musculoskeletal cause of severe and recurrent thoracic or abdominal pain. The etiology of SRS is unknown, it seems to arise from costal hypermobility with a tendency of one of the ribs (usually from 8th to 10th but also 11th and 12th have been described) to slip under the superior adjacent rib. Its prevalence is underestimated because SRS is mainly a clinical diagnosis, frequently missed. The critical aspect of the diagnosis is knowledge of the condition itself, which, when lacking, often results in the patient being referred to many different specialists and exposed to unnecessary and costly investigations. The management of the condition includes conservative techniques such as manipulation, localized anesthetic, and steroid or anesthetic nerve block. However, where conservative therapy fails, surgical treatment, with excision of the rib, may be performed. METHODS:: In this paper we describe the case of a patient with persistent and debilitating flank pain who, after many investigations, was diagnosed with SRS. RESULTS:: The usual conservative treatment failed, after which we treated the patient with injections of incobotulinumtoxin A into muscles inserting on the inferior side of the rib cage (quadratus lumborum muscle, muscle transversus abdomini, abdominal external oblique muscle, and recto abdomini) achieving a complete relief from pain. CONCLUSIONS:: To our knowledge botulinum toxin has never been proposed before for the treatment of SRS. We believe that it should be considered as a therapeutic option, especially where other medical treatments have failed or as an intermediate step before surgical intervention.

Concepts: Abdomen, Thorax, Rib, Human rib cage, Iliac crest, Abdominal external oblique muscle, Muscles of the torso, Quadratus lumborum muscle


Background: Sport climbing has been increasingly applied as therapy for patients with orthopaedic problems. Results from previous intervention studies have already revealed positive effects, especially for people with back problems, although there is a lack of baseline knowledge regarding the general effects of climbing. The aim of this present study is to investigate the muscle activation of the trunk while performing various static climbing positions at different inclination angles. Subjects/Material and Methods: Thirteen healthy adults without climbing experience were asked to hold three static climbing positions (base position, lifting a hand, lifting a foot) at three different handhold set-ups and six wall inclination angles (0°, 4°, 8°, 12°, 15°, 18°) for 5 seconds each. Bilateral muscle activity of Erector spinae, Multifidus, Latissimus dorsi, Obliquus externus abdominis, Obliquus internus abdominis and Rectus abdominis was measured using surface electromyography. Data were analysed for each muscle and climbing condition separately. Results: Compared to the vertical wall, the muscle activity starts to differ significantly (p ≤ 0.05) from 12° onwards. This inclination angle particularly affects the activity of all muscles when lifting a hand (0.000 ≤ p ≤ 0.048). The oblique abdominal muscles did not show any or little effects when lifting a foot or being in the base position, while all other muscles demonstrate a continuous increase. The EMG data were normalised to the corresponding base position and analysed for each muscle and climbing condition separately. Conclusion: Inclinable climbing walls are an appropriate method to increase muscle activity. Compared to the base position, activation of the oblique abdominal muscles, which are relevant for a stable trunk, is increased only when a hand is lifted. Climbing walls used for therapy should offer variable inclination angles. Further research should concentrate on the development and evaluation of climbing exercises for specific patients (eg people with scoliosis).

Concepts: Muscle, Electromyography, Abdomen, Iliac crest, Abdominal external oblique muscle, Muscles of the torso, Crunch, Abdominal internal oblique muscle



Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions.

Concepts: Radiology, Injury, Anatomy, Pubic symphysis, Rectus abdominis muscle, Muscles of the torso, Rectus sheath, Pyramidalis muscle


The abdominal wall is a prime target for therapeutic exercises aimed to prevent and rehabilitate low back pain as well as enhance performance training. This study examined the “Lewit”; a corrective exercise prescribed for several purposes, which is performed lying supine in a crook-lying position and involves forceful breathing. Muscle activation and lumbar posture was compared with bracing the abdominal wall (stiffening) with robust effort and “hollowing” (attempting to draw in the wall towards the naval) with robust effort. Eight healthy male volunteers with six channels of electromyography (EMG) were collected via surface electrode pairs of rectus abdominis, external oblique and internal oblique together with lumbar motion. The Lewit exercise caused higher muscle activity in the deeper abdominal wall muscles, in particular internal oblique and by default transverse abdominis were activated at 54% MVC on average and 84% MVC peak with no change in spine posture to maintain elastic equilibrium of the lumbar spine. The Lewit is a deep oblique muscle activation exercise and the activation levels are of sufficient magnitude for training muscle engrams. This information will assist strength and conditioning coaches with program design decisions where this corrective abdominal exercise may be considered for clients who elevate the ribcage during strength exertions, or for clients targeting the deep obliques.

Concepts: Spinal disc herniation, Muscle, Physical exercise, Electromyography, David Gilmour, Iliac crest, Abdominal external oblique muscle, Muscles of the torso


ABSTRACT Social, psychological, and physiological studies have provided evidence indicating that laughter imposes an increased demand on trunk muscles. It was the aim of this study to quantify the activation of trunk muscles during laughter yoga in comparison with crunch and back lifting exercises regarding the mean trunk muscle activity. Muscular activity during laughter yoga exercises was measured by surface electromyography of 5 trunk muscles. The activation level of internal oblique muscle during laughter yoga is higher compared to the traditional exercises. The multifidus, erector spinae, and rectus abdominis muscles were nearly half activated during laughter yoga, while the activation of the external oblique muscle was comparable with the crunch and back lifting exercises. Our results indicate that laughter yoga has a positive effect on trunk muscle activation. Thus, laughter seems to be a good activator of trunk muscles, but further research is required whether laughter yoga is a good exercise to improve neuromuscular recruitment patterns for spine stability.

Concepts: Muscle, Physical exercise, Electromyography, Exercise physiology, Iliac crest, Abdominal external oblique muscle, Muscles of the torso, Crunch


The purpose of this study was to describe ultrasound (US) changes in muscle thickness produced during automatic activation of the transversus abdominis (TrAb), internal oblique (IO), external oblique (EO), and rectus abdominis (RA), as well as the cross-sectional area (CSA) of the lumbar multifidus (LM), after 1 year of Pilates practice.

Concepts: Evaluation methods, Transversus abdominis muscle, Abdomen, Iliac crest, Abdominal external oblique muscle, Muscles of the torso, Iliohypogastric nerve, Crunch


During level walking, lumbar spine is subjected to cyclic movements and intricate loading of the spinal discs and trunk musculature. This study aimed to estimate the spinal loads (T12-S1) and trunk muscles forces during a complete gait cycle. Six men, 24-33years walk barefoot at self-selected speed (4-5km/h). 3D kinematics and ground reaction forces were recorded using a motion capturing system and two force plates, implemented in an inverse dynamic musculoskeletal model to predict the spinal loads and trunk muscles forces. Additionally, the sensitivity of the intra-abdominal pressure and lumbar segment rotational stiffness was investigated. Peak spinal loads and trunk muscle forces were between the gait instances of heel strike and toe off. In L4-L5 segment, sensitivity analysis showed that average peak compressive, antero-posterior and medio-lateral shear forces were 130-179%, 2-15% and 1-6%, with max standard deviation (±STD) of 40%, 6% and 3% of the body weight. Average peak global muscles forces were 24-55% (longissimus thoracis), 11-23% (iliocostalis thoracis), 12-16% (external oblique), 17-25% (internal oblique) and 0-8% (rectus abdominus) of body weight whereas, the average peak local muscles forces were 11-19% (longissimus lumborum), 14-31% (iliocostalis lumborum) and 12-17% (multifidus). Maximum±STD of the global and local muscles forces were 13% and 8% of the body weight. Large inter-individual differences were found in peak compressive and trunk muscles forces whereas the sensitivity analysis also showed a substantial variation.

Concepts: Lumbar vertebrae, Force, Classical mechanics, Ground reaction force, Longissimus, Muscles of the torso, Iliocostalis, Spinalis


Horseback riding is an effective exercise for improving postural control and balance. To reduce costs and improve accessibility, simulated horseback riding has been developed; but no differential effects of simulated and real horseback riding on muscle activation patterns in older adults have been studied. Thus, we compared muscle activation patterns for older and younger adults engaged in real and simulated horseback riding exercises, using surface electromyography recordings of the erector spinae, rectus abdominis, internal oblique abdominis, and rectus femoris muscles. We recorded muscle activity for three riding patterns: walk, slow trot, and fast trot. Muscle activation was uniformly higher for simulated (vs. real) horseback riding and increased from the walking pattern through slow and fast trot. There was no age effect, but among older participants, muscle activation was higher for simulated (vs. real) horseback riding across all gait types. Simulated and real riding produced a similar pattern of muscle activation of the thigh and trunk. These results demonstrate that simulated horseback riding can be an effective alternative to actual riding for increasing trunk and thigh muscle activation and improving postural control and balance, perhaps especially among older adults.

Concepts: Effect, Effectiveness, Muscle, Physical exercise, Electromyography, Horse, Rectus femoris, Muscles of the torso