Lumbar Local Stabilizers Assessment | Pressure Biofeedback Unit

For a long time, it was hypothesized that one cause of low back pain is a lack of coordinated recruitment of the local stabilizers of the lumbar spine, namely the transverse abdominis and multifidii.

The abdominal draw-in maneuver is supposed to selectively recruit the transverse abdominis and multifidii. Using a pressure device to supervise the exercise execution, should retrain its ability to stabilize the lumbar spine and consequently reduce symptoms of low back pain.

You will start in a four-point kneeling position. Instruct the patient to keep a neutral spine and then relax the abdomen completely during a deep exhalation. During the exhalation, they should then try to “pull the navel” towards the spine. They should hold the contraction for no longer than 10 seconds without breathing in the meantime. One set will count as 10 reps of 10 seconds, which will graduate to 3 sets of 90 seconds.

Proceed with the abdominal draw-in maneuver in prone position. The Pressure biofeedback unit is placed under the abdomen and inflated to 70mmHg. The patient is asked to breathe in and out once and then asked to cease breathing whilst performing the ABDIM which should result in a pressure decrease of 2-4mmHg.  Ideally, this can be done 10x10secs.

Make sure to check for compensatory contraction of the obliques which might show an excessive decrease in pressure.
In the third step, place the pressure biofeedback unit under the lumbar spine at the height of L3 and inflate the cuff to 40mmHg.The patient is then instructed to perform the ABDIM and increase the pressure in steps of 2-4mmHg. So from 40 to 42or44mmHg and so on. The contraction should be held whilst being able to keep breathing calmly. Ideally, the patient is able to hold this contraction for 15 seconds twice without compensation.

We have written a critically appraised topic on the pressure biofeedback unit’s ability to detect dysfunction in Transverse Abdominis activity during the abdominal draw-in maneuver and can say that Pressure BioFeedback measurements do not correlate with Transverse abdominis activity measured by ultrasound and it does not seem to be a valid tool for such purpose as Grooms et al. (2013) report likelihood ratios of close to 1 resulting in no change in post-test probability.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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If you are curious about other tests for motor control impairment in the lumbar spine, check out the following posts:

• Motor Control Impairment Signs & Symptoms
• Motor Control Dysfunction Screening

There are several orthopedic tests for the diagnosis of radiographic lumbar instability:

• Prone Instability Test
• Passive Lumbar Extension Test
• Interspinous Gap Change
• Low Midline Sill Sign

Grooms, D. R., Grindstaff, T. L., Croy, T., Hart, J. M., & Saliba, S. A. (2013). Clinimetric analysis of pressure biofeedback and transversus abdominis function in individuals with stabilization classification low back pain. journal of orthopaedic & sports physical therapy, 43(3), 184-193.