# EBP on the effectivity of the activation of the abdominal transversus in patients with chronic nonspecific low back pain

> Low back pain (LBP) is a pain, tension or stiffness which appears between the costal inferior margin and the gluteal folds (Chou R. 2010).

## Blended Intensive Program (BIP) Overview
In week 43 of 2023, Savonia University of Applied Sciences (Finland) hosted a Blended Intensive Program (BIP) focused on Evidence-Based Physical Therapy (EBP). The program included over 40 physiotherapy students and 7 teachers from three institutions:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Prague

Participants collaborated on articles covering themes such as McKenzie methods, back pain, spinal cord injuries, aquatic therapy, ergonomics, Nordic walking, sports injuries, and children with disabilities.

## Chronic Nonspecific Low Back Pain (CNSLBP)
Low back pain is the leading cause of long-term disability worldwide, with a lifetime incidence of 58-84%. Approximately 11% of men and 16% of women suffer from chronic LBP (lasting more than 12 weeks), and up to 90% of these cases are non-specific.

## Clinical Guidelines and Evidence Mapping
The 2021 clinical practice guidelines, "Interventions for the management of acute and chronic low back pain: Revision 2021" (George et al., 2021), categorize interventions into three groups based on evidence quality. Treatments in the "Should Use" category include:

* **Exercise:** General training, muscle strengthening and endurance, specific trunk activation, aerobic, aquatic, and multimodal approaches.
* **Manual and other-directed therapies:** Thrust or non-thrust joint mobilization.
* **Patient education:** Pain neuroscience education (not as a stand-alone treatment) and active treatments (yoga, stretching, Pilates, and strength training).

## Transversus Abdominis (TrA) Activation
Clinical observation suggests a weakness and lack of stabilization in the abdominal muscles of patients with CNSLBP. The transversus abdominis (TrA) is a deep abdominal muscle critical for lumbar stabilization. Research indicates:

* **Hides et al. (2011):** Found that the ability to contract the lumbar multifidus is 4.5 times higher in patients who demonstrate a good contraction of the TrA.
* **Wang et al. (2022):** Demonstrated that impaired postural control in patients with CNSLBP is related to poor contraction ability of the bilateral transversus abdominis.
* **Wong et al. (2014):** A systematic review and meta-analysis showed that motor control exercise training increases TrA activation and improves pain and disability levels compared to other interventions.

## Conclusion
Evidence supports the importance of TrA activation in the intervention of CNSLBP. Future studies should investigate the potential neurophysiological relationship between the TrA and other lumbar stabilizers to further refine motor control programs.

## Contributors
* **Students:** Fernández Anxo (A Coruña), Helvelahti Harkko (Savonia), Montoiro Miguel (A Coruña), Nurmiainen Riina (Savonia)
* **Faculty/Researchers:** Marja Äijö (Savonia), Mari Tuppurainen (Savonia), Dagmar Pavlu (Charles University), Ivana Vláčilová (Charles University), Jamile Vivas Costa (Universidade da Coruña), Montserrat Fernández Pereira (Universidade da Coruña), Verónica Robles García (Universidade da Coruña)

## References
* George SZ, et al. (2021). Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. *Journal of Orthopaedic & Sports Physical Therapy*.
* Hides J, et al. (2011). The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. *Manual Therapy*.
* Wang H, et al. (2022). Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study. *Gait & Posture*.
* Wong AYL, et al. (2014). Do Changes in Transversus Abdominis and Lumbar Multifidus During Conservative Treatment Explain Changes in Clinical Outcomes Related to Nonspecific Low Back Pain? A Systematic Review. *The Journal of Pain*.