Impact of the Abdominal Drawing-In Maneuver on Spinal Extensor Muscle Activity: A Randomized Controlled Double-Blind Trial Involving Individuals with Non-Specific Low Back Pain

Abstract

Non-specific low back pain (NSLBP) is a common musculoskeletal issue that can limit function and reduce the patient's quality of life. Enhancing spinal stabilizer muscle activity through targeted exercises may help improve spinal alignment and alleviate NSLBP symptoms. This study aimed to investigate whether incorporating the abdominal drawing-in maneuver (ADIM) into selected low back exercises influences the electromyographic (EMG) activity of key spinal extensor muscles. Forty participants with NSLBP (n = 29 female and n = 11 male; mean age = 21.42 ± 1.07 years; BMI = 20.65 ± 2.08 kg/m²; 80% right-side dominant) performed three exercises, prone trunk extension, superman, and unstable superman, with and without the ADIM. The EMG amplitudes of the iliocostalis lumborum pars lumborum (ICL), iliocostalis lumborum pars thoracis (ICT), and longissimus thoracis (LT) were measured. A cross-sectional observational study design was employed. Significant main effects were observed for both exercise types and the ADIM on the EMG amplitudes of the ICL, ICT, and LT (ICL: F1,14 = 82.69-114.23, p < 0.001, η² ≥ 0.88; ICT: F1,14 = 100.69-117.13, p < 0.001, η² ≥ 0.90; LT: F1,14 = 62.69-74.88, p < 0.001, η² ≥ 0.81). Under ADIM conditions, the ICL activity decreased significantly (right ICL mean difference: 14.06-20.02; left ICL: 13.06-21.32; p < 0.001), while the ICT and LT activity increased (ICT mean difference: 6.45-8.89; LT: 9.37-12.13; p < 0.001). These changes were most pronounced during the unstable superman exercise (p < 0.01). Integrating the ADIM into specific low back exercises can differentially modulate spinal extensor muscle activity. In particular, the unstable superman exercise demonstrated the greatest changes in the EMG amplitudes. These findings support the inclusion of the ADIM in exercise programs aimed at improving spinal stability and may have implications for NSLBP management. Future research should examine the effects of the ADIM in populations with varying experience levels to enhance its generalizability and refine the clinical recommendations.

Keywords: abdominal drawing-in maneuver; electromyography; non-specific low back pain; rehabilitation exercises; spinal muscle activation.

Figure 1

A comparison of the main effect on ICL muscle activity during the three different lower back exercises, with and without ADIM (mean ± SD). The mean of the measurements obtained for each exercise and the mean of their differences are presented with the p-value. ICL: iliocostalis lumborum pars lumborum; EMG value represents %MVIC: the percentage of maximal voluntary isometric contraction; ADIM: abdominal drawing-in maneuver.

Figure 2

A comparison of the main effect on ICT muscle activity during the three different lower back exercises, with and without ADIM (mean ± SD). The mean of the measurements obtained for each exercise and the mean of their differences are presented with the p-value. ICT: iliocostalis lumborum pars thoracis; EMG value represents %MVIC: the percentage of maximal voluntary isometric contraction; ADIM: abdominal drawing-in maneuver.

Figure 3

A comparison of the main effect on LT muscle activity during the three different lower back exercises, with and without ADIM (mean ± SD). The mean of the measurements obtained for each exercise and the mean of their differences are presented with the p-value. LT: longissimus thoracis; EMG value represents %MVIC: the percentage of maximal voluntary isometric contraction; ADIM: abdominal drawing-in maneuver.