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June 6, 2023

Effects of Performing an Abdominal Drawing-in Maneuver During Prone Hip Extension Exercises on Hip and Back Extensor Muscle Activity and Amount of Anterior Pelvic Tilt

Discover how the abdominal drawing-in maneuver influences hip and back extensor muscle activity and anterior pelvic tilt during prone hip extension exercises.

Brent Brookbush

Brent Brookbush

DPT, PT, MS, CPT, HMS, IMT

Research Review: Effects of Performing an Abdominal Drawing-in Maneuver During Prone Hip Extension Exercises on Hip and Back Extensor Muscle Activity and Amount of Anterior Pelvic Tilt

By Corbin Henault MEd, ATC

Edited by Brent Brookbush, DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation: Oh, J. S., Cynn, H. S., Won, J. H., Kwon, O. Y., & Yi, C. H. (2007). Effects of performing an abdominal drawing-in maneuver during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt. Journal of Orthopaedic & Sports Physical Therapy, 37(6), 320-324. Article

Introduction: The "abdominal drawing-in maneuver (ADIM)" is a light contraction of the transverse abominis (and muscles of the intrinsic stabilization subsystem ) achieved by gently pulling the lower abdominal region away from one's waist band (1). Increased activity of these muscles has been shown to play an important role in stabilizing the lumbar spine, pelvis and sacroiliac joint (2-11). This 2007, South Korean study, examined local muscle activity and pelvic tilt angle when using the ADIM during prone hip extension. The study demonstrated that the ADIM decreased erector spinae activity, increased gluteus maximus and medial hamstring (semimembranosus and semitendinosus ) activity and decreased incidence of anterior pelvic tilt (APT). These findings suggest human movement professionals may find the ADIM cue useful for optimizing pelvic alignment and muscle recruitment.

Dr. Brent Brookbush instructs Personal Trainer, Laura DeAngelis on proper form for the Quadruped Opposite Arm Leg Raise (Transverse Abdominis Activation)
Caption: Dr. Brent Brookbush instructs Personal Trainer, Laura DeAngelis on proper form for the Quadruped Opposite Arm Leg Raise (Transverse Abdominis Activation)

Quadruped Opposite Arm and Leg Raise - Transverse Abdominis Activation (TVA)

Study Summary

Study DesignComparative Repeated-measures
Level of EvidenceIII Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies and case-control studies
Subject CharacteristicsDemographics:
  • Age: 22.3 +/- 3.4 yrs
  • Number of participants: 20
  • Gender: 10-male and 10-female
  • Volunteers from Department of Physical Therapy, Yonsei University, Korea

Inclusion Criteria:

  • Young & healthy

Exclusion Criteria:

  • Past or present neurological, musculoskeletal or cardiopulmonary diseases
  • Hip flexion contracture
  • Significant gluteus maximus weakness
Methodology
  • Participants were familiarized with the abdominal drawing-in maneuver (ADIM) and familiarized with the pressure biofeedback unit during a 30-minute training session.
  • EMG activity of the erector spinae, gluteus maximus and medial hamstrings, and anterior pelvic tilt angle were measured during prone hip extension.
  • Participants were instructed to lay prone on a therapy table with the trunk, pelvis and legs aligned in a straight line.
  • Participants extended the dominant-leg hip without knee flexion to target bar (10° hip extension) holding for five seconds.
  • For ADIM condition, a pressure biofeedback unit inflated to 70 mmHg was placed between the table and the participant’s lower abdomen. Visual feedback was used to maintain 60 mmHg pressure through exercise.
  • Participants repeated hip extension with and without ADIM with a 5-minute rest between conditions.
Data Collection and Analysis

Pressure biofeedback unit (Chattanooga Group) was used to measure ADIM.

Hip extension target bar was set using an inclinometer to measure 10° per participant.

Electromyography (EMG):

  • Reference electrode attached on ulnar styloid process.
  • Electrodes placed 1 cm apart on the erector spinae, gluteus maximus and medial hamstrings
  • The mean root-mean-square (RMS) of 3 trials of 5- second maximal voluntary isometric contraction (MVIC) was calculated as a percentage (%MVIC) for each muscle and used for analysis

Anterior Pelvic Tilt was measured with CMS-HS 3-dimensional ultrasonic motion analysis system.

Statistical Analysis:

  • 4 separate 2-by-2 analyses of variance were used
  • Within-subject factor was the condition (with and without ADIM)
  • Between-subject factor was gender
  • Significance level for all testing was p<.05
Outcome Measures
  • EMG signal amplitude by gender
  • Anterior pelvic tilt by gender
  • EMG signal amplitude by ADIM condition
  • Anterior pelvic tilt by ADIM condition
Results

Between-subject (Gender):

No significant interactions for EMG amplitude:

Within-subject (with and without ADIM):

There were significant main effect EMG amplitudes for all muscles

For prone hip extension with ADIM:

  • EMG amplitude decreased significantly in the erector spinae (17±12 %MVIC compared to 47±14 %MVIC)
  • EMG amplitude increased significantly in the gluteus maximus (52±15 %MVIC compared to 24±8 %MVIC)
  • EMG amplitude increased significantly in the medial hamstrings (58±20 %MVIC compared to 47±14 %MVIC)
  • Anterior pelvic tilt angle showed a significant decrease (3°±1° compared to 10°±2°)
Our ConclusionsThe findings of this study reinforce the use of the ADIM to reduce recruitment of commonly over-active muscles (erector spinae) and increase recruitment of commonly under-active muscles (gluteus maximus and medial hamstrings).  Further, the cue improved pelvic alignment by reducing the common compensation pattern, anterior pelvic tilt.
Researchers' ConclusionsUsing the ADIM with a pressure biofeedback unit during prone hip extension exercise limits anterior pelvic tilt, increases gluteus maximus and medial hamstring activity and decreases erector spinae activity.

Dr. Brookbush instructs a student on how to reciprocally inhibit over-active synergists during gluteus maximus activation exercise.
Caption: Dr. Brookbush instructs a student on how to reciprocally inhibit over-active synergists during gluteus maximus activation exercise.

Gluteus Maximus Activation - Similar to the exercise performed in this study.

How does this Study Contribute to the Body of Research:

This study examined the impact of the abdominal drawing-in maneuver (ADIM) on muscle recruitment and pelvic tilt angle during prone hip extension. Similar to previous research, this study demonstrated the ADIM resulted in significant changes in recruitment patterns and pelvic tilt angle (1 - 11); however, this study was unique in its investigation of muscles not directly associated with the ADIM. The increase in gluteus maximus and medial hamstring activity and decrease in erector spinae  activity implies the ADIM effects more than the transverse abdominis (TVA) ; potentially altering recruitment patterns of the entire lumbo pelvic hip complex. Further, despite the ADIM being associated with the TVA  and other "weak" movers of the spine, the ADIM is capable of having a significant impact on biomechanics by reducing the tendency toward an anterior pelvic tilt during prone hip extension. Although further research is needed investigating the impact of the ADIM on functional activities, this study implies the ADIM has a larger impact on recruitment and motion than just TVA  activation.

How the Findings Apply to Practice:

Based on the findings of this study, the ADIM may have a larger impact on assessment and exercise selection than optimal recruitment of the TVA . Human movement professionals may consider abdominal distension, as well as an anterior pelvic tilt , signs of TVA  and intrinsic stabilization subsystem  dysfunction. Further, the study implies that the ADIM may be used for more than TVA  activation exercise, and should be included as a cue during all functional activities in which optimal hip extension is desired.

This study had many methodological strengths, including:

  1. The authors used EMG to quantify the activity of the erector spinae , gluteus maximus , and medial hamstrings , demonstrating a difference in activity of muscles not commonly associated with the ADIM.
  2. The pressure biofeedback unit reliably provided visual feedback to participants for accurate performance of the ADIM.
  3. The researchers selected a prone hip extension for this study, which may have aided in reducing the effect of confounding variables like stability, upper body muscle recruitment, gravity induced moment arms, etc.

Weaknesses that should be noted prior to clinical integration:

  1. EMG was not used to measure any of the abdominal, diaphragm or pelvic floor muscles normally associated with the ADIM, which may cast some doubt about whether a "true" ADIM was achieved.
  2. Participants were young, healthy individuals which may limit generalizability to individuals experiencing dysfunction of pain.
  3. Hip extension range of motion was not measured. Limited hip extension could alter the propensity toward an anterior pelvic tilt during prone hip extension.
  4. Muscle activity was measured via surface EMG, which adds the confounding variables of cross-talk and accurate placement.

How does it relate to Brookbush Institute Content?

The Brookbush Institutes (BI) Predictive Model for Lumbo-Pelvic Hip Complex Dysfunction (LPHCD)  identifies the erector spinae and biceps femoris as over-active; the gluteus maximus , medial hamstring , transverse abdominis (TVA)  and internal obliques  as under-active, and an anterior pelvic tilt as common osteokinematic dysfunction. Further, the BI recommends using the ADIM during TVA Activation exercise, as well as during functional activity. The findings of this study support this use of the ADIM for those exhibiting LPHCD .

The following videos illustrate transverse abdominis (TVA) isolated activation, TVA and gluteus maximus activation

TVA Isolated Activation

Gluteus Maximus Activation

TVA and Gluteus Maximus Activation and Progressions

Bibliography:

  1. Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004.
  2. Barker, P. J., Briggs, C. A., & Bogeski, G. (2004). Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments. Spine, 29(2), 129-138.
  3. Vleeming, A., Schuenke, M.D., Danneels,Willard, F.H. The functional coupling of the deep abdominal and paraspinal muscles: the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the thoracolumbar fascia. Journal of Anatomy, 2014. 225, 447-462
  4. van Wingerden, J. P., Vleeming, A., Buyruk, H. M., & Raissadat, K. (2004). Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. European Spine Journal, 13(3), 199-205.
  5. Vleeming, A., van Wingerden, J.P., Buyruk, H.M., Raissadat, K. Stabilization of the sacroiliac joint in vivo: verification of muscular contribution to force closure of the pelvis. European Spine Journal, 2004. 13: 199-205.
  6. Willard, F.H., Vleeming, A., Schuenke, M.D., Danneels, L., Schleip, R. The thoracolumbar fascia: anatomy, function and clinical considerations. Journal of Anatomy, 2012. 221, 507-536.
  7. Vleeming A, Pool-Goudzward AL, Stoeckart R, et al. The Posterior Layer of the Thoracolumbar Fascia: Its Function in Load Transfer from Spine to Legs. Spine 20:753-758, 1995
  8. Richardson, C., Snijders, C., Hides, J., Damen, L., Pas, M., Storm, J. (2002) The Relation Between the Transversus Abdominis Muscles, Sacroiliac Joint Mechanics, and Low Back Pain. Spine. 27 (4), 399-405.
  9. Hodges, P. W., Cresswell, A. G., Daggfeldt, K., & Thorstensson, A. (2001). In vivo measurement of the effect of intra-abdominal pressure on the human spine. Journal of biomechanics, 34(3), 347-353.
  10. Hodges, P. W., Eriksson, A. M., Shirley, D., & Gandevia, S. C. (2005). Intra-abdominal pressure increases stiffness of the lumbar spine. Journal of biomechanics, 38(9), 1873-1880.
  11. Stokes, I. A., Gardner-Morse, M. G., & Henry, S. M. (2010). Intra-abdominal pressure and abdominal wall muscular function: spinal unloading mechanism. Clinical Biomechanics, 25(9), 859-866.

© 2018 Brent Brookbush

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