Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain

STUDY DESIGN: Cross-sectional, case-control study. OBJECTIVES: To measure and compare the resting thickness of the 4 abdominal wall muscles, their associated perimuscular connective tissue (PMCT), and interrecti distance (IRD) in persons with and without lumbopelvic pain (LPP), using ultrasound imaging. BACKGROUND: The muscles and PMCT of the abdominal wall assist in controlling the spine. Functional deficits of the abdominal wall muscles have been detected in populations with LPP. Investigations of the abdominal wall in those with LPP are primarily concerned with muscle, most commonly the transversus abdominis (TrA) and internal oblique (10). Because the abdominal wall functions as a unit, all 4 abdominal muscles and their associated connective tissues should be considered concurrently. METHODS: B-mode ultrasound imaging was used to measure the resting thickness of the rectus abdominis (RA), external oblique, 10, and TrA muscles; the PMCT planes; and IRD in 50 male and female subjects, 25 with and 25 without LPP (mean +/- SD age, 36.3 +/- 9.4 and 46.6 +/- 8.0 years, respectively). Univariate correlation analysis was used to-identify covariates. Analyses of covariance (ANCOVAs) and the Kruskal-Wallis test (IRD) were used to compare cohorts (alpha = .05). RESULTS: The LPP cohort had less total abdominal muscle thickness (LPP mean +/- SD, 18.9 +/- 3.0 mm; control, 20.3 +/- 3.0 mm; ANCOVA adjusted for body mass index, P = .03), thicker PMCT (LPP, 5.5 +/- 0.2 mm; control, 4.3 +/- 0.2 mm; ANCOVA adjusted for body mass index, P = .007), and wider IRD (LPP, 11.5 +/- 2.0 mm; control, 8.4 +/- 1.8 mm; Kruskal-Wallis, P = .005). Analysis of individual muscle thickness revealed no difference in the external oblique, 10, and TrA, but a thinner RA in the LPP cohort (LPP mean +/- SD, 7.8 +/- 1.5 mm; control, 9.1 +/- 1.2 mm; ANCOVA adjusted for body mass index, P<.001). CONCLUSION: To our knowledge, this is the first study to investigate the morphological characteristics of all 4 abdominal muscles and PMCT in individuals with LPP. The results suggest that there may be altered loading of the PMCT and linea alba secondary to an altered motor control strategy involving a reduced contribution of the RA. Further, the change in RA and connective tissue morphology may be more evident than changes in external oblique, 10, and TrA thickness in persons with LPP. The causes and functional implications of these changes warrant further investigation, as does the role of the RA muscle in the development and persistence of LPP. J Orthop Sports Phys Ther 2013;43(1):11-19. Epub 16 November 2012. doi:10.2519/jospt.2013.4450