Variations in lateral abdominal muscle thickness during abdominal drawing-in maneuver in three positions in a young healthy population

Objective: To investigate the appropriate position for abdominal drawing-in maneuver (ADIM) exercise by rehabilitative ultrasound image. Design: Cross-sectional study. Methods: Twenty-eight young adults with no history of low back pain participated in the study. Three positions compared were crook lying position with hip 60o flexion, standing position with the feet hip width apart and knees straight, and saddle standing positionunsupported with the knees 20° flexed. Once in the appropriate position, the subjects were verbally cued to draw in their abdominal wall, with the intention of pulling their navel inward toward their lower back. The thickness of each transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles were measured via ultrasound and recorded at the end of inspiration. Results: When compared to the TrA thickness of rest, the TrA thickness was significantly increased in all three positions (crook lying, standing, and saddle standing) during the ADIM (p<0.05). IO thickness was significantly greater in standing and saddle standing than in crook lying (p<0.05). EO thickness was constant in all the three positions. Conclusions: The present study suggests that standing and saddle standing positions could be recommended for the ADIM to maximize recruitment of the TrA and IO activation. Specifically, the saddle standing position with knees flexed to 20° was observed to increase the TrA activation more than the standing position. These findings should be considered when core stability exercises such as the ADIM are conducted.