Increasing Activity and Co-contraction of Local Muscles in the Core Region and Lumbopelvic Motor Control through Immediate Respiratory Muscle Training: A Double-Blind Randomized Controlled Trial

Document Type : Original Article


Department of Sport Injury and Corrective Exercise, Bu-Ali University, Hamadan, Iran


Background: Core muscles play an important role during sports activities and these muscles control trunk stability via appropriate contraction. This study aimed to investigate the effect of immediate respiratory muscle sprint-interval training (RMSIT) on the activity of the selected trunk muscles and lumbopelvic motor control in athletes with chronic low back pain (CLBP).
Methods: A double-blind randomized controlled trial design was used for this study. The study population, 48 young athletes aged 18-25 years with CLBP, was randomly divided into training (n = 24) and control groups (n = 24). The study procedure was explained to the subjects. RMSIT was performed by the training group using a spirometer. The training program included six sets of 30-second breathing exercises. Surface electromyography of the selected local (transverse abdominis, multifidus) and global (erector spinae, rectus abdominis) muscles of the trunk and lumbopelvic motor control and patients’ perceived low back pain in pre- and post-tests were recorded in both groups.
Results: The results showed that the activity of the transverse abdominis and co-contraction of local muscles significantly increased (P ≤ 0.05) in the training group during static and dynamic overhead squat and single-leg squat. In addition, lumbopelvic stability in the right and left side significantly improved in the training group.
Conclusion: RMSIT can improve local muscle activity and co-contraction of local muscles activity in athletes with CLBP. Moreover, these training can improve lumbopelvic stability.


  1. Daste C, Abdoul H, Foissac F, Lefèvre-Colau MM, Poiraudeau S, Rannou F, et al. Patient acceptable symptom state for patient-reported outcomes in people with non-specific chronic low back pain. Ann Phys Rehabil Med. 2020:101451. doi: 10.1016/
  2. Brumagne S, Janssens L, Knapen S, Claeys K, Suuden-Johanson E. Persons with recurrent low back pain exhibit a rigid postural control strategy. Eur Spine 2008; 17(9):1177-84. doi: 10.1007/s00586-008-0709-7.
  3. Jung SH, Hwang UJ, Ahn SH, Kim HA, Kim JH, Kwon OY. Lumbopelvic motor control function between patients with chronic low back pain and healthy controls: A useful distinguishing tool: The STROBE study. Medicine (Baltimore). 2020; 99(15):e19621. doi: 10.1097/MD.0000000000019621.
  4. Bressel E, Dolny DG, Gibbons M. Trunk muscle activity during exercises performed on land and in water. Med Sci Sports Exerc. 2011; 43(10):1927-32. doi: 10.1249/MSS.0b013e318219dae7.
  5. Shah J, Veqar Z. Extensor trunk muscle activity during stabilization exercises: An update. J Indian Assoc Physiother. 2017; 11(1):12-16. doi: 10.4103/PJIAP_2_17.
  6. Aaberg E. Resistance Training Instruction-Advanced teaching principles and techniques for 65 exercises. Texas, EUA: Human Kinetics; 2007.
  7. Hides J, Stanton W, Mendis MD, Sexton M. The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. Man Ther. 2011; 16(6):573-7. doi: 10.1016/j.math.2011.05.007.
  8. Hides JA, Oostenbroek T, Franettovich Smith MM, Mendis MD. The effect of low back pain on trunk muscle size/function and hip strength in elite football (soccer) players. J Sports Sci. 2016; 34(24):2303-2311. doi: 10.1080/02640414.2016.
  9. Pinto RZ, Ferreira PH, Franco MR, Ferreira ML, Ferreira MC, Teixeira-Salmela LF, et al. Effect of 2 lumbar spine postures on transversus abdominis muscle thickness during a voluntary contraction in people with and without low back pain. J Manipulative Physiol Ther. 2011; 34(3):164-72. doi: 10.1016/j.jmpt.2011.02.009.
  10. Mesquita Montes A, Gouveia S, Crasto C, de Melo CA, Carvalho P, Santos R, et al. Abdominal muscle activity during breathing in different postural sets in healthy subjects. J Bodyw Mov Ther. 2017; 21(2):354-361. doi: 10.1016/j.jbmt.2016. 09.004.
  11. Moseley GL, Hodges PW. Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: A risk factor for chronic trouble? Behav Neurosci. 2006; 120(2):474-476. doi: 10.1037/0735-7044.120.2.474.
  12. Smith M, Coppieters MW, Hodges PW. Effect of experimentally induced low back pain on postural sway with breathing. Exp Brain Res. 2005; 166(1):109-17. doi: 10.1007/s00221-005-2352-4.
  13. Paungmali A, Joseph LH, Sitilertpisan P, Pirunsan U, Uthaikhup S. Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain. Pain Pract. 2017; 17(8):1008-1014. doi: 10.1111/papr.12552.
  14. Ward SR, Kim CW, Eng CM, Gottschalk LJ 4th, Tomiya A, Garfin SR, et al. Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability. J Bone Joint Surg Am. 2009; 91(1):176-85. doi: 10.2106/JBJS.G.01311.
  15. Lamberg EM, Hagins M. The effects of low back pain on natural breath control during a lowering task. Eur J Appl Physiol. 2012; 112(10):3519-24. doi: 10.1007/s00421-012-2328-6.
  16. Illi SK, Held U, Frank I, Spengler CM. Effect of respiratory muscle training on exercise performance in healthy individuals: A systematic review and meta-analysis. Sports Med. 2012; 42(8):707-24. doi: 10.1007/BF03262290.
  17. Taylor RW, Murdoch L, Carter P, Gerrard DF, Williams SM, Taylor BJ. Longitudinal study of physical activity and inactivity in preschoolers: The flame study. Med Sci Sports Exerc. 2009; 41(1):96-102. doi: 10.1249/MSS.0b013e3181849d81.
  18. Farahbakhsh F, Rostami M, Noormohammadpour P, Mehraki Zade A, Hassanmirazaei B, Faghih Jouibari M, et al. Prevalence of low back pain among athletes: A systematic review. J Back Musculoskelet Rehabil. 2018; 31(5):901-916. doi: 10.3233/BMR-170941.
  19. Gholami Borujeni B, Yalfani, A. Postural control and plantar pressure symmetry in male and female athletes with chronic low back pain when performing overhead squat. Journal of Kerman University of Medical Sciences. 2019; 26(4):307-315. doi: 10.22062/jkmu.2019.89524.
  20. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39(2):175-91. doi: 10.3758/bf03193146.
  21. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004; 4(1):1-6. doi: 1186/1471-2288-4-26.
  22. Audenaert EA, Khanduja V, Bauwens C, Van Hoof T, Pattyn C, Steenackers G. A discrete element model to predict anatomy of the psoas muscle and path of the tendon: Design implications for total hip arthroplasty. Clin Biomech (Bristol, Avon). 2019; 70:186-191. doi: 10.1016/j.clinbiomech.2019.09.004.
  23. Lewis CL, Foch E, Luko MM, Loverro KL, Khuu A. Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks. PLoS One. 2015; 10(5):e0126258. doi: 10.1371/journal.pone.0126258.
  24. Zawadka M, Smolka J, Skublewska-Paszkowska M, Lukasik E, Bys A, Zielinski G, et al. Sex-dependent differences in single-leg squat kinematics and their relationship to squat depth in physically active individuals. Sci Rep. 2020; 10(1):19601. doi: 10.1038/s41598-020-76674-2.
  25. Gholami-Borujeni B, Yalfani A, Ahmadnezhad L. Eight-Week inspiratory muscle training alters electromyography activity of the ankle muscles during overhead and single-leg squats: A randomized controlled trial. J Appl Biomech. 2020; 37(1):13-20. doi: 10.1123/jab.2019-0315.
  26. Borujeni BG, Yalfani A. Effect of respiratory muscle training session on ankle muscle activity in athletes with chronic low back pain performing overhead squats: A randomized controlled trial. Int J Evid Based Healthc. 2020; 18(2):256-264. doi: 10.1097/XEB.0000000000000204.
  27. Stegeman D, Hermens H. Standards for surface electromyography: The european project surface EMG for non-invasive assessment of muscles (SENIAM). Enschede: Roessingh Research and Development. 2007. P. 108-112.
  28. Ahmadnezhad L, Yalfani A, Gholami Borujeni B. Inspiratory muscle training in rehabilitation of low back pain: A randomized controlled trial. J Sport Rehabil. 2020; 29(8):1151-1158. doi: 10.1123/jsr.2019-0231.
  29. Jung SH, Kwon OY, Yi CH, Cho SH, Jeon HS, Weon JH, et al. Predictors of dysfunction and health-related quality of life in the flexion pattern subgroup of patients with chronic lower back pain: The STROBE study. Medicine (Baltimore). 2018; 97(29):e11363. doi: 10.1097/MD.0000000000011363.
  30. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008; 31(2):165-9. doi: 10.1097/MRR.0b013e3282fc0f93.
  31. Selkow NM, Eck MR, Rivas S. Transversus abdominis activation and timing improves following core stability training: A randomized trial. Int J Sports Phys Ther. 2017; 12(7):1048-1056. doi: 10.26603/ijspt20171048.
  32. Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Med Sci Monit. 2012; 18(3):CR174-81. doi: 10.12659/msm.882522.
  33. Disselhorst-Klug C, Williams S, Von Werder SC. Surface electromyography meets biomechanics or bringing sEMG to clinical application. International Conference on NeuroRehabilitation; P.1013-1016. doi: 10.1007/978-3-030-01845-0_203.
  34. Chiu LZ, Fry AC, Schilling BK, Johnson EJ, Weiss LW. Neuromuscular fatigue and potentiation following two successive high intensity resistance exercise sessions. Eur J Appl Physiol. 2004; 92(4-5):385-92. doi: 10.1007/s00421-004-1144-z.
  35. Volianitis S, McConnell AK, Jones DA. Assessment of maximum inspiratory pressure. Prior submaximal respiratory muscle activity ('warm-up') enhances maximum inspiratory activity and attenuates the learning effect of repeated measurement. 2001; 68(1):22-7. doi: 10.1159/000050458.
  36. Volianitis S, McConnell AK, Koutedakis Y, Jones DA. The influence of prior activity upon inspiratory muscle strength in rowers and non-rowers. Int J Sports Med. 1999; 20(8):542-7. doi: 10.1055/s-1999-9464.
  37. Hodges PW. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res. 2001; 141(2):261-6. doi: 10.1007/s002210100873.