ABSTRACT
Abdominal pain is a common and functionally limiting complaint within the healthcare system linked to impaired quality of life and increased health care utilization. This chief complaint is associated with an extensive differential diagnosis leading to high utilization of diagnostic testing, increased healthcare cost, and delayed access to care. In patients presenting with acute or chronic abdominal pain, musculoskeletal pain often requires expensive testing, thereby delaying definitive care. An improved triage process is warranted. Performing a musculoskeletal examination to determine if pain patterns can be mechanically reproduced at the site of origin, or remote to the site of pain, warrants referral to a musculoskeletal specialist. In our young and healthy population, once the musculoskeletal mediated abdominal pain origin is determined, we see significant success in the application of a treatment approach consisting of manipulative therapy, exercise, and instrument-assisted soft tissue mobilization. A multimodal treatment approach for musculoskeletal-mediated abdominal pain has not been previously described. This case study outlines a novel management approach for musculoskeletal-mediated abdominal pain and provides an alternative diagnostic technique, when implemented early in the evaluation and management process of atypical abdominal pain, that improves the quality of life.
ABSTRACT
BACKGROUND: Limited evidence exists on how strength and endurance exercises commonly used to prevent low back pain affect muscle morphometry and endurance. OBJECTIVE: The purpose of this study was to analyze the effects of 2 exercise regimens on the morphometry and endurance of key trunk musculature in a healthy population. DESIGN: The study was designed as a randomized controlled trial. SETTING: The study was conducted in a military training setting. PARTICIPANTS: A random subsample (n=340; 72% men, 28% women; mean [±SD] age=21.9±4.2 years; mean [±SD] body mass index=24.8±2.8 kg/m2) from the larger Prevention of Low Back Pain in the Military trial (N=4,325) was included. INTERVENTION: The core stabilization exercise program (CSEP) included low-load/low-repetition motor control exercises, whereas the traditional exercise program (TEP) included exercises conducted at a fast pace, with the use of high-load, high-repetition trunk strengthening exercises. MEASUREMENTS: Baseline and follow-up examinations included ultrasound imaging of the trunk muscles and endurance tests. Linear mixed models were fitted to study the group and time effect and their interactions, accounting for the clustering effect. RESULTS: Symmetry generally improved in the rest and contracted states, but there were no differences suggestive of muscle hypertrophy or improved ability to contract the trunk muscles between soldiers receiving the CSEP or the TEP. Total trunk endurance time decreased over the 12-week period, but endurance performance favored soldiers in the CSEP group. Endurance time was not associated with future episodes of low back pain. LIMITATIONS: The lack of morphological changes may not be detectable in an already-active cohort, or a more intensive dose was needed. CONCLUSIONS: Although improved symmetry was noted, neither the CSEP nor the TEP resulted in muscle hypertrophy. Longer endurance times were noted in individuals who completed the CSEP but were not strongly predictive of future low back pain episodes.
