Objective: To investigate the immediate changes in resting and contracted thickness of the transversus abdominis (TrA) muscle after application of thrust joint manipulation (TJM) vs sham manipulation in participants with low back pain.

Methods: A pretest-posttest randomized controlled trial design was performed. Consecutive subjects satisfying eligibility criteria completed patient-report outcome baseline measures, pretreatment rehabilitative ultrasound imaging (RUSI) measurements, followed by the randomly assigned intervention then, post-treatment RUSI measurements, and post-treatment & final patient-reported outcome measures. To compare the outcomes of TJM and sham manipulation on the TrA muscle thickness, a 2-by-2 analysis of variance (treatment [TJM and sham manipulation]) by time (pretreatment and post-treatment) was completed for both the TrA muscle thickness at rest and muscle thickness during contraction. Descriptive statistics including independent-sample t tests for continuous variables and χ² tests for categorical variables were used to analyze differences in patient-reported outcome measures between groups.

Results: Sixty-seven eligible participants agreed to participate. No significant interactions were identified for either muscle thickness at rest or contraction.

Conclusion: This study did not support the hypothesis that manipulation would result in greater changes in TrA thickness at rest or during contraction in participants with low back pain. Based on prior research that identified subgroups of participants likely to respond to manipulation, future research should include participants more likely to respond favorably to TJM. This study was a priori registered with clinicaltrails.gov (NCT02558855).

Author keywords: Lumbar Vertebrae; Low Back Pain; Abdominal Muscles

Author affiliations: KKF: Nova Southeastern University, Fort Lauderdale, FL; DeRosa Physical Therapy, Flagstaff, AZ; BS: DeRosa Physical Therapy, Flagstaff, AZ; TKJ: Department of Physical Therapy, Northern Arizona University, Flagstaff, AZ; JAC: Franklin Pierce University, Manchester, NH

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