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Item Metadata only ABDOMINAL DRAWING-IN MANEUVER WITH VISUAL BIOFEEDBACK ON MUSCLE ACTIVITY INYOUNG ADULTS(2025-12-31) Kantha P.; Sakulsriprasert P.; Wattananon P.; Kantha P.; Mahidol UniversityBackground: The abdominal drawing-in maneuver (ADIM) is a core stability exercise; however, controlling muscle activity of transversus abdominis/internal oblique (TrA/IO) is difficult. Real-time visual biofeedback (RVBF) is promising as an effective method for practice. This study aimed to investigate the effect of ADIM with RVBF on muscle activity. Methods: Twelve young adults were recruited for this study. Surface electromyography was attached to the following muscles: 1) TrA/IO, 2) lumbar multifidus (LM), 3) lumbar erector spinae (LES), 4) gluteus medius (GMed), and 5) gluteus maximus (GMax) during with and without ADIM reported as a percentage of maximal voluntary isometric contraction (%MVIC). The RVBF was used to provide feedback to participants during ADIM in both standing and lunge positions. Results: ADIM with 24.92% MVIC of TrA/IO can increase LM, LES, and GMed significantly in standing and GMax in the lunge position. Conclusions: ADIM with RVBF enhanced the improvement of back and hip muscle activity. Therefore, its use is recommended when performing exercises in the standing and lunge positions.Item Metadata only Core stabilization exercise can improve lumbar joint position sense in healthy individuals(2025-05-01) Prasertkul W.; Thawalyawichachit L.; Wattananon P.; Prasertkul W.; Mahidol UniversityBackground: Core stabilization exercises (CSE) are based on motor learning concepts focusing on sensorimotor function. It has been proposed that CSE can improve core stabilizer muscle function, leading to enhanced joint position sense. However, evidence to support the effects of CSE on joint position sense is still limited. Objective: To compare the immediate effect of CSE on joint position sense of the lumbar spine using a smartphone application in healthy individuals. Materials and methods: Fifty-six healthy individuals (9 males and 47 females) were recruited in the study. Two smartphones with the application were attached to the lumbar spine (L1) and sacrum (S2). They were asked to perform 45-degree lumbar flexion and return to neutral position, while lumbar joint position errors were recorded in each direction. They were then randomly assigned to CSE and control groups. After the intervention, they were asked to perform 45-degree lumbar flexion and return to a neutral position. Results: The CSE group demonstrated significant improvement (p<0.05) in lumbar joint position sense during the 45-degree flexion, whereas the control group did not show improvement. Both groups did not show significant improvement during the return to a neutral position. Conclusion: Findings suggested that one session of the CSE can improve lumbar joint position sense, which could be due to the increased activities of muscle spindles and Golgi tendon organs. In addition, our findings support the clinical utility of this smartphone application in measuring lumbar joint position sense.Item Metadata only Clinical prediction rule validity to identify individuals with recurrent low back pain(2022-01-01) Wattananon P.; Mahidol UniversityIntroduction. one set of clinical prediction rules (CPR) can be used clinically to identify patients with low back pain who are likely to benefit from motor control exercise. individuals with a history of recurrent low back pain during remission (rLBP) still have persisting impaired trunk neuromuscular control. Accordingly, CPR should detect these individuals with rLBP. This study aimed to determine the predictive validity of CPR to identify individuals with rLBP. Methods. overall, 30 subjects aged less than 40 years (22 subjects with rLBP and 8 subjects without a history of low back pain) were recruited. We used the following criteria as CPR: (1) presence of aberrant movement during active forward bend and (2) passive straight leg raising result greater than 91°. Kappa statistics and the chi-square test were used to determine predictive validity. diagnostic accuracy was also calculated. Results. Kappa demonstrated substantial agreement (kappa = 0.73), while the chi-square test showed significant association (2 = 16.28; p < 0.001) between positive CPR and rLBP. diagnostic accuracy demonstrated positive likelihood ratio of 3.82, while accuracy equalled 90%. Conclusions. our findings indicated the predictive validity of CPR to identify individuals with rLBP. The result from this study would help identify those predisposed to recurrent episodes of low back pain who would likely have a positive response to motor control exercise.Item Metadata only Inter-Rater Reliability of a 6-Item Movement Control Test Battery in Individuals With and Without Chronic Non-Specific Low Back Pain(2025-01-01) Thana-udomnan T.; Chansirinukor W.; Kongoun S.; Klahan K.; Wattananon P.; Thana-udomnan T.; Mahidol UniversityObjective: The purpose of this study was to investigate the inter-rater reliability of the 6-item movement control test battery (MCTB) in individuals with and without chronic non-specific low back pain (CNLBP) using different rating methods, including individual tests, summation, and direction-specific tests, for movement control impairment detection through real-time observation. Methods: Forty-seven participants with and without CNLBP were recruited. Participants were asked to perform MCTB (flexion-specific tests: waiter's bow, sitting knee extension, and quadruped rocking backward; extension-specific tests: pelvic tilt, prone knee flexion, and quadruped rocking forward), while 2 raters simultaneously and independently observed the movement control. Inter-rater reliability was analyzed using the chi-square test, percentage agreement (PA), kappa coefficient, and prevalence-adjusted and bias-adjusted kappa (PABAK). Results: The chi-square showed significant associations (P < .05) between the 2 raters in all tests and grading methods. For PA, all grading methods showed an acceptable level (PA > 70%), except prone knee flexion and extension-specific tests. The acceptable kappa levels (kappa > 0.4) were obtained in the flexion-specific tests and all individual tests except the prone knee flexion. The kappa of the summation did not reach the acceptable agreement level; however, this method yielded acceptable inter-rater reliability after using PABAK (PABAK = 0.62). Conclusions: The findings support inter-rater reliability of the flexion-specific tests, summation, and most individual tests for clinical use. However, the prone knee flexion and the extension-specific tests should be used with caution.Item Metadata only The effects of hip flexor stretching with and without abdominal exercises in asymptomatic individuals with hyperlordosis(2022-07-02) Janyathitipath T.; Sakulsriprasert P.; Wattananon P.; Kantha P.; Mahidol UniversityBackground/Aims Hyperlordosis is associated with shortened hip flexor muscles,causing low back pain. The aim of this study was to investigate the effects of hip flexorstretching with and without abdominal exercises in individuals with hyperlordosis.Methods A total of 30 participants with hyperlordosis, aged between 20 and 30 years,were divided into three groups. Participants in the hold-relax group performed hold-relaxstretching for 10 seconds, five repetitions, on both legs. Participants in the abdominalhollowing group performed hold-relax stretching and added an abdominal hollowingexercise for 10 seconds a repetition, 10 repetitions a set for three sets. Participants inthe curl-up group performed hold-relax stretching and then performed curl-up exercisesfor 10 repetitions a set for three sets. The angle of lumbar lordosis, hip muscle length(degrees), percentage of maximum voluntary contraction of transversus abdominis andinternal abdominal oblique, external abdominal oblique, rectus abdominis, lumbar erectorspinae and multifidus muscles were investigated at pre-test, post-test and followed up 3days after the end of the intervention.Results Significant within-group differences were found in the angle of lumbar lordosisfor all groups (P0.05), muscle length of hip flexor, and percentage of maximum voluntarycontraction of the lumbar erector spinae and multifidus muscles in the curl-up group(P0.05). The significant difference between pre-test and follow up in the hold-relaxgroup and curl-up group reflects the retention of at least 3 days.Conclusions Hold-relax stretching can reduce the angle of lumbar lordosis and increasehip muscle length. In the curl-up group, the lumbar erector spinae and multifidusmuscles decreased. Therefore, performing curl-up exercises after hold-relax stretchingis recommended to decrease the angle of lumbar lordosis and percentage of maximumvoluntary contraction of lumbar erector spinae and multifidus muscles.Item Metadata only Patients with low back pain use stiffening strategy to compensate for movement control during active prone hip rotation: A cross-sectional study(2022-01-01) Wattananon P.; Mahidol UniversityBACKGROUND: New motor adaptation to pain theory suggests that patients with low back pain (LBP) use the lumbopelvic stiffening strategy by redistribution of within and between muscle activities to protect painful structure. This could result in an altered postural control of the lumbopelvic region during active prone hip rotation (PHR). OBJECTIVE: To investigate coordination and timing of lumbopelvic and hip movements, and smoothness of the lumbopelvic control during PHR between participants with and without LBP. METHODS: Eight participants with LBP and eight participants without LBP were recruited. The electromagnetic tracking system was used to record kinematic data during PHR. Cross-correlation between hip rotation and lumbopelvic movement in the transverse plane was calculated. Correlation at zero time-lag, time-lag, correlation at time-lag, and maximal lumbopelvic motion were derived. Frequency of movement disruption was identified. An independent t-test was used in conjunction with the effect size and 95% minimal detectable difference (MDD95) to determine the difference in kinematic parameters. RESULTS: Participants with LBP demonstrated a significant delay (exceeding MDD95) in lumbopelvic motion while nonsignificant frequency of disrupted motion on the painful side PHR demonstrated a trend with a large effect size that exceeded MDD95. There were trends with moderate to large effect sizes and differences exceeding MDD95 in delay of lumbopelvic motion with greater movement disruption on the nonpainful side in participants with LBP. CONCLUSION: Participants with LBP used a lumbopelvic stiffening strategy for postural control to protect painful structures; however, the stiffening might complicate efforts to smoothly control lumbopelvic movement.Item Metadata only Neuromuscular responses to combined neuromuscular electrical stimulation and motor control exercises in a patient with recurrent low back pain: A single subject research report(2022-01-01) Wattananon P.; Mahidol UniversityBackground: Previous studies have demonstrated changes in lumbar multifidus muscle (LM) contractility after motor control exercises (MCE), and it has been hypothesized that adding neuromuscular electrical stimulation (NMES) may help to re-activate motor units. Objective: To present the effects of combined NMES and MCE on LM contractility, spatial and temporal motor unit recruitment, and movement control in a patient with recurrent low back pain (rLBP). Methods: Motion tracking system was used to measure quality of movement (smoothness) during an active forward bend, while ultrasound imaging and decomposition electromyography were used to measure the LM contractility and motor unit recruitment during the Sorensen test. These data were collected pre and post intervention. Perceived improvement was also recorded. Results: Improved movement smoothness post intervention was found, with increases in LM contractility from 68.1% to 97.7%, and from 74.2% to 86.7% on the right and left sides, respectively. Number of motor unit increased from 14 to 18 units, while mean firing rate decreased from 10.9 to 7.1 pulses/second post intervention. The patient also reported a perceived improvement of +2 on the Global Rating of Change (GROC). However, this change was not greater than +3 to be considered as minimal clinically important difference. Conclusion: These findings indicate improvements in movement control, LM contractility, and changes in spatial and temporal motor unit recruitment in the study patient, suggesting the potential clinical utility and the need for further research on combined NMES and MCE in the treatment of patients with rLBP.Item Metadata only Exploring the therapeutic potential of transcranial direct current stimulation for chronic low back pain: a scoping review(2025-06-01) Ibrahim A.A.; Klahan K.; Sornkaew K.; Tretriluxana J.; Silfies S.P.; Wattananon P.; Ibrahim A.A.; Mahidol UniversityINTRODUCTION: Chronic low back pain (CLBP) is a common disabling condition, inflicting a substantial socioeconomic burden. Given its association with neuroplastic changes, as evidenced by central and peripheral sensitization, neuromodulatory techniques such as transcranial direct current stimulation (tDCS) have emerged as potential treatments. This scoping review aimed to identify and map the existing literature on tDCS studies for CLBP to provide insight into how these studies are conducted, and to address their potential gaps in knowledge. EVIDENCE ACQUISITION: PubMed, Embase, Web of Science, and Cochrane Library were searched for relevant studies from inception to 23 March 2025. Eligible studies included were those examining tDCS alone or with other interventions in adults with CLBP, regardless of the outcome evaluated and included adults with CLBP. The review was conducted using Arksey and O'Malley's six-stage framework and was guided by the PRISMA for scoping review framework. EVIDENCE SYNTHESIS: Of 134 screened records, 26 studies were included: 23 randomized controlled trials and 3 quasi-experimental studies. Half of the studies (50%) had a low risk of bias while one-third (34.6%) showed a high or serious risk of bias. Outcomes evaluated varied and included clinical, biophysical, biomechanical, and psychosocial measures. There was considerable variability in tDCS treatment protocols across studies. The effectiveness of tDCS was inconsistent, particularly for clinical outcomes, with some studies indicating positive effects while others reported no significant effects. CONCLUSIONS: Overall, this review reveals inconsistent results for tDCS effectiveness in CLBP, likely due to variability in study designs, sample characteristics, treatment protocols, and outcome measures. Future well-designed trials are needed to clarify the therapeutic potential of tDCS for CLBP, particularly in combination with other interventions.Item Metadata only Investigation of core muscle activation in patients with chronic low back pain based on the 6-item movement control test battery: A secondary data analysis(2026-06-01) Polsa K.; Kingcha P.; Sungnak P.; Junsiri P.; Vachalathiti R.; Wattananon P.; Polsa K.; Mahidol UniversityBackground The 6-item movement control test battery (6MCTB) can identify movement control impairment (MCI) in patients with chronic low back pain (CLBP). However, it remains unclear whether altered activation of core stabilizing muscles underlies poor test performance. This study aimed to determine whether performance on the 6MCTB (individual tests, direction-specific classification, and summation) is associated with lumbar multifidus (LM) and transversus abdominis (TrA) activation in patients with CLBP. Methods Forty-two patients with CLBP underwent the 6MCTB, comprising three flexion-specific tests (waiter's bow, sitting knee extension, quadruped rocking backward) and three extension-specific tests (posterior pelvic tilt, prone knee flexion, quadruped rocking forward). The LM and TrA activation were measured using rehabilitative ultrasound imaging. Independent samples t-tests were used to compare LM and TrA activation between participants with positive and negative test results across different rating approaches. Results LM activation showed significantly reduced activation ( P < 0.05) in patients with positive flexion-specific tests, extension-specific tests, and summation compared to those with negative results. TrA activation did not differ significantly between positive and negative groups ( P > 0.05) across most tests, except prone knee flexion, which showed an unexpected increase in TrA activation in the positive group. Conclusion Based on individual tests, direction-specific classification, and summation from the 6MCTB, poorer test performance was consistently associated with reduced LM activation in patients with CLBP. However, TrA activation showed no consistent between-group differences. These findings suggest that LM dysfunction is more strongly associated with 6MCTB performance than with TrA activation in this testing context.Item Metadata only Association between quadriceps muscle strength and ultrasound-derived echogenicity in individuals with patellofemoral pain syndrome: A cross-sectional study(2026-07-01) Kantiya A.; Fungkiatphaiboon P.; Praoprirtpirom K.; Tangsriwong K.; Wang H.K.; Wattananon P.; Kantiya A.; Mahidol UniversityBackground Patellofemoral pain syndrome (PFPS) is commonly associated with quadriceps weakness and altered knee mechanics. While muscle quantity is frequently assessed, the role of muscle quality, indirectly represented by ultrasound-derived echogenicity, remains unclear in this population. This study aimed to compare quadriceps strength between individuals with PFPS and healthy controls (CON) and to explore whether quadriceps strength is associated with rectus femoris echogenicity, age, BMI, and knee function. Methods A cross-sectional study was conducted with 55 participants with PFPS and 43 healthy controls. Rehabilitative ultrasound imaging was used to measure rectus femoris echogenicity at rest and during contraction at 5% body weight. Quadriceps strength was assessed using hand-held dynamometry, and knee function was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Results The PFPS group demonstrated significantly lower quadriceps strength than the CON group ( P = 0.045). In the PFPS group, quadriceps strength was significantly and inversely correlated with resting echogenicity ( r = −0.284, P = 0.035), contraction echogenicity ( r = −0.296, P = 0.028), and age ( r = −0.381, P = 0.004). Quadriceps strength was positively correlated with KOOS scores ( r = 0.434, P = 0.001). However, after controlling for age and BMI, the associations between quadriceps strength and resting echogenicity ( r = −0.167, P = 0.233) and contraction echogenicity ( r = −0.173, P = 0.215) were attenuated and no longer statistically significant. No significant correlations were observed in the CON group. Conclusion Individuals with PFPS demonstrated reduced quadriceps strength. Rectus femoris echogenicity may provide complementary information regarding muscle quality, but its association with strength appears to be partly influenced by age and BMI.