Journal of Bodywork & Movement Therapies xxx (2017) 1e6

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Journal of Bodywork & Movement Therapies

journal homepage: www.elsevier.com/jbmt

Experimental study

Asymmetry of activation of lateral abdominal muscles during the

neurodevelopmental traction technique
Anna Gogola, PhD a, *, Rafał Gnat, PhD a, b, Małgorzata Zaborowska, Msc c,
Dorota Dziub, Msc c, Michalina Gwo 
zd
z, Msc c
a
Department of Physiotherapy, The Jerzy Kukuczka University of Physical Education, Katowice, Poland
b
Motion Analysis Laboratory, The Jerzy Kukuczka University of Physical Education, Katowice, Poland
c
Faculty of Physiotherapy, The Jerzy Kukuczka University of Physical Education, Katowice, Poland

a r t i c l e i n f o a b s t r a c t

Article history: Objective: The aim of the study was to evaluate the symmetry and pattern of activation of lateral
Received 4 September 2016 abdominal muscles (LAM) in response to neurodevelopmental traction technique.
Received in revised form Design and participants: Measurements of LAM thickness were performed in four experimental condi-
12 March 2017
tions: during traction with the force of 5% body weight (5% traction): 1) in neutral position, 2) in 20

Accepted 27 March 2017
posterior trunk inclination; during traction with the force of 15% body weight (15% traction): 3) in neutral
position, 4) in 20
posterior trunk inclination. Thirty-seven healthy children participated in the study.
Keywords:
Interventions: Not applicable.
Neurodevelopmental traction technique
Ultrasound
Main outcome measures: To evaluate LAM activation level ultrasound technology was employed (two
Lateral abdominal muscles Mindray DP660 devices (Mindray, Shenzhen, China) with 75L38EA linear probes). An experiment with
Asymmetry repeated measurements of the dependent variables was conducted.
Results: Side-to-side LAM activation asymmetry showed relatively high magnitude, however, significant
difference was found only in case of the obliquus externus (OE) during stronger traction (P < 0.05). The
magnitude of LAM thickness change formed a gradient, with the most profound transversus abdominis
(TrA) showing the smallest change, and the most superficial OE e the greatest. The inter-muscle dif-
ferences were most pronounced between the OE and TrA (P < 0.001).
Conclusions: During the neurodevelopmental traction technique there is a difference in individual LAM
activation level, with deeper muscles showing less intense activation. In statistical terms, the only signs
of side-to-side asymmetry of LAM activation are visible in case of the OE, however, the magnitude of
asymmetry is relatively high.
The results allow to identify patterns of activation of LAM in children showing typical development that
will serve as a reference in future studies in children with neurological disorder.
© 2017 Elsevier Ltd. All rights reserved.

1. Introduction
In the domain of modern physiotherapy the popular and vivid
issues are structure and function of the core region muscles
(Bergmark, 1989; Cholewicki et al., 1997; O'Sullivan et al., 1997;
Hodges, 1999; Tokuno et al., 2013). In adults, these muscles are
responsible for position and movement control of the trunk above
the pelvis (Aruin and Latash, 1995; Hodges et al., 1999; Marshall
* Corresponding author. Department of Physiotherapy, The Jerzy Kukuczka Uni-
versity of Physical Education, Mikolowska Street 72b/14, 40-065 Katowice, Poland.
E-mail address: aniagogola@op.pl (A. Gogola).
and Murphy, 2003; Lee et al., 2009). Expanded to three di-
mensions, precise neuromuscular control of the trunk becomes a
crucial factor in core stability. Maintaining this stability is highly
required in order to effectively perform any form of motor activity
(Kibler et al., 2006).
In adults, disturbed neuromuscular control of the core region
frequently manifests itself in the form of low back pain (McGill,
2002; Hodges, 2003). In such cases, numerous sources delineate
the most useful therapeutic approaches (e.g. Unsgaard-Tondel
et al., 2010; Vasseljen and Fladmark, 2010). In children, low
postural tone constitutes a common symptom of insufficient core
control (Raine, 2006; Howle, 2002; Gogola et al., 2014). Here, the

http://dx.doi.org/10.1016/j.jbmt.2017.03.019
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Please cite this article in press as: Gogola, A., et al., Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental
traction technique, Journal of Bodywork & Movement Therapies (2017), http://dx.doi.org/10.1016/j.jbmt.2017.03.019
2 A. Gogola et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e6
therapy focuses on optimizing ‘postural stability’ perceived as a
basis for any anti-gravitational motor activity (Lynch-Ellerington,
1998). There is, however, no clear indication as to which muscles
should be regarded as anti-gravitational. It is also well known that
besides low postural tone, postural asymmetry constitutes the
other common sign of neuromuscular insufficiency during child-
hood. Its symptoms may be found in such pathological states as
developmental coordination disorder (Wilson et al., 2013), cere-
bral palsy (Einspieler et al., 2012), syndrome of contractures
(Karski, 2011) and kinetic imbalance due to suboccipital strain
(Brand et al., 2005).
In the aspect presented here, the problem of asymmetry was
mainly explored by scientists interested in adult populations. The
question of whether the left and right core muscles show symmetry
in healthy people has already been asked several times. Aiming to
find the answer, the core muscles were frequently subjected to
observation, in particular the lateral abdominal muscles (LAM). In
an attempt to increase the level of their activity various experi-
mental tasks have been employed, e.g. the active straight leg raise
(Teyhen et al., 2009; Mens et al., 2001) rapid upper limb movement
(Allison and Brendan, 2008; Hodges et al., 1999), abdominal
drawing-in manoeuvre (Park, 2013; Olivier et al., 2013) or
abdominal bracing exercise (Park et al., 2014). Using stimulation of
these types, LAM responses were evaluated in healthy subjects
demonstrating a moderate level of daily physical activity (Mannion
et al., 2008; Springer et al., 2006; Rankin et al., 2006) or in patients
with low back pain (Ferreira et al., 2004; Hodges and Richardson,
1996; Hides et al., 2009). Some part of the research focused on
LAM activation during asymmetric movement patterns in sports
(Hides et al., 2008). Most authors agree that in healthy, adult sub-
jects a symmetrical activation of LAM is the most typical (Rankin
et al., 2006; Springer et al., 2006; Mannion et al., 2008).
In the developmental period of life, neither the pattern of LAM
activation nor the symmetry of the activation have been subjected
to investigation. Based on the assumption that within the frame-
work of neurodevelopmental therapy an increase in core muscles
activity, including LAM, is beneficial in order to improve ‘postural
stability’, we recently provided a piece of evidence (Gogola et al.,
2016). With the use of ultrasounds, we investigated the responses
of the three LAM (obliquus externus (OE), obliquus internus (OI)
and transversus abdominis (TrA)) to the application of the neuro-
developmental traction technique. The results revealed the ex-
pected response; however, the response was different for each
individual muscle. The superficial LAM responded more distinctly
to the traction. The OE and OI significantly increased their thick-
ness. In contrast, the TrA showed hardly any response or it
decreased its thickness. This was in contrast with the evidence
obtained in adults (Hides et al., 2010; Moseley et al., 2003; Tsao and
Hodges, 2008) in whom increases in TrA thickness were usually
demonstrated.
Our previous results indicate that, indeed, application of the
traction technique influences the level of LAM activity. However, it
is still not known whether it may be helpful in attempts to reduce
symptoms of LAM activation asymmetry perceived as a sign of
disturbed core region neuromuscular control in children. In this
context, the aim of the current study was to answer the following
questions: 1) is there a difference in individual LAM activation level
during the neurodevelopmental traction technique using the head
as the key point?; 2) is there a difference between the activation
level of the left and right LAM?; 3) is there a difference in the
magnitude of activation asymmetry between individual LAM?; 4)
does force of the applied traction influence LAM activation level
and its asymmetry? Only healthy children were involved because
our intention was to observe muscular reactions without any
interference from a dysfunctional nervous system.
Please cite this article in press as: Gogola, A., et al., Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental
traction technique, Journal of Bodywork & Movement Therapies (2017), http://dx.doi.org/10.1016/j.jbmt.2017.03.019
2. Subjects and methods
2.1. Subjects
Forty-three children together with their parents agreed to
participate. The children were tested against the selection criteria.
The inclusion criteria were: age between 11 and 13 years (before
the puberty spurt); ability to comply with verbal commands;
typical, undisturbed neuromotor development. The exclusion
criteria were: history or current diagnoses of any serious ortho-
paedic or neurologic conditions (e.g. fractures, congenital de-
formations, cerebral palsy, etc.); history of any surgical
interventions; history of serious musculoskeletal pain and
dysfunction (of more than 2-week duration, requiring medical/
physiotherapeutic assistance), or any recent (1 month prior to the
experiment) musculoskeletal pain and dysfunction; minor mala-
dies on the day of measurement (cold, headache, excessive fatigue,
etc.); obesity precluding ultrasound measurement of LAM thick-
ness (body mass index higher than 22 kg/m3). Three children were
excluded due to a history of fractures, two due to a history of sur-
gical interventions within the abdominal area and one due to
recent undiagnosed pain within the left ankle and knee. Thirty-
seven children (22 girls) who qualified for the study (mean age
12.00 (±0.82) years, body mass 43.68 (±8.22) kg and height 151.46
(±7.76) cm) received detailed information on the objectives and
procedures. No dropouts were recorded during the procedure. In
the case of all included children written informed consent was
obtained from their parents. The study was approved by the
institutional Biomedical Research Ethics Committee.
2.2. Design
The experimental study was conducted with repeated mea-
surements of the dependent variables. Measurements of LAM
thickness (indicating LAM activation level) were performed in four
experimental conditions: during traction with the force of 5% body
weight (5% traction): 1) in neutral position, 2) in 20
posterior trunk
inclination; during traction with the force of 15% body weight (15%
traction): 3) in neutral position, 4) in 20
posterior trunk
inclination.
2.3. Outcome measures
To evaluate LAM activation level ultrasound technology was
employed (two Mindray DP660 devices (Mindray, Shenzhen,
China) with 75L38EA linear probes) in accordance to the method-
ology presented in detail by Gnat et al. (2012). B-mode images
showing three layers of LAM (OE, OI, TrA) were bilaterally recorded
in four experimental conditions and subjected to further analysis.
The analysed parameters were: percent thickness change of the
individual LAM between neutral and inclined trunk positions (a
measure of LAM activation level) as well as asymmetry index of the
thickness change (a measure of LAM activation asymmetry), both
during 5% traction and 15% traction. Previous research showed that
these measurements present an acceptable level of reliability (Gnat
et al., 2012) and are valid indicators of LAM activation based on
their strong correlation with electromyographic signal from LAM
(Vasseljen et al., 2009).
2.4. Procedure
Detailed description of the experimental procedure is presented
elsewhere (Gogola et al., 2016). Briefly, the neurodevelopmental
traction technique is performed while sitting and consists of two
components: a traction force applied to the trunk through the head
 A. Gogola et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e6 3

and a posterior trunk inclination. These components were imitated

in a standardised manner. Traction with the desired force was
applied to the head with the use of a pulley system and a Glisson
loop. To achieve posterior trunk inclination the subjects were
seated on a stool mounted on a movable platform. Initially, the
subjects were positioned directly under the pulley with their
trunks in a neutral position. Subsequently, the platform was moved
forward (the pulley remained stationary on the ceiling), which
produced posterior inclination of the trunk. This was stopped when
the range of inclination reached 20
(see Fig. 1).
The desired levels of traction forces (5% and 15% of the body-
weight) as well as the optimal range of posterior trunk inclination
(20
) were established prior to the experiment in the pilot study. In
this study the level of intra-rater reliability of our raters was eval-
Fig. 2. Left: raw real-time ultrasound image of the lateral abdominal muscles; right: an
uated too. In the neutral trunk position the intraclass correlation image after editing in Photoshop software showing 3 layers of lateral abdominal
coefficients (model (3,3)) for the OE, OI and TrA equalled 0.95, 0.93 muscles (OE e obliquus externus abdominis, OI e obliquus internus abdominis, TrA e
and 0.82, respectively. In the inclined trunk position they were 0.96, transversus abdominis) and subcutaneous tissue (ST). As an example, TrA thickness
0.95 and 0.91, respectively. Standard errors of measurement were was measured along the three black lines depicted on the edited image. The mean
value of these 3 measurements was subjected to further analysis. The thickness of the
smaller than 0.4 mm. two remaining muscles was measured accordingly.
When the raters and the subject were ready, the measurements
started. After the application of 5% traction, the images of the right
TC ¼ (TN-TI)  100% / TN
and left LAM were first recorded in the neutral trunk position and
next, after moving the platform anteriorly, in 20
posterior trunk
where:
inclination. After this, the platform and the trunk returned to the
neutral position and the traction force was released. The neutral
TC e thickness change
trunk positioneinclined trunk position cycle, together with the
TN e thickness in neutral trunk position
registration of images, was repeated 6 six times. Subsequently, after
TI e thickness in inclined trunk position
a pause of 10 min, this same approach was used with 15% traction.
AI ¼ j(TCl-TCr)j  100% / j(TCl þ TCr)j
2.5. Data processing
where:
After completing the procedure we gathered 6 images of the left
AI e asymmetry index
and 6 images of the right LAM for experimental conditions 1e4.
TCl e thickness change recorded for the left LAM
Thickness of each individual LAM during each condition was
TCr e thickness change recorded for the right LAM
measured as described in detail by Gnat et al. (2012) and Gogola
et al. (2016) (see Fig. 2). Mean thickness measured on all 6 im-
ages was subjected to analysis. To reduce bias, the names of image
files had been coded by a third person before the measurements 2.6. Statistical analysis
were taken.
The percent thickness change as well as the asymmetry index of Differences of the calculated thickness changes and asymmetry
each individual LAM were calculated according to the formulas: indexes were assessed: between individual LAM e using one-way
analysis of variance followed by post hoc Tukey test; between 5%
and 15% tractions e using the dependent t-Student test; between
left and right side of the body within the given LAM e using the
independent t-Student test. The critical P level was set at 0.05.

3. Results

Descriptive statistics for LAM thickness change and asymmetry

Fig. 1. Two main components of the neurodevelopmental traction technique were
imitated during the measurement. Traction with the desired force was applied to the
head with the use of a pulley system and a Glisson loop. To achieve posterior trunk
inclination the subjects were seated on a stool mounted on a movable platform.
Initially, the subjects were positioned with their trunks in a neutral position (left).
Subsequently, the platform was moved forward, which produced 20
posterior incli-
nation of the trunk (controlled with the use of a Rippstein plurimeter secured on the
subject's sternum) (right). In the neutral and inclined trunk positions the images of
lateral abdominal muscles were recorded bilaterally and simultaneously.
indexes are presented in Tables 1 and 2, respectively. As far as
thickness change is concerned, 5% traction elicited bigger changes
than 15% traction (see Fig. 3). The differences between lighter and
stronger tractions were significant in the case of each LAM, both on
the left and right sides of the body (all P < 0.05, see Table 1). The
magnitude of LAM thickness change formed a characteristic
gradient, with the most profound muscle (TrA) showing the
smallest change, and the most superficial muscle (OE) e the
biggest. Moreover, in the case of the TrA, the response most often
assumed negative values. The inter-muscle differences were most
pronounced between the OE and TrA (P < 0.001, both on the left and
right, and during 5% and 15% tractions). Between the OI and TrA
they were significant only on the left side of the body (P < 0.01,
during both 5% and 15% tractions), and between the OE and OI were
non-significant only on the right side during 15% traction (P > 0.05,

Please cite this article in press as: Gogola, A., et al., Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental
traction technique, Journal of Bodywork & Movement Therapies (2017), http://dx.doi.org/10.1016/j.jbmt.2017.03.019
4 A. Gogola et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e6

Table 1 4. Discussion
Descriptive statistics (%) for the left and right lateral abdominal muscles thickness
change between the neutral and inclined trunk positions calculated for tractions
with forces of 5% and 15% bodyweight. Presented are P levels of differences between
In frames of the presented study we investigated in children
the individual lateral abdominal muscles; between 5% and 15% tractions; and be- showing typical development symmetry of LAM activation during
tween the left and right side of the body within the given lateral abdominal muscle. axial traction through the head in neutral and inclined trunk po-
OE e obliquus externus abdominis, OI e obliquus internus abdominis, TrA e sitions. These two elements e traction and trunk inclination e are
transversus abdominis, SD e standard deviation, NS e non-significant.
the two components of the neurodevelopmental traction tech-
Traction Muscle Left Right P left vs.righta nique. Our results indicate, in statistical terms, that there is no
Mean (SD) Mean (SD) significant difference between thickness change of the left and
min-max min-max right LAM when applying 5% traction. Slight asymmetry is visible
5% OE 37.57 (21.16) 34.59 (30.41) NS only in the behaviour of the OE during 15% traction (see Tables 1
1.97e87.43 13.30e121.41 and 2). However, relying on statistical outcomes may be
OI 13.37 (13.58) 13.05 (15.16) NS misleading in this case. A tendency towards greater asymmetry
11.28e53.05 21.67e49.68 during 15% traction is clearly visible in Fig. 1 (bigger inclination of
TrA 0.62 (17.40) 2.92 (18.87) NS
lines for 15% traction) and Fig. 2 (higher location of points indi-
36.46e39.82 39.73e47.69
P OE vs. OIc <0.001 <0.001 cating mean asymmetry indexes for traction 15%). Moreover, the
P OE vs TrAc <0.001 <0.001 amount of asymmetry, as indicated by the asymmetry indexes, was
P OI vs. TrAc <0.01 NS high. It ranged between 32 and 69% for 5% traction and between 56
15% OE 21.59 (23.10) 10.92 (20.40) <0.05 and 74% for 15% traction. It seems that such an amount of asym-
11.75e90.18 36.77e51.84 metry cannot pass unnoticed. It is difficult to compare our results
OI 6.64 (10.63) 3.00 (11.90) NS with other studies, since none of them investigated children in a
13.68e30.61 24.23e22.71
comparable manner. We found the most similar methodology
TrA 5.75 (16.35) 3.84 (13.17) NS
50.29e21.13 28.82e26.03 presented by Kim et al. (2013). These authors assessed LAM activity
P OE vs. OIc
<0.01 NS during sudden, unexpected postural perturbation to the trunk in 15
P OE vs TrAc <0.001 <0.001 male healthy adults (mean age 27.13 ± 5.51 years). They found
P OI vs. TrAc <0.01 NS
asymmetry indexes of 37%, 17% and 10% for TrA, OI, and OE,
P 5% vs. 15%b OE <0.001 <0.001 respectively. We also recorded a similar gradient of asymmetry
OI <0.01 <0.001 indexes (TrA e the biggest, OE e the smallest), however our indexes
TrA <0.05 <0.05
were much larger than these found by Kim et al. (due to differences
a
t-Student test for independent data. in asymmetry indexes calculation, our indexes need to be multi-
b
t-Student test for dependent data.
c plied by 2 to become comparable to Kim's et al.). Signs of a greater
Tukey test.
symmetry of LAM activation in healthy adults may also be found in
the study by Rankin et al. (2006). The authors found near perfect
Table 2 symmetry for all abdominal muscles when the relative thickness of
Descriptive statistics (%) for the lateral abdominal muscles asymmetry indexes these muscles was assessed (all muscles exhibited less than 1.5%
calculated for tractions with forces of 5% and 15% bodyweight. Presented are P levels difference between sides). Similarly, Teyhen et al. (2012), who
of differences between the individual lateral abdominal muscles; and between 5%
assessed the symmetry of LAM thickness changes at rest and during
and 15% tractions. OE e obliquus externus abdominis, OI e obliquus internus
abdominis, TrA e transversus abdominis, SD e standard deviation, NS e non-
the active straight leg raise manoeuvre, obtained results compa-
significant. rable to Rankin et al. (2006). Mannion et al. (2008), who measured
LAM thickness changes during abdominal drawing-in exercises,
Muscle Traction 5% Traction 15% P 5% vs.
15%a
found no significant differences between left and right sides of the
Mean (SD) Mean (SD) body. Mean inter-side differences for individual LAM ranged from
min-max min-max
11% to 26%. Therefore, it seems that although we found hardly any
OE 32.20 (21.57) 56.54 (48.78) <0.01 statistically significant results, it is justified to suggest that children
2.31e85.56 2.26e189.70
with typical development may present more asymmetrical acti-
OI 48.07 (37.09) 61.11 (45.76) NS
1.86e155.51 1.42e170.62 vation of LAM than healthy adult subjects.
TrA 58.90 (59.29) 74.29 (60.65) NS As for clinical recommendations, we suggest that light 5% trac-
0.51e213.84 0.30e236.42 tion shows greater potential than stronger 15% traction. If we as-
P OE vs. OIb NS NS sume that in order to facilitate normal development and central
P OE vs. TrAb <0.05 NS
P OI vs. TrAb NS NS
stability the symmetrical activation of all LAM (Kim et al., 2013) as
a
well as more intensive activation of the TrA (local muscles) are
t-Student test for dependent data.
b needed (Hides et al., 2010; Moseley et al., 2003; Tsao and Hodges,
Tukey test.
2008), we could find both these qualities in 5% traction. As
mentioned above, 5% traction offers greater symmetry of LAM
activation and stronger activation of the TrA or a smaller tendency
see Table 1). Significant side-to-side asymmetry was found in the to TrA deactivation; in the case of 15% traction, negative mean
case of the OE during stronger traction (P < 0.05, see Table 1). thickness changes (possible deactivation) were recorded for the TrA
The asymmetry indexes also showed a characteristic gradient (see Table 1). Moreover, the 5% traction elicits more intense (also in
with the TrA being the most asymmetric and the OI the least. statistical terms) activation of LAM in general (see Table 1 and
Although the inter-muscle difference was significant only between Fig. 3). This effect was also demonstrated by Gogola et al. (2016).
OE and TrA in the case of 5% traction (P < 0.05, see Table 2) the What is worth mentioning is that our experiment also indicates
mentioned gradient is clearly noticeable in Fig. 4. The asymmetry that children are to more likely develop core region stability using
index also showed a tendency to assume higher values in the case superficial muscles. We recorded the largest thickness changes
of 15% traction. Again, the observed differences were significant between neutral and inclined trunk positions for the OE, smaller for
only in the case of one LAM e the OE (P < 0.01, see Table 2). the OI, and the smallest for the TrA. In fact, it was not uncommon

Please cite this article in press as: Gogola, A., et al., Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental
traction technique, Journal of Bodywork & Movement Therapies (2017), http://dx.doi.org/10.1016/j.jbmt.2017.03.019
 A. Gogola et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e6 5

Fig. 3. Mean values (whiskers indicate 95% confidence intervals) of the left and right lateral abdominal muscles thickness change between the neutral and inclined trunk positions
during tractions with forces of 5% and 15% bodyweight. OE e obliquus externus abdominis, OI e obliquus internus abdominis, TrA e transversus abdominis.

Fig. 4. Mean values (whiskers indicate 95% confidence intervals) of lateral abdominal muscles asymmetry indexes during tractions with forces of 5% and 15% body weight. OE e
obliquus externus abdominis, OI e obliquus internus abdominis, TrA e transversus abdominis.

that this last muscle decreased its thickness (especially during 15%
traction), which may imply deactivation.
Basing on the above-mentioned findings we may count two
features of LAM activation that potentially are different in healthy
children and adults: 1) more asymmetrical LAM activation in chil-
dren; and 2) more intensive activation of the superficial LAM in
children. If true, these characteristics may be treated as vectors of the
maturation process of the core stability mechanisms. Taking this one
step further, they may be regarded as indicators of dysfunctional
states. Building postural tone is often called the cephalo-caudal
process (Citow and MacDonald, 2001; Lee, 1990). Perhaps, at least
in the core region, it is also a process directed from superficial
towards deeper muscular layers and from asymmetrical activation
towards more symmetrical activation. Muscle stiffness in the deep
muscles do not seem to provide the primary mechanism of trunk
stability as suggested in adults (Gardner-Morse and Stokes, 1998).
We would also like to acknowledge the high reliability indices of
our measurements, which emphasize their credibility as well as the
limitations of the study. Among the limitations of our study we may
count the employment of the biomechanical model of neuro-
developmental traction, which might be slightly different from the
typical conditions. This was, however, necessary in order to achieve
the desired standardization of the measurement. Our target group
may be questioned as well. We explained why healthy children

Please cite this article in press as: Gogola, A., et al., Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental
traction technique, Journal of Bodywork & Movement Therapies (2017), http://dx.doi.org/10.1016/j.jbmt.2017.03.019
6 A. Gogola et al. / Journal of Bodywork & Movement Therapies xxx (2017) 1e6
were chosen. Their age, 11e13 years, provided higher compliance
with verbal commands. Obtained results prompt us to conduct
further research of younger and dysfunctional populations. Lack of
hand domination assessment as well as lack of measurement with
no traction is also a limitation of our study.
5. Conclusions
1. During the neurodevelopmental traction technique using the
head as the key point there is a difference in individual LAM
activation level, with deeper muscles showing less intense
activation.
2. In statistical terms, the only signs of side-to-side asymmetry of
LAM activation are visible in 15% traction. However, values of
asymmetry indexes are relatively high.
3. There is no unanimous evidence that the magnitude of LAM
asymmetry differs between individual LAM.
4. Traction force influences LAM activation level and its asymme-
try: 5% traction elicits greater and more symmetrical activation,
and thus may be recommended as more useful therapeutically.
Conflicts of interest
None.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
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