Ultrasound assessment of the diaphragm and abdominal muscles among elite wrestlers with and without low back pain- a case-control study

Low back pain (LBP) is a common condition among wrestlers. The core muscles, especially the abdominal and diaphragm muscles, are crucial for maintaining spinal stability. Previous studies have shown changes in spinal stabilization in athletes with LBP. This study aimed to compare diaphragm function and abdominal muscle activity between elite wrestlers with and without LBP. Thirty elite wrestlers (15 with LBP and 15 without LBP) participated in this case–control study. Abdominal muscle activity during active straight leg raising (ASLR), diaphragm thickness changes between normal inspiration and expiration, and diaphragm excursion during deep respiration were measured using ultrasound imaging. Data were analyzed using independent t-tests for parametric variables, and Mann–Whitney U tests for non-parametric variables, with a significance level set at 0.05. Elite wrestlers without LBP displayed significantly greater internal oblique (IO) muscle activity (t = 16, P ≤ 0.05, effect size = 0.73) and a greater change in diaphragm thickness between inspiration and expiration (t = 7.38, P ≤ 0.05, effect size = 2.76). In contrast, wrestlers with LBP demonstrated significantly higher external oblique (EO) muscle activity (U = 5, P ≤ 0.05, effect size = 0.81). No significant differences were found between the groups for the remaining measurements. The results suggest that differences in diaphragmatic thickness change and abdominal muscle activity are evident between elite wrestlers with and without LBP.