Document Type : Original Articles


1 department of physical therapy, school of rehabilitation sciences, isfahan university of medical sciences, isfahan, iran

2 Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences,

3 Department of Internal Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Research Institute for Primary Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences

6 Research Advisory Center, Islamic Azad University of Isfahan (Khorasgan) Branch, Isfahan, Iran

7 Research Institute for Primary Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Functional abdominal bloating (FAB) is a subjective sensation of increased abdominal pressure. Musculoskeletal factors may be related to functional abdominal bloating, but this association has not been investigated. The present study compares trunk-related musculoskeletal factors (spinal alignment and abdominal muscle function) in females with and without FAB.
Methods: This is a protocol study of a case-control study that will be conducted in females with (n=45) and without FAB (n=45), aged 18-60 years. A specially designed load cell setup and a flexicurve ruler will be used for the measurements of static abdominal muscle force and endurance, thoracic kyphosis, and lumbar lordosis, respectively. Additionally, skeletal muscle mass will be measured using body composition analysis. Depending on data distribution, an independent t-test or Mann-Whitney test will be used to determine differences in variables between the two groups. A multiple logistic regression will be used to investigate the adjusted associations of the trunk-related musculoskeletal variables and associations of the trunk-related musculoskeletal variables with functional abdominal bloating.


  1. Mari A, Backer FA, Mahamid M, Amara H, Carter D, Boltin D, et al. Bloating and Abdominal Distension: Clinical Approach and Management. Adv Ther. 2019;36(5):1075-84.
  2. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel Disorders. Gastroenterology. 2016. S0016-5085(16)00222-5.
  3. Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M. Prevalence of Rome IV Functional Bowel Disorders Among Adults in the United States, Canada, and the United Kingdom. Gastroenterology. 2020;158(5):1262-73.e3.
  4. Daneshpajouhnejad P, Keshteli AH, Sadeghpour S, Ardestani SK, Adibi P. Bloating in Iran: SEPAHAN Systematic Review No. 4. Int J Prev Med. 2012;3(Suppl 1):S26-33.
  5. Sullivan SN. Functional abdominal bloating with distention. ISRN Gastroenterol. 2012;2012:721820.
  6. Sullivan SN. A prospective study of unexplained visible abdominal bloating. N Z Med J. 1994;107(988):428-30.
  7. Foley A, Burgell R, Barrett JS, Gibson PR. Management Strategies for Abdominal Bloating and Distension. Gastroenterol Hepatol (N Y). 2014;10(9):561-71.
  8. Barba E, Burri E, Accarino A, Cisternas D, Quiroga S, Monclus E, et al. Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback. Gastroenterology. 2015;148(4):732-9.
  9. Tremolaterra F, Villoria A, Azpiroz F, Serra J, Aguadé S, Malagelada JR. Impaired viscerosomatic reflexes and abdominal-wall dystony associated with bloating. Gastroenterology. 2006;130(4):1062-8.
  10. Brusciano L, Limongelli P, del Genio G, Rossetti G, Sansone S, Healey A, et al. Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders. Int J Colorectal Dis. 2009;24(8):961-7.
  11. Ohba T, Ebata S, Koyama K, Haro H. Prevalence and key radiographic spinal malalignment parameters that influence the risk for gastroesophageal reflux disease in patients treated surgically for adult spinal deformity. BMC Gastroenterol. 2018;18(1):8.
  12. Tsuchie H, Miyakoshi N, Masutani N, Takahashi K, Kobayashi A, Hongo M, et al. Impact of spinal kyphosis on gastric myoelectrical activity in elderly patients with osteoporosis. Biomed Res. 2019;40(6):215-23.
  13. Alvarez WC. Hysterical type of nongaseous abdominal bloating. Arch Intern Med (Chic). 1949;84(2):217-45.
  14. Miyakoshi N, Kasukawa Y, Sasaki H, Kamo K, Shimada Y. Impact of spinal kyphosis on gastroesophageal reflux disease symptoms in patients with osteoporosis. Osteoporos Int. 2009;20(7):1193-8.
  15. Imagama S, Hasegawa Y, Wakao N, Hirano K, Hamajima N, Ishiguro N. Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people. Eur Spine J. 2012;21(11):2149-57.
  16. Imagama S, Ando K, Kobayashi K, Machino M, Tanaka S, Morozumi M, et al. Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study. Eur Spine J. 2019;28(11):2619-28.
  17. Adibi P, Ani A, Vaez A, Hadizadeh F, Snieder H, Roohafza H. Multidisciplinary approach to functional somatic syndromes: study protocol for a population-based prospective cohort study. BMJ Open. 2022;12(7):e048941.
  18. Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149-60.
  19. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352-60.
  20. Barrett E, McCreesh K, Lewis J. Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: a systematic review. Man Ther. 2014;19(1):10-7.
  21. Roghani T, Khalkhali Zavieh M, Talebian S, Akbarzadeh Baghban A, Katzman W. Back Muscle Function in Older Women With Age-Related Hyperkyphosis: A Comparative Study. J Manipulative Physiol Ther. 2019;42(4):284-94.
  22. Graves JE, Pollock ML, Carpenter DM, Leggett SH, Jones A, MacMillan M, et al. Quantitative assessment of full range-of-motion isometric lumbar extension strength. Spine (Phila Pa 1976). 1990;15(4):289-94.
  23. Mika A, Unnithan VB, Mika P. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine (Phila Pa 1976). 2005;30(2):241-6.
  24. Mesquita MMA, Santos MS, Vasconcelos ABS, de Sá CA, Pereira LCD, da Silva-Santos Í BM, et al. Reliability of a Test for Assessment of Isometric Trunk Muscle Strength in Elderly Women. J Aging Res. 2019;2019:9061839.
  25. Moreau CE, Green BN, Johnson CD, Moreau SR. Isometric back extension endurance tests: a review of the literature. J Manipulative Physiol Ther. 2001;24(2):110-22.
  26. Roghani T, Khalkhali Zavieh M, Rahimi A, Talebian S, Manshadi FD, Akbarzadeh Baghban A, et al. The reliability and validity of a designed setup for the assessment of static back extensor force and endurance in older women with and without hyperkyphosis. Physiother Theory Pract. 2018;34(11):882-93.
  27. Mijnarends DM, Meijers JM, Halfens RJ, ter Borg S, Luiking YC, Verlaan S, et al. Validity and reliability of tools to measure muscle mass, strength, and physical performance in community-dwelling older people: a systematic review. J Am Med Dir Assoc. 2013;14(3):170-8.
  28. Makizako H, Kubozono T, Kiyama R, Takenaka T, Kuwahata S, Tabira T, et al. Associations of social frailty with loss of muscle mass and muscle weakness among community-dwelling older adults. Geriatr Gerontol Int. 2019;19(1):76-80.
  29. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.