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Sibson BE, Yegian AK, Yawar A, Lieberman DE. Effects of back muscle fatigue and modified trunk inertia on lumbar kinematics, kinetics and muscle activity during walking. J Exp Biol 2025; 228:jeb250479. [PMID: 40241484 DOI: 10.1242/jeb.250479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2025] [Accepted: 04/02/2025] [Indexed: 04/18/2025]
Abstract
Back endurance is a strong predictor of back pain, but the mechanisms underlying this relationship are not clear. Fatigue reduces muscles' force-generating capacity, so greater fatigability may increase lumbar motion and loading and trunk muscle co-contraction. Using a novel pack to modify inertia, we tested the effect of back fatigue and increased trunk inertia on lumbar kinematics, kinetics and muscle activity during walking. Lumbar kinematic and kinetic amplitudes and maximum muscle activity were measured per stride across four conditions: pre- and post-fatigue, with and without increased trunk inertia. The pack caused increases in maximum lumbar erector spinae (ES) activity by 3.19 times the average value calculated during the pre-fatigue no-pack trial (P<0.001), amplitude of lumbar flexion-extension moment by 0.0189 N m (kg g m)-1 (P<0.001), lumbar lateral bending moment by 0.0028 N m (kg g m)-1 (P=0.019) and lumbar axial rotation moment by 0.0203 N m (kg g m)-1 (P<0.001), and decreases in the amplitude of roll angle by 1.31 deg and yaw angle by 6.65 deg (both P<0.001). Back endurance is positively associated with change in maximum lumbar ES activity (r=0.69, P=0.013) and negatively associated with change in maximum rectus abdominus (RA) activity (r=-0.72, P=0.008) and lumbar flexion-extension moment amplitude (r=-0.62, P=0.031). Overall, individuals with less back endurance had increased maximum RA activity and sagittal kinetics post-fatigue whereas individuals with higher back endurance showed the opposite response. Increased RA activity with less back endurance may be a protective mechanism for stabilizing the trunk in response to increased sagittal lumbar loading due to fatigue.
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Affiliation(s)
- Benjamin E Sibson
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02215, USA
| | - Andrew K Yegian
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Ali Yawar
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
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Sibson BE, Harris AR, Yegian AK, Uwimana A, Nuhu A, Thomas A, Anderson DE, Ojiambo RM, Lieberman DE. Associations of back muscle endurance with occupational back muscle activity and spinal loading among subsistence farmers and office workers in Rwanda. PLoS One 2024; 19:e0309658. [PMID: 39495738 PMCID: PMC11534227 DOI: 10.1371/journal.pone.0309658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/16/2024] [Indexed: 11/06/2024] Open
Abstract
Over the course of the physical activity transition, machines have largely replaced skeletal muscle as the source of work for locomotion and other forms of occupational physical activity in industrial environments. To better characterize this transition and its effect on back muscles and the spine, we tested to what extent typical occupational activities of rural subsistence farmers demand higher magnitudes and increased variability of back muscle activity and spinal loading compared to occupational activities of urban office workers in Rwanda, and whether these differences were associated with back muscle endurance, the dominant risk factor for back pain. Using electromyography, inertial measurement units, and OpenSim musculoskeletal modeling, we measured back muscle activity and spinal loading continuously while participants performed occupational activities for one hour. We measured back muscle endurance using electromyography median frequency analysis. During occupational work, subsistence farmers activate their back muscles and load their spines at 390% higher magnitudes and with 193% greater variability than office workers. Partial correlations accounting for body mass show magnitude and variability response variables are positively associated with back muscle endurance (R = 0.39-0.90 [P < 0.001-0.210] and R = 0.54-0.72 [P = 0.007-0.071], respectively). Body mass is negatively correlated with back muscle endurance (R = -0.60, P = 0.031), suggesting higher back muscle endurance may be also partly attributable to having lower body mass. Because higher back muscle endurance is a major factor that prevents back pain, these results reinforce evidence that under-activating back muscles and under-loading spines at work increases vulnerability to back pain and may be an evolutionary mismatch. As sedentary occupations become more common, there is a need to study the extent to which occupational and leisure time physical activities that increase back muscle endurance helps prevent back pain.
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Affiliation(s)
- Benjamin E. Sibson
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States of America
| | - Alexandra R. Harris
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States of America
| | - Andrew K. Yegian
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States of America
| | - Aimable Uwimana
- Division of Basic Sciences, University of Global Health Equity, Butaro, Rwanda
| | - Assuman Nuhu
- Department of Physiotherapy, University of Rwanda, Kigali City, Rwanda
| | - Alec Thomas
- Institute of Sports Science, University of Lausanne, Lausanne, Switzerland
| | - Dennis E. Anderson
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Robert M. Ojiambo
- Division of Basic Sciences, University of Global Health Equity, Butaro, Rwanda
| | - Daniel E. Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, United States of America
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Yamashita M, Ishida T, Osuka S, Watanabe K, Samukawa M, Kasahara S, Kondo E, Tohyama H. Trunk Muscle Activities during Ergometer Rowing in Rowers with and without Low Back Pain. J Sports Sci Med 2023; 22:338-344. [PMID: 37293422 PMCID: PMC10245001 DOI: 10.52082/jssm.2023.338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
This study aimed to determine the differences in trunk muscle activity during rowing at maximal effort between rowers with and without low back pain (LBP). Ten rowers with LBP and 12 rowers without LBP were enrolled in this study. All rowers performed a 500-m trial using a rowing ergometer at maximal effort. The amplitudes of the activities of the thoracic erector spinae (TES), lumbar erector spinae (LES), latissimus dorsi (LD), rectus abdominis (RA), and external oblique (EO) muscles were analyzed using a wireless surface electromyography (EMG) system. EMG data at each stroke were converted into 10-time series data by recording averages at every 10% in the 100% stroke cycle and normalized by maximum voluntary isometric contraction in each muscle. Two-way repeated measures analysis of variance was performed. Significant interactions were found in the activities of the TES and LES (P < 0.001 and P = 0.047, respectively). In the post hoc test, the TES activity in the LBP group was significantly higher than that in the control group at the 10% to 20% and 20% to 30% stroke cycles (P = 0.013 and P = 0.007, respectively). The LES activity in the LBP group was significantly higher than that in the control group at the 0% to 10% stroke cycle (P < 0.001). There was a main group effect on the LD activity, with significantly higher activity in the LBP group than in the control group (P = 0.023). There were no significant interactions or main effects in the EO and RA activities between the groups. The present study showed that rowers with LBP compared with those without LBP exhibited significantly higher TES, LES, and LD muscle activities. This indicates that rowers with LBP exhibit excessive back muscle activity during rowing under maximal effort.
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Affiliation(s)
- Momoko Yamashita
- Department of Sports Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Satoshi Osuka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kentaro Watanabe
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
- Department of Rehabilitation, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Satoshi Kasahara
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Eiji Kondo
- Department of Sports Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
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Cortical function and sensorimotor plasticity are prognostic factors associated with future low back pain after an acute episode: the Understanding persistent Pain Where it ResiDes prospective cohort study. Pain 2023; 164:14-26. [PMID: 35559930 DOI: 10.1097/j.pain.0000000000002684] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/25/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N = 120) participated in a prospective cohort study with 6-month follow-up. Candidate predictors were selected from the neurobiological (eg, sensorimotor cortical excitability assessed by sensory and motor-evoked potentials and brain-derived neurotrophic factor genotype), psychological (eg, depression and anxiety), symptom-related (eg, LBP history), and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with the presence of LBP at 6 months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress, and pain catastrophizing were the strongest predictors ( R2 = 0.47) of pain intensity at 6 months. Older age and higher pain catastrophizing were the strongest predictors ( R2 = 0.30) of disability at 6 months. When the LBP outcome was dichotomised, sensory cortex and corticomotor excitability, brain-derived neurotrophic factor genotype, depression and anxiety, LBP history and baseline pain intensity, discriminated between those who did and did not report LBP at 6 months (C-statistic 0.91). This study identifies novel risk factors for the development of future LBP. Neurobiological risk factors, when added to a multivariable linear regression model, explained a further 15% of the variance in the 6-month pain intensity.
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Yazici A, Yerlikaya T. Investigation of the relationship between the clinical evaluation results of lumbar region muscles with cross-sectional area and fat infiltration. J Back Musculoskelet Rehabil 2022; 35:1277-1287. [PMID: 35599467 DOI: 10.3233/bmr-210241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The relationship between the endurance of the lumbar paraspinal muscles and morphological changes needs to be clarified. In this context, the importance can be revealed of increasing the endurance level of the paraspinal muscles in the prevention and treatment of low back diseases. OBJECTIVE The aim of this study was to examine the relationship between the clinical evaluation results of the cross-sectional area (CSA) and fat infiltration of the lumbar deep paraspinal muscles. METHODS The study included 37 patients with mechanical low back pain (mechanical), 41 patients with lumbar hernia without root compression (discopathy) and 36 healthy individuals as a control group. The functional status of the lumbar deep paraspinal muscles was evaluated clinically with muscle endurance tests. The fat infiltration and CSA of the muscles were evaluated on axial MRI sections at the L3-S1 level. RESULTS The mean values of the prone bridge, Biering-Sorenson, and trunk flexion tests were seen to be highest in the control group and lowest in the discopathy group (p< 0.001). In all tests, the longest test period was obtained at < 10% fat infiltration and the shortest at > 50% fat infiltration. It was observed that as the amount of fat infiltration of the muscles increased, the test times were shortened. There was no significant relationship between the endurance level and the CSA of the groups. CONCLUSION The study results demonstrated that the endurance of the paraspinal muscles is associated with the fat infiltration of the muscles. In patients with chronic low back pain, information about muscle morphology and degeneration can be obtained with simple endurance tests without the need for further measurements. On clinical examination, a weak endurance level of the paraspinal muscles indicates the presence of a low back problem and an increase in the amount of fat infiltration.
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Affiliation(s)
- Alikemal Yazici
- Orthopedics and Traumatology Department, Faculty of Medicine, Near East University, Nicosia, Cyprus.,Buyuk Anadolu Hospital, Orthopedics and Traumatology Department, Samsun, Turkey
| | - Tuba Yerlikaya
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Near East University, Nicosia, Cyprus
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Koumantakis GA, Oldham JA. Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls: Reliability, clinical applicability and between-group differences. World J Orthop 2021; 12:816-832. [PMID: 34888142 PMCID: PMC8613684 DOI: 10.5312/wjo.v12.i11.816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/27/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain (LBP) prevention and rehabilitation. High reliability of paraspinal strength and electromyographic (EMG)-fatigue parameters has not been universally reported. Moreover, the discriminative validity of these parameters requires further exploration, under the threat of potentially poor reliability of the methods examined. AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants. METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers, for reliability. Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction (MVIC) protocol, performed in a custom-made device. For the fatigue test, participants performed a 60% MIVC level continuous isometric contraction of the paraspinals, in conjunction with EMG analysis from 4 muscle sites of the lumbar spine. Initial median frequency (IMF), the median frequency slope (MFslope), as well as the root mean square (RMS) slope EMG parameters were used as fatigue measures. Data were analysed with repeated measures ANOVA for test-retest differences. For reliability, the intraclass correlation coefficient (ICC3,1), standard error of the measurement (SEM) and the smallest detectable difference (SDD) were reported. Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance, with age, weight and strength as covariates. RESULTS Isometric strength presented statistically significant between-day differences (P < 0.01), however these did not exceed 10% (healthy: 7.2%/LBP-patients: 9.7%) and ICC reliability values were excellent, yet test-retest error was increased for the patient group (healthy: ICC3,1: 0.92-0.96, SEM: 5.72-5.94 Hz, SDD: 18.51%-18.57%/LBP-patients: ICC3,1: 0.91-0.96, SEM: 6.49-6.96, SDD: 30.75%-31.61%). For the frequency data, IMF reliability was excellent (healthy: ICC3,1: 0.91-0.94, SEM: 3.45-7.27 Hz, SDD: 9.56%-20.14%/patients: ICC3,1: 0.90-0.94, SEM: 6.41-7.59 Hz, SDD: 17.75%-21.02%) and of MF raw and normalised slopes was good (healthy: ICC3,1: 0.78-0.82, SEM: 4.93-6.02 Hz, SDD: 13.66-16.67%/LBP-patients: ICC3,1: 0.83-0.85, SEM: 6.75-7.47 Hz, SDD: 18.69%-20.69%). However, the reliability for RMS data presented unacceptably high SDD values and were not considered further. For discriminative validity, less MVIC and less steep MFslopes were registered for the patient group (P < 0.01). CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.
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Affiliation(s)
- George A Koumantakis
- Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, University of West Attica (UNIWA), Athens 12243, Attiki, Greece
| | - Jacqueline A Oldham
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M1 7DN, Lancs, United Kingdom
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Jenkins LC, Chang WJ, Buscemi V, Liston M, Skippen P, Cashin AG, McAuley JH, Schabrun SM. Low Somatosensory Cortex Excitability in the Acute Stage of Low Back Pain Causes Chronic Pain. THE JOURNAL OF PAIN 2021; 23:289-304. [PMID: 34492395 DOI: 10.1016/j.jpain.2021.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/26/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022]
Abstract
Determining the mechanistic causes of complex biopsychosocial health conditions such as low back pain (LBP) is challenging, and research is scarce. Cross-sectional studies demonstrate altered excitability and organization of the somatosensory and motor cortex in people with acute and chronic LBP, however, no study has explored these mechanisms longitudinally or attempted to draw causal inferences. Using sensory evoked potential area measurements and transcranial magnetic stimulation derived map volume we analyzed somatosensory and motor cortex excitability in 120 adults experiencing acute LBP. Following multivariable regression modelling with adjustment for confounding, we identified lower primary (OR = 2.08, 95% CI = 1.22-3.57) and secondary (OR = 2.56, 95% CI = 1.37-4.76) somatosensory cortex excitability significantly increased the odds of developing chronic pain at 6-month follow-up. Corticomotor excitability in the acute stage of LBP was associated with higher pain intensity at 6-month follow-up (B = -0.15, 95% CI: -0.28 to -0.02) but this association did not remain after confounder adjustment. These data provide evidence that low somatosensory cortex excitability in the acute stage of LBP is a cause of chronic pain. PERSPECTIVE: This prospective longitudinal cohort study design identified low sensorimotor cortex excitability during the acute stage of LBP in people who developed chronic pain. Interventions that target this proposed mechanism may be relevant to the prevention of chronic pain.
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Affiliation(s)
- Luke C Jenkins
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Wei-Ju Chang
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Valentina Buscemi
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Liston
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia; Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Centre for Human and Applied Physiological Sciences, Faculty of Life Science and Medicine, Kings College, London
| | - Patrick Skippen
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia; School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Siobhan M Schabrun
- Centre for Pain IMPACT, Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia.
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Macedo LB, Richards J, Borges DT, Melo SA, Reis DD, Brasileiro JS. The influence of Kinesio Taping on muscle fatigue in individuals with low back pain: A randomised controlled trial. J Back Musculoskelet Rehabil 2021; 34:613-621. [PMID: 33682693 DOI: 10.3233/bmr-200207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the effect of different taping techniques on back muscle fatigue in people with low back pain. METHODS Sixty women with chronic non-specific low back pain were randomly assigned to four groups of 15 participants each: control (CG), Kinesio Taping (KT) with tension (KTT), KT no tension (KTNT) and Micropore® (MP), which were applied over the erector spinae muscles. The median frequency (MF) fatigue slopes of the longissimus muscle and sustained contraction time during a trunk fatigue test (Ito test), and pain using the numerical pain rating scale (NPRS) were collected at three time points: pre-treatment, three and ten days after intervention at a university laboratory. RESULTS Significant differences were seen in the MF slopes between groups (p= 0.01, η2= 0.20), with the KTT showing a mean difference (MD = 0.31, p= 0.04) and KTNT (MD = 0.28, p= 0.04) compared with CG. Significant reductions in NPRS were seen between time points (p< 0.001, η2= 0.28), with a reduction between pre and 3 days (MD = 1.87, p< 0.001), and pre and 10 days (MD = 1.38, p< 0.001), with KTT and KTNT both showing clinically important changes. CONCLUSION KT, with or without tension, has a tendency to reduce back muscle fatigue and reduce pain in individuals with chronic non-specific low back pain.
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Affiliation(s)
- Liane Brito Macedo
- Faculty of Health Sciences of Trairí, Federal University of Rio Grande do Norte, Santa Cruz, Brazil.,Physiotherapy Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Jim Richards
- Allied Health Research unit, University of Central Lancashire, Preston, UK
| | - Daniel Tezoni Borges
- Physiotherapy Department, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Samara Alencar Melo
- Physiotherapy Department, Federal University of Rio Grande do Norte, Natal, Brazil
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Sibson BE, Tobolsky VA, Kistner TM, Holowka NB, Jemutai J, Sigei TK, Ojiambo R, Okutoyi P, Lieberman DE. Trunk muscle endurance, strength and flexibility in rural subsistence farmers and urban industrialized adults in western Kenya. Am J Hum Biol 2021; 34:e23611. [PMID: 33988283 DOI: 10.1002/ajhb.23611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES High trunk muscle endurance, strength, and moderate flexibility reportedly help maintain musculoskeletal health, but there is evidence for tradeoffs among these variables as well as sex differences in trunk muscle endurance and strength. To test if these observations extend similarly to both men and women in nonindustrial and industrial environments, we investigated intra-individual associations and group and sex differences in trunk muscle endurance, strength, and flexibility among 74 (35 F, 39 M; age range: 18-61 years) adults from the same Kalenjin-speaking population in western Kenya. We specifically compared men and women from an urban community with professions that do not involve manual labor with rural subsistence farmers, including women who frequently carry heavy loads. METHODS Trunk muscle endurance, strength, and flexibility were measured with exercise tests and electromyography (EMG). RESULTS We found a positive correlation between trunk extensor strength and endurance (R = .271, p ≤ .05) and no associations between strength or endurance and flexibility. Rural women had higher trunk extensor and flexor endurance, EMG-determined longissimus lumborum endurance, and trunk extensor strength than urban women (all p ≤ .05). Rural women had higher trunk extensor and flexor endurance than rural men (both p ≤ .05). Urban women had lower trunk flexor and extensor endurance than urban men (both p ≤ .01). CONCLUSIONS High levels of physical activity among nonindustrial subsistence farmers, particularly head carrying among women, appear to be associated with high trunk muscle endurance and strength, which may have important benefits for helping maintain musculoskeletal health.
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Affiliation(s)
- Benjamin E Sibson
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Victoria A Tobolsky
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Timothy M Kistner
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
| | - Nicholas B Holowka
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA.,Department of Anthropology, University at Buffalo, Buffalo, New York, USA
| | | | - Timothy K Sigei
- Department of Mathematics, Physics, and Computing, Moi University, Eldoret, Kenya
| | - Robert Ojiambo
- Division of Biomedical Sciences, University of Global Health Equity, Butaro, Rwanda
| | - Paul Okutoyi
- Department of Orthopaedics, Moi University Medical School, Eldoret, Kenya
| | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge, Massachusetts, USA
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Deane JA, Lim AKP, McGregor AH, Strutton PH. Understanding the impact of lumbar disc degeneration and chronic low back pain: A cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations. PLoS One 2021; 16:e0249308. [PMID: 33793605 PMCID: PMC8016216 DOI: 10.1371/journal.pone.0249308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
People with chronic low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. The aim and objective of this study was to determine differences in postural control strategies (peak amplitude, APAs and CPAs) between symptomatic and asymptomatic adults with and without Lumbar Disc Degeneration (LDD) using surface electromyography during forward postural perturbation. Ninety-seven subjects participated in the study (mean age 50 years (SD 12)). 3T MRI was used to acquire T2 weighted images (L1-S1). LDD was determined using Pfirrmann grading. A bespoke translational platform was designed to deliver horizontal perturbations in sagittal and frontal planes. Electromyographic activity was analysed bilaterally from 8 trunk and lower limb muscles during four established APA and CPA epochs. A Kruskal-Wallis H test with Bonferroni correction for multiple comparisons was conducted. Four groups were identified: no LDD no pain (n = 19), LDD no pain (n = 38), LDD pain (n = 35) and no LDD pain (n = 5). There were no significant differences in age or gender between groups. The most significant difference between groups was observed during forward perturbation. In the APA and CPA phases of predictable forward perturbation there were significant differences ankle strategy between groups (p = 0.007–0.008); lateral gastrocnemius and tibialis anterior activity was higher in the LDD pain than the LDD no pain group. There were no significant differences in the unpredictable condition (p>0.05). These findings were different from the remaining groups, where significant differences in hip strategy were observed during both perturbation conditions (p = 0.004–0.006). Symptomatic LDD patients exhibit different electromyographic strategies to asymptomatic LDD controls. Future LBP electromyographic research should benefit from considering assessment of both lower limbs in addition to the spine. This approach could prevent underestimation of postural control deficits and guide targeted rehabilitation.
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Affiliation(s)
- Janet A Deane
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Health Sciences, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Adrian K P Lim
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Imaging, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Paul H Strutton
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Rezai V, Mahdavi-Nejad R, Zolaktaf V. Comparing the Effects of Different Types of Aquatic Walking on Endurance and Electrical Activities of Spine Extensor Muscles in Men with Nonspecific Chronic Back Pain. Int J Prev Med 2020; 11:168. [PMID: 33312477 PMCID: PMC7716608 DOI: 10.4103/ijpvm.ijpvm_403_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/10/2020] [Indexed: 11/04/2022] Open
Abstract
Background Chronic back pain is one of the most challenging medical problems worldwide that results in disability, physical problems, and high costs for the family and society. Therefore, it can be very beneficial to find an appropriate treatment with minimum side-effects for this disease. The present study attempted to compare the effects of different water gait protocols on the endurance and electrical activity of spine extensor muscles in men with nonspecific chronic back pain. Methods The study adopted an experimental design in which 30 men with non-specific chronic back pain were selected through convenience sampling and using simple randomization method assigned into three groups of forward walking, backward walking, and sideways walking. Walking exercises were performed for 8 weeks, three sessions per week for 30 min. Twenty-four hours before and 48 h after the intervention, the endurance of spine extensor muscles and electrical activities were measured using the Ito test and electromyography, respectively. Data were analyzed in SPSS 23 using paired sample t-test and analysis of variance. Results The results showed that backward walking in water significantly increases endurance and electromyography activities of spine extensor muscles (P < 0.05), while forward and sideways walking had no significant effect on these variables (P > 0.05). The results obtained from Bonferroni post-hoc test showed a significant difference between the strength of trunk extensor muscles and EMG of spinal cord extensor muscles in forward and backward water gait groups (P = 0.001, 0.006). Conclusions According to the findings of this study, it seems that walking backward can be an effective therapeutic method for patients with chronic back pain.
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Affiliation(s)
- Vahid Rezai
- Department of Corrective Exercises, Faculty of Physical Education, University of Isfahan, Isfahan, Iran
| | - Reza Mahdavi-Nejad
- Department of Corrective Exercises, Faculty of Physical Education, University of Isfahan, Isfahan, Iran
| | - Vahid Zolaktaf
- Department of Corrective Exercises, Faculty of Physical Education, University of Isfahan, Isfahan, Iran
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12
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Cavaleri R, Chipchase LS, Massé-Alarie H, Schabrun SM, Shraim MA, Hodges PW. Corticomotor reorganization during short-term visuomotor training in the lower back: A randomized controlled study. Brain Behav 2020; 10:e01702. [PMID: 32633899 PMCID: PMC7428511 DOI: 10.1002/brb3.1702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/29/2020] [Accepted: 05/17/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Accumulating evidence suggests that motor skill training is associated with structural and functional reorganization of the primary motor cortex. However, previous studies have focussed primarily upon the upper limb, and it is unclear whether comparable reorganization occurs following training of other regions, such as the lower back. Although this holds important implications for rehabilitation, no studies have examined corticomotor adaptations following short-term motor training in the lower back. METHOD The aims of this study were to (a) determine whether a short-term lumbopelvic tilt visuomotor task induced reorganization of the corticomotor representations of lower back muscles, (b) quantify the variability of corticomotor responses to motor training, and (c) determine whether any improvements in task performance were correlated with corticomotor reorganization. Participants were allocated randomly to perform a lumbopelvic tilt motor training task (n = 15) or a finger abduction control task involving no lumbopelvic movement (n = 15). Transcranial magnetic stimulation was used to map corticomotor representations of the lumbar erector spinae before, during, and after repeated performance of the allocated task. RESULTS No relationship between corticomotor reorganization and improved task performance was identified. Substantial variability was observed in terms of corticomotor responses to motor training, with approximately 50% of participants showing no corticomotor reorganization despite significant improvements in task performance. CONCLUSION These findings suggest that short-term improvements in lower back visuomotor task performance may be driven by changes in remote subcortical and/or spinal networks rather than adaptations in corticomotor pathways. However, further research using tasks of varying complexities and durations is required to confirm this hypothesis.
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Affiliation(s)
- Rocco Cavaleri
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Lucy S Chipchase
- School of Health Sciences, Western Sydney University, Campbelltown, New South Wales, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Hugo Massé-Alarie
- CIRRIS Research Centre, Department of Rehabilitation, Laval University, Quebec, Canada.,Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Muath A Shraim
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul W Hodges
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
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13
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A Study on Trunk Muscle Activation of 2 Deep Water Running Styles (High-Knee and Cross-Country Style) and Land Walking. J Sport Rehabil 2020; 29:73-78. [PMID: 30526263 DOI: 10.1123/jsr.2017-0334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 10/16/2018] [Accepted: 10/28/2018] [Indexed: 11/18/2022]
Abstract
Context: Deep water running (DWR) is an aquatic aerobic exercise which involves running in water without the feet touching the bottom of the pool, and it may involve different activation of trunk muscles compared with running or walking on land. This form of exercise is gradually being adopted as a form of therapeutic exercise for people with low back pain. It is proposed that different types of running or walking in water may be a more comfortable form of training for the trunk and abdominal muscles compared with exercising on dry land. Objectives: This study aimed to examine the trunk muscle activation in DWR in 2 different styles—high knee style and cross-country style, and these were compared with walking on land. Participants: Eleven healthy individuals (2 females and 9 males, mean age = 24 [4.6]) were recruited for this study. Outcome Measures: Surface electromyography was used to examine the activities of the right transversus abdominis, rectus abdominis, lumbar multifidus, and lumbar erector spinae muscles in 5 conditions: static standing on land and in water, running in deep water with high knee and cross-country styles, and finally walking on a treadmill. Results: The percentage of maximal voluntary contraction of the transversus abdominis was significantly higher for both running styles in DWR, compared with that of static standing in water. Comparing directly the 2 styles, muscle activity was higher with a high knee action compared to without. The activation of transversus abdominis during high-knee DWR was comparable with that during treadmill walking and this may have clinical implications. Conclusion: The results of this study confirmed that running in deep water with a high knee action activated trunk muscles differently compared with standing or walking on land.
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14
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Jenkins L, Chang WJ, Buscemi V, Cunningham C, Cashin A, McAuley JH, Liston M, Schabrun SM. Is there a causal relationship between acute stage sensorimotor cortex activity and the development of chronic low back pain? a protocol and statistical analysis plan. BMJ Open 2019; 9:e035792. [PMID: 31888948 PMCID: PMC6937113 DOI: 10.1136/bmjopen-2019-035792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Why some people develop chronic pain following an acute episode of low back pain is unknown. Recent cross-sectional studies have suggested a relationship between aberrant sensorimotor cortex activity and pain persistence. The UPWaRD (Understanding persistent Pain Where it ResiDes) cohort study is the first prospective, longitudinal investigation of sensorimotor cortex activity in low back pain. This paper describes the development of a causal model and statistical analysis plan for investigating the causal effect of sensorimotor cortex activity on the development of chronic low back pain. METHODS AND ANALYSIS Sensorimotor cortex activity was assessed within 6 weeks of low back pain onset using somatosensory evoked potentials and transcranial magnetic stimulation mapping techniques. Chronic low back pain is defined as ongoing pain (Numerical Rating score ≥1) or disability (Roland Morris Disability Questionnaire score ≥3) at 6 months follow-up. Variables that could confound the relationship between sensorimotor cortex activity and chronic low back pain were identified using a directed acyclic graph and content expertise was used to specify known causal paths. The statistical model was developed 'a priori' to control for confounding variables identified in the directed acyclic graph, allowing an unbiased estimate of the causal effect of sensorimotor activity in acute low back pain on the development of chronic pain. The statistical analysis plan was finalised prior to follow-up of all participants and initiation of analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from Western Sydney University Human Research Ethics Committee (H10465) and from Neuroscience Research Australia (SSA: 16/002). Dissemination will occur through presentations at national and international conferences and publications in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12619000002189 (retrospectively registered).
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Affiliation(s)
- Luke Jenkins
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Wei-Ju Chang
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Valentina Buscemi
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Chelsea Cunningham
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Aidan Cashin
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - James H McAuley
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Liston
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia (NeuRA), Randwick, New South Wales, Australia
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15
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Age- and sex-specific effects in paravertebral surface electromyographic back extensor muscle fatigue in chronic low back pain. GeroScience 2019; 42:251-269. [PMID: 31773454 PMCID: PMC7031171 DOI: 10.1007/s11357-019-00134-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/04/2019] [Indexed: 01/07/2023] Open
Abstract
The impact of aging on the back muscles is not well understood, yet may hold clues to both normal aging and chronic low back pain (cLBP). This study sought to investigate whether the median frequency (MF) surface electromyographic (SEMG) back muscle fatigue method—a proxy for glycolytic muscle metabolism—would be able to detect age- and sex-specific differences in neuromuscular and muscle metabolic functions in individuals with cLBP in a reliable way, and whether it would be as sensitive as when used on healthy individuals. With participants seated on a dynamometer (20° trunk anteflexion), paraspinal SEMG activity was recorded bilaterally from the multifidus (L5), longissimus (L2), and iliolumbalis (L1) muscles during isometric, sustained back extensions loaded at 80% of maximum from 117 younger (58 females) and 112 older (56 female) cLBP individuals. Tests were repeated after 1–2 days and 6 weeks. Median frequency, the SEMG variable indicating neuromuscular fatigue, was analyzed. Maximum back extensor strength was comparable between younger and older participants. Significantly less MF-SEMG back muscle fatigue was observed in older as compared to younger, and in older female as compared to older male cLBP individuals. Relative reliability was excellent, but absolute reliability appeared large for this SEMG-fatigue measure. Findings suggest that cLBP likely does not mask the age-specific diagnostic potential of the MF-SEMG back extensor fatigue method. Thus, this method possesses a great potential to be further developed into a valuable biomarker capable of detecting back muscle function at risk of sarcopenia at very early stages.
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16
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Asymmetry of lumbar muscles fatigability with non-specific chronic low back pain patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2526-2534. [DOI: 10.1007/s00586-019-06140-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 08/06/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
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Schabrun SM, Burns E, Thapa T, Hodges P. The Response of the Primary Motor Cortex to Neuromodulation is Altered in Chronic Low Back Pain: A Preliminary Study. PAIN MEDICINE 2019; 19:1227-1236. [PMID: 29016867 DOI: 10.1093/pm/pnx168] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective Neuromodulation is increasingly investigated for the treatment of low back pain (LBP). However, the neurophysiological effects of common neuromodulatory techniques (anodal transcranial direct current stimulation [tDCS] and peripheral electrical stimulation [PES]) have not been investigated in people with chronic LBP. Here we aimed to compare the effect of three neuromodulatory protocols (anodal tDCS, high intensity PES, and a priming protocol of combined tDCS/PES) on primary motor cortex (M1) excitability in people with and without chronic LBP. Design Cross-sectional. Setting University laboratory. Participants Ten individuals with chronic LBP and 10 pain-free controls. Methods Participants received four interventions in random order across separate sessions: 1) anodal tDCS to M1 + PES to the back muscles; 2) tDCS + sham PES; 3) sham tDCS + PES; or 4) sham tDCS + sham PES. Motor cortical excitability (map volume, discrete map peaks, and cortical silent period [CSP]) was measured before and after each intervention. Results Anodal tDCS increased M1 excitability (increased map volume and reduced CSP) in controls but had no effect in the LBP group. PES reduced M1 excitability in both groups. The combined tDCS + PES treatment increased M1 excitability in the LBP group but had no effect in controls. Conclusions The neurophysiological response to common neuromodulatory treatments differs between people with and without LBP. This has relevance for the design and tailoring of neuromodulation in pain. Further, if the goal of treatment is to increase M1 excitability, a priming protocol (e.g., combined tDCS + PES) may be more effective than tDCS alone.
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Affiliation(s)
- Siobhan M Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- School of Health and Rehabilitations Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Emma Burns
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Tribikram Thapa
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Paul Hodges
- School of Health and Rehabilitations Sciences, The University of Queensland, Brisbane, Queensland, Australia
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18
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Daneau C, Cantin V, Descarreaux M. Effect of Massage on Clinical and Physiological Variables During Muscle Fatigue Task in Participants With Chronic Low Back Pain: A Crossover Study. J Manipulative Physiol Ther 2019; 42:55-65. [PMID: 30955910 DOI: 10.1016/j.jmpt.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/08/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if a reduction of short-term physiological and clinical effects of muscle fatigue can be seen after a session of massage in nonspecific chronic low back pain (cLBP) individuals and to study the possible association between physiological and clinical changes induced by massage. METHODS Thirty-six cLBP individuals participated in 2 experimental sessions. In one session, the Sorenson protocol was preceded by a 30-minute massage, but in the other session, only the Sorenson test was performed by participants. Lumbar paraspinal muscle activity was recorded using surface electromyography, and maximal voluntary contraction force was measured using a load cell. Participants rated their lumbar pain intensity before and after massage and after the Sorensen protocol. A 2-way repeated-measures analysis of variance was conducted to test the effect of massage on both variables for both conditions. Pearson correlation analyses were conducted to determine the linear association between physiological and clinical responses to massage. RESULTS Results showed that pain perception was significantly reduced after massage (P = .004) but did not seem to influence pain score increases occurring after the Sorensen protocol. Individuals with a high score of low back pain-related disability showed lower back muscle endurance time (r = -.35). Massage yielded no significant effect on fatigue-related physiological variables. CONCLUSION The perception of pain in cLBP individuals was reduced after massage. Although massage yielded some positives clinical effects, they were not explained by a reduction in physiological effect of muscle fatigue.
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Affiliation(s)
- Catherine Daneau
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
| | - Vincent Cantin
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Martin Descarreaux
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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19
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Chang WJ, Buscemi V, Liston MB, McAuley JH, Hodges PW, Schabrun SM. Sensorimotor Cortical Activity in Acute Low Back Pain: A Cross-Sectional Study. THE JOURNAL OF PAIN 2019; 20:819-829. [PMID: 30660764 DOI: 10.1016/j.jpain.2019.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/04/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
Sensorimotor cortical activity is altered in both the immediate acute and chronic stages of musculoskeletal pain. However, these changes are opposite, with decreased cortical activity reported in experimentally induced acute pain (lasting minutes to hours), and increased cortical activity in chronic, clinical pain (lasting >6 months). It is unknown whether sensorimotor cortical activity is altered in acute, clinical musculoskeletal pain (lasting <4 weeks). In 36 individuals with acute, nonspecific, clinical low back pain (LBP) and 36 age- and sex-matched, pain-free controls, we investigated the processing of non-noxious afferent inputs using sensory evoked potentials (SEPs), as well as corticomotor excitability and organization of the primary motor cortex using transcranial magnetic stimulation. Processing of non-noxious sensory inputs was lower (smaller area of the N80-N150-P260 SEP complex) in acute LBP (F1,70 = 45.28, P < .01). The examination of specific SEP components revealed a smaller area of the N150 and P260 SEP components in acute LBP, although interindividual variability was high. Motor cortical map volume was lower in acute LBP (F1,70 = 5.61, P = .02). These findings demonstrate that acute LBP is characterized by lower sensorimotor cortical activity at the group level. However, individual variation was high, suggesting individual adaptation of cortical plasticity in acute pain. PERSPECTIVE: This is the first study to examine sensorimotor cortical activity in the acute stage of clinical LBP. This information is critical for understanding the neurophysiology of acute LBP.
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Affiliation(s)
- Wei-Ju Chang
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Valentina Buscemi
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Matthew B Liston
- Centre for Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, Shepherd's House, King's College London, UK
| | - James H McAuley
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Queensland, Australia
| | - Siobhan M Schabrun
- Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia..
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Wang Y, Freedman L, Buck M, Bohorquez J, Rutkove SB, Keel J. Electrical Impedance Myography for Assessing Paraspinal Muscles of Patients with Low Back Pain. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2019; 10:103-109. [PMID: 33584890 PMCID: PMC7851978 DOI: 10.2478/joeb-2019-0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 06/12/2023]
Abstract
The objective of this study was to determine the potential value of electrical impedance myography (EIM) for assessing lumbosacral paraspinal muscle (LPM) condition in lower back pain (LBP) patients. Standard methods for assessing the condition of LPMs, such as magnetic resonance imaging, are inconvenient and expensive. One tool that could be useful for this purpose is electrical impedance myography (EIM) a technique that can be performed rapidly at the bedside. After undergoing a screening history and examination, subjects were studied with the mView EIM device (Myolex, Inc, Boston). Bilateral LPMs were measured three times each and the two closest sets of measurements averaged on each side. Data analysis included non-parametric two-group comparisons between healthy subjects and back pain patients, receiver-operating curve analyses, and correlation analyses to age and body mass index. A total of 86 healthy individuals (median age (interquartile range) (IQR), 45.5 years (30.3-56.0 years), 42 men, 44 women) and 47 LBP (median age 51.0 year (39.5-57.5) years, 21 men, 26 women) were enrolled. Median EIM 100kHz phase was lower in the LBP patients (9.3°(IQR 8.4°-10.6°) versus 11.4°(IQR 9.4°-13.0°), p = 0.0007). Significantly increased normalized side-to-side differences were present for all three EIM variables (e.g., median 100 kHz phase 0.15 (IQR 0.07-0.31 in LBP patients versus 0.09 (IQR 0.04-0.17) in healthy individuals). A significant correlation between 100 kHz EIM phase and reactance was found with age (Rspearman=-0.46, P=0.0002 and Rspearman=-0.440, P=0.0003) but not for resistance. This study provides early evidence supporting that EIM has the potential to serve as a useful tool for evaluating the condition of LPMs.
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Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University Beijing, China
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | | | | | - Seward B. Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - John Keel
- Emory Orthopaedics/Spine Center, Emory University, Atlanta, USA
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Orakifar N, Shaterzadeh-Yazdi MJ, Salehi R, Mehravar M, Namnik N. Muscle Activity Pattern Dysfunction During Sit to Stand and Stand to Sit in the Movement System Impairment Subgroups of Low Back Pain. Arch Phys Med Rehabil 2018; 100:851-858. [PMID: 30315764 DOI: 10.1016/j.apmr.2018.08.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate impairment in the activity pattern of some muscles involved in sit to stand (STD) and stand to sit (STS) among 2 low back pain (LBP) subgroups of the Movement System Impairment (MSI) model. DESIGN Case-control study. SETTING A university medical center. PARTICIPANTS Fifteen women without chronic LBP and 22 women with chronic LBP (N=37) in 2 subgroups (15 into the lumbar extension rotation (LER) and 7 into lumbar flexion rotation [LFR]) voluntarily participated in this study. INTERVENTIONS Participants were asked to perform STD and STS at a preferred speed. Surface electromyography (EMG) were measured bilaterally from the internal oblique (IO), lumbar erector spine (ES), medial hamstring (MH), and lateral hamstring (LH) muscles. MAIN OUTCOME MEASURES Changes in mean and maximum amplitude, time to peak amplitude, duration of muscle activity, and bilateral asymmetry of these variables. RESULTS During STD, bilateral asymmetry in mean amplitude of MH in the LER subgroup (P=.031) and bilateral asymmetry in duration of LH in the LFR subgroup (P=.026) were exhibited. Also, in this task reduced time to peak left MH activation were found in the LFR subgroup than 2 other groups (control; P=.028/LER; P=.004). During STS, increased left ES maximum amplitude were observed in the LFR subgroup than LER subgroup (P=.029). Also, reduced time to peak right ES (P=.035) and left LH (P=.038) activation in the LER subgroup than control subjects and reduced time to peak left LH activation in LFR subgroup than control subjects (P=.041) were observed during STS. CONCLUSIONS The differences between the 2 LBP subgroups may be a result of impairment in the activity pattern of some muscles during functional activity.
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Affiliation(s)
- Neda Orakifar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Reza Salehi
- Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Namnik
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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The relationship between functionality and erector spinae activity in patients with specific low back pain during dynamic and static movements. Gait Posture 2018; 66:208-213. [PMID: 30205316 DOI: 10.1016/j.gaitpost.2018.08.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/15/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Alterations in the activity of the lumbar erector spinae (LES) muscles on both sides of the spine have been inconsistently reported in patients with specific low back pain (sLBP) after measuring the muscular activity with surface electromyography (sEMG). It also remains unclear whether these alterations in LES activity can be related to the functional level of patients with sLBP. RESEARCH QUESTION This study investigated the LES activity in patients with sLBP during activities of daily living (ADL) which included dynamic and static movement tasks. Moreover, the alterations in LES activity were correlated with the first seven questions of the Zurich Claudication Questionnaire (ZCQ-SS). METHODS Thirty patients with specific LBP and twenty healthy subjects were recruited to perform five ADLs including 'static waist flexion', 'sit to stand',' 30-seconds standing', '6-minutes walking' and 'climbing stairs'. sEMG sensors were mounted on the left and right LES muscles. The integrated EMG (IEMG) was calculated from the preprocessed sEMG data as statistical comparison criteria. RESULTS LES activity was significantly higher in patients during 'sit to stand',' 30-seconds standing' and 'climbing stairs' and significantly lower during 'static waist flexion' compared to healthy controls. All tasks showed a significant correlation with the ZCQ-SS score except for '6-minutes walking', whereby LES activity and ZCQ-SS score correspondingly increased during 'sit to stand' and 'climbing stairs' and the LES activity decreased with an increasing ZCQ-SS score during 'static waist flexion' and' 30-seconds standing'. SIGNIFICANCE There was a high correlation between alterations in LES activity and the level of functionality in LBP patients. However, the LES activity showed an opposite behavior during static and dynamic movement tasks. The methodology presented can be a useful tool for quantifying improvements in functionality after rehabilitation processes.
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Lima M, Ferreira AS, Reis FJJ, Paes V, Meziat-Filho N. Chronic low back pain and back muscle activity during functional tasks. Gait Posture 2018; 61:250-256. [PMID: 29413793 DOI: 10.1016/j.gaitpost.2018.01.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/05/2018] [Accepted: 01/21/2018] [Indexed: 02/02/2023]
Abstract
There is evidence that patients with low back pain favor their trunk muscles when moving. However, it is unknown whether this maladaptive behavior is generalized across different functional tasks. This study analyzed the back muscle activity of patients with chronic low back pain compared to asymptomatic controls during five functional tasks. The secondary aim of this study was to test whether the electromyographic activity of patients' back muscles was correlated with either the TAMPA scale score or the Örebro Questionnaire. Forty patients with chronic, non-specific low back pain and 40 asymptomatic participants were assessed on the electromyographic activity of the lumbar longissimus, ilio-costal and multifidus while picking up and placing an object on the ground, sitting down and standing up, and climbing stairs. There was statistical evidence of two-way interactions involving group by task (F4,308 = 7.921, p < 0.001, η2 = 0.049) and task by muscle (F18,1386 = 2.912, p < 0.001, η2 = 0.004), but not group by muscle (F7,539 = 1.104, p = 0.359, η2 = 0.004). Patients with chronic low back pain showed an increase in back muscle activity regardless of the type of functional task, except the left side of multifidus muscle during the picking up of a ball on the ground task. There was no correlation between the measure of kinesiophobia or the Örebro questionnaire score and the level of electromyographic activity.
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Affiliation(s)
- Maicom Lima
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Research Laboratory of Exercise Science, CEFAN, Brazilian Navy, Brazil.
| | - Arthur Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil.
| | - Felipe José Jandre Reis
- Instituto Federal do Rio de Janeiro, Brazil; Department of Clinical Medicine, Universidade Federal do Rio de Janeiro, Brazil.
| | - Vanessa Paes
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil; Research Laboratory of Exercise Science, CEFAN, Brazilian Navy, Brazil.
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta, UNISUAM,Praça das Nações 34, terceiro andar, Bonsucesso, Rio de Janeiro, RJ, 21041-010, Brazil.
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Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVE Here we aimed to determine whether motor cortical reorganization in low back pain (LBP) can be identified using noninvasive surface electromyographic (EMG) recordings of back muscles at different lumbar levels, and whether cortical reorganization is related to clinical features of LBP. SUMMARY OF BACKGROUND DATA Reorganization of motor regions of the brain may contribute to altered motor control, pain, and disability in chronic LBP. However, data have been limited by the need for invasive recordings of back muscle myoelectric activity. The relationship between altered cortical organization and clinical features of LBP remains unclear. METHODS In 27 individuals with recurrent, nonspecific LBP and 23 pain-free controls, we mapped the motor cortical representation of the paraspinal muscles using transcranial magnetic stimulation in conjunction with noninvasive surface EMG recordings at L3 and L5 levels. Clinical measures of pain severity, location, and duration were made. RESULTS The results demonstrate a loss of discrete motor cortical organization of the paraspinal muscles in chronic LBP that can be identified using noninvasive EMG recordings. A loss of discrete cortical organization was clearer when surface electrodes were positioned at L3 rather than L5. A novel finding was that altered motor cortical organization (number of discrete peaks and map volume) was associated with the severity and location of LBP. CONCLUSION These data suggest that surface EMG positioned at L3 is appropriate for the identification of changes in the motor cortex in LBP. Furthermore, our data have implications for treatment strategies that aim to restore cortical organization in LBP. LEVEL OF EVIDENCE 2.
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Burns E, Chipchase LS, Schabrun SM. Temporal and spatial characteristics of post-silent period electromyographic bursting in low back muscles: comparison between persons with and without low back pain. Int J Neurosci 2017; 127:1074-1081. [DOI: 10.1080/00207454.2017.1326036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emma Burns
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, Australia
| | - Lucy S. Chipchase
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, Australia
| | - Siobhan M. Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Penrith, Australia
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Jubany J, Marina M, Angulo-Barroso R. Electromyographic and Kinematic Analysis of Trunk and Limb Muscles During a Holding Task in Individuals With Chronic Low Back Pain and Healthy Controls. PM R 2017; 9:1106-1116. [DOI: 10.1016/j.pmrj.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 03/30/2017] [Accepted: 04/08/2017] [Indexed: 11/28/2022]
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Rossi DM, Morcelli MH, Cardozo AC, Denadai BS, Gonçalves M, Navega MT. Rate of force development and muscle activation of trunk muscles in women with and without low back pain: A case-control study. Phys Ther Sport 2016; 26:41-48. [PMID: 28667897 DOI: 10.1016/j.ptsp.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/22/2016] [Accepted: 12/26/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the rate of force development (RFD) and the rate of electromyography rise (RER) of global and local trunk muscles in women with and without low back pain. DESIGN Cross-sectional study. SETTING Laboratory setting. PARTICIPANTS Twenty-eight women divided into low back pain (LBP, n = 14) and control groups (CG, n = 14) participated in this study. MAIN OUTCOME MEASURES Subjects performed isometric contractions of trunk using an isokinetic dynamometer, and simultaneously the electromyography (EMG) signals were collected for global (rectus abdominis and longissimus thoracic) and local (internal oblique and multifidus) muscles. All variables were calculated using Matlab software. RESULTS Symptomatic subjects showed lower RFD during trunk extension and it was correlated to a reduced RER mainly in the trunk extensor musculature (p < 0.05). During trunk flexion, LBP exhibited a delayed time to reach peak RFD (p < 0.05) compared to CG. RER for global anterior muscle was higher than for local muscle (p < 0.05) and it was more persistent in asymptomatic women. CG also presented greater activation amplitude for both agonist and antagonist trunk muscles, mainly the global ones. CONCLUSION Symptomatic women showed lower RFD and it was correlated to a reduced capacity of rapid muscle activation mainly in the trunk extensor musculature.
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Affiliation(s)
- Denise Martineli Rossi
- Department of Biomechanics, Medicine and Rehabilitation of Locomotor, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Mary Hellen Morcelli
- Department of Physical Therapy and Occupational Therapy, São Paulo State University, Marília, SP, Brazil
| | | | | | - Mauro Gonçalves
- Department of Physical Education, São Paulo State University, Rio Claro, SP, Brazil
| | - Marcelo Tavella Navega
- Department of Physical Therapy and Occupational Therapy, São Paulo State University, Marília, SP, Brazil
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Pienaar AW, Barnard JG. Development, validity and reliability of a new pressure air biofeedback device (PAB) for measuring isometric extension strength of the lumbar spine. J Med Eng Technol 2016; 41:216-222. [PMID: 27838945 DOI: 10.1080/03091902.2016.1253794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This study describes the development of a new portable muscle testing device, using air pressure as a biofeedback and strength testing tool. For this purpose, a pressure air biofeedback device (PAB®) was developed to measure and record the isometric extension strength of the lumbar multifidus muscle in asymptomatic and low back pain (LBP) persons. A total of 42 subjects (age 47.58 years, ±18.58) participated in this study. The validity of PAB® was assessed by comparing a selected measure, air pressure force in millibar (mb), to a standard criterion; calibrated weights in kilograms (kg) during day-to-day tests. Furthermore, clinical trial-to-trial and day-to-day tests of maximum voluntary isometric contraction (MVIC) of L5 lumbar multifidus were done to compare air pressure force (mb) to electromyography (EMG) in microvolt (μV) and to measure the reliability of PAB®. A highly significant relationship were found between air pressure output (mb) and calibrated weights (kg). In addition, Pearson correlation calculations showed a significant relationship between PAB® force (mb) and EMG activity (μV) for all subjects (n = 42) examined, as well as for the asymptomatic group (n = 24). No relationship was detected for the LBP group (n = 18). In terms of lumbar extension strength, we found that asymptomatic subjects were significantly stronger than LBP subjects. The results of the PAB® test differentiated between LBP and asymptomatic subject's lumbar isometric extension strength without any risk to the subjects and also indicate that the lumbar isometric extension test with the new PAB® device is reliable and valid.
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Affiliation(s)
- Andries W Pienaar
- a Biokinetics Laboratory, Department of Sport Science , Stellenbosch University , Stellenbosch , South Africa
| | - Justhinus G Barnard
- a Biokinetics Laboratory, Department of Sport Science , Stellenbosch University , Stellenbosch , South Africa
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Liang C, Sun J, Cui X, Jiang Z, Zhang W, Li T. Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy. BMC Musculoskelet Disord 2016; 17:305. [PMID: 27444272 PMCID: PMC4957349 DOI: 10.1186/s12891-016-1164-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 07/12/2016] [Indexed: 11/30/2022] Open
Abstract
Background Spinal sagittal imbalance is a widely acknowledged problem, but there is insufficient knowledge regarding its occurrence. In some patients with lumbar disc herniation (LDH), their symptom is similar to spinal sagittal imbalance. The aim of this study is to illustrate the spinopelvic sagittal characteristics and identity the role of spinal musculature in the mechanism of sagittal imbalance in patients with LDH. Methods Twenty-five adults with spinal sagittal imbalance who initially came to our clinic for treatment of LDH, followed by posterior discectomy were reviewed. The horizontal distance between C7 plumb line-sagittal vertical axis (C7PL-SVA) greater than 5 cm anteriorly with forward bending posture is considered as spinal sagittal imbalance. Radiographic parameters including thoracic kyphotic angle (TK), lumbar lordotic angle (LL), pelvic tilting angle (PT), sacral slope angle (SS) and an electromyography(EMG) index ‘the largest recruitment order’ were recorded and compared. Results All patients restored coronal and sagittal balance immediately after lumbar discectomy. The mean C7PL-SVA and trunk shift value decreased from (11.6 ± 6.6 cm, and 2.9 ± 6.1 cm) preoperatively to (−0.5 ± 2.6 cm and 0.2 ± 0.5 cm) postoperatively, while preoperative LL and SS increased from (25.3° ± 14.0° and 25.6° ± 9.5°) to (42.4° ± 10.2° and 30.4° ± 8.7°) after surgery (P < 0.05). The preoperative mean TK and PT (24.7° ± 11.3° and 20.7° ± 7.8°) decreased to (22.0° ± 9.8° and 15.8 ± 5.5°) postoperatively (P < 0.05). The largest recruitment order on the level of T7-T8, T12-L1 and the herniated level all improved compared with before and after surgery (P < 0.05). All patients have been followed up for more than 2 years. The mean ODI was 77.8 % before surgery to 4.2 % at the final follow-up. Conclusions Spinal sagittal imbalance caused by LDH is one type of compensatory sagittal imbalance. Compensatory mechanism of spinal sagittal imbalance mainly includes a loss of lumbar lordosis, an increase of thoracic kyphosis and pelvis tilt. Spinal musculature plays an important role in spinal sagittal imbalance in patients with LDH.
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Affiliation(s)
- Chen Liang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China
| | - Jianmin Sun
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China.
| | - Xingang Cui
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China
| | - Zhensong Jiang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China
| | - Wen Zhang
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China
| | - Tao Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No.324 Jing Wu Road, Jinan, 250021, People's Republic of China
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Jacobs JV, Lomond KV, Hitt JR, DeSarno MJ, Bunn JY, Henry SM. Effects of low back pain and of stabilization or movement-system-impairment treatments on induced postural responses: A planned secondary analysis of a randomised controlled trial. MANUAL THERAPY 2016; 21:210-9. [PMID: 26324322 PMCID: PMC4713345 DOI: 10.1016/j.math.2015.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/23/2015] [Accepted: 08/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Motor retraining for non-specific chronic low back pain (LBP) often focuses on voluntary postural tasks. This training, however, may not transfer to other known postural impairments, such as automatic postural responses to external perturbations. OBJECTIVES To evaluate the extent current treatments of motor retraining ameliorate impaired postural coordination when responding to a perturbation of standing balance. DESIGN Planned secondary analysis of a prospectively registered (NCT01362049), randomized controlled trial with a blinded assessor. METHOD Sixty-eight subjects with chronic, recurrent, non-specific LBP were allocated to perform a postural response task as a secondary assessment one week before and one week after receiving either stabilization or Movement System Impairment (MSI)-directed treatment over 6 weekly 1-h sessions plus home exercises. For assessment, subjects completed the Oswestry disability and numeric pain rating questionnaires and then performed a postural response task of maintaining standing balance in response to 3 trials in each of 4 randomly presented directions of linear surface translations of the platform under the subjects' feet. Integrated amplitudes of surface electromyography (EMG) were recorded bilaterally from the rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles during the postural response task. RESULTS No significant effects of treatment on EMG responses were evident. Oswestry and numeric pain ratings decreased similarly following both treatments. CONCLUSIONS Stabilization and MSI-directed treatments do not affect trunk EMG responses to perturbations of standing balance in people with LBP, suggesting current methods of motor retraining do not sufficiently transfer to tasks of reactive postural control.
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Affiliation(s)
- Jesse V Jacobs
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
| | - Karen V Lomond
- School of Health Sciences, Central Michigan University, 1179 Health Professions Building, Mount Pleasant, MI 48859, USA.
| | - Juvena R Hitt
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
| | - Michael J DeSarno
- Department of Medical Biostatistics, Hills 23C/25H, 105 Carrigan Drive, University of Vermont, Burlington, VT 05405, USA.
| | - Janice Y Bunn
- Department of Medical Biostatistics, Hills 23C/25H, 105 Carrigan Drive, University of Vermont, Burlington, VT 05405, USA.
| | - Sharon M Henry
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
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Villafañe JH, Gobbo M, Peranzoni M, Naik G, Imperio G, Cleland JA, Negrini S. Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: a systematic review. Disabil Rehabil 2016; 38:1859-71. [PMID: 26732899 DOI: 10.3109/09638288.2015.1107777] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE This systematic literature review aimed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain (CNSLBP). METHODS Extensive research was performed in MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Physiotherapy Evidence Database (PEDro) and Cochrane Central Register of Controlled Trials (CENTRAL) databases from their inception to September 2014. Potentially relevant articles were also manually looked for in the reference lists of the identified publications. Studies examining lumbar muscle fatigue in people with CNSLBP were selected. Two reviewers independently selected the articles, carried out the study quality assessment and extracted the results. A modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) scale was used to evaluate the scientific rigour of the selected works. RESULTS Twenty-four studies fulfilled the selection criteria and were included in the systematic review. We found conflicting data regarding the validity of methods used to examine back muscle fatigue. The Biering-Sorensen test, performed in conjunction with surface electromyography spectral analysis, turned out to be the most widely used and comparatively, the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise, even though critical limitations are discussed. CONCLUSIONS Future research should address the identification of an advanced method for lower back fatigue assessment in patients with CNSLBP which, eventually, might provide physical therapists with an objective and reliable test usable in everyday clinical practise. Implications for Rehabilitation Despite its limitations, the Biering-Sorensen test is currently the most used, convenient and easily available fatiguing test for lumbar muscles. To increase validity and reliability of the Biering-Sorensen test, concomitant activation of synergistic muscles should be taken into account. Pooled mean frequency and half-width of the spectrum are currently the most valid electromyographic parameters to assess fatigue in chronic non-specific low back pain. Body mass index, grading of pain and level of disability of the study population should be reported to enhance research quality.
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Affiliation(s)
| | - Massimiliano Gobbo
- b Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy ;,c Laboratory of Neuromuscular Rehabilitation , Teresa Camplani Foundation - Domus Salutis Clinic , Brescia , Italy
| | | | - Ganesh Naik
- e Centre for Health Technologies (CHT), Faculty of Engineering & Information Technology, University of Technology , Sydney , Australia
| | | | - Joshua A Cleland
- d Department of Physical Therapy , Franklin Pierce University , Concord , NH , USA
| | - Stefano Negrini
- a IRCCS Don Gnocchi Foundation , Milan , Italy ;,b Department of Clinical and Experimental Sciences , University of Brescia , Brescia , Italy
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You YL, Su TK, Liaw LJ, Wu WL, Chu IH, Guo LY. The effect of six weeks of sling exercise training on trunk muscular strength and endurance for clients with low back pain. J Phys Ther Sci 2015; 27:2591-6. [PMID: 26356255 PMCID: PMC4563321 DOI: 10.1589/jpts.27.2591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/18/2015] [Indexed: 01/13/2023] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of 6 weeks sling
exercise training for clients with low back pain on the levels of pain, disability,
muscular strength and endurance. [Subjects and Methods] Twelve chronic LBP subjects
participated in this study. Subjects were randomly divided into a control group and a
training group. Subjects in the training group performed sling exercise training for six
weeks, and participants in the control group did not perform any exercise. [Results] Pain,
disability levels and muscular strength significantly improved in the training group, but
not in the control group. The left multifidus showed a significant improvement in muscular
endurance, measured as the slope of the median frequency after training. [Conclusion] Six
weeks of sling exercise training was effective at reducing pain intensity, and improving
the disability level and trunk muscular strength of subjects with low back pain.
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Affiliation(s)
- Yu-Lin You
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University: Kaohsiung City 701, Taiwan ; Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Taiwan
| | - Tzu-Kai Su
- Division of Physical Medicine and Rehabilitation, Ten-Chen General Hospital, Taiwan
| | - Lih-Jiun Liaw
- Department of Physical Therapy, College of Allied Health, Kaohsiung Medical University, Taiwan
| | - Wen-Lan Wu
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University: Kaohsiung City 701, Taiwan
| | - I-Hua Chu
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University: Kaohsiung City 701, Taiwan
| | - Lan-Yuen Guo
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University: Kaohsiung City 701, Taiwan
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Lomond KV, Jacobs JV, Hitt JR, DeSarno MJ, Bunn JY, Henry SM. Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial. Spine J 2015; 15:596-606. [PMID: 25452017 PMCID: PMC4375040 DOI: 10.1016/j.spinee.2014.10.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 09/18/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND People with low back pain (LBP) exhibit impaired anticipatory postural adjustments (APAs). OBJECTIVE To evaluate whether current motor retraining treatments address LBP-associated changes in movement coordination during tasks that do and do not require APAs. DESIGN Prospectively registered randomized controlled trial with a blinded assessor. SETTING Outcome evaluations occurred in a university laboratory; treatments were carried out in outpatient physical therapy clinics. PATIENTS Fifteen subjects without LBP and 33 subjects with chronic, recurrent, and nonspecific LBP. INTERVENTION Twelve subjects with LBP received stabilization treatment, 21 received movement system impairment-based treatment, for more than 6 weekly 1-hour sessions plus home exercises. MEASUREMENTS Pre- and post-treatment, surface electromyography (EMG) was recorded bilaterally from trunk and leg muscles during unsupported and supported leg-lifting tasks, which did and did not require an APA, respectively. Vertical reaction forces under the contralateral leg were recorded to characterize the APA. Oswestry disability scores and numeric pain ratings were also recorded. RESULTS Persons with LBP demonstrated an impaired APA compared with persons without LBP, characterized by increased premovement contralateral force application and increased postmovement trunk EMG amplitude, regardless of the task. After treatments, both groups similarly improved in disability and function; however, APA characteristics did not change (ie, force application or EMG amplitude) in either task. LIMITATIONS Treating clinicians were not blinded to treatment allocation, only short-term outcomes were assessed, and main effects of treatment do not rule out nonspecific effects of time or repeated exposure. CONCLUSIONS Movement impairments in persons with LBP are not limited to tasks requiring an APA. Stabilization and movement system impairment-based treatments for LBP do not ameliorate and may exacerbate APA impairments (ie, excessive force application and increased post-movement trunk muscle activation).
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Affiliation(s)
- Karen V. Lomond
- School of Health Sciences, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Jesse V. Jacobs
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Juvena R. Hitt
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Michael J. DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Janice Y. Bunn
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA
| | - Sharon M. Henry
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
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Zwambag DP, Ricketts TA, Brown SH. Sarcomere length organization as a design for cooperative function amongst all lumbar spine muscles. J Biomech 2014; 47:3087-93. [DOI: 10.1016/j.jbiomech.2014.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
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Mohseni Bandpei MA, Rahmani N, Majdoleslam B, Abdollahi I, Ali SS, Ahmad A. Reliability of Surface Electromyography in the Assessment of Paraspinal Muscle Fatigue: An Updated Systematic Review. J Manipulative Physiol Ther 2014; 37:510-21. [DOI: 10.1016/j.jmpt.2014.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 12/18/2022]
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Lomond KV, Henry SM, Hitt JR, DeSarno MJ, Bunn JY. Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain. ACTA ACUST UNITED AC 2014; 19:425-32. [PMID: 24853255 DOI: 10.1016/j.math.2014.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/22/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Interventions that target trunk muscle impairments in people with LBP have been promoted; however, the treatment effects on muscle activation impairments during postural tasks remain unclear. Thus, our objective was to evaluate the effects trunk stabilization vs. general strength and conditioning exercises on the automatic postural response in persons with chronic low back pain (LBP). Fifty-eight subjects with chronic, recurrent LBP (n = 58) (i.e., longer than six months) were recruited and randomly assigned to one of two, 10-week physical therapy programs: stabilization (n = 29) or strength and conditioning (n = 29). Pain and function were measured at 11 weeks and 6 months post-treatment initiation. To quantify postural following support surface perturbations, surface electrodes recorded electromyography (EMG) of trunk and leg muscles and force plates recorded forces under the feet, to calculate the center of pressure. Both groups demonstrated significant improvements in pain and function out to 6 months. There were also changes in muscle activation patterns immediately post-treatment, but not at 6 months. However, changes in center of pressure (COP) responses were treatment specific. Following treatment, the stabilization group demonstrated later onset of COP displacement, while the onset of COP displacement in the strengthening group was significantly earlier following treatment. Despite two different treatments, clinical improvements and muscle activation patterns were similar for both groups, indicating that the stabilization treatment protocol does not preferentially improve treatment outcomes or inter-muscle postural coordination patterns for persons with LBP. CLINICAL TRIAL REGISTRATION NUMBER NCT01611792.
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Affiliation(s)
- Karen V Lomond
- Health and Exercise Sciences Divison, Central Michigan University, Mt. Pleasant, MI, USA.
| | - Sharon M Henry
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Juvena R Hitt
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, VT, USA
| | - Michael J DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Janice Y Bunn
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
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Miura T, Sakuraba K. Properties of Force Output and Spectral EMG in Young Patients with Nonspecific Low Back Pain during Isometric Trunk Extension. J Phys Ther Sci 2014; 26:323-9. [PMID: 24707077 PMCID: PMC3975996 DOI: 10.1589/jpts.26.323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/22/2013] [Indexed: 12/19/2022] Open
Abstract
[Purpose] To clarify the influence of nonspecific low back pain (NSLBP) on force
fluctuation and the myoelectric data of back muscles during isometric trunk extension at
low to high force levels. [Subjects] Fourteen male subjects with NSLBP and 14 healthy male
control subjects participated in this study. [Methods] All participants extended their
trunk isometrically maintaining 10 levels of target force [2, 5, 10, 15, 20, 30, 50, 70,
80 and 90% of maximal voluntary contraction (MVC) in a random order] for about 4 seconds
with visual feedback. A force transducer and tri-axis force sensor were positioned at the
7th thoracic vertebra to measure force output and the direction of force. Myoelectric
activities of the back muscles (longissimus thoracis, L2 level; multifidus, S1 level) were
recorded by surface electromyography. [Results] Force output of NSLBP subjects fluctuated
more than that of healthy subjects at 30% and 50%MVC. Higher median power frequency in the
multifidus was observed in NSLBP subjects at moderate to high force levels. [Conclusion]
These results show that the properties of force output in NSLBP subjects differ from those
in healthy subjects, suggesting that the assessment of force fluctuation of back muscles
at moderate force levels is a useful index for evaluating and discriminating NSLBP.
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Affiliation(s)
- Tatsuhiro Miura
- Department of Sports Medicine, Graduate School of Medicine, Juntendo University, Japan
| | - Keishoku Sakuraba
- Department of Sports Medicine, Graduate School of Health and Sports Science, Juntendo University, Japan
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Tsou JY, Su FC, Tsao PC, Hong MY, Cheng SC, Chang HW, Yang JS, Chi CH. Electromyography activity of selected trunk muscles during cardiopulmonary resuscitation. Am J Emerg Med 2014; 32:216-20. [DOI: 10.1016/j.ajem.2013.10.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 11/29/2022] Open
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Targeting chronic recurrent low back pain from the top-down and the bottom-up: a combined transcranial direct current stimulation and peripheral electrical stimulation intervention. Brain Stimul 2014; 7:451-9. [PMID: 24582372 DOI: 10.1016/j.brs.2014.01.058] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 01/20/2014] [Accepted: 01/26/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Mechanisms such as neural sensitization and maladaptive cortical organization provide novel targets for therapy in chronic recurrent low back pain (CLBP). OBJECTIVE We investigated the effect of a transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) treatment on pain, cortical organization, sensitization and sensory function in CLBP. METHODS Using a placebo-controlled crossover design, 16 individuals received four treatments in separate sessions: (i) anodal tDCS/PES; (ii) anodal tDCS/sham PES; (iii) sham tDCS/PES; or (iv) sham tDCS/sham PES. Pain was assessed at baseline, immediately following, and at 1 and 3 days after treatment. Motor cortical organization, sensitization and sensory function were measured before and immediately after treatment. RESULTS Combined tDCS/PES reduced pain and sensitization, normalized motor cortical organization and improved sensory function. The reduction in pain was greater in individuals with more pronounced sensitization. Applied alone, tDCS or PES also reduced pain. However, with the exception of improved sensory function and reduced map volume following PES, clinical and neurophysiological outcomes were unaltered by tDCS or PES applied separately. No changes were observed following sham treatment. CONCLUSION Our data suggest a combined tDCS/PES intervention more effectively improves CLBP symptoms and mechanisms of cortical organization and sensitization, than either intervention applied alone or a sham control.
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El Ouaaid Z, Shirazi-Adl A, Plamondon A, Larivière C. Trunk strength, muscle activity and spinal loads in maximum isometric flexion and extension exertions: A combined in vivo-computational study. J Biomech 2013; 46:2228-35. [DOI: 10.1016/j.jbiomech.2013.06.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
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Beneck GJ, Baker LL, Kulig K. Spectral analysis of EMG using intramuscular electrodes reveals non-linear fatigability characteristics in persons with chronic low back pain. J Electromyogr Kinesiol 2012; 23:70-7. [PMID: 22883392 DOI: 10.1016/j.jelekin.2012.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/22/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022] Open
Abstract
Greater fatigability across lumbar extensors has been reported in persons with chronic low back pain (LBP), however, extensor atrophy tends to be local to the site of pain. Therefore, specific ultrasound guided local and remote intramuscular electromyographic recordings were undertaken during an isometric horizontal trunk hold in two carefully matched cohorts; persons with and without LBP. The test was performed to self-determined maximal hold time, and the control group held the horizontal position longer (P < 0.001). A power spectral analysis was performed to calculate the normalized median frequency (NMF) slope for both the first and last 30s of the fatigue test due to the group difference in hold times. There were no significant group differences in NMF slope at the first 30s of testing (P = 0.650). The NMF slope for the first and last 30s was not different in healthy subjects (P = 0.688), but was different in persons with LBP, illustrated by shallowing of the slope at the last 30s of the test (P = 0.008). A between muscle comparison in the LBP group showed greater non-linear behavior in the deep multifidus (painful region) in contrast to T10 longissimus thoracis (nonpainful region) (P = 0.013). Possible explanations for these findings are discussed.
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Affiliation(s)
- George J Beneck
- Department of Physical Therapy, California State University Long Beach, Long Beach, CA 90840, USA.
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42
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Wang Z, Wu L, Sun J, He L, Wang S, Yang L. Squat, stoop, or semi-squat: a comparative experiment on lifting technique. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2012; 32:630-636. [PMID: 22886983 DOI: 10.1007/s11596-012-1009-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Indexed: 11/25/2022]
Abstract
There are actually no sufficient data for lifting technique assessment. A laboratory study was undertaken to determine the effect of 3 regular lifting techniques on erector muscle activation, cardiovascular strain and subjective response. Thirty student volunteers participated in the study, and were required to lift a weight with different techniques. Stoop-, squat-, semi-squat-lifting resulted in 3, 2 and 1 time of the highest percentage of the maximum voluntary electrical activation (MVE%) respectively. In the same order, the lowest median frequency (MF) existed 1, 1 and 2 times. Muscle fatigue was 4 times in squat, 36 in semi-squat and 43 in stoop lifting. Heart rate was the highest in squat and lowest in stoop respectively, with a middle level in semi-squat lifting. It may be recommended to adopt mainly the semi-squat technique for daily lifting works. For heavy lifting, it should use the squat technique. Stoop lifting may also be used alternatively but for light things.
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Affiliation(s)
- Zhenglun Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Wu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jingzhi Sun
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lihua He
- School of Public Health, Beijing University, Beijing, 100191, China
| | - Sheng Wang
- School of Public Health, Beijing University, Beijing, 100191, China
| | - Lei Yang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Dedering Å. Lumbar muscle fatigue and subjective health measurements in patients with lumbar disc herniation 2 years after surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:646-54. [PMID: 22198274 DOI: 10.1007/s00586-011-2109-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 10/20/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION In this prospective study the purpose was to evaluate patients with lumbar-disc herniation regarding changes in back-muscle fatigue and subjective health measurements 2 years after surgery. METHODS Endurance time, EMG median frequency and ratings of lumbar-muscle fatigue and pain were measured before surgery, 4 weeks after and 2 years after surgery in 26 patients (19 men and 7 women) with lumbar-disc herniation. A modified Sørensen test was performed with concurrent recordings of electromyography from the lumbar muscles at four recording sites. The questionnaires Oswestry disability index, Roland-Morris disability questionnaire, Self-efficacy scale, SF-36, Back beliefs questionnaire, Odom and a 6-grade physical activity scale were used. RESULTS Two years after surgery the patients had longer endurance times (increase from 178 s to 231 s, p < 0.001), a non-significant tendency for flatter L5 slopes (decrease from -0.20 to -0.16 Hz/s, p < 0.066), higher initial median frequency (L1 increase from 58 to 64 Hz p < 0.001, L5 increase from 76 to 84 Hz p = 0.001) and improved questionnaire scores. The questionnaires Oswestry, Roland-Morris and SF-36 physical functioning correlated with the endurance time 0.69-0.93 and with L5 slope 0.01-0.93 and the highest correlations were found in women. CONCLUSION Both EMG and endurance time measurements are needed for evaluating fatigue in lumbar-disc herniation.
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Affiliation(s)
- Åsa Dedering
- Department of Physical Therapy, Karolinska University Hospital, 17176, Stockholm, Sweden.
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Balasubramanian V, Dutt A, Rai S. Analysis of muscle fatigue in helicopter pilots. APPLIED ERGONOMICS 2011; 42:913-918. [PMID: 21411058 DOI: 10.1016/j.apergo.2011.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 02/16/2011] [Accepted: 02/20/2011] [Indexed: 05/30/2023]
Abstract
Helicopter pilots espouse ergonomically unfavourable postures and endure vibration which result in low back pain. The objective of this study was to investigate the effects of a helicopter flight on pilots back and shoulder muscles using surface Electromyography (sEMG) analysis. This study also correlates low back pain symptoms from Rehabilitation Bioengineering Group Pain Scale (RBGPS) questionnaire with muscle fatigue rates obtained. RBGPS was administered on 20 Coast Guard helicopter pilots. sEMG was acquired before and after flight from erector spinae and trapezius muscles in 8 of these 20 pilots. Statistical analysis of time and frequency domain parameters indicated significant fatigue in right trapezius muscle due to flying. Muscle fatigue correlated with average duration of flight (r² = 0.913), total service as pilot (r² = 0.825), pain (r² = 0.463) and total flying hours (r² = 0.507). However, muscle fatigue weakly correlated with Body Mass Index (BMI) (r² = 0.000144) and age (r² = 0.033).
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Jacobs JV, Henry SM, Jones SL, Hitt JR, Bunn JY. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol 2011; 106:2506-14. [PMID: 21795622 DOI: 10.1152/jn.00296.2011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
People with a history of low back pain (LBP) exhibit altered responses to postural perturbations, and the central neural control underlying these changes in postural responses remains unclear. To characterize more thoroughly the change in muscle activation patterns of people with LBP in response to a perturbation of standing balance, and to gain insight into the influence of early- vs. late-phase postural responses (differentiated by estimates of voluntary reaction times), this study evaluated the intermuscular patterns of electromyographic (EMG) activations from 24 people with and 21 people without a history of chronic, recurrent LBP in response to 12 directions of support surface translations. Two-factor general linear models examined differences between the 2 subject groups and 12 recorded muscles of the trunk and lower leg in the percentage of trials with bursts of EMG activation as well as the amplitudes of integrated EMG activation for each perturbation direction. The subjects with LBP exhibited 1) higher baseline EMG amplitudes of the erector spinae muscles before perturbation onset, 2) fewer early-phase activations at the internal oblique and gastrocnemius muscles, 3) fewer late-phase activations at the erector spinae, internal and external oblique, rectus abdominae, and tibialis anterior muscles, and 4) higher EMG amplitudes of the gastrocnemius muscle following the perturbation. The results indicate that a history of LBP associates with higher baseline muscle activation and that EMG responses are modulated from this activated state, rather than exhibiting acute burst activity from a quiescent state, perhaps to circumvent trunk displacements.
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Affiliation(s)
- Jesse V Jacobs
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont 05405, USA.
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Dedering A, Gnospelius A, Elfving B. Reliability of measurements of endurance time, electromyographic fatigue and recovery, and associations to activity limitations, in patients with lumbar disc herniation. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2011; 15:189-98. [PMID: 20183858 DOI: 10.1002/pri.457] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Electromyographic (EMG) spectral parameters and endurance tests for back muscles have long been used to estimate low-back muscle fatigue. PURPOSE The present purpose was to evaluate the test-retest reliability of a fatigue-testing protocol and to investigate associations between activity limitations and fatigue in patients with lumbar disc herniation. METHODS To evaluate the reliability, endurance time, EMG spectral parameters and ratings of lumbar muscle fatigue and back pain were measured three times in 15 patients with lumbar disc herniation. The patients performed a modified Sørensen test with concurrent recordings of electromyography from the lumbar muscles at four recording sites. Ratings of their perceived fatigue and pain on a Borg scale were collected simultaneously. Recovery over five minutes was recorded. Questionnaires about activity, participation, self-efficacy and health were also used. RESULTS Endurance time had an ICC of 0.85 indicating good reliability. Initial, end and median frequency recovery had intraclass correlation coefficients (ICCs) over 0.6 that is acceptable but with large standard errors of measurement. The median frequency slopes for the four recording sites had ICCs of 0.19-0.48. Agreement coefficients for the Borg ratings ranged between 0.78 and 0.97. Moderate correlation was found between activity limitations and endurance time. CONCLUSIONS Endurance time measurement and Borg ratings may be recommended for evaluating intervention both with groups of patients, i.e. for research purposes, and for individuals. The median frequency parameters may be recommended for groups only. The study shows the importance of establishing the reliability of the patient category if the results are to be used to evaluate intervention.
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Affiliation(s)
- Asa Dedering
- Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
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Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine (Phila Pa 1976) 2010; 35:E1178-86. [PMID: 20881658 DOI: 10.1097/brs.0b013e3181e53334] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An experimental and comparative study of chronic low back pain (CLBP) patients and healthy controls. OBJECTIVE To use a motivation-independent electromyography (EMG) based test of back muscle capacity to determine whether back muscle deconditioning is present in CLBP patients and whether it is related to pain-related psychological variables. SUMMARY OF BACKGROUND DATA The verification of the deconditioning syndrome in CLBP patients might be biased by the use of performance-based measures to assess physical fitness, especially in patients having fear of injury. Also, the use of lumbar-specific measures of physical fitness, such as back muscle strength and endurance, might be more sensitive to physical deconditioning than more general assessments such as aerobic capacity. METHODS A time-limited submaximal fatigue test was performed by 27 nonspecific CLBP subjects (14 men) who had not had any surgery, and 31 healthy controls (17 men) while surface EMG signals were collected from back muscles. Motivation-independent EMG indices, which are sensitive to muscle fatigue or to activation patterns, were then computed and entered as input into previously developed regression equations to predict endurance (PTend) and strength (PStrength). Between-group comparisons were completed with patients divided in subgroups based on a median split of pain intensity, fear of movement, or pain catastrophizing scores. RESULTS Differences between healthy and CLBP subgroups were mainly observed when patients were divided using pain catastrophizing scores (PCS). High-PCS patients showed significantly lower PTend than low-PCS patients. Various EMG indices showed comparable results to PTend. However, some of them also pointed out that the PCS-low patients were more fatigue-resistant and showed different activation patterns comparatively to healthy subjects. CONCLUSION These results suggest that physical deconditioning that is specific to back muscle capacity was present in a subgroup of patients while the opposite was observed in another subgroup, pain catastrophizing being related to this outcome. These findings support previous theoretical models of pain/disability.
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Shin G, D’Souza C. EMG activity of low back extensor muscles during cyclic flexion/extension. J Electromyogr Kinesiol 2010; 20:742-9. [DOI: 10.1016/j.jelekin.2010.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 02/10/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022] Open
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People with recurrent low back pain respond differently to trunk loading despite remission from symptoms. Spine (Phila Pa 1976) 2010; 35:818-24. [PMID: 20228708 DOI: 10.1097/brs.0b013e3181bc98f1] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional design. OBJECTIVE To compare lumbar multifidus electromyographic activity (EMG) during predictable and unpredictable trunk loading between people with and without recurrent unilateral low back pain (LBP) during symptom remission. SUMMARY OF BACKGROUND DATA Unpredictable loading is a common injury mechanism for LBP. Paraspinal muscle responses to trunk loading differ between people with and without a history of LBP, but whether the response differs between specific regions within the paraspinal muscles is unclear. Differences between deep (DM) and superficial fibers (SM) of multifidus have been implicated in other tasks. It is unknown whether DM and SM EMG differ between people in remission from recurrent LBP and healthy people during trunk loading. METHODS DM and SM EMG was recorded bilaterally at L5 with intramuscular electrodes during predictable and unpredictable trunk loading and compared during 10 milliseconds epochs (250 milliseconds before to 150 milliseconds after loading) between sides, loading conditions, and groups. RESULTS DM EMG increased above baseline before and after predictable load onset, but returned to baseline at the time of impact. Both DM EMG bursts were less in the remission group and less on the non-painful side. Peak SM EMG amplitude on the previously painful side was earlier in the remission group than healthy participants. DM and SM EMG were less after unpredictable load onset in the remission group than healthy participants. CONCLUSION Despite symptom remission, DM EMG during predictable loading and DM and SM EMG during unpredictable loading were less in people with recurrent LBP than healthy participants.
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Larivière C, Gravel D, Gardiner P, Bertrand Arsenault A, Gagnon D, Loisel P. A submaximal test to assess back muscle capacity: Evaluation of construct validity. J Electromyogr Kinesiol 2009; 19:e422-9. [DOI: 10.1016/j.jelekin.2008.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 11/26/2008] [Accepted: 11/26/2008] [Indexed: 10/21/2022] Open
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