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Suo M, Zhou L, Wang J, Huang H, Zhang J, Sun T, Liu X, Chen X, Song C, Li Z. The Application of Surface Electromyography Technology in Evaluating Paraspinal Muscle Function. Diagnostics (Basel) 2024; 14:1086. [PMID: 38893614 PMCID: PMC11172025 DOI: 10.3390/diagnostics14111086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
Surface electromyography (sEMG) has emerged as a valuable tool for assessing muscle activity in various clinical and research settings. This review focuses on the application of sEMG specifically in the context of paraspinal muscles. The paraspinal muscles play a critical role in providing stability and facilitating movement of the spine. Dysfunctions or alterations in paraspinal muscle activity can lead to various musculoskeletal disorders and spinal pathologies. Therefore, understanding and quantifying paraspinal muscle activity is crucial for accurate diagnosis, treatment planning, and monitoring therapeutic interventions. This review discusses the clinical applications of sEMG in paraspinal muscles, including the assessment of low back pain, spinal disorders, and rehabilitation interventions. It explores how sEMG can aid in diagnosing the potential causes of low back pain and monitoring the effectiveness of physical therapy, spinal manipulative therapy, and exercise protocols. It also discusses emerging technologies and advancements in sEMG techniques that aim to enhance the accuracy and reliability of paraspinal muscle assessment. In summary, the application of sEMG in paraspinal muscles provides valuable insights into muscle function, dysfunction, and therapeutic interventions. By examining the literature on sEMG in paraspinal muscles, this review offers a comprehensive understanding of the current state of research, identifies knowledge gaps, and suggests future directions for optimizing the use of sEMG in assessing paraspinal muscle activity.
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Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Lina Zhou
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China;
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
| | - Xin Chen
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
| | - Chunli Song
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China;
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; (M.S.); (J.W.); (H.H.); (J.Z.); (T.S.); (X.L.)
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Dalian 116000, China
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Mackay EJ, Robey NJ, Suprak DN, Buddhadev HH, San Juan JG. The effect of EMG biofeedback training on muscle activation in an impingement population. J Electromyogr Kinesiol 2023; 70:102772. [PMID: 37043978 DOI: 10.1016/j.jelekin.2023.102772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
Subacromial impingement syndrome (SAIS) is one of the most diagnosed causes of pain in the upper extremity. The purpose of this study was to investigate muscle activity between asymptomatic and SAIS shoulders on the same subject while understanding the effectiveness of EMG biofeedback training (EBFB) on bilateral overhead movements. Ten participants (7 male), that tested positive for 2/3 SAIS clinical tests, volunteered for the study. Bilateral muscle activity was measured via electrodes on the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and lumbar paraspinals (LP). Participants performed bilateral scapular plane overhead movements before and after EBFB. EBFB consisted of 10 bilateral repetitions of I, W, T, and Y exercises focused on reducing UT and increasing LT and SA activity. Prior to EBFB, no significant difference in muscle activity was present between sides. A significant main effect of time indicated that after EBFB both sides exhibited reduced UT activity at 60° (p = 0.003) and 90° (p = 0.036), LT activity was increased at all measured humeral angles (p < 0.0005), and SA muscle activity was increased at 110° (p = 0.001). EBFB in conjunction with scapular based exercise effectively alters muscle activity of asymptomatic and symptomatic scapular musculature.
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Affiliation(s)
- Eliot J Mackay
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States.
| | - Nathan J Robey
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States
| | - David N Suprak
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States
| | - Harsh H Buddhadev
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States
| | - Jun G San Juan
- Department of Health and Human Development, Western Washington University, Bellingham, WA, United States.
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Yang S, Chen C, Du S, Tang Y, Li K, Yu X, Tan J, Zhang C, Rong Z, Xu J, Wu W, Luo F. Assessment of isokinetic trunk muscle strength and its association with health-related quality of life in patients with degenerative spinal deformity. BMC Musculoskelet Disord 2020; 21:827. [PMID: 33298028 PMCID: PMC7724710 DOI: 10.1186/s12891-020-03844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
Background A considerable portion of the elderly population are increasingly afflicted by degenerative spinal deformity (DSD), which seriously affects patient health-related quality of life (HRQoL). HRQoL index is used across many studies to show correlations between radio-graphical alignment, disability, and pain in patients with DSD. However, imaged structural deformity represents only one aspect for consideration, namely, the disability effect of DSD. We assessed the isokinetic strength of trunk muscle in patients with degenerative spinal deformity (DSD), and investigated its relationship with HRQoL. Methods In total, 38 patients with DSD (DSD group) and 32 healthy individuals (control group) were recruited. Both groups were homogeneous for age, weight, height and body mass index (BMI). Assessments were performed using the isokinetic dynamometer IsoMed-2000; trunk extensor, flexor strength and flexion/extension (F/E) ratios were explored concentrically at speeds of 30°, 60° and 120° per second. The grip strength of both hands was measured using a hand-held dynamometer. Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), a Roland-Morris disability questionnaire (RDQ), and a 36-item Short Form Health Survey (SF-36) evaluated patient HRQoL. Correlations between trunk strength and HRQoL were analyzed. Results When compared with the control group, the DSD group showed lower trunk extensor strength at three velocity movements, and higher F/E ratios at 60° and 120°/s (p < 0.05). Both groups exhibited similar trunk flexor strength and grip strength (p > 0.05). In DSD group, trunk extensor strength at 60°/s was negatively associated with ODI and RDQ (p < 0.05). A negative relationship between trunk flexor strength at 120°/s and ODI was also recorded (p < 0.05). In addition, trunk extensor strength at 60°/s and trunk flexor strength at 120°/s were positively correlated with physical functioning and role-physical scores according to the SF-36 (p < 0.05). Conclusions We identified isolated trunk extensor myopathy in DSD, which causes an imbalance in trunk muscle strength. Isokinetic trunk extensor strength at 60°/s and trunk flexor strength at 120°/s can predict disability, and decrease physical HRQoL in DSD patients.
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Affiliation(s)
- Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.,Department of Orthopaedics, The 83nd Group Army Hospital of the People's Liberation Army (PLA 371 Central Hospital), Xinxiang Medical College, 210 Wenhua Street, Hongqi district, Xinxiang, 453000, Henan, China
| | - Can Chen
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Shiyu Du
- War Wounded Medical Service Research Office (Department of War Injury and Rescue Service), Army Specialty Medical Center of the People's Liberation Army (Daping Hospital, Third Military Medical University), Chongqing, 400042, China
| | - Yong Tang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.,Department of Orthopaedics, The 72nd Group Army Hospital of the People's Liberation Army, Huzhou University, Huzhou, 313000, Zhejiang, China
| | - Kai Li
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Xueke Yu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Jiulin Tan
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Chengmin Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Zhigang Rong
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Street, Shapingba, Chongqing, 400038, China.
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Chronic Pain Diagnosis Using Machine Learning, Questionnaires, and QST: A Sensitivity Experiment. Diagnostics (Basel) 2020; 10:diagnostics10110958. [PMID: 33212774 PMCID: PMC7697204 DOI: 10.3390/diagnostics10110958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
In the last decade, machine learning has been widely used in different fields, especially because of its capacity to work with complex data. With the support of machine learning techniques, different studies have been using data-driven approaches to better understand some syndromes like mild cognitive impairment, Alzheimer’s disease, schizophrenia, and chronic pain. Chronic pain is a complex disease that can recurrently be misdiagnosed due to its comorbidities with other syndromes with which it shares symptoms. Within that context, several studies have been suggesting different machine learning algorithms to classify or predict chronic pain conditions. Those algorithms were fed with a diversity of data types, from self-report data based on questionnaires to the most advanced brain imaging techniques. In this study, we assessed the sensitivity of different algorithms and datasets classifying chronic pain syndromes. Together with this assessment, we highlighted important methodological steps that should be taken into account when an experiment using machine learning is conducted. The best results were obtained by ensemble-based algorithms and the dataset containing the greatest diversity of information, resulting in area under the receiver operating curve (AUC) values of around 0.85. In addition, the performance of the algorithms is strongly related to the hyper-parameters. Thus, a good strategy for hyper-parameter optimization should be used to extract the most from the algorithm. These findings support the notion that machine learning can be a powerful tool to better understand chronic pain conditions.
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Ekström L, Zhang Q, Abrahamson J, Beck J, Johansson C, Westin O, Todd C, Baranto A. A model for evaluation of the electric activity and oxygenation in the erector spinae muscle during isometric loading adapted for spine patients. J Orthop Surg Res 2020; 15:155. [PMID: 32303232 PMCID: PMC7165389 DOI: 10.1186/s13018-020-01652-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Simultaneous measurement of electromyography (EMG) and local muscle oxygenation is proposed in an isometric loading model adjusted for patients that have undergone spinal surgery. METHODS Twelve patients with degenerative lumbar spinal stenosis (DLSS) were included. They were subjected to a test protocol before and after surgery. The protocol consisted of two parts, a dynamic and an isometric Ito loading with a time frame of 60 s and accompanying rest of 120 s. The Ito test was repeated three times. EMG was measured bilaterally at the L4 level and L2 and was recorded using surface electrodes and collected (Biopac Systems Inc.). EMG signal was expressed as RMS and median frequency (MF). Muscle tissue oxygen saturation (MrSO2) was monitored using a near-infrared spectroscopy (NIRS) device (INVOS® 5100C Oxymeter). Two NIRS sensors were positioned bilaterally at the L4 level. The intensity of the leg and back pain and perceived exertion before, during, and after the test was evaluated with a visual analogue scale (VAS) and Borg RPE-scale, respectively. RESULTS All patients were able to perform and complete the test protocol pre- and postoperatively. A consistency of lower median and range values was noted in the sensors of EMG1 (15.3 μV, range 4.5-30.7 μV) and EMG2 (13.6 μV, range 4.0-46.5 μV) that were positioned lateral to NIRS sensors at L4 compared with EMG3 (18.9 μV, range 6.5-50.0 μV) and EMG4 (20.4 μV, range 7.5-49.0 μV) at L2. Right and left side of the erector spinae exhibited a similar electrical activity behaviour over time during Ito test (60 s). Regional MrSO2 decreased over time during loading and returned to the baseline level during recovery on both left and right side. Both low back and leg pain was significantly reduced postoperatively. CONCLUSION Simultaneous measurement of surface EMG and NIRS seems to be a promising tool for objective assessment of paraspinal muscle function in terms of muscular activity and local muscle oxygenation changes in response to isometric trunk extension in patients that have undergone laminectomy for spinal stenosis.
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Affiliation(s)
- Lars Ekström
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden.
| | - Qiuxia Zhang
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Josefin Abrahamson
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Joel Beck
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Christer Johansson
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Olof Westin
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
| | - Carl Todd
- The Carl Todd Clinic, 5 Pickwick Park, Park Lane, Corsham, SN13 0HN, UK
| | - Adad Baranto
- Institute of Clinical Sciences, Department of Orthopedics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, R-House, Floor 7, SE-431 80 Mölndal, Gothenburg, Sweden
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Sung PS, Schalk BM, Latuszek N, Hosmer E. Compensatory spinopelvic motions with and without a handheld task following a perturbation in standing between subjects with and without chronic low back pain. Gait Posture 2020; 76:7-13. [PMID: 31707307 DOI: 10.1016/j.gaitpost.2019.10.040] [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] [Received: 05/10/2019] [Revised: 10/01/2019] [Accepted: 10/29/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND A handheld task-related compensation strategy could be used to avoid injuries in subjects with chronic low back pain (LBP). Those who suffer with LBP demonstrate reduced spinopelvic motion; however, there is a lack of understanding on dynamic mobility with a handheld task. RESEARCH QUESTION Are there differences in three-dimensional spinopelvic motions following a treadmill-induced perturbation in subjects with LBP while considering a handheld task? METHODS Twenty-five subjects (11 female and 14 male) with LBP and 38 control subjects (15 female and 23 male) participated in the study. Each group was introduced to walking perturbations (0.86 m/sec, velocity in 0.1 sec) with and without a handheld tray in a standing position. The induced trip allowed subjects to recover by walking forward for a 5 second duration while the spinopelvic angles were measured during the trip and the subsequent recovery period. RESULTS There was no significant group difference in the three-dimensional (3D) spinopelvic motions while holding or not holding a tray. However, the groups demonstrated a significant interaction on tray usage with 3D motions in the spinopelvic regions (F = 13.46, p = 0.001). The sagittal plane motion was significantly minimized with a handheld task for both the lumbar spine and pelvis in the LBP group. SIGNIFICANCE The LBP group demonstrated minimized lumbar and pelvic motions in the sagittal plane, which underpins their concern to reduce motion while holding a tray. The significant interaction between groups on tray usage for spinopelvic compensation represents a strategy for avoiding injuries. Further studies are required to determine strategies to enhance lumbopelvic integration with handheld tasks in individuals with LBP.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy/ Motion Analysis Center, Central Michigan University, United States.
| | - Bradley M Schalk
- Department of Physical Therapy/ Motion Analysis Center, Central Michigan University, United States
| | - Nicholas Latuszek
- Department of Health Sciences, Central Michigan University, United States
| | - Emily Hosmer
- Department of Health Sciences, Central Michigan University, United States
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Chiou SY, Koutsos E, Georgiou P, Strutton PH. Association between spectral characteristics of paraspinal muscles and functional disability in patients with low back pain: a cohort study. BMJ Open 2018; 8:e017091. [PMID: 29444776 PMCID: PMC5829836 DOI: 10.1136/bmjopen-2017-017091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Characteristics of muscle activity, represented by surface electromyography (EMG), have revealed differences between patients with low back pain (LBP) and healthy adults; how they relate to functional and clinical parameters remains unclear. The purpose of the current study was to examine the correlation between frequency characteristics of EMG (analysed using continuous wavelet transform (CWT) analysis) and patients' self-rated score of disability. DESIGN AND SETTING This is a case-control study with 15 patients with mechanical LBP without radicular symptoms. Patients were recruited from the orthopaedic clinic at Charing Cross Hospital. Ten healthy adults were recruited from the staff working in the hospital and associated university. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and bilateral EMG activity was obtained from erector spinae at vertebral levels L4 and T12. Subjects performed three brief maximal voluntary isometric contractions (MVICs) of the back extensors and the torque was measured using a dynamometer. CWT was applied to the EMG signals of each muscle in a 200 ms window centred around the peak torque obtained during the MVICs. The ratio (low/high frequencies) of the energy, the peak power and the frequency of the peak power were calculated for each recording site, averaged and correlated with the individual's RMDQ score. RESULTS Patients had lower peak power (T12 and L4) and lower frequency of the peak power (at T12) than the healthy adults. Additionally, RMDQ positively correlated to the average ratio of energy at T12 (r=0.63; p=0.012), that is, greater self-rated disability corresponded to a dominant distribution of energy in the lower frequencies. CONCLUSION The current findings reveal alterations in EMG profile and its association with self-related back pain disability, suggesting that spectral characteristics of EMG reflect muscle function.
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Affiliation(s)
- Shin-Yi Chiou
- The Nick Davey Laboratory, Human Performance Group, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, UK
| | - Ermis Koutsos
- Department of Electrical and Electronic Engineering, Centre for Bio-inspired Technology, Imperial College London, London, UK
| | - Pantelis Georgiou
- Department of Electrical and Electronic Engineering, Centre for Bio-inspired Technology, Imperial College London, London, UK
| | - Paul H Strutton
- The Nick Davey Laboratory, Human Performance Group, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Charing Cross Hospital, London, UK
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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: 1.3] [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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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: 0.4] [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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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: 35] [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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Bauer CM, Rast FM, Ernst MJ, Oetiker S, Meichtry A, Kool J, Rissanen SM, Suni JH, Kankaanpää M. Pain intensity attenuates movement control of the lumbar spine in low back pain. J Electromyogr Kinesiol 2015; 25:919-27. [PMID: 26524940 DOI: 10.1016/j.jelekin.2015.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/09/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Pain intensity attenuates muscular activity, proprioception, and tactile acuity, with consequent changes of joint kinematics. People suffering from low back pain (LBP) frequently show movement control impairments of the lumbar spine in sagittal plane. This cross-sectional, observational study investigated if the intensity of LBP attenuates lumbar movement control. The hypothesis was that lumbar movement control becomes more limited with increased pain intensity. METHODS The effect of LBP intensity, measured with a numeric rating scale (NRS), on lumbar movement control was tested using three movement control tests. The lumbar range of motion (ROM), the ratio of lumbar and hip ROM as indicators of direction specific movement control, and the recurrence and determinism of repetitive lumbar movement patterns were assessed in ninety-four persons suffering from LBP of different intensity and measured with an inertial measurement unit system. Generalized linear models were fitted for each outcome. RESULTS Lumbar ROM (+ 0.03°, p = 0.24) and ratio of lumbar and hip ROM (0.01, p = 0.84) were unaffected by LBP intensity. Each one point increase on the NRS resulted in a decrease of recurrence and determinism of lumbar movement patterns (-3.11 to -0.06, p ⩽ 0.05). DISCUSSION Our results indicate changes in movement control in people suffering from LBP. Whether decreased recurrence and determinism of lumbar movement patterns are intensifiers of LBP intensity or a consequence thereof should be addressed in a future prospective study.
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Affiliation(s)
- C M Bauer
- Zurich University of Applied Sciences, Department of Health, Institute of Physiotherapy, Technikumstrasse 71, 8400 Winterthur, Switzerland; University of Tampere, School of Medicine, Kalevantie 4, 33014 University of Tampere, Finland.
| | - F M Rast
- Zurich University of Applied Sciences, Department of Health, Institute of Physiotherapy, Technikumstrasse 71, 8400 Winterthur, Switzerland
| | - M J Ernst
- Zurich University of Applied Sciences, Department of Health, Institute of Physiotherapy, Technikumstrasse 71, 8400 Winterthur, Switzerland
| | - S Oetiker
- Zurich University of Applied Sciences, Department of Health, Institute of Physiotherapy, Technikumstrasse 71, 8400 Winterthur, Switzerland
| | - A Meichtry
- Zurich University of Applied Sciences, Department of Health, Institute of Physiotherapy, Technikumstrasse 71, 8400 Winterthur, Switzerland
| | - J Kool
- Zurich University of Applied Sciences, Department of Health, Institute of Physiotherapy, Technikumstrasse 71, 8400 Winterthur, Switzerland
| | - S M Rissanen
- University of Eastern Finland, Department of Applied Physics, P.O. Box 1627, 70211 Kuopio, Finland.
| | - J H Suni
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33500 Tampere, Finland.
| | - M Kankaanpää
- University of Tampere, School of Medicine, Kalevantie 4, 33014 University of Tampere, Finland; Pirkanmaa Hospital District, Physical and Rehabilitation Medicine Outpatient Clinic, Box 2000, 33521 Tampere, Finland.
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Moal B, Bronsard N, Raya JG, Vital JM, Schwab F, Skalli W, Lafage V. Volume and fat infiltration of spino-pelvic musculature in adults with spinal deformity. World J Orthop 2015; 6:727-737. [PMID: 26495250 PMCID: PMC4610915 DOI: 10.5312/wjo.v6.i9.727] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/20/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate fat infiltration and volume of spino-pelvic muscles in adults spinal deformity (ASD) with magnetic resonance imaging (MRI) and 3D reconstructions.
METHODS: Nineteen female ASD patients (mean age 60 ± 13) were included prospectively and consecutively and had T1-weighted Turbo Spin Echo sequence MRIs with Dixon method from the proximal tibia up to T12 vertebra. The Dixon method permitted to evaluate the proportion of fat inside each muscle (fat-water ratio). In order to investigate the accuracy of the Dixon method for estimating fat vs water, the same MRI acquisition was performed on phantoms of four vials composed of different proportion of fat vs water. With Muscl’X software, 3D reconstructions of 17 muscles or group of muscles were obtained identifying the muscle’s contour on a limited number of axial images [Deformation of parametric specific objects (DPSO) Method]. Musclar volume (Vmuscle), infiltrated fat volume (Vfat) and percentage of fat infiltration [Pfat, calculated as follow: Pfat = 100 × (Vfat/Vmuscle)] were characterized by extensor or flexor function respectively for the spine, hip and knee and theirs relationship with demographic data were investigated.
RESULTS: Phantom acquisition demonstrated a non linear relation between Dixon fat-water ratio and the real fat-water ratio. In order to correct the Dixon fat-water ratio, the non linear relation was approximated with a polynomial function of degree three using the phantom acquisition. On average, Pfat was 13.3% ± 5.3%. Muscles from the spinal extensor group had a Pfat significantly greater than the other muscles groups, and the largest variability (Pfat = 31.9% ± 13.8%, P < 0.001). Muscles from the hip extensor group ranked 2nd in terms of Pfat (14% ± 8%), and were significantly greater than those of the knee extensor (P = 0.030). Muscles from the knee extensor group demonstrated the least Pfat (12% ± 8%). They were also the only group with a significant correlation between Vmuscle and Pfat (r = -0.741, P < 0.001), however this correlation was lacking in the other groups. No correlation was found between the Vmuscle total and age or body mass index. Except for the spine flexors, Pfat was correlated with age. Vmuscle and Vfat distributions demonstrated that muscular degeneration impacted the spinal extensors most.
CONCLUSION: Mechanisms of fat infiltration are not similar among the muscle groups. Degeneration impacted the spinal and hip extensors most, key muscles of the sagittal alignment.
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Pagé I, Abboud J, O Shaughnessy J, Laurencelle L, Descarreaux M. Chronic low back pain clinical outcomes present higher associations with the STarT Back Screening Tool than with physiologic measures: a 12-month cohort study. BMC Musculoskelet Disord 2015; 16:201. [PMID: 26286385 PMCID: PMC4541753 DOI: 10.1186/s12891-015-0669-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stratification strategies based on identifying patient's prognosis in order to guide patient care constitute one of the most prominent and recent approach in low back pain research. The STarT Back Screening Tool (SBST) although promising, has not been studied in patients with chronic low back pain (cLBP). Considering how challenging it is to translate research into practice, the value of integrating a new tool should be thoroughly assessed. The purpose was therefore to assess associations between the short- and long-terms clinical status and two types of variables, physiologic measures and the SBST, in participants with cLBP. The ability of both types of variables to discriminate between participants with and without higher levels of disability, pain, fear of movement and patient's global impression of change was also investigated. METHODS Fifty-three volunteers with cLBP participated in an initial evaluation and follow-ups at 2-, 4-, 6- and 12-month. Physiologic measures (maximal voluntary contraction, maximal endurance and muscle activity evaluated during prone and lateral isometric tasks) and the SBST were assessed at baseline. Disability (Oswestry Disability Index, ODI), pain intensity (101-point Numerical Rating Scale, NRS), fear of movement (Tampa Scale for Kinesiophobia, TSK) and patient's global impression of change (7-point scale, PGIC) were evaluated at baseline and at each follow-up. Aside the use of correlation analyses to assess potential associations; ROC curves were performed to evaluate the discriminative ability of physiologic measures and the SBST. RESULTS The SBST allowed for the identification of participants presenting higher levels of disability (ODI ≥24 %), pain (NRS ≥37 %) or fear of movement (TSK ≥41/68) over a 12-month period (AUC = 0.71 to 0.84, ps < 0.05). The SBST score was also correlated with disability at each follow-up (τ = 0.22 to 0.33, ps < 0.05) and with pain intensity and fear of movement at follow-ups. Among physiologic measures, only maximal voluntary contraction was correlated to disability, pain intensity or fear of movement during the follow-up (|τ| = 0.26 to 0.32, ps < 0.05) and none was able to identify participants presenting higher levels of outcomes (AUC ps > 0.05). CONCLUSION Physiologic measures obtained during prone and lateral tests have limited associations with the clinical status over a 12-month period in patients with nonspecific chronic low back pain. On the other hand, the STarT Back Screening Tool is useful for the identification of patients who will present higher levels of disability, pain intensity and fear of movement over a year. TRIAL REGISTRATION Clinicaltrials.gov NCT02226692.
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Affiliation(s)
- Isabelle Pagé
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada.
| | - Jacques Abboud
- Département d'anatomie, UQTR, Trois-Rivières, Québec, Canada.
| | - Julie O Shaughnessy
- Département de chiropratique, UQTR, Trois-Rivières, Québec, Canada. Julie.O'
| | - Louis Laurencelle
- Département des sciences de l'activité physique, UQTR, Trois-Rivières, Québec, Canada.
| | - Martin Descarreaux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351 Boul. Des Forges, Trois-Rivières, G9A 5H7, Québec, Canada.
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Kankaanpää M, Colier WN, Taimela S, Anders C, Airaksinen O, Kokko-Aro SM, Hänninen O. Back extensor muscle oxygenation and fatigability in healthy subjects and low back pain patients during dynamic back extension exertion. ACTA ACUST UNITED AC 2014; 12:267-73. [PMID: 16289763 DOI: 10.1016/j.pathophys.2005.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 09/12/2005] [Accepted: 09/13/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to assess if chronic low back pain patients have impaired paraspinal muscle O2 turnover and endurance capacity as compared to healthy control subjects during dynamic exercise. Middle-aged healthy male subjects (n = 12, control) and male patients with chronic low back pain (n = 17, CLBP) participated in the study. L4–L5 level paraspinal muscle fatigue was objectively assessed during earlier validated 90 s dynamic back endurance test (spectral EMG, MPFslope). Also EMG amplitude (EMGamplitude) and initial MPF (MPFinitial) were assessed from the initial 5 s of the endurance contraction. Simultaneously near infrared spectroscopy (NIRS) was used for quantitative measurement of local L4–L5 paraspinal muscle O2 consumption. Subcutaneous tissue thickness (ATT) was measured from the EMG and NIRS recording sites. The results indicated that control and CLBP groups were compatible as regarding anthropometric variables, paraspinal muscle activation levels (EMGamplitude), initial MPF (MPFinitial) and ATT. When the ATT was used as a covariate in the ANOVA analysis, CLBP group did not show significantly greater paraspinal muscle fatigability (right MPFslope – 12.2 ± 10.7%/min, left right MPFslope – 12.6 ± 13.3%/min) or O2 consumption (right NIRSslope – 52.8 ± 79.6 μM/l/s) as compared to healthy controls (right MPFslope – 11.9 ± 7.6%/min, left MPFslope – 12.7 ± 8.6%/min, right NIRSslope – 53.7 ± 95.2 μM/l/s). As a conclusion, these CLBP male patients did not show any impaired rate of paraspinal muscle oxygen consumption or excessive paraspinal muscle fatigability during dynamic exercise as compared with healthy controls. Subcutaneous tissue thickness has a strong influence on the NIRS and EMG amplitude measurements and, if unchecked, it could result in the false interpretation of the results.
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Affiliation(s)
- Markku Kankaanpää
- Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland.
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Moal B, Raya J, Jolivet E, Schwab F, Blondel B, Lafage V, Skalli W. Validation of 3D spino-pelvic muscle reconstructions based on dedicated MRI sequences for fat-water quantification. Ing Rech Biomed 2014. [DOI: 10.1016/j.irbm.2013.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Hu Y, Kwok JW, Tse JYH, Luk KDK. Time-varying surface electromyography topography as a prognostic tool for chronic low back pain rehabilitation. Spine J 2014; 14:1049-56. [PMID: 24530438 DOI: 10.1016/j.spinee.2013.11.060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 11/12/2013] [Accepted: 11/21/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Nonsurgical rehabilitation therapy is a commonly used strategy to treat chronic low back pain (LBP). The selection of the most appropriate therapeutic options is still a big challenge in clinical practices. Surface electromyography (sEMG) topography has been proposed to be an objective assessment of LBP rehabilitation. The quantitative analysis of dynamic sEMG would provide an objective tool of prognosis for LBP rehabilitation. PURPOSE To evaluate the prognostic value of quantitative sEMG topographic analysis and to verify the accuracy of the performance of proposed time-varying topographic parameters for identifying the patients who have better response toward the rehabilitation program. STUDY DESIGN A retrospective study of consecutive patients. PATIENT SAMPLE Thirty-eight patients with chronic nonspecific LBP and 43 healthy subjects. OUTCOME MEASURES The accuracy of the time-varying quantitative sEMG topographic analysis for monitoring LBP rehabilitation progress was determined by calculating the corresponding receiver-operating characteristic (ROC) curves. Physiologic measure was the sEMG during lumbar flexion and extension. METHODS Patients who suffered from chronic nonspecific LBP without the history of back surgery and any medical conditions causing acute exacerbation of LBP during the clinical test were enlisted to perform the clinical test during the 12-week physiotherapy (PT) treatment. Low back pain patients were classified into two groups: "responding" and "nonresponding" based on the clinical assessment. The responding group referred to the LBP patients who began to recover after the PT treatment, whereas the nonresponding group referred to some LBP patients who did not recover or got worse after the treatment. The results of the time-varying analysis in the responding group were compared with those in the nonresponding group. In addition, the accuracy of the analysis was analyzed through ROC curves. RESULTS The time-varying analysis showed discrepancies in the root-mean-square difference (RMSD) parameters between the responding and nonresponding groups. The relative area (RA) and relative width (RW) of RMSD at flexion and extension in the responding group were significantly lower than those in the nonresponding group (p<.05). The areas under the ROC curve of RA and RW of RMSD at flexion and extension were greater than 0.7 and were statistically significant. CONCLUSIONS The quantitative time-varying analysis of sEMG topography showed significant difference between the healthy and LBP groups. The discrepancies in quantitative dynamic sEMG topography of LBP group from normal group, in terms of RA and RW of RMSD at flexion and extension, were able to identify those LBP subjects who would respond to a conservative rehabilitation program focused on functional restoration of lumbar muscle.
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Affiliation(s)
- Yong Hu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong.
| | - Jerry Weilun Kwok
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong
| | - Jessica Yuk-Hang Tse
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong
| | - Keith Dip-Kei Luk
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 12 Sandy Bay Rd, Pokfulam, Hong Kong
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Steele J, Bruce-Low S, Smith D. A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin 2014; 30:865-911. [PMID: 24328452 DOI: 10.1185/03007995.2013.875465] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE 'Disuse' and 'Deconditioning' in relation to low back pain (LBP) are terms often used interchangeably. Discussions of 'disuse' refer to general physical inactivity, which evidence suggests does not differ between symptomatic and asymptomatic persons. 'Deconditioning' refers to a decrease in function, commonly both cardiovascular/aerobic fitness and muscular strength/endurance, again noting little difference. However, examination of decreased function relating specifically to lumbar extensor musculature deconditioning has yet to be examined, corroborating all possible methods. Thus, this review attempts to reappraise the deconditioning hypothesis in LBP, specifically considering lumbar extensor deconditioning. METHODS A literature review was conducted examining both cross-sectional and prospective data on specific lumbar extensor deconditioning and LBP. A narrative approach and 'snowballing' style literature search was used involving initial use of PubMed and Google Scholar databases searching up to December 2012. Included were studies utilizing the following three research methods, allowing specific induction of the role of such deconditioning; (1) strength/endurance testing of the isolated lumbar extensor musculature, (2) imaging and histochemical examination of the lumbar extensor musculature, and (3) fatigue testing of the lumbar extensor musculature using electromyography. RESULTS/FINDINGS Despite issues interpreting individual studies due to methods, the majority of evidence suggests LBP is associated with decreased strength/endurance, atrophy, and excessive fatigability of the lumbar extensors. Prospective studies also suggest lumbar extensor deconditioning may be a common risk factor predicting acute low back injury and LBP. CONCLUSIONS The hypothesis of specific lumbar extensor deconditioning as being a causal factor in LBP is presently well supported. It is by no means the only causative factor and further research should more rigorously test this hypothesis addressing the methodological issues highlighted regarding previous studies. However, its role suggests specific exercise may be a worthwhile preventative and rehabilitative approach.
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Affiliation(s)
- James Steele
- Southampton Solent University , Southampton, Hampshire , UK
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19
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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: 1.3] [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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20
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Dideriksen JL, Gizzi L, Petzke F, Falla D. Deterministic accessory spinal movement in functional tasks characterizes individuals with low back pain. Clin Neurophysiol 2013; 125:1663-8. [PMID: 24418221 DOI: 10.1016/j.clinph.2013.11.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To apply a novel method to assess the characteristics of spinal movement in subjects with low back pain (LBP) in a functional task. METHODS 17 subjects suffering from chronic non-specific LBP (average pain intensity: 1.8±1.6), and 17 age and gender matched controls performed a repetitive lifting task. Spinal movement was recorded using a novel sensor strip with 12 angle sensors recording the spinal dynamics in evenly spaced (25mm) locations along the spine. Recurrence quantification analysis was applied to different components of the angles to assess the structure of its variability. RESULTS Mechanically, the LBP and control group performed the task similarly. Reported pain increased in the LBP group, yet task-related angular movement was not different. However, the percentage of determinism for the accessory angular movement (movement variability not directly related to task execution) was significantly higher for the LBP group, indicating a more deterministic (less random) structure of the muscle activation pattern variability. CONCLUSION The structure of the variability of spinal movement differs in subjects with chronic non-specific LBP. SIGNIFICANCE The determinism of accessory spinal movement may be a useful measure for evaluation of movement impairment in LBP and for monitoring rehabilitation effects.
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Affiliation(s)
- J L Dideriksen
- Department of Neurorehabilitation Engineering, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - L Gizzi
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - F Petzke
- Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany
| | - D Falla
- Department of Neurorehabilitation Engineering, Bernstein Center for Computational Neuroscience, University Medical Center Göttingen, Georg-August University, Göttingen, Germany; Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany.
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Cuesta-Vargas AI, Gonzalez-Sanchez M. Relationship of moderate and low isometric lumbar extension through architectural and muscular activity variables: a cross sectional study. BMC Med Imaging 2013; 13:38. [PMID: 24252273 PMCID: PMC3840670 DOI: 10.1186/1471-2342-13-38] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 11/13/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND No study relating the changes obtained in the architecture of erector spinae (ES) muscle were registered with ultrasound and different intensities of muscle contraction recorded by surface EMG (electromyography) on the ES muscle was found. The aim of this study was analyse the relationship in the response of the ES muscle during isometric moderate and light lumbar isometric extension considering architecture and functional muscle variables. METHODS Cross-sectional study. 46 subjects (52% men) with a group mean age of 30.4 (±7.78). The participants developed isometric lumbar extension while performing moderate and low isometric trunk and hip extension in a sitting position with hips flexed 90 degrees and the lumbar spine in neutral position. During these measurements, electromyography recordings and ultrasound images were taken bilaterally. Bilaterally pennation angle, muscle thickness, torque and muscle activation were measured. This study was developed at the human movement analysis laboratory of the Health Science Faculty of the University of Malaga (Spain). RESULTS Strong and moderate correlations were found at moderate and low intensities contraction between the variable of the same intensity, with correlation values ranging from 0.726 (Torque Moderate - EMG Left Moderate) to 0.923 (Angle Left Light - Angle Right Light) (p < 0.001). This correlation is observed between the variables that describe the same intensity of contraction, showing a poor correlation between variables of different intensities. CONCLUSION There is a strong relationship between architecture and function variables of ES muscle when describe an isometric lumbar extension at light or moderate intensity.
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Affiliation(s)
- Antonio I Cuesta-Vargas
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Victoria Park Road, Kelvin Grove QLD 4059, Australia
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071, Málaga, Spain
| | - Manuel Gonzalez-Sanchez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071, Málaga, Spain
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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: 1.8] [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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Inoue H, Montgomery S, Aghdasi B, Tan Y, Tian H, Jian X, Terrell R, Singh V, Wang JC. Analysis of Relationship between Paraspinal Muscle Fatty Degeneration and Cervical Spine Motion Using Kinetic Magnetic Resonance Imaging. Global Spine J 2012; 2:33-8. [PMID: 24353944 PMCID: PMC3864418 DOI: 10.1055/s-0032-1307253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/25/2012] [Indexed: 11/20/2022] Open
Abstract
The alignment and mobility of the cervical spine is influenced by factors related to the vertebral bodies, intervertebral discs, ligaments, facet joints, and muscles. Few reports have described the role played by the paraspinal muscles in cervical spine mobility. In this study, we investigate the relationship between fatty degeneration of the paraspinal muscles and cervical motion as assessed with kinetic magnetic resonance imaging (kMRI). One hundred eighty-eight symptomatic patients underwent cervical kMRI in neutral, flexion, and extension positions. We quantified cervical paraspinal muscle fatty infiltration and measured angular variation and translational motion at each cervical level, and the global Cobb angle. Cervical paraspinal muscle fatty degeneration demonstrated a pattern in which C3 and C7 had significantly more fatty infiltration than C4, C5, and C6. Additionally, when the normal group was compared with the fatty degeneration group with respect to angular variation, translational motion, and Cobb angle, no significant differences were found except in angular variation at the C3-C4 level. In conclusion, we found a significantly larger quantity of fatty degeneration in the paraspinal muscles at C3 and C7 than the middle cervical levels. Also, we demonstrate that fatty degeneration does not significantly affect cervical lordotic alignment or mobility characteristics.
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Affiliation(s)
- Hirokazu Inoue
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Scott Montgomery
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Bayan Aghdasi
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Yanlin Tan
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Haijun Tian
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Xiong Jian
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Rodney Terrell
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Vijay Singh
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles, California
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Reliability of magnetic resonance imaging measurements of the cross-sectional area of the muscle contractile and non-contractile components. Surg Radiol Anat 2011; 33:735-41. [PMID: 21618015 DOI: 10.1007/s00276-011-0825-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE Magnetic resonance imaging (MRI) is increasingly used to study skeletal muscles patients with muscular disorders. We report an MRI technique for evaluating the trunk muscles. This technique takes both the component surface area (CSA) and the density of the muscles on MRI axial slices into account . Using a computer-based image analysis system, we combined MRI data measuring the muscle CSA, which was separated into the contractile component (CCSA) and the non-contractile component (NCCSA). The purpose of this study was to analyze the reliability of this method of measuring the CSA, CCSA and NCCSA in trunk muscles on MRI axial slices through L4 and T12. METHODS Thirty volunteer subjects were enrolled in this study. Two acquisitions were performed. For the reliability analyses, each of the two slices (T12 and L4) from 30 subjects was measured by three raters trained in this technique, on two occasions 2 weeks apart. Each muscle was surrounded and its CSA, NCCSA and CCSA were recorded. For each muscle, the agreement between the two sets of 30 measurements performed by three observers was evaluated by calculating an intra-class correlation coefficient (ICC). RESULTS Regarding the slice through L4 and T12, the reliabilities of the measurement of CSA, CCSA were very good for all the muscles except the parietal muscles. CONCLUSION MRI measurements of the trunk muscle cross-sectional areas and of the CCSA and NCCSA are reliable.
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A Double-Blind, Controlled, Randomized Trial to Evaluate the Efficacy of Botulinum Toxin for the Treatment of Lumbar Myofascial Pain in Humans. Reg Anesth Pain Med 2010; 35:255-60. [DOI: 10.1097/aap.0b013e3181d23241] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hu Y, Siu SHF, Mak JNF, Luk KDK. Lumbar muscle electromyographic dynamic topography during flexion-extension. J Electromyogr Kinesiol 2010; 20:246-55. [DOI: 10.1016/j.jelekin.2009.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 04/25/2009] [Accepted: 05/26/2009] [Indexed: 11/30/2022] Open
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Heydari A, Nargol AVF, Jones APC, Humphrey AR, Greenough CG. EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain. 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 2010; 19:1145-52. [PMID: 20127260 DOI: 10.1007/s00586-010-1277-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 07/20/2009] [Accepted: 01/10/2010] [Indexed: 11/28/2022]
Abstract
Studies of EMG power spectra have established associations between low-back pain (LBP) and median frequency (MF). This 2-year prospective study investigates the association of LBP with EMG variables over time. 120 health care workers underwent paraspinal EMG measurements and assessment of back pain disability. The EMG recordings were performed under isometric trunk extension at 2/3 maximum voluntary contraction and acquired from erector spinae muscles at the level of L4/L5. 108 (90%) subjects were reviewed at a minimum 2-year follow up. 16 out of 93 subjects with no history of chronic low-back pain became worse as measured by time off work, disability, reported pain and self-assessment rating. The value of the EMG variable half-width at inception demonstrated significant association with changes in subject's outcome measure and their own assessment of their LBP at follow up (p < 0.05). Based on self-assessment data, subjects with no history of chronic LBP with half-width of greater than 56 Hz were at threefold greater risk of developing back pain compared with the remainder of the population (p = 0.045). The value of the initial median frequency (IMF) and MF slope at inception were also associated with the subjects' own assessment of LBP at follow up. Subjects with an IMF greater than 49 Hz were at 5.8-fold greater risk of developing back pain compared with the remainder of the population (p = 0.014). EMG variables recorded from lumbar paraspinal muscles can identify a sub group of subjects at increased risk of developing low-back pain in the future.
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Affiliation(s)
- Abbas Heydari
- The Teesside Spine Centre, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
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28
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Sung PS, Zurcher U, Kaufman M. Reliability difference between spectral and entropic measures of erector spinae muscle fatigability. J Electromyogr Kinesiol 2010; 20:25-30. [PMID: 19121587 DOI: 10.1016/j.jelekin.2008.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 10/03/2008] [Accepted: 11/23/2008] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paul S Sung
- Department of Physical Therapy, College of Health Science, Korea University, Seoul, Republic of Korea.
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29
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Gille O, Jolivet E, Dousset V, Degrise C, Obeid I, Vital JM, Skalli W. Erector spinae muscle changes on magnetic resonance imaging following lumbar surgery through a posterior approach. Spine (Phila Pa 1976) 2007; 32:1236-41. [PMID: 17495782 DOI: 10.1097/brs.0b013e31805471fe] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized study of patients undergoing lumbar arthrodesis. OBJECTIVES To quantify MRI changes of the erector spinae following lumbar surgery through a posterior approach and the possible protection of these muscles during surgery by the use of cholinergic blockade. SUMMARY OF BACKGROUND DATA It has been shown that lumbar spine surgery through a posterior approach can induce iatrogenic lesions in the erector spinae. We have shown in a previous study that histologic changes on muscular biopsy performed in the multifidus at the end of the surgical procedure were not modified by the use of cholinergic blockade during surgery. METHODS Twenty patients scheduled to undergo pedicle-screw enhanced L4-L5 arthrodesis were enrolled in this study. Ten patients received curare during anesthesia and 10 patients did not. MRI was obtained the day before the operation and at 6 months of follow-up on the same MR scanner. T1-weighted images were obtained in the axial plane. The 2 slices immediately proximal and distal to the pedicle screw construct on the postoperative MRI were selected. The corresponding slices were selected on the preoperative MRI. Each erector spinae on the 4 slices was surrounded using a mouse-guided tool. The contractile component of the cross-sectional area (CCSA) was calculated from the number of pixels surrounded and the signal intensity of each pixel. RESULTS There was only slight changes in the erector spinae CCSA proximal to a posterior lumbar arthrodesis. Erector spinae CCSA decreased by 27% distal to the arthrodesis. Curare showed no efficacy in preventing muscle damage. CONCLUSIONS Erector spinae muscle alterations mainly occur distal to posterior lumbar surgical procedures.
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Affiliation(s)
- Olivier Gille
- University Hospital of Bordeaux, Spinal Unit, Department of Orthopaedic Surgery, Bordeaux, France
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Elfving B, Dedering A. Task dependency in back muscle fatigue--correlations between two test methods. Clin Biomech (Bristol, Avon) 2007; 22:28-33. [PMID: 17046123 DOI: 10.1016/j.clinbiomech.2006.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 08/21/2006] [Accepted: 08/22/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various test methods which engage the back muscles in different tasks have been used in studies of back muscle fatigue with electromyography. The present objective was to study task dependency in lumbar muscle fatigue by comparing two test methods. METHODS In this cross-sectional study, 22 healthy subjects performed a seated (45s) and a prone test (to the limit of endurance) of back muscle fatigue in randomised order. Fatigue of the lumbar muscles was assessed using electromyography spectral variables and ratings of back muscle fatigue (Borg scale). Linear regression of the median frequency during contraction, and conventional statistical tests of group differences and correlations were used. FINDINGS Significant differences (P<0.001) between the seated and the prone test were found for the initial median frequency, the slope, the median frequency decrease during the whole contraction, and for the ratings. However, correlation coefficients between the seated and the prone test were low for the median frequency decrease (r=0.42), absent for the slopes of median frequency (r=-0.08), higher for the Borg ratings (r(s)=0.51; P<0.05) and highest for the initial median frequency (r=0.69; P<0.05). Within each test, correlations between the Borg ratings and the electromyography variables were essentially absent (r<0.19). INTERPRETATION Electromyography variables assessed in one type of task in a fatiguing test may not be valid for other types of fatiguing tasks, for example in daily life work situations. Thus task dependency has to be considered when using surface electromyography in determining lumbar muscle fatigue. Ratings of fatigue, however, seem to be less task dependent than the electromyography variables.
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Affiliation(s)
- Britt Elfving
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy 23 100, Karolinska Institutet, 141 83 Huddinge, Sweden.
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal review: a survey of the "surgical and research" articles in the European Spine Journal, 2005. 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 2006; 15:8-15. [PMID: 16411129 PMCID: PMC3454563 DOI: 10.1007/s00586-005-1062-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Accepted: 12/16/2005] [Indexed: 10/25/2022]
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Airaksinen MK, Kankaanpää M, Aranko O, Leinonen V, Arokoski JPA, Airaksinen O. Wireless on-line electromyography in recording neck muscle function: A pilot study. PATHOPHYSIOLOGY 2005; 12:303-6. [PMID: 16256323 DOI: 10.1016/j.pathophys.2005.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 09/16/2005] [Accepted: 09/16/2005] [Indexed: 11/29/2022] Open
Abstract
AIM The surface electromyography (SEMG) records muscle activity without causing pain and therefore it can be used in the on-line kinetic evaluation of rehabilitation methods. The cables are a problem in the clinical work. The aim of this pilot study was to introduce a wireless on-line SEMG method in the measurements of neck muscle activity and preliminarily evaluate its usability in dynamic exercises in a healthy and a neck pain subject. METHOD The bilateral wireless on-line SEMG measurements were performed at the level C4-C5 of the cervical spine. The subjects (one healthy 32-year-old female and one neck pain patient, 35-year-old female) were performing slow cervical flexions with eyes open. The angle of the flexion was measured with inclinometer. RESULTS In healthy subjects, the SEMG curve demonstrated clear flexion-relaxation rhythm whereas in the patient the rhythm was blurred. The SEMG signal quality was, however, good in both cases. CONCLUSION Wireless on-line SEMG method seems promising in daily clinical work for the measurements of neck muscle activity.
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Affiliation(s)
- Minna K Airaksinen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, 70200 Kuopio, Finland.
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