Reproducibility of lumbar paraspinal surface electromyogram power spectra

EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain

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.

Strategies to identify changes in SEMG due to muscle fatigue during cycling

Detection, quantification and analysis of muscle fatigue are crucial in occupational/rehabilitation and sporting settings. Sports organizations such as the Australian Institute of Sports (AIS) currently monitor fatigue by a battery of tests including invasive techniques that require taking blood samples and/or muscle biopsies, the latter of which is highly invasive, painful, time consuming and expensive. SEMG is non-invasive monitoring of muscle activation and is an indication of localized muscle fatigue based on the observed shift of the power spectral density of the SEMG. But the success of SEMG based techniques is currently limited to isometric contraction and is not acceptable to the human movement community. This paper proposes and tests the use of spectral analysis of narrow windows of SEMG near the peak of a cyclic activity to identify the onset of muscle fatigue during cyclic activities. The results demonstrate a highly significant relationship of reduction of the median frequency with the onset of muscle fatigue. The paper also reports the validation of the SEMG study using biochemical analysis of muscle biopsy and blood tests and further verified using power output of the cycle and speed of pedalling.

The value of electromyography of the lumbar paraspinal muscles in discriminating between chronic-low-back-pain sufferers and normal subjects

The authors studied the surface electromyographic (EMG) spectrum of the paraspinal muscles of 350 subjects. They were classified by their history as normal (n=175), chronic low back pain (n=145), or past history (n=30). They pulled upwards on a floor-mounted load cell at two-thirds of their maximum voluntary contraction for 30 s, while the EMG was measured from the paraspinal muscles at the L4/L5 level. From the EMG signal the root-mean-square (RMS) was calculated. Power spectrum analysis allowed calculation of the median frequency slope, the initial median frequency (IMF), modal frequency, peak amplitude and spectral width at half peak amplitude (half-width). All of the variables of the chronic group were significantly different from the normal group, except the median frequency slope, RMS slope and mode. Half-width, age and maximum voluntary contraction were shown to be independent predictors of back pain classification. Half-width classified the subjects with a sensitivity of 0.65 and a specificity of 0.75.

Strategies to identify changes in SEMG due to muscle fatigue during cycling

Detection, quantification and analysis of muscle fatigue is crucial in occupational/rehabilitation and sporting settings. Sports organizations such as Australian Institute of Sports (AIS) currently monitor fatigue by a battery of tests including invasive techniques that require taking blood samples and/or muscle biopsies, the latter of which is highly invasive, painful, time consuming and expensive. SEMG is non-invasive monitoring of the muscle activation and is an indication of localized muscle fatigue based on the observed shift of the power spectral density of the SEMG. But the success of SEMG based techniques is currently limited to isometric contraction and is not acceptable to the human movement community. This paper proposes and tests a simple signal processing technique to identify the onset of muscle fatigue during cyclic activities of muscles such as VL and VM during cycling. Based on experiments conducted with 7 participants, using power output as a measure of fatigue, the technique is able to identify the muscle fatigue with 98% significance.

Reliability of electromyographic and torque measures during isometric axial rotation exertions of the trunk

OBJECTIVE

The aim of the present study was to investigate the between-days reliability of electromyographic (EMG) measurement of 6 bilateral trunk muscles and also the torque output in 3 planes during isometric right and left axial rotation at different exertion levels.

METHODS

Ten healthy subjects performed isometric right and left axial rotation at 100, 70, 50 and 30% maximum voluntary contractions in two testing sessions at least 7 days apart. EMG amplitude and frequency analyses of the recorded surface EMG signals were performed for rectus abdominis, external oblique, internal oblique, latissimus dorsi, iliocostalis lumborum and multifidus bilaterally. The primary torque in the transverse plane and the coupling torques in sagittal and coronal planes were measured.

RESULTS

For both EMG amplitude and frequency values, good (intraclass correlation coefficient, ICC=0.75-0.89) to excellent (ICC>/=0.90) reliability was found in the 6 trunk muscles at different exertion levels during axial rotation. The reliability of both maximal isometric axial rotation torque and coupling torques in sagittal and coronal planes were found to be excellent (ICC>/=0.93).

CONCLUSIONS

Good to excellent reliability of EMG measures of trunk muscles and torque measurements during isometric axial rotation was demonstrated. This provides further confidence of using EMG and triaxial torque assessment as outcome measures in rehabilitation and in the evaluation of the human performance in the work place.

Between-days reliability of electromyographic measures of paraspinal muscle fatigue at 40, 50 and 60% levels of maximal voluntary contractile force

OBJECTIVE

To ascertain which percentage of maximal voluntary contractile force of the paraspinal muscles, when tested in a functional position, is most reliable for assessing electromyographic (EMG) fatigue changes.

SUBJECTS

Ten healthy volunteers with no history of low back pain (six males).

MAIN OUTCOME MEASURES

The surface EMG signal during 60-second isometric contractions of the paraspinal muscles at 40, 50 and 60% levels of maximal voluntary contractile force was captured and analysed. Each contraction level was assessed on two occasions, at least three days apart. The initial median frequency, the decline in median frequency slope and the increase in root mean square values were assessed for between-days reliability, using intraclass correlation coefficients (ICCs) and standard errors of measurements (SEM). Normalized median frequency and root mean square values were also assessed.

RESULTS

At 40% of maximal voluntary contraction, little or no EMG fatigue changes occurred in any of the observed parameters. At 50% maximal voluntary contraction the initial mean frequency and root mean square changes proved highly reliable, with ICCs ranging from 0.74 to 0.86 and 0.75 to 1.00 respectively. Normalizing the root mean square data reduced the reliability, but this was still acceptable with ICCs 0.70-0.83. The median frequency decline slope proved less reliable with ICCs 0.24-0.74 for raw and 0.26-0.77 for normalized data. At 60% maximal voluntary contraction the initial mean frequency proved as reliable as initial median frequency at 50% with ICCs 0.70-0.89. The raw and normalized root mean squares (ICCs 0.43-0.89 and 0.30-0.87 respectively) and raw and normalized median frequency (ICCs 0.27-0.51 and 0.24-0.53 respectively) changes were less reliable than at 50% MVC. Overall, the reliability is better at the L4/5 than at the L2/3 level.

CONCLUSION

Outcome measures taken at 50% maximal voluntary contraction are the most reliable in functional testing the paraspinal muscles of healthy volunteers. With initial median frequency and root mean square values being more reliable parameters than median frequency decline. At the L4/5 level, however, all parameters were acceptably reliable at 50% of maximum effort. However the between-subject variability of the median frequency decline and root mean square incline slopes suggest that these parameters are not yet fully suitable for monitoring fatigue changes during prolonged isometric contraction.

Evaluation of measurement strategies to increase the reliability of EMG indices to assess back muscle fatigue and recovery

The purpose of this study was to assess different measurement strategies to increase the reliability of different electromyographic (EMG) indices developed for the assessment of back muscle impairments. Forty male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three sessions at least 2 days apart within 2 weeks. Surface EMG signals were recorded from four pairs (bilaterally) of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10) while the subjects performed, in a static dynamometer, two static trunk extension tasks at 75% of the maximal voluntary contraction separated by a 60 s rest period: (1) a 30 s fatigue task and (2) a 5 s recovery task. Different EMG indices (based on individual muscles or averaged across bilateral homologous muscles or across all muscles) were computed to evaluate muscular fatigue and recovery. Intra-class correlation coefficient (ICC) and standard error of measurement (SEM) in percentage of the grand mean were calculated for each EMG variable. Reliable EMG indices are achieved for both healthy and chronic low back pain subjects when (1) electrodes are positioned on medial back muscles (multifidus at the L5 level and longissimus at L1) and (2) measures are averaged across bilateral muscles and/or across two fatigue tests performed within a session. The most reliable EMG indices were the bilateral average of medial back muscles (ICC range: 0.68-0.91; SEM range: 5-35%) and the average of all back muscles (ICC range: 0.77-0.91; SEM range: 5-30%). The averaging of measures across two fatigue tests is predicted to increase the reliability by about 13%. With regards to EMG indices of fatigue, the identification of the most fatigable muscle also lead to satisfactory results (ICC range: 0.74-0.79; SEM range: 21-26%). The assessment of back muscle impairments through EMG analysis necessitates the use of multiple electrodes to achieve reliable results.

Factors in the reproducibility of electromyographic power spectrum analysis of lumbar paraspinal muscle fatigue

STUDY DESIGN

An investigation of the reliability of various factors used to analyze electromyograms of paraspinal muscles of the lumbar spine.

OBJECTIVES

To determine the reproducibility of several electromyographic variables over time and to assess the influence of confounding factors.

SUMMARY OF BACKGROUND DATA

Previous reliability studies have included small numbers of subjects and often have not explored the factors that can influence the reliability of this technique.

METHODS

In the first study, 39 volunteers underwent electromyographic tests on three occasions at two loads. The time interval was 1 week between tests. Electromyographic variables measured included half-width (spectral width at half maximum amplitude), initial median frequency, median frequency slope, initial root mean square, root mean square, and root mean square slope. In the second study to determine the influence of posture, nine volunteers were tested on two occasions with a change in posture between tests.

RESULTS

Reliability was better for tests at the higher loads. Initial median frequency, half-width, and root mean square all had acceptable reproducibility over time, with a coefficient of variation less than 10. Initial median frequency and half-width proved to be the most suitable variables; they yielded the largest between-subject variation and, of all variables, were affected the least by changes in load. The remaining variables were very load-dependent. A change in posture greatly influenced the reproducibility.

CONCLUSION

These results demonstrate that only initial median frequency and half-width have acceptable reproducibility over time and at different loads, with the potential to be useful in discriminating between individuals. Changes in posture can greatly change an electromyographic result.

Reliability of spectral EMG parameters of healthy back extensors during submaximum isometric fatiguing contractions and recovery

Spectral EMG parameters are being used as an objective evaluation of low back rehabilitation programs. The reliability of these spectral parameters is important in determining the validity of this evaluation tool. Two groups of eight subjects, with no history of back pain, were measured: the first group every day for one week; the second group one day per week for four weeks. During each session, subjects performed a 30-second isometric fatiguing contraction of the back extensors at 60% MVC followed by a 60-second rest and a 10-second repeat contraction. The intraclass correlation coefficient (ICC) did not demonstrate high reliability (ICC < 0.6) for the rate of median power frequency (MedPF) change (Hz/s), the magnitude of the recovery (Hz) and differences between the dominant and the non-dominant sides within a subject. However, the initial MedPF (Hz) of the fatigue and repeat contractions demonstrated excellent reliability (ICC > 0.8) with five or more repeated measures. The practical implication of this work is that the experimental condition must have sufficiently large changes in MedPF (signal)--at least larger than the variability inherent in the MedPF (noise)--to constitute a valid measure.

Assessment of spinal musculature using surface electromyographic spectral color mapping

STUDY DESIGN

A technique is described for analyzing electromyogram data from lumbar spinal muscles, with special reference to discrimination of people with back pain. The ability to discriminate was evaluated in 99 people (61 healthy and 38 with chronic or acute back pain), and the influence of load was assessed.

OBJECTIVES

To evaluate methods of analysis of complex electromyogram data and to assess correlation of electromyogram information with clinical condition in people with and without back pain.

SUMMARY OF BACKGROUND INFORMATION

In previous analyses of electromyogram data, only a small part of the data have been used. Spinal muscular decompensation has been postulated in chronic low back pain, but there has been no direct demonstration of this phenomenon. Objective measures are still elusive.

METHODS

Lumbar spinal surface electromyograms were recorded during an isometric lifting task. The data were represented graphically as color-coded plots of electromyogram frequency, time, and electromyogram amplitude. Spectral width at half-peak amplitude (spectral half width) was calculated from the digitized, summed data. Ninety-nine people were tested: 48 men (29 with no recent [in the past 2 years] history of back pain, 16 with chronic back pain, 3 with acute back pain) and 51 women (32 with no recent back pain and 19 with chronic back pain).

RESULTS

Spectral color maps in people with chronic back pain were markedly different from those in healthy people. Spectral half width was greater in people with chronic back pain than in healthy people (P < 0.01). Blinded analysis of spectral color maps allowed discrimination of people with back pain from healthy people with a sensitivity of 76% and a specificity of 81%. People with a history of back pain had markedly variable half widths.

CONCLUSIONS

A new method of analysis of electromyogram data from lumbar spinal muscles has allowed discrimination between people with back pain and healthy people. This provides direct evidence of a correlation between muscular electrical function, measured by electromyogram, and low back pain. This technique may have potential as an objective measurement tool.