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Marotta N, de Sire A, Bartalotta I, Sgro M, Zito R, Invernizzi M, Ammendolia A, Iona T. Role of the Flexion Relaxation Phenomenon in the Analysis of Low Back Pain Risk in the Powerlifter: A Proof-of-Principle Study. J Sport Rehabil 2024; 33:333-339. [PMID: 38734422 DOI: 10.1123/jsr.2023-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 02/19/2024] [Accepted: 03/19/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Unlike the most common training approaches for bodybuilding, powerlifting programs are generally based on maximum and submaximal loads, putting enormous stresses on the lumbar spine. The flexion relaxation phenomenon evaluation is a clinical tool used for low back pain (LBP) assessment. This study aimed to evaluate the role of the flexion relaxation phenomenon in the analysis of LBP in the powerlifters. METHODS Healthy professional powerlifters participated in the study. In fact, we divided the participants into a LBP-low-risk group and a LBP-high-risk group, based on a prior history of LBP. Outcome measures included flexion relaxation ratio (FRR) and trough surface electromyography collected during trunk maximum voluntary flexion; furthermore, during a bench press lifting, we measured the height of the arched back (ARCH), using a camera and the Kinovea video editing software, to consider a potential correlation with the risk of LBP. RESULTS We included a group of 18 male (aged 24-39 y) powerlifters of 93 kg category. We measured a nonsignificant mean difference of ARCH between low-risk LBP group and high-risk LBP subjects. Curiously, maximum voluntary flexions were both above the threshold of 3.2 μV; therefore, with an absence of appropriate myoelectric silence, on the contrary, the FRR ratios were higher than 9.5, considering the presence of the phenomenon, exclusively for the low-risk group. The lumbar arched back measurement data did not report any association with the LBP risk, regarding the maximum voluntary flexion value, and even more than the FRR there is a relationship with the presence or the absence of LBP risk. CONCLUSIONS FRR could be considered as a useful parameter for studying the risk of LBP in powerlifting. The FRR index not only refers to the possible myoelectric silence of the lumbar muscles in trunk maximum forward flexion but also takes into account the energy value delivered by the lumbar muscles during the flexion. Furthermore, we can indicate that the size of the powerlifter ARCH may not be a determining factor in the occurrence of LBP.
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Affiliation(s)
- Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
| | - Isabella Bartalotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
| | - Maria Sgro
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
| | - Roberta Zito
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro,"Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
| | - Teresa Iona
- Motor Sciences, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia,"Catanzaro, Italy
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Marotta N, de Sire A, Lippi L, Moggio L, Tasselli A, Invernizzi M, Ammendolia A, Iona T. Impact of yoga asanas on flexion and relaxation phenomenon in women with chronic low back pain: Prophet model prospective study. J Orthop Res 2024. [PMID: 38379407 DOI: 10.1002/jor.25790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
Chronic nonspecific low back pain (NSLBP) is a prevalent condition with socioeconomic and healthcare challenges. The flexion-relaxation phenomenon (FRP) evaluation is a valid clinical tool for low back pain (LBP) assessment. Yoga, a holistic mind-body practice, has been explored as an LBP intervention. This study aimed to evaluate the impact of yoga asanas on the FRP in women with NSLBP. The study included healthy and chronic NSLBP females who underwent an eight-session yoga asanas program, with the first session conducted in-clinic and the rest delivered with tele-approach. Outcome measures included pain intensity, flexion-relaxation ratio (FRR), and trough surface electromyography collected during trunk maximum voluntary flexion (MVF). The study included 11 healthy and 10 NSLBP women. Repeated measures test in chronic NSLBP group showed a significant decrease in pain intensity after the 4 weeks follow-up (visual analog scale [VAS]: 6.80 ± 1.48 vs. 3.30 ± 1.25; p < 0.001) and an FRR improvement after the intervention (5.12 ± 0.93 vs. 9.49 ± 0.92; p < 0.001). VAS and FRR effect sizes were 0.77 and 0.47, respectively. Therefore, we performed a Prophet evaluation to assess FRR trends, finding a growth rate (k) of 0.405 ± 0.448, with a forecast 1 month after the end of the intervention approaching the trend line of the control group. The findings suggested that tele-yoga asana might have a positive impact on pain intensity and the FRP in chronic LBP. Further research is warranted to confirm the long-term effects of yoga for managing LBP.
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Affiliation(s)
- Nicola Marotta
- Physical and Rehabilitative Medicine Division, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine Division, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine Division, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Rehabilitation Unit, Ospedale degli Infermi, Biella, Italy
| | - Anna Tasselli
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine Division, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine Division, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Teresa Iona
- Motor Sciences Division, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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De Carvalho D, Mackey S, To D, Summers A, Frey M, Romme K, Hogg-Johnson S, Howarth SJ. A systematic review and meta analysis of measurement properties for the flexion relaxation ratio in people with and without non specific spine pain. Sci Rep 2024; 14:3260. [PMID: 38332128 PMCID: PMC10853169 DOI: 10.1038/s41598-024-52900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
This review sought to identify, critically appraise, compare, and summarize the literature on the reliability, discriminative validity and responsiveness of the flexion relaxation ratio (FRR) in adults (≥ 18 years old) with or without spine pain (any duration), in either a clinical or research context. The review protocol was registered on Open Science Framework ( https://doi.org/10.17605/OSF.IO/27EDF ) and follows COSMIN, PRISMA, and PRESS guidelines. Six databases were searched from inception to June 1, 2022. The search string was developed by content experts and a health services librarian. Two pairs of reviewers independently completed titles/abstracts and full text screening for inclusion, data extraction, and risk of bias assessment (COSMIN RoB Toolkit). At all stages, discrepancies were resolved through consensus meetings. Data were pooled where possible with a three-level random effects meta-analyses and a modified GRADE assessment was used for the summary of findings. Following duplicate removal, 728 titles/abstracts and 219 full texts were screened with 23 included in this review. We found, with moderate certainty of evidence, that the cervical FRR has high test-retest reliability and lumbar FRR has moderate to high test-retest reliability, and with high certainty of evidence that the cervical and lumbar FRR can discriminate between healthy and clinical groups (standardized mean difference - 1.16 [95% CI - 2.00, - 0.32] and - 1.21 [- 1.84, - 0.58] respectively). There was not enough evidence to summarize findings for thoracic FRR discriminative validity or the standard error of measurement for the FRR. Several studies used FRR assuming responsiveness, but no studies were designed in a way that could confirm responsiveness. The evidence supports adequate reliability of FRR for the cervical and lumbar spine, and discriminative validity for the cervical and lumbar spine only. Improvements in study design and reporting are needed to strengthen the evidence base to determine the remaining measurement properties of this outcome.
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Affiliation(s)
- Diana De Carvalho
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Sarah Mackey
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Daphne To
- Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Allyson Summers
- Division of Population Health and Applied Health Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mona Frey
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Kristen Romme
- Health Sciences Library, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sheilah Hogg-Johnson
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Samuel J Howarth
- Division of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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Moissenet F, Armand S, Genevay S. Measurement properties of 72 movement biomarkers aiming to discriminate non‑specific chronic low back pain patients from an asymptomatic population. Sci Rep 2023; 13:6483. [PMID: 37081110 PMCID: PMC10119171 DOI: 10.1038/s41598-023-33504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/13/2023] [Indexed: 04/22/2023] Open
Abstract
The identification of relevant and valid biomarkers to distinguish patients with non-specific chronic low back pain (NSCLBP) from an asymptomatic population in terms of musculoskeletal factors could contribute to patient follow-up and to evaluate therapeutic strategies. Several parameters related to movement impairments have been proposed in the literature in that respect. However, most of them were assessed in only one study, and only 8% were evaluated in terms of reliability, validity and interpretability. The aim of this study was to consolidate the current knowledge about movement biomarkers to discriminate NSCLBP patients from an asymptomatic population. For that, an experimental protocol was established to assess the reliability, validity and interpretability of a set of 72 movement biomarkers on 30 asymptomatic participants and 30 NSCLBP patients. Correlations between the biomarkers and common patient reported outcome measures were also analysed. Four biomarkers reached at least a good level in reliability (ICC ≥ 0.75) and validity (significant difference between asymptomatic participants and NSCLBP patients, p ≤ 0.01) domains and could thus be possibly considered as valuable biomarkers: maximal lumbar sagittal angle, lumbar sagittal angle range of motion, mean lumbar sagittal angular velocity, and maximal upper lumbar sagittal angle during trunk sagittal bending. These four biomarkers demonstrated typically larger values in asymptomatic participants than in NSCLBP patients. They are in general weakly correlated with patient reported outcome measures, arguing for a potential interest in including related musculoskeletal factors in the establishment of a valuable diagnosis and in guiding treatment response.
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Affiliation(s)
- Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Department of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
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Zhang G, Gao L, Zhang D, Li H, Shen Y, Zhang Z, Huang Y. Mawangdui-Guidance Qigong Exercise for patients with chronic non-specific low back pain: Study protocol of a randomized controlled trial. Front Neurosci 2023; 17:1090138. [PMID: 36992848 PMCID: PMC10040536 DOI: 10.3389/fnins.2023.1090138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/23/2023] [Indexed: 03/15/2023] Open
Abstract
IntroductionWorldwide, there is a high frequency of chronic non-specific low back pain (CNLBP), which is a significant public health concern. The etiology is complicated and diverse, and it includes a number of risk factors such as diminished stability and weak core muscles. Mawangdui-Guidance Qigong has been employed extensively to bolster the body in China for countless years. However, the effectiveness of treating CNLBP has not been assessed by a randomized controlled trial (RCT). In order to verify the results of the Mawangdui-Guidance Qigong Exercise and examine its biomechanical mechanism, we intend to perform a randomized controlled trial.Methods and analysisOver the course of 4 weeks, 84 individuals with CNLBP will be randomly assigned to receive either Mawangdui-Guidance Qigong Exercise, motor control exercise, or medication (celecoxib). Electromyographic data, including muscle activation time, iEMGs, root mean square value (RMS) and median frequency (MF), will be the main outcomes. The Japanese Orthopedic Association (JOA) Score, the Mcgill Pain Questionnaire (MPQ), beta-endorphin, and substance P are examples of secondary outcomes. At the start of treatment and 4 weeks later, all outcomes will be evaluated. SPSS version 20.0 (SPSS Inc., Chicago, IL, USA) will be used for all of the analysis.DiscussionThe prospective findings are anticipated to offer an alternative treatment for CNLBP and provide a possible explanation of the mechanism of Mawangdui-Guidance Qigong Exercise on CNLBP.Ethics and disseminationThe Sichuan Regional Ethics Review Committee on Traditional Chinese Medicine has given the study approval (Approval No. 2020KL-067). It has also registered at the website of China Clinical Trial Center Registration. The application adheres to the Declaration of Helsinki’s tenets (Version Edinburgh 2000). Peer-reviewed papers will be used to publicize the trial’s findings.Trial registration numberClinicalTrials.gov, identifier ChiCTR2000041080.
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Affiliation(s)
- Guilong Zhang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liang Gao
- Beijing Bo’ai Hospital China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
| | - Di Zhang
- Department of Rehabilitation, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongjian Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Orthopedics, Yibin Hospital of Traditional Chinese Medicine, Yibin, Sichuan, China
| | - Yuquan Shen
- Department of Rehabilitation, The First People’s Hospital of Longquanyi District, Chengdu, China
| | - Zhengsong Zhang
- Traditional Chinese Medicine (TCM) Preventive Medical Center, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- *Correspondence: Yong Huang,
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Gouteron A, Tabard-Fougère A, Moissenet F, Bourredjem A, Rose-Dulcina K, Genevay S, Laroche D, Armand S. Sensitivity and specificity of the flexion and extension relaxation ratios to identify altered paraspinal muscles' flexion relaxation phenomenon in nonspecific chronic low back pain patients. J Electromyogr Kinesiol 2023; 68:102740. [PMID: 36549262 DOI: 10.1016/j.jelekin.2022.102740] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Among the main methods used to identify an altered flexion relaxation phenomenon (FRP) in nonspecific chronic low back pain (NSCLBP), it has been previously demonstrated that flexion relaxation ratio (FRR) and extension relaxation ratio (ERR) are more objective than the visual reference method. OBJECTIVE To determine the sensitivity and specificity of the different methods used to calculate the ratios in terms of their ability to identify an altered FRP in NSCLBP. METHODS Forty-four NSCLBP patients performed a standing maximal trunk flexion task. Surface electromyography (sEMG) was recorded along the erector spinae longissimus (ESL) and multifidus (MF) muscles. Altered FRP based on sEMG was visually identified by three experts (current standard). Six FRR methods and five ERR methods were used both for the ESL and MF muscles. ROC curves (with areas under the curve (AUC) and sensitivity/specificity) were generated for each ratio. RESULTS All methods used to calculate these ratios had an AUC higher than 0.9, excellent sensitivity (>90 %), and good specificity (80-100 %) for both ESL and MF muscles. CONCLUSION Both FRP ratios (FRR and ERR) for MF and ESL muscles, appear to be an objective, sensitive and specific method for identifying altered FRP in NSCLBP patients.
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Affiliation(s)
- Anaïs Gouteron
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, Faculty of Sport Sciences, Burgundy, Dijon, France; Department of Physical Medicine and Rehabilitation, University Hospital Dijon, Burgundy, Dijon, France; INSERM CIC 1432, Clinical Investigation Center P Module, Technological Investigation Platform University Hospital Dijon, Burgundy, Dijon, France; Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Anne Tabard-Fougère
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon, Burgundy, Dijon, France
| | - Kévin Rose-Dulcina
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Davy Laroche
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, Faculty of Sport Sciences, Burgundy, Dijon, France; INSERM CIC 1432, Clinical Investigation Center P Module, Technological Investigation Platform University Hospital Dijon, Burgundy, Dijon, France
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Zheng X, Reneman MF, Echeita JA, Schiphorst Preuper RHR, Kruitbosch H, Otten E, Lamoth CJC. Association between central sensitization and gait in chronic low back pain: Insights from a machine learning approach. Comput Biol Med 2022; 144:105329. [DOI: 10.1016/j.compbiomed.2022.105329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/30/2022]
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Lai WY, Cui H, Hu Y. Correlation between change in pain, disability, and surface electromyography topographic parameters after interferential current treatment in patients with chronic low back pain. J Phys Ther Sci 2021; 33:772-778. [PMID: 34658523 PMCID: PMC8516599 DOI: 10.1589/jpts.33.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Surface electromyography (SEMG) topography is used to objectively assess
patients with low back pain (LBP). This study aimed to investigate the correlation between
SEMG topographic variables, pain, and disability in patients with chronic LBP (CLBP) after
interferential current (IFC) treatment, and to evaluate IFC treatment efficacy using SEMG
topography. [Participants and Methods] Twenty nine patients with CLBP were recruited for a
6-week IFC treatment. Pain and disability scores, and the root-mean-square difference
(RMSD) of SEMG topographic variables (relative areas [RAs] at flexion and extension) were
compared before and after the intervention by repeated measures ANOVA; the correlation
between variables was also explored and p-value was set at 0.001. [Results] Significant
positive correlations between changes in pain score and the RMSD of RA at flexion
(r(29)=0.593), and between changes in pain and disability scores (r(29)=0.426) were
observed. All participants showed statistically significant improvements in the RMSD of RA
at flexion, pain score, and disability score after IFC treatment. [Conclusion] SEMG
topographic variables are closely associated with changes in pain score in patients with
CLBP after IFC treatment. The RMSD of RA at flexion can be used as an objective marker in
IFC treatment efficacy evaluation.
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Affiliation(s)
- Wai Ying Lai
- Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong: 12 Sandy Bay Road, Pokfulam, Hong Kong.,Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong
| | - Hongyan Cui
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, China
| | - Yong Hu
- Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong: 12 Sandy Bay Road, Pokfulam, Hong Kong.,Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, China
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Gouteron A, Tabard-Fougère A, Bourredjem A, Casillas JM, Armand S, Genevay S. The flexion relaxation phenomenon in nonspecific chronic low back pain: prevalence, reproducibility and flexion-extension ratios. A systematic review and meta-analysis. 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 2021; 31:136-151. [PMID: 34553264 DOI: 10.1007/s00586-021-06992-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The flexion relaxation phenomenon (FRP) is characterized by the reduction of paraspinal muscle activity at maximum trunk flexion. The FRP is reported to be altered (persistence of spinal muscle activity) in nonspecific chronic low back pain (NSCLBP) and is considered a promising biomarker. The aim of this systematic review was to synthetize current knowledge on FRP in the NSCLBP population regarding prevalence, the reliability of FRP measurement using surface electromyography (sEMG), the average value, and variation of the relaxation ratios (RR). METHODS Five databases were searched (PubMed, EMBASE, Web of Sciences, Cochrane Library, Pedro). A qualitative analysis was done for all included studies and meta-analysis studying prevalence, mean value of flexion relaxation ratio (FRR) and extension relaxation ratio (ERR), and difference between asymptomatic and NSCLBP FRR. RESULTS Twenty-seven studies were included for qualitative analysis and 21 studies for meta-analysis. The prevalence of the altered FRP was 55% (95%CI [32-79%]) in the NSCLBP population. The studies on reliability reported good within-session and between-session reproducibility. In the NSLBP population, the mean FRR was 2.96 (95%CI [2.02; 3.90]) and the mean ERR was 4.07 (95%CI [2.08; 6.07]). The difference between asymptomatic and NSCLBP FRR was - 1.19 (95%CI [- 1.92, - 0.45]). In all meta-analysis, the I2 index was > 80%. CONCLUSION An altered FRP is frequently found in NSCLBP population using sEMG and the test has a good reproducibility. The difference between asymptomatic and NSCLBP FRR was significant. Nevertheless, considering the high heterogeneity observed, additional research is required to confirm the value of RR.
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Affiliation(s)
- Anaïs Gouteron
- Inserm UMR 1093, Cognition, Action, Plasticité sensori-motrice, Dijon, France. .,University Hospital Dijon-Burgundy Franche-Comté, France, Pôle Rééducation-Réadaptation, CHU de Dijon, 23, Rue Gaffarel, 21078, Dijon, France.
| | - Anne Tabard-Fougère
- Geneva University Hospitals and University of Geneva, Willy Taillard Laboratory of Kinesiology, Geneva, Switzerland
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon, Burgundy, Dijon, France
| | - Jean-Marie Casillas
- Inserm UMR 1093, Cognition, Action, Plasticité sensori-motrice, Dijon, France.,Inserm CIC 1432, Module P, Plateforme d'investigation Technologique, CHU de Dijon, Dijon, France.,University Hospital Dijon-Burgundy Franche-Comté, France, Pôle Rééducation-Réadaptation, CHU de Dijon, 23, Rue Gaffarel, 21078, Dijon, France
| | - Stéphane Armand
- Geneva University Hospitals and University of Geneva, Willy Taillard Laboratory of Kinesiology, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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A systematic review of movement and muscular activity biomarkers to discriminate non-specific chronic low back pain patients from an asymptomatic population. Sci Rep 2021; 11:5850. [PMID: 33712658 PMCID: PMC7955136 DOI: 10.1038/s41598-021-84034-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
The identification of relevant and valid biomarkers to distinguish patients with non-specific chronic low back pain (NSCLBP) from an asymptomatic population in terms of musculoskeletal factors could contribute to patient follow-up and to evaluate therapeutic strategies. Several parameters related to movement and/or muscular activity impairments have been proposed in the literature in that respect. In this article, we propose a systematic and comprehensive review of these parameters (i.e. potential biomarkers) and related measurement properties. This systematic review (PROSPERO registration number: CRD42020144877) was conducted in Medline, Embase, and Web of Knowledge databases until July 2019. In the included studies, all movements or muscular activity parameters having demonstrated at least a moderate level of construct validity were defined as biomarkers, and their measurement properties were assessed. In total, 92 studies were included. This allowed to identify 121 movement and 150 muscular activity biomarkers. An extensive measurement properties assessment was found in 31 movement and 14 muscular activity biomarkers. On the whole, these biomarkers support the primary biomechanical concepts proposed for low back pain. However, a consensus concerning a robust and standardised biomechanical approach to assess low back pain is needed.
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Christe G, Crombez G, Edd S, Opsommer E, Jolles BM, Favre J. Relationship between psychological factors and spinal motor behaviour in low back pain: a systematic review and meta-analysis. Pain 2021; 162:672-686. [PMID: 33591109 DOI: 10.1097/j.pain.0000000000002065] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
ABSTRACT This meta-analysis investigated whether more negative psychological factors are associated with less spinal amplitude of movement and higher trunk muscle activity in individuals with low back pain. Furthermore, it examined whether pain intensity was a confounding factor in this relationship. We included studies that provided at least 1 correlation coefficient between psychological (pain-related fear, catastrophizing, depression, anxiety, and self-efficacy) and spinal motor behaviour (spinal amplitude and trunk muscle activity) measures. In total, 52 studies (3949 participants) were included. The pooled correlation coefficients (95% confidence interval; number of participants) were -0.13 (-0.18 to -0.09; 2832) for pain-related fear, -0.16 (-0.23 to -0.09; 756) for catastrophizing, -0.08 (-0.13 to -0.03; 1570) for depression, -0.08 (-0.30 to 0.14; 336) for anxiety, and -0.06 (-0.46 to 0.36; 66) for self-efficacy. The results indicated that higher levels of pain-related fear, catastrophizing, and depression are significantly associated with reduced amplitudes of movement and larger muscle activity and were consistent across subgroup and moderation analyses. Pain intensity did not significantly affect the association between these psychological factors and spinal motor behaviour and had a very small independent association with spinal motor behaviour. In conclusion, the very small effect sizes found in the meta-analyses question the role of psychological factors as major causes of spinal movement avoidance in low back pain. Experimental studies with more specific and individualized measures of psychological factors, pain intensity, and spinal motor behaviour are recommended.
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Affiliation(s)
- Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Ghent University, Gent, Belgium
| | - Shannon Edd
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Emmanuelle Opsommer
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Brigitte M Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Julien Favre
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Ballard MT, Drury C, Bazrgari B. Changes in Lumbo-Pelvic Coordination of Individuals With and Without Low Back Pain When Wearing a Hip Orthosis. Front Sports Act Living 2020; 2:90. [PMID: 33345081 PMCID: PMC7739660 DOI: 10.3389/fspor.2020.00090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/05/2020] [Indexed: 11/13/2022] Open
Abstract
Individuals with low back pain demonstrate an abnormal lumbo-pelvic coordination compared to back-healthy individuals. This abnormal coordination presents itself as a reduction in lumbar contributions and an increase in pelvic rotations during a trunk forward bending and backward return task. This study investigated the ability of a hip orthosis in correcting such an abnormal lumbo-pelvic coordination by restricting pelvic rotation and, hence increasing lumbar contributions. The effects of the hip orthosis on the lumbo-pelvic coordination were investigated in 20 low back pain patients and 20 asymptomatic controls. The orthosis reduced pelvic rotation by 12.7° and increased lumbar contributions by 11%. Contrary to our expectation, orthosis-induced changes in lumbo-pelvic coordination were smaller in patients; most likely because our relatively young patient group had smaller unrestricted pelvic rotations compared to asymptomatic individuals. Considering the observed capability of a hip orthosis in causing the expected changes in lumbo-pelvic coordination when there is a relatively large pelvic contribution to trunk motion, application of a hip orthosis may provide a promising method of correcting abnormal lumbo-pelvic coordination, particularly among patients who demonstrate larger pelvic rotation, that warrants further investigation.
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Affiliation(s)
- Matthew T Ballard
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States
| | - Colin Drury
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States
| | - Babak Bazrgari
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States
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Shigetoh H, Nishi Y, Osumi M, Morioka S. Combined abnormal muscle activity and pain-related factors affect disability in patients with chronic low back pain: An association rule analysis. PLoS One 2020; 15:e0244111. [PMID: 33332431 PMCID: PMC7746291 DOI: 10.1371/journal.pone.0244111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/02/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives In patients with chronic low back pain (CLBP), reduced lumbar flexion-relaxation and reduced variability of muscle activity distribution are reported as abnormal muscle activity. It is not known how abnormal muscle activity and pain-related factors are related to CLBP-based disability. Here, we performed an association rule analysis to investigated how CLBP disability, muscle activity, and pain-related factors in CLBP patients are related. Methods Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae muscle with four-channel electrodes from 24 CLBP patients while they performed a trunk flexion re-extension task. We calculated the average value of muscle activities of all channels and then calculated the flexion relaxation ratio (FRR) and the spatial variability of muscle activities. We also assessed the pain-related factors and CLBP disability by a questionnaire method. A clustering association rules analysis was performed to determine the relationships among pain-related factors, the FRR, and the variability of muscle activity distribution. Results The association rules of severe CLBP disability were divisible into five classes, including ‘low FRR-related rules.’ The rules of the mild CLBP disability were divisible into four classes, including ‘high FRR-related rules’ and ‘high muscle variability-related rules.’ When we combined pain-related factors with the FRR and muscle variability, the relationship between abnormal FRR/muscle variability and CLBP disability became stronger. Discussion Our findings thus highlight the importance of focusing on not only the patients’ pain-related factors but also the abnormal motor control associated with CLBP, which causes CLBP disability.
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Affiliation(s)
- Hayato Shigetoh
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo-cho, Nara, Japan
- Miura Internal Medicine Michiko Pediatrics Clinic, Marugame-shi, Kagawa, Japan
- * E-mail:
| | - Yuki Nishi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo-cho, Nara, Japan
| | - Michihiro Osumi
- Neuro Rehabilitation Research Center, Kio University, Koryo-cho, Nara, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo-cho, Nara, Japan
- Neuro Rehabilitation Research Center, Kio University, Koryo-cho, Nara, Japan
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Matthew RP, Seko S, Bailey J, Bajcsy R, Lotz J. Simple Spline Representation for Identifying Sit-to-Stand Strategies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:4097-4103. [PMID: 31946772 DOI: 10.1109/embc.2019.8857429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Standing from a seated position is an activity of daily living and a common clinical test of strength and balance. While this action is well-studied biomechanically, there remains a need for a clear modelling method for appropriately capturing performance and discriminating between standing strategies. This paper presents a simple framework for representing the rise from a chair as a set of splines. This formulation is inherently differentiable, defines a clear start and end point of the motion, and allows for secondary analysis of dynamic and energetic effects. This method is tested on two healthy subjects performing four different standing strategies. The spline method was found to accurately capture the standing action, with mean absolute errors of 1-2 cm for joint position, and 2-3 degrees angular error across the different standing strategies. Analysis of the spline trajectories revealed strategy-specific differences in kinematic, kinetic, and dynamic bio-markers. This suggests that low order splines can be used to accurately capture variations in sit-to-stand actions.
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Naranjo-Hernández D, Reina-Tosina J, Roa LM. Sensor Technologies to Manage the Physiological Traits of Chronic Pain: A Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E365. [PMID: 31936420 PMCID: PMC7014460 DOI: 10.3390/s20020365] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/03/2020] [Accepted: 01/05/2020] [Indexed: 12/15/2022]
Abstract
Non-oncologic chronic pain is a common high-morbidity impairment worldwide and acknowledged as a condition with significant incidence on quality of life. Pain intensity is largely perceived as a subjective experience, what makes challenging its objective measurement. However, the physiological traces of pain make possible its correlation with vital signs, such as heart rate variability, skin conductance, electromyogram, etc., or health performance metrics derived from daily activity monitoring or facial expressions, which can be acquired with diverse sensor technologies and multisensory approaches. As the assessment and management of pain are essential issues for a wide range of clinical disorders and treatments, this paper reviews different sensor-based approaches applied to the objective evaluation of non-oncological chronic pain. The space of available technologies and resources aimed at pain assessment represent a diversified set of alternatives that can be exploited to address the multidimensional nature of pain.
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Affiliation(s)
- David Naranjo-Hernández
- Biomedical Engineering Group, University of Seville, 41092 Seville, Spain; (J.R.-T.); (L.M.R.)
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Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. J Orthop Sports Phys Ther 2019; 49:464-476. [PMID: 31151377 DOI: 10.2519/jospt.2019.8827] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Spinal health depends on optimal back muscle performance, and this is determined by muscle structure and function. There has been substantial research evaluating the differences in structure and function of many back muscles, including the multifidus and erector spinae, but with considerable variation in results. Many studies have shown atrophy, fat infiltration, and connective tissue accumulation in back muscles, particularly deep fibers of the multifidus, but the results are not uniform. In terms of function, results are also somewhat inconsistent, often reporting lower multifidus activation and augmented recruitment of more superficial components of the multifidus and erector spinae, but, again, with variation between studies. A major recent observation has been the identification of time-dependent differences in features of back muscle adaptation, from acute to subacute/recurrent to chronic states of the condition. Further, these adaptations have been shown to be explained by different time-dependent mechanisms. This has substantial impact on the rationale for rehabilitation approaches. The aim of this commentary was to review and consolidate the breadth of research investigating adaptation in back muscle structure and function, to consider explanations for some of the variation between studies, and to propose how this model can be used to guide rehabilitation in a manner that is tailored to individual patients and to underlying mechanisms. J Orthop Sports Phys Ther 2019;49(6):464-476. doi:10.2519/jospt.2019.8827.
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Ansari B, Bhati P, Singla D, Nazish N, Hussain ME. Lumbar Muscle Activation Pattern During Forward and Backward Walking in Participants With and Without Chronic Low Back Pain: An Electromyographic Study. J Chiropr Med 2019; 17:217-225. [PMID: 30846913 DOI: 10.1016/j.jcm.2018.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to investigate the electromyographic activity of lumbar multifidus (MF) and erector spinae (ES) muscle during forward walking (FW) and backward walking (BW) in participants with and without chronic low back pain (CLBP). Methods Twenty-one patients with CLBP were recruited from outpatient department of Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia. Twenty-one age-matched healthy controls without CLBP were recruited from community. Maximum voluntary isometric contraction (MVIC) was quantified for MF and ES using standard guidelines. Electromyographic activity of MF and ES was recorded using surface electrodes during FW and BW on a motorized treadmill, which was later normalized by respective MVIC's of each muscle. Results Muscle activity (in percentage MVIC) was determined to be higher for both the muscles during BW. Activity of MF muscle was significantly higher in CLBP patients compared with healthy controls (P < .04). Electromyographic activity of MF and ES was significantly increased during BW (MF: P < .001; ES: P < .001) compared with FW in both healthy and CLBP groups. Conclusion BW leads to greater activation of the paraspinal muscles. Along with global extensor (ES), activity of core extensor (MF) is also higher during BW than FW in both healthy participants and CLBP patients. BW is a more favorable aerobic activity to enhance lumbar paraspinal recruitment. These findings may have important clinical implications in the rehabilitation of CLBP.
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Affiliation(s)
- Bushra Ansari
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Pooja Bhati
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Deepika Singla
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Nabeela Nazish
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Mohammad Ejaz Hussain
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
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da Silva RA, Vieira ER, Léonard G, Beaulieu LD, Ngomo S, Nowotny AH, Amorim CF. Age- and low back pain-related differences in trunk muscle activation during one-legged stance balance task. Gait Posture 2019; 69:25-30. [PMID: 30658312 DOI: 10.1016/j.gaitpost.2019.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postural control declines with age and can be affected by low back pain. Poor balance has been reported in people with chronic low back pain (CLBP), which in turn could be explained by the changes in trunk muscle activation. RESEARCH QUESTION Are there differences between younger and older adults with and without chronic low back pain (CLBP) on trunk muscle activity during one-legged stance task? METHODS Twenty (20) with, and 20 subjects without nonspecific CLBP participated in the study. Each group was comprised of 10 younger (50% males; mean age: 31 years) and 10 older adults (50% males; mean age: 71 years). Subjects performed 3 × 30-second trials of one-legged stance, with eyes open, on a force platform, while surface electromyography (EMG) measurements were obtained bilaterally on the multifidus at L5, iliocostalis lumborum at L3, rectus abdominis and biceps femoris muscles.EMG amplitude analysis was processed by the Root Mean Square (250 ms window epochs) and normalized by the peak of activation during the balance tasks, to determine the muscular activity of each muscle. RESULTS Participants with CLBP presented 15% lower lumbar muscle activation (p < 0.05), and 23% higher co-activation (ratio between rectus adominis by multifidus) than participants without CLBP, regardless of age. Significant differences (p < 0.05) between older and young groups were observed only for lower lumbar muscles (mean 24% lower in older than younger adults) and rectus adominis muscles (mean 17% lower in older than younger adults). SIGNIFICANCE CLBP individuals have different trunk muscle activity than those without CLBP, and older adults exhibit lower trunk activation during one-legged stance balance task. The use of the EMG in evaluation of trunk neuromuscular function during one-legged stance may thus be a valuable tool when assessing balance in CLBP and older people.
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Affiliation(s)
- Rubens A da Silva
- Département des Sciences de la Santé, Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Centre de recherche Intersectoriel en santé durable - UQAC, Laboratoire de recherche BioNR - UQAC, Saguenay, Québec, Canada; Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), UNOPAR University, Doctoral and Masters Program in Rehabilitation Sciences UEL/UNOPAR, Londrina, PR, Brazil.
| | - Edgar R Vieira
- Florida International University (FIU), Physical Therapy & Neuroscience Departments, Wertheim Colleges of Nursing and Health Sciences & Medicine, 11200 SW 8th St., AHC3-430, Miami, FL, USA
| | - Guillaume Léonard
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis-David Beaulieu
- Département des Sciences de la Santé, Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Centre de recherche Intersectoriel en santé durable - UQAC, Laboratoire de recherche BioNR - UQAC, Saguenay, Québec, Canada
| | - Suzy Ngomo
- Département des Sciences de la Santé, Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Centre de recherche Intersectoriel en santé durable - UQAC, Laboratoire de recherche BioNR - UQAC, Saguenay, Québec, Canada
| | - Alexandre H Nowotny
- Laboratory of Functional Evaluation and Human Motor Performance (LAFUP), UNOPAR University, Doctoral and Masters Program in Rehabilitation Sciences UEL/UNOPAR, Londrina, PR, Brazil
| | - César F Amorim
- Département des Sciences de la Santé, Programme de physiothérapie de l'Université McGill offert en extension à l'Université du Québec à Chicoutimi (UQAC), Centre de recherche Intersectoriel en santé durable - UQAC, Laboratoire de recherche BioNR - UQAC, Saguenay, Québec, Canada; Florida International University (FIU), Physical Therapy & Neuroscience Departments, Wertheim Colleges of Nursing and Health Sciences & Medicine, 11200 SW 8th St., AHC3-430, Miami, FL, USA; Doctoral and Masters Program in Physical Therapy, UNICID, São Paulo, SP, Brazil
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Arguisuelas MD, Lisón JF, Doménech-Fernández J, Martínez-Hurtado I, Salvador Coloma P, Sánchez-Zuriaga D. Effects of myofascial release in erector spinae myoelectric activity and lumbar spine kinematics in non-specific chronic low back pain: Randomized controlled trial. Clin Biomech (Bristol, Avon) 2019; 63:27-33. [PMID: 30784788 DOI: 10.1016/j.clinbiomech.2019.02.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Flexion-relaxation response of the lumbar erector spinae has been previously studied after different interventions such as exercise programs or spinal manipulation, in subjects with chronic low back pain. The objective of the study was to investigate the effects of an isolated myofascial release protocol on erector spinae myoelectric activity and lumbar spine kinematics in chronic low back pain. METHODS Thirty-six participants, with nonspecific chronic low back pain, were randomized to myofascial release group (n = 18) receiving four sessions of myofascial treatment, each lasting 40 min, and to control group (n = 18) receiving a sham myofascial release. Electromyographic and kinematic variables as well as pain and disability questionnaires were analyzed. FINDINGS There was a bilateral reduction of the flexion relaxation ratio in individuals receiving myofascial release and who did not show myoelectric silence at baseline (right difference M = 0.34, 95% CI [0.16, 0.33], p ≤ .05 and left difference M = 0.45, 95% CI [0.16, 0.73], p ≤ .05). There was also a significant reduction in pain in the myofascial release group (difference M = -9.1, 95% CI [-16.3, -1.8], p ≤ .05) and disability (difference M = -5.6, 95% CI [-9.1, -2.1], p ≤ .05), compared with control group. No significant differences between groups were found for the kinematic variables. INTERPRETATION The myofascial release protocol contributed to the normalization of the flexion- relaxation response in individuals who did not show myoelectric silence before the intervention, and also showed a significant reduction in pain and disability compared with the sham group.
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Affiliation(s)
- M D Arguisuelas
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
| | - J F Lisón
- Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain; CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Carlos III Health Institute, Spain
| | - J Doménech-Fernández
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain; Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, Valencia, Spain
| | - I Martínez-Hurtado
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - P Salvador Coloma
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - D Sánchez-Zuriaga
- Department of Anatomy and Human Embryology, Universitat de València, Valencia, Spain
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Laird RA, Keating JL, Ussing K, Li P, Kent P. Does movement matter in people with back pain? Investigating 'atypical' lumbo-pelvic kinematics in people with and without back pain using wireless movement sensors. BMC Musculoskelet Disord 2019; 20:28. [PMID: 30658610 PMCID: PMC6339318 DOI: 10.1186/s12891-018-2387-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Interventions for low back pain (LBP) commonly target ‘dysfunctional’ or atypical lumbo-pelvic kinematics in the belief that correcting aberrant movement improves patients’ pain and activity outcomes. If atypical kinematic parameters and postures have a relationship to LBP, they could be expected to more prevalent in people with LBP compared to people without LBP (NoLBP). This exploratory study measured, defined and compared atypical kinematic parameters in people with and without LBP. Methods Wireless inertial motion and EMG sensors were used to measure lumbo-pelvic kinematics during standing trunk flexion (range of motion (ROM), timing, sequence coordination, and extensor muscle activation) and in sitting (relative sitting position, pelvic tilt range) in a sample of 126 of adults without LBP and 140 chronic LBP subjects. Atypical movement was defined using the 10th/90th centiles of the NoLBP group. Mean differences and prevalence rates for atypical movement were calculated. Dichotomised pain scores for ‘high-pain-on-bending’ and ‘high-pain-on-sitting’ were tested for their association with atypical kinematic variables. Results For standing flexion, significant mean differences, after adjusting for age and gender factors, were seen for the LBP group with (i) reduced ROM (trunk flexion (NoLBP 111o, LBP 93o, p < .0001), lumbar flexion (NoLBP 52o, LBP 46o, p < .0001), pelvic flexion (NoLBP 59o, LBP 48o, p < .0001), (ii) greater extensor muscle activation for the LBP group (NoLBP 0.012, LBP 0.25 p < .0001), (iii) a greater delay in pelvic motion at the onset of flexion (NoLBP − 0.21 s; LBP − 0.36 s, p = 0.023), (iv) and longer movement duration for the LBP group (NoLBP 2.28 s; LBP 3.18 s, p < .0001). Atypical movement was significantly more prevalent in the LBP group for small trunk (× 5.4), lumbar (× 3.0) and pelvic ROM (× 3.9), low FRR (× 4.9), delayed pelvic motion at 20o flexion (× 2.9), and longer movement duration (× 4.7). No differences between groups were seen for any sitting parameters. High pain intensity was significantly associated with small lumbar ROM and pelvic ROM. Conclusion Significant movement differences during flexion were seen in people with LBP, with a higher prevalence of small ROM, slower movement, delayed pelvic movement and greater lumbar extensor muscle activation but without differences for any sitting parameter. Electronic supplementary material The online version of this article (10.1186/s12891-018-2387-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert A Laird
- Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria, 3199, Australia.
| | - Jennifer L Keating
- Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria, 3199, Australia
| | - Kasper Ussing
- Spine Centre of Southern Denmark, Hospital of Lillebaelt, Middelfart, Denmark
| | - Paoline Li
- SuperSpine Physiotherapy, 380 Springvale Rd, Forest Hill, Melbourne, 3131, Australia
| | - Peter Kent
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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The relationship between functionality and erector spinae activity in patients with specific low back pain during dynamic and static movements. Gait Posture 2018; 66:208-213. [PMID: 30205316 DOI: 10.1016/j.gaitpost.2018.08.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/15/2018] [Accepted: 08/31/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Alterations in the activity of the lumbar erector spinae (LES) muscles on both sides of the spine have been inconsistently reported in patients with specific low back pain (sLBP) after measuring the muscular activity with surface electromyography (sEMG). It also remains unclear whether these alterations in LES activity can be related to the functional level of patients with sLBP. RESEARCH QUESTION This study investigated the LES activity in patients with sLBP during activities of daily living (ADL) which included dynamic and static movement tasks. Moreover, the alterations in LES activity were correlated with the first seven questions of the Zurich Claudication Questionnaire (ZCQ-SS). METHODS Thirty patients with specific LBP and twenty healthy subjects were recruited to perform five ADLs including 'static waist flexion', 'sit to stand',' 30-seconds standing', '6-minutes walking' and 'climbing stairs'. sEMG sensors were mounted on the left and right LES muscles. The integrated EMG (IEMG) was calculated from the preprocessed sEMG data as statistical comparison criteria. RESULTS LES activity was significantly higher in patients during 'sit to stand',' 30-seconds standing' and 'climbing stairs' and significantly lower during 'static waist flexion' compared to healthy controls. All tasks showed a significant correlation with the ZCQ-SS score except for '6-minutes walking', whereby LES activity and ZCQ-SS score correspondingly increased during 'sit to stand' and 'climbing stairs' and the LES activity decreased with an increasing ZCQ-SS score during 'static waist flexion' and' 30-seconds standing'. SIGNIFICANCE There was a high correlation between alterations in LES activity and the level of functionality in LBP patients. However, the LES activity showed an opposite behavior during static and dynamic movement tasks. The methodology presented can be a useful tool for quantifying improvements in functionality after rehabilitation processes.
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Flexion-Relaxation Phenomenon in Children and Adolescents With and Without Nonspecific Chronic Low Back Pain: An Electromyographic and Kinematic Cross-Sectional Comparative Study. Spine (Phila Pa 1976) 2018; 43:1322-1330. [PMID: 29509654 DOI: 10.1097/brs.0000000000002621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional comparative study. OBJECTIVE This study aimed to investigate the flexion-relaxation phenomenon (FRP), in standing trunk flexion and slumped sitting tasks, by comparing children and adolescents suffering from nonspecific chronic low back pain (NSCLBP) with controls (CTRL). SUMMARY OF BACKGROUND DATA The absence of the FRP can accurately discriminate adults with NSCLBP from those without during standing trunk flexion and slumped sitting tasks. Even if the FRP has been extensively studied in adults with NSCLBP, only one study has evaluated the FRP in adolescents, during a slumped sitting task, and this suggested that the FRP was also present in adolescents with NSCLBP. METHODS Thirty-seven children and adolescents with NSCLBP and 23 CTRL performed standing trunk flexion and slumped sitting tasks. All participants were equipped with surface electromyography (EMG) electrodes on the erector spinae longissimus (ESL) and multifidus (M) muscles and reflective markers on the spinous processes of C7, L1, and S1. Global (C7-S1), thoracic (C7-L1), and lumbar (L1-S1) trunk flexion absolute angle were measured. The FRP was reported using visual inspection and a flexion-relaxation ratio (FRR). A self-reference threshold was used to identify the time of FRP onset. Repeated-measures analysis of variance (ANOVA) was used to determine the main and interaction effects of task, group and muscle on FRR, and the relative maximal angle at FRP onset of the global trunk (C7-S1). RESULTS Results showed three main findings: (1) the FRP's low sensitivity in discriminating between NSCLBP and CTRL participants in groups, tasks, or muscles; (2) similar observed maximal flexion angles in both groups during flexion tasks; and (3) similar observed relative maximal global trunk flexion angles at FRP onset in groups, tasks, and muscles. CONCLUSION These results are not consistent with the literature on adults and could lead to modified therapeutic management of NSCLBP in children and adolescents. LEVEL OF EVIDENCE 3.
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du Rose A, Breen A, Breen A. Relationships between muscle electrical activity and the control of inter-vertebral motion during a forward bending task. J Electromyogr Kinesiol 2018; 43:48-54. [PMID: 30237131 DOI: 10.1016/j.jelekin.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022] Open
Abstract
Muscle strengthening exercises are commonly used in primary care for the treatment of chronic, non-specific low back pain (CNSLBP) as it has been theorised that increased muscle activity contributes to the stabilisation of inter-vertebral motion segments during bending and other spinal movements, however this has never been demonstrated in vivo. This study used contemporaneous quantitative fluoroscopy (QF) and surface electromyography (sEMG) to investigate relationships between continuous inter-vertebral motion variables and muscle electrical activity in the lumbar multifidus (LMU), lumbar and thoracic erector spinae (LES and TES) during standardised lumbar flexion and return in 18 healthy male human subjects. Our results demonstrated that the variability in the sharing of angular motion (i.e. Motion Share Variability MSV) and motion segment laxity during a bending task were significantly (p < 0.05) negatively correlated (Spearman) with muscle electrical activity throughout the participant bend for both locally and globally acting muscle groups. MSV was also strongly correlated with L2-3 laxity. The former suggests a damping mechanism reducing irregular displacements (i.e. less variability in the sharing of segmental motion) during bending and an action of spinal stabilisation by muscles at segmental levels, and the latter a synergy between laxity at L2-3 and MSV. While this has previously been theorised, it has never been shown in vivo at the inter-vertebral level. These assessments may be considered for use in validation studies of exercise programs for CNSLBP, however further replication is required.
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Affiliation(s)
- Alister du Rose
- University of South Wales, Treforest, Pontypridd, Wales CF37 1DL, UK.
| | - Alex Breen
- AECC University College, Bournemouth, Dorset, England BH52DF, UK
| | - Alan Breen
- AECC University College, Bournemouth, Dorset, England BH52DF, UK
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du Rose A. Have Studies that Measure Lumbar Kinematics and Muscle Activity Concurrently during Sagittal Bending Improved Understanding of Spinal Stability and Sub-System Interactions? A Systematic Review. Healthcare (Basel) 2018; 6:healthcare6030112. [PMID: 30205578 PMCID: PMC6163188 DOI: 10.3390/healthcare6030112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/15/2018] [Accepted: 09/07/2018] [Indexed: 11/26/2022] Open
Abstract
In order to improve understanding of the complex interactions between spinal sub-systems (i.e., the passive (ligaments, discs, fascia and bones), the active (muscles and tendons) and the neural control systems), it is necessary to take a dynamic approach that incorporates the measurement of multiple systems concurrently. There are currently no reviews of studies that have investigated dynamic sagittal bending movements using a combination of electromyography (EMG) and lumbar kinematic measurements. As such it is not clear how understanding of spinal stability concepts has advanced with regards to this functional movement of the spine. The primary aim of this review was therefore to evaluate how such studies have contributed to improved understanding of lumbar spinal stability mechanisms. PubMed and Cochrane databases were searched using combinations of the keywords related to spinal stability and sagittal bending tasks, using strict inclusion and exclusion criteria and adhering to PRISMA guidelines. Whilst examples of the interactions between the passive and active sub-systems were shown, typically small sample sizes meant that results were not generalizable. The majority of studies used regional kinematic measurements, and whilst this was appropriate in terms of individual study aims, the studies could not provide insight into sub-system interaction at the level of the spinal motion segment. In addition, the heterogeneity in methodologies made comparison between studies difficult. The review suggests that since Panjabi’s seminal spinal control papers, only limited advancement in the understanding of these theories has been provided by the studies under review, particularly at an inter-segmental level. This lack of progression indicates a requirement for new research approaches that incorporate multiple system measurements at a motion segment level.
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Affiliation(s)
- Alister du Rose
- Faculty of Life Sciences and Education, University of South Wales, Treforest, Pontypridd, Wales CF37 1DL, UK.
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Pool-Goudzwaard A, Groeneveld W, Coppieters MW, Waterink W. Changes in spontaneous overt motor execution immediately after observing others' painful action: two pilot studies. Exp Brain Res 2018; 236:2333-2345. [PMID: 29876631 PMCID: PMC6061486 DOI: 10.1007/s00221-018-5290-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 05/15/2018] [Indexed: 11/05/2022]
Abstract
Research has demonstrated that motor control is directly influenced by observation of others’ action, stimulating the mirror neuron system. In addition, there is evidence that both emotion and empathy after observing a painful stimulus affects motor cortical excitability and reaction times. Aim of the present two pilot studies is a) to test for significant influence of observing other’s painful bending of the trunk on execution of the same activity in a self-directed bending action (study 1) and to compare these results with a bending action according to a strict bending protocol (study 2). In addition to study 1, differences between Low Back Pain (LBP) patients versus healthy subjects are tested. Video footage of a (1) neutral, (2) painful, and (3) happy bending action was presented in random order. Changes in flexion–relaxation phenomenon (FRP) of back muscles were studied directly after watching the videos with surface EMG, in study 1 during a self-directed bending action in LBP patients and healthy subjects, in study 2 according to a strict bending protocol. FRP ratios were calculated by a custom-made analysis scheme tested for sufficient reliability prior to both studies. Evoked emotions were measured with an Emotional Questionnaire after each video. A Mixed Model ANOVA was used to test for the effect video and the difference between LBP and healthy subjects on the FRP-rs. Differences in evoked emotion will be tested with a Wilcoxon Signed Rank Test. In study 1, 24 healthy controls and 16 LBP patients FRP-rs were significantly influenced after observing a painful video in all subjects versus a happy and neutral video (p = 0.00). No differences were present between LBP and healthy controls. All subjects experienced more fear after observation of the painful video (p 0.05). In study 2, 6 healthy subjects followed the strict FRP bending protocol for three times after observing each video. No significant changes occurred in FRPs per video compared to FRPs of six healthy subjects carrying out the spontaneous bending activity. Observing a painful action in another person changes motor performance and increases fear in both people with and without back pain, during self-directed trunk flexion, but not during a protocolled trunk flexion.
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Affiliation(s)
- Annelies Pool-Goudzwaard
- Amsterdam Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands. .,Somt University of Physiotherapy, Amersfoort, The Netherlands.
| | - Wim Groeneveld
- Department of Neuroscience, Faculty of Health Sciences and Medicine, ErasmusMC University, Rotterdam, The Netherlands
| | - Michel W Coppieters
- Amsterdam Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Wim Waterink
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
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MacRae CS, Critchley D, Lewis JS, Shortland A. Comparison of standing postural control and gait parameters in people with and without chronic low back pain: a cross-sectional case-control study. BMJ Open Sport Exerc Med 2018; 4:e000286. [PMID: 29387444 PMCID: PMC5783032 DOI: 10.1136/bmjsem-2017-000286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Differences in postural control and gait have been identified between people with and without chronic low back pain (CLBP); however, many previous studies present data from small samples, or have used methodologies with questionable reliability. This study, employing robust methodology, hypothesised that there would be a difference in postural control, and spatiotemporal parameters of gait in people with CLBP compared with asymptomatic individuals. Methods This cross-sectional case–control study age-matched and gender-matched 16 CLBP and 16 asymptomatic participants. Participants were assessed barefoot (1) standing, over three 40 s trials, under four posture challenging conditions (2) during gait. Primary outcome was postural stability (assessed by root mean squared error of centre of pressure (CoP) displacement (CoPRMSEAP) and mean CoP velocity (CoPVELAP), both in the anteroposterior direction); gait outcomes were hip range of movement and peak moments, walking speed, cadence and stride length, assessed using force plates and a motion analysis system. Results There were no differences between groups in CoPRMSEAP (P=0.26), or CoPVELAP (P=0.60) for any standing condition. During gait, no differences were observed between groups for spatiotemporal parameters, maximum, minimum and total ranges of hip movement, or peak hip flexor or extensor moments in the sagittal plane. Conclusions In contrast to previous research, this study suggests that people with mild to moderate CLBP present with similar standing postural control, and parameters of gait to asymptomatic individuals. Treatments directed at influencing postural stability (eg, standing on a wobble board) or specific parameters of gait may be an unnecessary addition to a treatment programme.
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Affiliation(s)
- Catharine Siân MacRae
- College of Health and Life Sciences, Brunel University, Uxbridge, UK.,Therapy Services, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Duncan Critchley
- Division of Health and Social Care Research, Academic Department of Physiotherapy, King's College London, London, UK
| | - Jeremy S Lewis
- Department of Allied Health Professions, University of Hertfordshire, Hatfield, UK.,Musculoskeletal Services, Central London Community Healthcare NHS Foundation Trust, London, UK
| | - Adam Shortland
- One Small Step Gait Laboratory, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Biomedical Engineering, King's College London, London, UK
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Ma Y, Shan X. Spasm and flexion-relaxation phenomenon response to large lifting load during the performance of a trunk flexion-extension exercise. BMC Musculoskelet Disord 2017; 18:505. [PMID: 29187168 PMCID: PMC5707781 DOI: 10.1186/s12891-017-1869-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The flexion relaxation phenomenon (FRP) has been widely investigated. Nevertheless, no study has been reported on the FRP as well as spasm response to large lifting load. The aim of this study was to evaluate the effect of large lifting load on the FRP response and spasm during execution of a flexion-extension exercise. METHODS Twenty-two healthy male university students without low back pain history participated this study. Subjects randomly performed three trials of trunk flexion-extension cycles of 5 s flexion and 5 s extension in each of 4 conditions (three large lifting loads of 15, 20 and 25 kg and one lifting load of 0 kg for comparison). Surface EMG from bilateral erector spinae was recorded during the performance of a trunk anterior flexion-extension exercise. The relaxation phase was determined through the onset of electromyography (EMG) signals. Spasm was evaluated in the relaxation period. The mean normalized electromyography (NEMG) was derived from the raw EMG. RESULTS Spasm was observed in more than 45% of the individuals and the intensity of muscle activation was increased by more than 78% in the relaxation phase. CONCLUSIONS A large lifting load could lead to a high prevalence of spasms as well as a high intensity of muscle activations on erector spinae muscle in the relaxation period, which may be associated with the development of low back disorder during the performance of a flexion-extension exercise.
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Affiliation(s)
- Yanjun Ma
- Biomechanics Laboratory, College of Physical Education, Shandong Normal University, 88 Wenhua East Road, Jinan, Shandong 250014 People’s Republic of China
| | - Xinhai Shan
- Biomechanics Laboratory, College of Physical Education, Shandong Normal University, 88 Wenhua East Road, Jinan, Shandong 250014 People’s Republic of China
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Prins MR, Griffioen M, Veeger TTJ, Kiers H, Meijer OG, van der Wurff P, Bruijn SM, van Dieën JH. Evidence of splinting in low back pain? A systematic review of perturbation studies. 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 2017; 27:40-59. [PMID: 28900711 DOI: 10.1007/s00586-017-5287-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/26/2017] [Accepted: 08/19/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this systematic review was to assess whether LBP patients demonstrate signs of splinting by evaluating the reactions to unexpected mechanical perturbations in terms of (1) trunk muscle activity, (2) kinetic and (3) kinematic trunk responses and (4) estimated mechanical properties of the trunk. METHODS The literature was systematically reviewed to identify studies that compared responses to mechanical trunk perturbations between LBP patients and healthy controls in terms of muscle activation, kinematics, kinetics, and/or mechanical properties. If more than four studies reported an outcome, the results of these studies were pooled. RESULTS Nineteen studies were included, of which sixteen reported muscle activation, five kinematic responses, two kinetic responses, and two estimated mechanical trunk properties. We found evidence of a longer response time of muscle activation, which would be in line with splinting behaviour in LBP. No signs of splinting behaviour were found in any of the other outcome measures. CONCLUSIONS We conclude that there is currently no convincing evidence for the presence of splinting behaviour in LBP patients, because we found no indications for splinting in terms of kinetic and kinematic responses to perturbation and derived mechanical properties of the trunk. Consistent evidence on delayed onsets of muscle activation in response to perturbations was found, but this may have other causes than splinting behaviour.
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Affiliation(s)
- Maarten R Prins
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, The Netherlands. .,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | - Mariëtte Griffioen
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thom T J Veeger
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Onno G Meijer
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Peter van der Wurff
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, The Netherlands.,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Sjoerd M Bruijn
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Jaap H van Dieën
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Comparison of the trunk-pelvis and lower extremities sagittal plane inter-segmental coordination and variability during walking in persons with and without chronic low back pain. Hum Mov Sci 2017; 52:55-66. [PMID: 28119210 DOI: 10.1016/j.humov.2017.01.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/31/2016] [Accepted: 01/05/2017] [Indexed: 11/21/2022]
Abstract
Inter-segmental coordination can be influenced by chronic low back pain (CLBP). The sagittal plane lower extremities inter-segmental coordination pattern and variability, in conjunction with the pelvis and trunk, were assessed in subjects with and without non-specific CLBP during free-speed walking. Kinematic data were collected from 10 non-specific CLBP and 10 non-CLBP control volunteers while the subjects were walking at their preferred speed. Sagittal plane time-normalized segmental angles and velocities were used to calculate continuous relative phase for each data point. Mean absolute relative phase (MARP) and deviation phase (DP) were derived to quantify the trunk-pelvis and bilateral pelvis-thigh, thigh-shank and shank-foot coordination pattern and variability over the stance and swing phases of gait. Mann-Whitney U test was employed to compare the means of DP and MARP values between two groups (same side comparison). Statistical analysis revealed more in-phase/less variable trunk-pelvis coordination in the CLBP group (P<0.05). CLBP group demonstrated less variable right or left pelvis-thigh coordination pattern (P<0.05). Moreover, the left thigh-shank and left shank-foot MARP values in the CLBP group, were more in-phase than left MARP values in the non-CLBP control group during the swing phase (P<0.05). In conclusion, the sagittal plane lower extremities, pelvis and trunk coordination pattern and variability could be generally affected by CLBP during walking. These changes can be possible compensatory strategies of the motor control system which can be considered in the CLBP subjects.
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Zwambag DP, De Carvalho DE, Brown SH. Decreasing the required lumbar extensor moment induces earlier onset of flexion relaxation. J Electromyogr Kinesiol 2016; 30:38-45. [DOI: 10.1016/j.jelekin.2016.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/29/2016] [Accepted: 05/26/2016] [Indexed: 11/29/2022] Open
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Investigating the effects of movement speed on the lumbopelvic coordination during trunk flexion. Hum Mov Sci 2016; 48:153-60. [DOI: 10.1016/j.humov.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 05/06/2016] [Accepted: 05/16/2016] [Indexed: 11/22/2022]
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Capodaglio P, Nilsson J, Jurisic DH. Changes in paravertebral EMG spectrum parallel to strength increases after rehabilitation in chronic low back pain patients. Clin Rehabil 2016. [DOI: 10.1177/026921559500900413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this preliminary report was to identify parameters related to functional improvement in healthy subjects and in patients with chronic low back pain (LBP) undergoing an intensive rehabilitation programme. Four healthy controls and four chronic LBP patients were evaluated before and after a four-week rehabilitation programme. Dynamic and static strength tests, namely sustained isometric contractions, and trunk flexion-extension movements were performed in conjunction with surface electromyographic (EMG) measurements. Significant pre-rehabilitation differences were found between the two groups. Measured forces and the ratio between EMG amplitude values during extension and during flexion changed significantly in LBP patients immediately after rehabilitation. No significant changes were found in the control subjects after the rehabilitation programme. After rehabilitation, the slope of decay of the median frequency of the EMG power spectrum at L4 level, during a 60-second isometric submaximal (60% MVC) contraction, decreased significantly ( p < 0.02), indicating a lower fatigue level.
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Affiliation(s)
- Paolo Capodaglio
- Ergonomics Unit, Clinica del Lavoro Foundation, IRCCS, Medical Rehabilitation Centre, Montescano (PV)
| | - Jan Nilsson
- Bioengineering Laboratory, Clinica del Lavoro Foundation, IRCCS, Medical Rehabilitation Centre, Castel Goffredo (MN)
| | - Daniela H Jurisic
- Clinica del Lavoro Foundation, IRCCS, Medical Rehabilitation Centre, Pavia, Italy
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The influences of foot placement on lumbopelvic rhythm during trunk flexion motion. J Biomech 2016; 49:1692-1697. [DOI: 10.1016/j.jbiomech.2016.03.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 01/05/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022]
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Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain. Healthcare (Basel) 2016; 4:healthcare4020027. [PMID: 27417615 PMCID: PMC4934580 DOI: 10.3390/healthcare4020027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/11/2016] [Accepted: 05/06/2016] [Indexed: 11/23/2022] Open
Abstract
Biofeedback is a process in which biological information is measured and fed back to a patient and clinician for the purpose of gaining increased awareness and control over physiological domains. Surface electromyography (SEMG), a measure of muscle activity, allows both a patient and clinician to have direct and immediate access to muscle functioning that is not possible with manual palpation or visual observation. SEMG biofeedback can be used to help “down-train” elevated muscle activity or to “up-train” weak, inhibited, or paretic muscles. This article presents a historical and clinical overview of SEMG and its use in chronic low back pain assessment and biofeedback training.
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Factors to consider in identifying critical points in lumbar spine flexion relaxation. J Electromyogr Kinesiol 2015; 25:914-8. [DOI: 10.1016/j.jelekin.2015.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/07/2015] [Accepted: 10/26/2015] [Indexed: 11/20/2022] Open
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Wang TY, Pao JL, Yang RS, Jang JSR, Hsu WL. The adaptive changes in muscle coordination following lumbar spinal fusion. Hum Mov Sci 2015; 40:284-97. [DOI: 10.1016/j.humov.2015.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/03/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
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Hu B, Ning X. The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting. ERGONOMICS 2015; 58:1424-1432. [PMID: 25677418 DOI: 10.1080/00140139.2015.1005173] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. PRACTITIONER SUMMARY Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.
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Affiliation(s)
- Boyi Hu
- a Department of Industrial and Management Systems Engineering , West Virginia University , Morgantown , WV , USA
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The efficacy of surface electromyographic biofeedback assisted stretching for the treatment of chronic low back pain: A case-series. J Bodyw Mov Ther 2015; 19:8-16. [DOI: 10.1016/j.jbmt.2013.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/09/2013] [Accepted: 12/14/2013] [Indexed: 11/23/2022]
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40
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Hu B, Ning X, Nussbaum MA. The influence of hand load on lumbar-pelvic coordination during lifting task. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/1541931214581337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Manual material handling (MMH) tasks such as weight lifting are very common in many industries. The effect of hand load on lumbar-pelvic continuous relative phase (CRP) coordination during lifting was investigated in this study. Twelve male subjects performed sagittal symmetric lifting tasks with or without load in hand; meanwhile lumbar kinematics data were recorded. Results of the current study demonstrated a significant difference of lumbar-pelvic coordination between the two conditions. Subjects tended to show more in-phase CRP pattern when lifting a load. Also, when lifting a load subjects’ lumbar-pelvic motion pattern made their torso generated larger loading on the L5/S1 joint. The findings of this study can be used to better understand how hand load influences lifting biomechanics.
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Affiliation(s)
- Boyi Hu
- Department of Industrial and Management Systems Engineering, West Virginia University, Morgantown, WV 26505, USA
| | - Xiaopeng Ning
- Department of Industrial and Management Systems Engineering, West Virginia University, Morgantown, WV 26505, USA
| | - Maury A. Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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Pao JL, Yang RS, Hsiao CH, Hsu WL. Trunk Control Ability after Minimally Invasive Lumbar Fusion Surgery during the Early Postoperative Phase. J Phys Ther Sci 2014; 26:1165-71. [PMID: 25202174 PMCID: PMC4155213 DOI: 10.1589/jpts.26.1165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/16/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Lumbar fusion has been used for spinal disorders when conservative treatment
fails. The minimally invasive approach causes minimal damage to the back muscles and
shortens the postoperative recovery time. However, evidence regarding functional recovery
in patients after minimally invasive lumbar spinal fusion is limited. The purpose of this
study was to investigate how trunk control ability is affected after minimally invasive
lumbar fusion surgery during the early postoperative phase. [Subjects and Methods] Sixteen
patients and 16 age- and sex-matched healthy participants were recruited. Participants
were asked to perform a maximum forward reaching task and were evaluated 1 day before and
again 1 month after the lumbar fusion surgery. Center of pressure (COP) displacement, back
muscle strength, and scores for the Visual Analog Scale, and Chinese version of the
modified Oswestry Disability Index (ODI) were recorded. [Results] The healthy control
group exhibited more favorable outcomes than the patient group both before and after
surgery in back strength, reaching distance, reaching velocity, and COP displacement. The
patient group improved significantly after surgery in all clinical outcome measurements.
However, reaching distance decreased, and the reaching velocity as well as COP
displacement did not differ before and after surgery. [Conclusion] The LBP patients with
lumbar fusion surgery showed improvement in pain intensity 1 month after surgery but no
improvement in trunk control during forward reaching. The results provide evidence that
the back muscle strength was not fully recovered in patients 1 month after surgery and
limited their ability to move their trunk forward.
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Affiliation(s)
- Jwo-Luen Pao
- Institute of Biomedical Engineering, National Taiwan University, Taiwan ; Division of Orthopedic Surgery, Department of Surgery, Far Eastern Memorial Hospital, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taiwan ; Department of Orthopedics, College of Medicine, National Taiwan University, Taiwan
| | - Chen-Hsi Hsiao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan ; Physical Therapy Center, National Taiwan University Hospital, Taiwan
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Schinkel-Ivy A, Nairn BC, Drake JDM. Quantification of the lumbar flexion-relaxation phenomenon: comparing outcomes of lumbar erector spinae and superficial lumbar multifidus in standing full trunk flexion and slumped sitting postures. J Manipulative Physiol Ther 2014; 37:494-501. [PMID: 25109838 DOI: 10.1016/j.jmpt.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 01/15/2014] [Accepted: 01/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to identify differences in flexion-relaxation outcomes in asymptomatic participants, with respect to both flexion-relaxation phenomenon (FRP) occurrence and spinal onset angles, as a function of posture and choice of muscle being examined. METHODS This was a cross-sectional study in a laboratory setting. Thirty asymptomatic participants performed standing full trunk flexion and slumped sitting postures while activation levels of the lumbar erector spinae and superficial lumbar multifidus were monitored. Two thresholds were used to define whether FRP was present in each muscle and, if present, at what trunk flexion angle it occurred. These outcomes were compared descriptively between muscles and between postures. RESULTS Most participants displayed FRP in both muscles during standing full flexion; occurrences were more variable in slumped sitting. On average, FRP during standing full flexion and slumped sitting occurred at approximately 80% and 52% of participants' maximum flexion value, respectively. Variability in the slumped sitting onset angles was greater than that in standing full flexion. CONCLUSION Outcomes for FRP during standing full flexion in asymptomatic participants appeared to be more robust and were not affected by the choice of either lumbar erector spinae or superficial lumbar multifidus. Conversely, during slumped sitting, FRP occurrence varied substantially depending on choice of muscle, although onset angles were relatively consistent between muscles. Although the choice of one muscle over the other may be warranted, it may be prudent to examine both muscles during FRP investigations in sitting postures, in order to fully characterize the behavior and activation patterns of the lumbar musculature.
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Affiliation(s)
- Alison Schinkel-Ivy
- PhD Candidate, School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Brian C Nairn
- PhD Candidate, School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Janessa D M Drake
- Assistant Professor, School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada.
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Neblett R, Mayer TG, Brede E, Gatchel RJ. The effect of prior lumbar surgeries on the flexion relaxation phenomenon and its responsiveness to rehabilitative treatment. Spine J 2014; 14:892-902. [PMID: 24246746 DOI: 10.1016/j.spinee.2013.07.442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 06/12/2013] [Accepted: 07/13/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Abnormal pretreatment flexion-relaxation in chronic disabling occupational lumbar spinal disorder patients has been shown to improve with functional restoration rehabilitation. Little is known about the effects of prior lumbar surgeries on flexion-relaxation and its responsiveness to treatment. PURPOSE To quantify the effect of prior lumbar surgeries on the flexion-relaxation phenomenon and its responsiveness to rehabilitative treatment. STUDY DESIGN/SETTING A prospective cohort study of chronic disabling occupational lumbar spinal disorder patients, including those with and without prior lumbar spinal surgeries. PATIENT SAMPLE A sample of 126 chronic disabling occupational lumbar spinal disorder patients with prior work-related injuries entered an interdisciplinary functional restoration program and agreed to enroll in this study. Fifty-seven patients had undergone surgical decompression or discectomy (n=32) or lumbar fusion (n=25), and the rest had no history of prior injury-related spine surgery (n=69). At post-treatment, 116 patients were reevaluated, including those with prior decompressions or discectomies (n=30), lumbar fusions (n=21), and no surgery (n=65). A comparison group of 30 pain-free control subjects was tested with an identical assessment protocol, and compared with post-rehabilitation outcomes. OUTCOME MEASURES Mean surface electromyography (SEMG) at maximum voluntary flexion; subject achievement of flexion-relaxation (SEMG≤3.5 μV); gross lumbar, true lumbar, and pelvic flexion ROM; and a pain visual analog scale self-report during forward bending task. Identical measures were obtained at pretreatment and post-treatment. METHODS Patients entered an interdisciplinary functional restoration program, including a quantitatively directed, medically supervised exercise process and a multimodal psychosocial disability management component. The functional restoration program was accompanied by a SEMG-assisted stretching training program, designed to teach relaxation of the lumbar musculature during end-range flexion, thereby improving or normalizing flexion-relaxation and increasing lumbar flexion ROM. At 1 year after discharge from the program, a structured interview was used to obtain socioeconomic outcomes. RESULTS At pre-rehabilitation, the no surgery group patients demonstrated significantly better performance than both surgery groups on absolute SEMG at maximum voluntary flexion and on true lumbar flexion ROM. Both surgery groups were less likely to achieve flexion-relaxation than the no surgery patients. The fusion patients had reduced gross lumbar flexion ROM and greater pain during bending compared with the no surgery patients, and reduced true lumbar flexion ROM compared with the discectomy patients. At post-rehabilitation, all groups improved substantially on all measures. When post-rehabilitation measures were compared with the pain-free control group, with gross and true lumbar ROM corrected by 8° per spinal segment fused, there were no differences between any of the patient groups and the pain-free control subjects on spinal ROM and only small differences in SEMG. The three groups had comparable socioeconomic outcomes at 1 year post-treatment in work retention, health-care utilization, new injury, and new surgery. CONCLUSIONS Despite the fact that the patients with prior surgery demonstrated greater pretreatment SEMG and ROM deficits, functional restoration treatment, combined with SEMG-assisted stretching training, was successful in improving all these measures by post-treatment. After treatment, both groups demonstrated ROM within anticipated limits, and the majority of patients in all three groups successfully achieved flexion-relaxation. In a chronic disabling occupational lumbar spinal disorder cohort, surgery patients were nearly equal to nonoperated patients in responding to interdisciplinary functional restoration rehabilitation on measures investigated in this study, achieving close to normal performance measures associated with pain-free controls. The responsiveness and final scores shown in this study suggests that flexion-relaxation may be a useful, objective diagnostic tool to measure changes in physical capacity for chronic disabling occupational lumbar spinal disorder patients.
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Affiliation(s)
- Randy Neblett
- PRIDE Research Foundation, 5701 Maple Ave. #100, Dallas, TX 75235, USA
| | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235, USA.
| | - Emily Brede
- PRIDE Research Foundation, 5701 Maple Ave. #100, Dallas, TX 75235, USA
| | - Robert J Gatchel
- Department of Psychology, College of Science, The University of Texas at Arlington, 313 Life Science Building, Arlington, TX 76019, USA
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Henchoz Y, Tétreau C, Abboud J, Piché M, Descarreaux M. Effects of noxious stimulation and pain expectations on neuromuscular control of the spine in patients with chronic low back pain. Spine J 2013; 13:1263-72. [PMID: 24090825 DOI: 10.1016/j.spinee.2013.07.452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 05/31/2013] [Accepted: 07/15/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Alterations of the neuromuscular control of the lumbar spine have been reported in patients with chronic low back pain (LBP). During trunk flexion and extension tasks, the reduced myoelectric activity of the low back extensor musculature observed during full trunk flexion is typically absent in patients with chronic LBP. PURPOSE To determine whether pain expectations could modulate neuromuscular responses to experimental LBP to a higher extent in patients with chronic LBP compared with controls. STUDY DESIGN A cross-sectional, case-control study. PATIENT SAMPLE Twenty-two patients with nonspecific chronic LBP and 22 age- and sex-matched control participants. METHODS Trunk flexion-extension tasks were performed under three experimental conditions: innocuous heat, noxious stimulation with low pain expectation, and noxious stimulation with high pain expectation. Noxious stimulations were delivered using a contact heat thermode applied on the skin of the lumbar region (L4-L5), whereas low or high pain expectations were induced by verbal and visual instructions. OUTCOME MEASURES Surface electromyography of erector spinae at L2-L3 and L4-L5, as well as lumbopelvic kinematic variables were collected during the tasks. Pain was evaluated using a numerical rating scale. Pain catastrophizing, disability, anxiety, and fear-avoidance beliefs were measured using validated questionnaires. RESULTS Two-way mixed analysis of variance revealed that pain was significantly different among the three experimental conditions (F2,84=317.5; p<.001). Increased myoelectric activity of the low back extensor musculature during full trunk flexion was observed in the high compared with low pain expectations condition at the L2-L3 level (F2,84=9.5; p<.001) and at the L4-L5 level (F2,84=3.7; p=.030). At the L4-L5 level, this effect was significantly more pronounced for the control participants compared with patients with chronic LBP (F2,84=3.4; p=.045). Pearson correlation analysis revealed that increased lumbar muscle activity in full flexion induced by expectations was associated with higher pain catastrophizing in patients with chronic LBP (r=0.54; p=.012). CONCLUSIONS Repeated exposure to pain appears to generate rigid and less variable patterns of muscle activation in patients with chronic LBP, which attenuate their response to pain expectations. Patients with high levels of pain catastrophizing show higher myoelectric activity of lumbar muscles in full flexion and exhibit greater neuromechanical changes when expecting strong pain.
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Affiliation(s)
- Yves Henchoz
- Département de chiropratique, Université du Québec à Trois-Rivières, 3351 boul. Des Forges, Trois-Rivières, G9A 5H7, Canada
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Mohseni-Bandpei MA, Watson MJ, Richardson B. Application of Surface Electromyography in the Assessment of Low Back Pain: A Literature Review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.2000.5.2.93] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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What is the best surface EMG measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls? Clin J Pain 2013; 29:334-40. [PMID: 23328325 DOI: 10.1097/ajp.0b013e318267252d] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Lumbar flexion-relaxation (FR) is a well-known phenomenon that can reliably be seen in normal subjects but not in most chronic low back pain (CLBP) patients. The purpose of this study was to determine which surface electromyographic (SEMG) measures of FR best distinguish CLBP patients from pain-free control subjects. Standing SEMG and lumbar flexion range of motion (ROM) were also evaluated. METHODS A cohort of 218 CLBP patients, who were admitted to a functional restoration program, received a standardized SEMG and ROM assessment during standing trunk flexion and reextension. An asymptomatic control group of 30 nonpatients received an identical assessment. Both groups were compared on 8 separate SEMG and 3 flexion ROM measures. RESULTS A receiver operating characteristic curve analysis was used to determine how well each measure distinguished between the CLBP patients and the pain-free control subjects. All SEMG measures of FR performed acceptably. Between 79% and 82% of patients, and 83% and 100% of controls were correctly classified. Standing SEMG performed less well. Gross flexion ROM was the best single classification measure tested, correctly classifying 88% of patients and 83% of controls. A series of discriminant analyses found that certain combinations of SEMG and ROM performed slightly better than gross ROM alone for correctly classifying the 2 subjects groups. DISCUSSION Because all SEMG measures of FR performed acceptably, the determination of which SEMG measure of FR is "best" is largely dependent on one's specific purpose. In addition, ROM measures were found to be important components of the FR assessment.
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Potter L, McCarthy C, Oldham J. Physiological effects of spinal manipulation: a review of proposed theories. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331905x55820] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abboud J, Marchand AA, Sorra K, Descarreaux M. Musculoskeletal physical outcome measures in individuals with tension-type headache: A scoping review. Cephalalgia 2013; 33:1319-36. [DOI: 10.1177/0333102413492913] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Individuals with tension-type headache (TTH), in addition to headache pain, typically suffer from pericranial muscle tenderness and increased cervical muscle tone. Physical and physiological outcomes related to musculoskeletal function, however, are not commonly assessed in clinical studies and not systematically proposed as outcome measures in headache-related practice guidelines. Objectives To review which musculoskeletal outcomes are used in the clinical assessment of patients with TTH and which are associated with headache pain and related dysfunction. Methods: Literature searches were performed in MEDLINE, PubMed, the Cochrane databases and EMBASE using terms relating to musculoskeletal physical outcomes in TTH. Results Twenty-six studies met selection criteria. Physiological outcomes typically reported in laboratory studies were trigger points, pressure pain threshold, range of motion and tenderness. A greater number of trigger points and lower pressure pain threshold were reported in patients with episodic TTH in comparison with healthy subjects. Individuals with chronic TTH, when compared with non-headache controls, consistently showed a greater number of trigger points, a lower value of pressure pain threshold and a more severe forward head posture. Conclusion Musculoskeletal outcomes, such as trigger points, pressure pain threshold and forward head posture should inform TTH pathophysiology, diagnosis and interdisciplinary patient care.
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Mörl F, Bradl I. Lumbar posture and muscular activity while sitting during office work. J Electromyogr Kinesiol 2013; 23:362-8. [DOI: 10.1016/j.jelekin.2012.10.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 09/11/2012] [Accepted: 10/02/2012] [Indexed: 11/28/2022] Open
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