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

Trunk extensor muscle endurance and its relationship to action potential conduction velocity and spectral parameters estimated using high-density electromyography

Trunk extensor muscle fatigue typically manifests as a decline in spectral content of surface electromyography. However, previous research on the relationship of this decline with trunk extensor muscle endurance have shown inconsistent results. The decline of spectral content mainly reflects the decrease in average motor unit action potential conduction velocity (CV). We evaluated whether the rate of change in CV, as well as two approaches employing the change in spectral content, are related to trunk extensor muscle endurance. Fourteen healthy male participants without a low-back pain history performed a non-strictly controlled static forward trunk bending trial until exhaustion while standing. For 13 participants, physiologically plausible CV estimates were obtained from high-density surface electromyography bilaterally from T6 to L5. Laterally between L1 and L2, the linear rate of CV change was strongly correlated to endurance time (R2 = 0.79), whereas analyses involving the linear rate of change in spectral measures showed a lower (R2 = 0.38) or no correlation. For medial electrode locations, estimating CV and its relationship with endurance time was less successful, while the linear rate of change in spectral measures correlated moderately to endurance time (R2 = 0.44; R2 = 0.56). This study provides guidance on monitoring trunk extensor muscle fatigue development using electromyography.

Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls: Reliability, clinical applicability and between-group differences

BACKGROUND

Paraspinal muscle strength and fatigue are considered important in low back pain (LBP) prevention and rehabilitation. High reliability of paraspinal strength and electromyographic (EMG)-fatigue parameters has not been universally reported. Moreover, the discriminative validity of these parameters requires further exploration, under the threat of potentially poor reliability of the methods examined.

AIM

To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants.

METHODS

Test-retest measurements were performed in 26 healthy and 66 LBP volunteers, for reliability. Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction (MVIC) protocol, performed in a custom-made device. For the fatigue test, participants performed a 60% MIVC level continuous isometric contraction of the paraspinals, in conjunction with EMG analysis from 4 muscle sites of the lumbar spine. Initial median frequency (IMF), the median frequency slope (MFslope), as well as the root mean square (RMS) slope EMG parameters were used as fatigue measures. Data were analysed with repeated measures ANOVA for test-retest differences. For reliability, the intraclass correlation coefficient (ICC_3,1), standard error of the measurement (SEM) and the smallest detectable difference (SDD) were reported. Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance, with age, weight and strength as covariates.

RESULTS

Isometric strength presented statistically significant between-day differences (P < 0.01), however these did not exceed 10% (healthy: 7.2%/LBP-patients: 9.7%) and ICC reliability values were excellent, yet test-retest error was increased for the patient group (healthy: ICC_3,1: 0.92-0.96, SEM: 5.72-5.94 Hz, SDD: 18.51%-18.57%/LBP-patients: ICC_3,1: 0.91-0.96, SEM: 6.49-6.96, SDD: 30.75%-31.61%). For the frequency data, IMF reliability was excellent (healthy: ICC_3,1: 0.91-0.94, SEM: 3.45-7.27 Hz, SDD: 9.56%-20.14%/patients: ICC_3,1: 0.90-0.94, SEM: 6.41-7.59 Hz, SDD: 17.75%-21.02%) and of MF raw and normalised slopes was good (healthy: ICC_3,1: 0.78-0.82, SEM: 4.93-6.02 Hz, SDD: 13.66-16.67%/LBP-patients: ICC_3,1: 0.83-0.85, SEM: 6.75-7.47 Hz, SDD: 18.69%-20.69%). However, the reliability for RMS data presented unacceptably high SDD values and were not considered further. For discriminative validity, less MVIC and less steep MFslopes were registered for the patient group (P < 0.01).

CONCLUSION

Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.

Training induced fatigability assessed by sEMG in Pre-Olympic ice-skaters

The aim of this study was to investigate the size of the change and asymmetry in fatigability of gluteus maximus muscles during endurance training in short-track. The research has taken into account the position of athletes during skating and the problem of fatigue and pain in these muscles. The research covered involved eight female athletes of the Polish National Team in short track, which had been prepared to the Olympic Games in PyeongChang. The surface electromyography (sEMG) system was used to measure fatigue of right and left gluteus maximus muscles, in the modified Biering–Sorensen test. The test was conducted five times during the training: before training, after warmup, and after each of 3 series of the endurance training. Comparing the mean frequency of the surface electromyography power spectrum of the test, statistically significant reduction of the average frequency value of the right muscle from 55.61 ± 7.08 to 48.64 ± 4.48 Hz and left muscle from 58.78 ± 4.98 to 53.18 ± 4.62 Hz was reported, which prove the muscle fatigue. In subsequent series tests, the sEMG signal frequency of begin decrease more than the end of the each measurement, which determines the fatigue threshold. The size of the d Cohen effect in fatigue drops along with subsequent five tests during the training. Skaters has higher frequency reduction of the right lower limb, which indicates its greater fatigue during skateing. The fatigue and asymmetry in muscle observed in short-track has implications for training and performance.

Hip Abductor Fatigability and Recovery Are Related to the Development of Low Back Pain During Prolonged Standing

A prolonged standing exposure can identify asymptomatic adults who have a higher risk of developing clinical low back pain later in life. Hip abductor cocontraction differences can predict low back pain development during standing exposures. This study’s purpose was to determine if hip abductor strength, fatigability, and recovery during prolonged standing were related to standing-induced low back pain. Forty young, asymptomatic adults (50% female) performed two 2-hour standing sessions; a fatiguing hip abductor exercise was performed prior to 1 of the 2 standing sessions. Hip abductor strength and surface electromyography of gluteus medius and tensor fascia latae were measured. Self-reported low back pain differentiated low back pain developing (PD) and nonpain developing (NPD) groups. The PD group hip abductors fatigued before the NPD group, with similar perceived effort and force losses. Mean power frequency decreases with fatigue were similar between pain groups for all muscles measured after the fatiguing exercise. Unlike NPDs, PDs did not recover force losses after 120 minutes of standing. Hip abductor fatigability may be related to the development of low back pain in this population.

Infrared imaging of the anterior deltoid during overhead static exertions

Infrared imaging has been used to detect the presence of neuromuscular disorders of the cervical spine and upper extremities. Despite diagnostic uses, evaluative or prognostic uses of thermography are limited. The objective of this study was to quantify surface temperature changes over the anterior deltoid and evaluate efficacy of thermography as an assessment tool. Surface temperature, discomfort ratings and endurance time were quantified during overhead static exertions until exhaustion at two work loads (15 and 30% maximum voluntary contraction) and shoulder angles (90 degrees and 115 degrees ). Ten participants free of confounding conditions participated in the study. The 90 degrees shoulder angle and 30% exertion level resulted in significantly faster thermal image rates of change, shorter endurance times and faster perceived discomfort increases. Thermography readings were more sensitive to changes in shoulder posture than load changes. This study provides preliminary evidence that thermography may be a useful exposure assessment tool. There is a need for new evaluation tools to quantify risk factor exposure for injury. Thermography was sensitive to changes in task loadings, illustrating its potential use for risk assessment. Specifically, changes in observed blood flow patterns during task performance are likely to conform to known physiological responses to injury.

Short-term repeatability of parameters extracted from radial displacement of muscle belly

The aim of this study is to analyse the short-term repeatability of the parameters extracted from radial muscle belly response on a stimulation pulse. The method uses a prefixed tension of a displacement sensor tip to the muscle and is being developed for noninvasive and selective evaluation of skeletal muscle contraction properties. Five parameters were extracted and statistically evaluated from the measured displacement: maximal displacement, delay time, contraction time, sustain time and half relaxation time. Care has been taken to leave sufficient time between stimulation pulses in order to reduce the effect of muscle fatigue and a constant pre-tension was assured by controlled step motor in consecutive measurement by withdrawal and anew placement of the sensor to the muscle belly after each measurement. Intra-class correlation coefficient (ICC) and normalized squared error (NSEM) were used as measures of short-term repeatability and accuracy (precision) of the measurements while fatigue rate was evaluated using area ratio fatigue index and normalized slope. All five measured parameters have been found highly repeatable (ICC from 0.86 to 0.98) and can be measured with high precision (NSEM from 0.43 to 1.93). Maximal displacement and half relaxation time show largest influence to muscle fatigue rate and are also expected to be the best measure of the fatigue rate. This investigation should serve as an initial study of repeatability of the presented method that should help in subsequent investigations and use of the method.

Reliability of surface EMG during sustained contractions of the quadriceps

The purpose of this study was to determine test-retest reliability for median frequency (MDF) and amplitude of surface EMG during sustained fatiguing contractions of the quadriceps. Twenty-two healthy subjects (11 males and 11 females) were tested on two days held one week apart. Surface EMG was recorded from rectus femoris (RF), vastus lateralis (VL) and vastus medialis (VM) during sustained isometric contractions at 80% and 20% of maximal voluntary contraction (MVC) held to exhaustion. Quadriceps fatigue was described using four measures for both MDF and amplitude of EMG: initial, final, normalized final and slope. For both MDF and amplitude, the initial, final and normalized EMG showed moderate to high reliability for all three muscle groups at both contraction levels (ICC=0.59-0.88 for MDF; ICC=0.58-0.99 for amplitude). Slope of MDF and amplitude was associated with a large degree of variability and low ICCs for the 80% but not the 20% MVC. MDF and amplitude of EMG during sustained contractions of the quadriceps are reproducible; normalized final values of MDF and amplitude show better reliability than slope.

Intra-rater reliability of electromyographic recordings and subjective evaluation of neck muscle fatigue among helicopter pilots

The aim was to evaluate the reliability of a method of measuring neck muscle fatigue among helicopter pilots.

METHOD

Surface EMG from three areas in the neck region, bilaterally, was recorded among 10 male helicopter pilots while they were performing isometric contractions in flexion and extension for 45 s, sustaining a force representing 75% of maximum strength in a seated position. Perceived fatigue was rated using the Borg CR-10 scale. The test was repeated twice the first day and then two additional times with one-week intervals. Variables analyzed were the slope of the median frequency change, the normalized slope, and the ratings after 15, 30 and 45 s; and also the initial median frequency (IMDF). The intra-class correlation (ICC) and the measurement error (S(w)), intra- and inter-day were calculated statistically.

RESULTS

The best reliability for the slope was found for the 45 s intra-day analysis taking all measurements into account (ICC 0.65-0.83). The reliability after 30 s was poorer but still acceptable (ICC 0.52-0.71). For the subjective ratings, the highest reliability was found after 30 s inter-day (ICC 0.86-0.88). IMDF showed generally high reliability for the intra-day analyses (ICC 0.63-0.80).

CONCLUSION

The method is reliable for use in further research. Since performing a contraction of 75% of maximum was quite strenuous, we recommend that the protocol be shortened to 30 s.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Surface electromyography assessment of back muscle intrinsic properties

The purpose of this study was to assess (1) the reliability and (2) the sensitivity to low back pain status and gender of different EMG indices developed for the assessment of back muscle weakness, muscle fiber composition and fatigability. Healthy subjects (men and women) and chronic low back pain patients (men only) performed, in a static dynamometer, maximal and submaximal static trunk extension tasks (short and long duration) to assess weakness, fiber composition and fatigue. Surface EMG signals were recorded from four (bilateral) pairs of back muscles and three pairs of abdominal muscles. To assess reliability of the different EMG parameters, 40 male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three occasions. Reliable EMG indices were achieved for both healthy and chronic low back pain subjects when specific measurement strategies were applied. The EMG parameters used to quantify weakness and fiber composition were insensitive to low back status and gender. The EMG fatigue parameters did not detect differences between genders but unexpectedly, healthy men showed higher fatigability than back pain patients. This result was attributed to the smaller absolute load that was attributed to the patients, a load that was defined relative to their maximal strength, a problematic measure with this population. An attempt was made to predict maximal back strength from anthropometric measurements but this prediction was prone to errors. The main difficulties and some potential solutions related to the assessment of back muscle intrinsic properties were discussed.

Muscle recovery from a short fatigue test and consequence on the reliability of EMG indices of fatigue

The purpose of the present study was to evaluate if rest intervals of 10 or 15 min allow the back muscles to recover completely, from an electromyographic (EMG) point of view, after performing a fatiguing contraction. Twelve healthy males stood in a dynamometer with the trunk in a vertical position and performed three trunk extension fatiguing trials (30 s contractions sustained at 75% of the maximal voluntary contraction) separated successively by a 15 min (between trial 1 and 2) and a 10 min (between trial 2 and 3) rest period. The EMG signals from four pairs of back muscles were collected at 2,048 Hz with active surface electrodes. Different EMG indices computed from the temporal and frequency domains of the EMG signal were considered to evaluate muscular fatigue and recovery from trial 1 to trial 2 and from trial 2 to trial 3. No significant differences (one-way ANOVAs between the three trials, alpha=0.05) were obtained for the different EMG indices computed. The percentage of variance explained by the inter-trial effect was none in most cases, corroborating that no systematic error was present between the trials and suggesting that complete muscle recovery was allowed with 10 or 15 min rest periods. These results support the use of rest periods of 10 to 15 min between multiple fatigue tests, at least for back muscles and for high intensity short duration fatigue tasks as the one used in the present study.

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

OBJECTIVE

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

SUBJECTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Measures of low back function: a review of reproducibility studies

OBJECTIVE

The objective of the present study was to make a systematic literature review with preset quality criteria concerning reproducibility of the tests of the low back regarding strength, endurance and range of motion.

DESIGN

Literature in Medline and local databases was reviewed for articles concerning the reproducibility of strength, endurance, and range of motion measurements.

BACKGROUND

Measures of low back function are widely used, and are important for both clinical and research purposes in relation to low back problems. A review of the reproducibility of these tests has not previously been made.

METHODS

After extensive discussion among all the authors, general evaluation parameters were defined for the quality assessment. Every study was graded from 0 to 2 for each parameter. Parameters evaluated were: number of subjects, subject description, method description, test/retest interval, description of results, and statistics.

RESULTS

The literature search revealed a total of 79 studies. Most studies suffered from methodological weaknesses and only eleven studies received ten or more quality points (maximum 14). The results from the highest graded studies are highlighted.

CONCLUSIONS

It may be concluded that there is a considerable lack of information about the reproducibility of functional measures for the low back, and therefore a recommendation for consensus is difficult. However, most tests performed in the sagittal plane are reliable for use on groups.

RELEVANCE

Measures of low back function are thought to be of great importance for clinicians, and low back researchers in general. A review of reproducibility will be helpful both as a survey of tests, and to provide information on the usefulness in relation to the level of reproducibility.

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

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

Does methocarbamol affect fatigue markers in the low-back electromyogram?

Many low-back patients undergo electromyography (EMG)-based evaluations of muscle performance but present to the clinic after being prescribed muscle relaxants. The question that needed to be addressed was, do centrally acting muscle relaxants (methocarbamol; Robaxin) affect the EMG spectral indices of muscle fatigue that are often used to assess muscle performance. Participants performed an isometric spine extension protocol involving a 30 s fatigue exertion trial, then 1 min rest, and finally a 10 s long repeat exertion trial, at a 60% maximum voluntary contraction (MVC) level of exertion. Seven men were tested on two separate days (approximately 3-7 days apart), one day while medicated (six doses) with Robaxin and on another while not medicated. Specifically, the following parameters were studied in the bilateral multifidus (L5), lower erector spinae (L3) and upper erector spinae (T9): the slope of median power frequencies (MPFs) over the duration of the trial and the initial y-intercept of the MPF. The results generally suggest that methocarbamol (Robaxin) does not have any significant affect on the EMG median power frequency of the extensors during a fatiguing contraction followed by a repeat exertion, at least in normal people (one exception was observed--one side of multifidus at L5). However, given that this appears to be the first study of its kind, and that a relatively small number of subjects were used in this study, further investigation is needed to make a definitive conclusion about the effects of this drug on the several features of the electromyogram, over a broad spectrum of the clinical population performing a wider variety of tasks.