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Alfaya FF, Reddy RS, Alshahrani MS, Gautam AP, Mukherjee D, Al Salim ZA, Alqhtani RS, Ghulam HSH, Alyami AM, Al Adal S, Jabour AA. Exploring the Interplay of Muscular Endurance, Functional Balance, and Limits of Stability: A Comparative Study in Individuals with Lumbar Spondylosis Using a Computerized Stabilometric Force Platform. Life (Basel) 2023; 13:2104. [PMID: 37895485 PMCID: PMC10608059 DOI: 10.3390/life13102104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
Lumbar spondylosis, characterized by degenerative changes in the lumbar spine, often leads to pain, reduced spinal stability, and musculoskeletal dysfunction. Understanding the impact of lumbar spondylosis on musculoskeletal function, particularly lumbar extensor endurance, functional balance, and limits of stability, is crucial for improving the management and well-being of affected individuals. This study aimed to assess lumbar extensor endurance, functional balance, and limits of stability in individuals with lumbar spondylosis compared to age-matched healthy individuals and explore the correlations among these parameters within the lumbar spondylosis group. The lumbar spondylosis group consisted of 60 individuals initially screened by an orthopedician and referred to physical therapy. Age-matched healthy controls (n = 60) were recruited. Inclusion criteria encompassed adults aged 45-70 years for both groups. Lumbar extensor endurance was assessed using the Sorensen test, functional balance with the Berg Balance Scale, and limits of stability using a computerized stabilometric force platform. Lumbar extensor endurance was significantly lower in individuals with lumbar spondylosis compared to healthy controls (23.06 s vs. 52.45 s, p < 0.001). Functional balance, as assessed by the Berg Balance Scale, demonstrated a significant decrement in the lumbar spondylosis group (48.36 vs. 53.34, p < 0.001). Additionally, limits of stability variables, under both eyes-open and eyes-closed conditions, exhibited marked impairments in the lumbar spondylosis group (p < 0.001 for all variables). Within the lumbar spondylosis group, lumbar extensor endurance exhibited significant positive correlations with functional balance (0.46, p < 0.001) and negative correlations with limits of stability variables (r ranging from -0.38 to -0.49, p < 0.01 for all variables). This study underscores the significance of addressing lumbar extensor endurance, functional balance, and stability impairments in the comprehensive management of lumbar spondylosis.
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Affiliation(s)
- Fareed F Alfaya
- Department of Orthopedic Surgery, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Mastour Saeed Alshahrani
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Ajay Prashad Gautam
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Debjani Mukherjee
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Zuhair A Al Salim
- Department of Sport Science and Physical Activity, College of Science, University of Hafr Al Batin, Hafr Al Batin 39524, Saudi Arabia
| | - Raee S Alqhtani
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | - Hussain Saleh H Ghulam
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | - Abdullah Mohammed Alyami
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
| | - Saeed Al Adal
- Physical Therapy Department, Medical Applied Sciences College, Najran University, Najran 66462, Saudi Arabia
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Abboud J, Ducas J, Marineau-Bélanger É, Gallina A. Lumbar muscle adaptations to external perturbations are modulated by trunk posture. Eur J Appl Physiol 2023; 123:2191-2202. [PMID: 37247004 DOI: 10.1007/s00421-023-05223-2] [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: 09/23/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE To investigate if the recruitment of different regions within the lumbar extensor muscles in response to unexpected perturbations depends on trunk posture. METHODS In a semi-seated posture, healthy adult participants experienced unexpected posterior-anterior trunk perturbations in three different postures: neutral, trunk flexion and left trunk rotation. High-density surface electromyography was used to identify the regional distribution of activation within the lumbar erector spinae muscles. The effect of posture and side (left vs right) on muscle activity and centroid coordinates was investigated at baseline and in response to perturbations. RESULTS Higher muscle activity was observed in trunk flexion compared to neutral and rotation postures at baseline (multiple p < 0.001) and in response to the perturbation (multiple p < 0.01). At baseline, the centroid of the electromyographic amplitude distribution was localized more medially in trunk flexion compared to trunk neutral posture (p = 0.003), while activation was localized more laterally in response to the perturbation (multiple p < 0.05). When the trunk was rotated, the electromyographic amplitude distribution was localized more cranially on the left than the right side, both at baseline (p = 0.001) and in response to the perturbation (p = 0.001). Finally, a more lateral location of the centroid on the left side in rotation compared to neutral posture was observed in response to the perturbation (multiple p < 0.001). CONCLUSIONS Regional differences in the distribution of electromyographic amplitude indicate that different muscle regions were recruited in different trunk postures and in response to perturbations, possibly based on regional mechanical advantage of the erector spinae muscle fibers.
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Affiliation(s)
- Jacques Abboud
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, QC, G8Z 4M3, Canada.
- Groupe de Recherche sur les Affections Neuromusculosquelettiques GRAN, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
| | - Julien Ducas
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, QC, G8Z 4M3, Canada
- Groupe de Recherche sur les Affections Neuromusculosquelettiques GRAN, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Émile Marineau-Bélanger
- Département des Sciences de l'Activité Physique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières, QC, G8Z 4M3, Canada
- Groupe de Recherche sur les Affections Neuromusculosquelettiques GRAN, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Alessio Gallina
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Abu Bakar F, Staal JB, van Cingel R, Saito H, Ostelo R, van Dieën JH. Not all movements are equal: Differences in the variability of trunk motor behavior between people with and without low back pain-A systematic review with descriptive synthesis. PLoS One 2023; 18:e0286895. [PMID: 37682939 PMCID: PMC10490924 DOI: 10.1371/journal.pone.0286895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/02/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Differences in variability of trunk motor behavior between people with and without low back pain (LBP) have been reported in the literature. However, the direction and consistency of these differences remain unclear. Understanding variability of trunk motor behavior between individuals with LBP and those without is crucial to better understand the impact of LBP and potentially optimize treatment outcomes. Identifying such differences may help tailor therapeutic interventions. OBJECTIVE This systematic review aims to answer the question: Is variability of trunk motor behavior different between people with and without LBP and if so, do people with LBP show more or less variability? Furthermore, we addressed the question whether the results are dependent on characteristics of the patient group, the task performed and the type of variability measure. METHODS This study was registered in PROSPERO (CRD42020180003). A comprehensive systematic literature search was performed by searching PubMed, Embase, Cinahl, Cochrane Central Register of Controlled Trials, Web of Science and Sport Discus. Studies were eligible if they (1) included a LBP group and a control group, (2) included adults with non-specific low back pain of any duration and (3) measured kinematic variability, EMG variability and/or kinetic variability. Risk of Bias was evaluated and a descriptive synthesis was performed. RESULTS Thirty-nine studies were included, thirty-one of which were included in the descriptive synthesis. In most studies and experimental conditions, variability did not significantly differ between groups. When significant differences were found, less variability in patients with LBP was more frequently reported than more variability, especially in gait-related tasks. CONCLUSIONS Given the considerable risk of bias of the included studies and the clinical characteristics of the participants with low severity scores for pain, disability and psychological measures, there is insufficient evidence to draw firm conclusions.
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Affiliation(s)
- Florian Abu Bakar
- Han University of Applied Sciences, Research Group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
| | - J. Bart Staal
- Han University of Applied Sciences, Research Group Musculoskeletal Rehabilitation Nijmegen, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Robert van Cingel
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
- Sports Medical Centre Papendal, Arnhem, The Netherlands
| | - Hiroki Saito
- Department of Physical Therapy, Tokyo University of Technology, Tokyo, Japan
| | - Raymond Ostelo
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Jaap H. van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Matheve T, Hodges P, Danneels L. The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. J Clin Med 2023; 12:5510. [PMID: 37685576 PMCID: PMC10487902 DOI: 10.3390/jcm12175510] [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: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of low back pain differs between individuals. Consequently, interventions should be tailored to the individual patient and be based on a thorough clinical examination taking into account the multidimensional nature of CLBP. Considering the complexity of this process, we will provide a state-of-the-art update on back muscle dysfunctions in patients with CLBP and their implications for treatment. To this end, we will first give an overview of (1) dysfunctions in back muscle structure and function, (2) the potential of exercise therapy to address these dysfunctions, and (3) the relationship between changes in back muscle dysfunctions and clinical parameters. In a second part, we will describe a framework for an individualised approach for back muscle training in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, UHasselt, 3500 Diepenbeek, Belgium
| | - Paul Hodges
- NHMRC—Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
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Xu F, Riden W, Filer W, Hu X. Evaluation of Lumbar Muscle Activation Patterns during Trunk Movements using High-Density Electromyography: A Preliminary Report. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6082-6085. [PMID: 34892504 DOI: 10.1109/embc46164.2021.9631075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lumbar paraspinal muscles are heavily involved in daily and work-related activities including trunk bending, trunk twisting, and lifting. Repetitive or inappropriate activation of the lumbar muscles while performing these activities can lead to low back pain. The aim of this preliminary study was to quantify the activation patterns of multiple lumbar muscles when participants performed three different trunk movement tasks, including sustained lumbar flexion posture, dynamic lumbar flexion and extension, and left-right twisting movements. Two 8×8 high-density electromyogram (HD-EMG) electrode arrays were used to record the lumbar muscle activity during these movements. We observed a symmetric and rapid increase in the amplitude of EMG in the erector spinae muscles during the sustained flexion or oscillation tasks. Asymmetric activation patterns were observed in bilateral lumbar muscles during the trunk twisting task. In addition, we observed substantial bilateral co-activation of the lumbar muscles for both twisting directions. These preliminary results demonstrated the potential feasibility of using HD-EMG as a tool to monitor spatial activation patterns of the lumbar muscles during different trunk movements. This approach can also be further developed to assess lumbar muscle function in individuals with low back pain.
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Jung KS, Jung JH, In TS, Cho HY. Influences of Kinesio Taping with Therapeutic Exercise in Patients with Low Back Pain. Healthcare (Basel) 2021; 9:healthcare9080927. [PMID: 34442064 PMCID: PMC8394962 DOI: 10.3390/healthcare9080927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to evaluate the effect of core stability exercise combined with Kinesio taping on pain, endurance, and balance in patients with lower back pain (LBP). 46 patients with LBP were recruited and randomly allocated into the core stability exercise with taping (CSET) group and the core stability exercise (CSE) group. All participants performed core stability exercises for 40 min/day, 5 times/week for 8 weeks, and additional Kinesio taping was applied to the lower backs in the CSET group. The primary outcome measure was the pain intensity using the visual analog scale, and secondary outcome measures were trunk endurance and balance using the Biering-Sorensen test and force plate, respectively. After the intervention, the CSET group showed significant improvements in pain and postural balance compared to the CSE group (p < 0.05). However, there was no significant difference in trunk endurance between two groups (p > 0.05). This study found that core stability exercise was effective in reducing pain and enhancing balance in patients with LBP, and demonstrated that the application of additional Kinesio taping further increased these effects. Therefore, we recommend that core exercise combined with Kinesio taping may be used to improve the pain and postural balance of patients with LBP in clinics.
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Affiliation(s)
- Kyoung-sim Jung
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
| | - Jin-hwa Jung
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Korea;
| | - Tae-sung In
- Department of Physical Therapy, Gimcheon University, Gimcheon 39528, Korea;
- Correspondence: (T.-s.I.); (H.-y.C.)
| | - Hwi-young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
- Correspondence: (T.-s.I.); (H.-y.C.)
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Serafino F, Trucco M, Occhionero A, Cerone GL, Chiarotto A, Vieira T, Gallina A. Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains. BMC Musculoskelet Disord 2021; 22:432. [PMID: 33975570 PMCID: PMC8114502 DOI: 10.1186/s12891-021-04287-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Altered regional activation of the lumbar extensors has been previously observed in individuals with low back pain (LBP) performing high-effort and fatiguing tasks. It is currently unknown whether similar alterations can be observed during low-effort functional tasks. Similarly, previous studies did not investigate whether side differences in regional activation are present in individuals with LBP. Finally, there is limited evidence of whether the extent of the alteration of regional activation is associated with clinical factors. Therefore, the aim of this study was to investigate whether individuals with LBP exhibit asymmetric regional activation of the thoraco-lumbar extensor muscles during functional tasks, and if the extent of neuromuscular control alteration is associated with clinical and psychosocial outcome domains. METHODS 21 participants with and 21 without LBP performed five functional tasks (gait, sit-to-stand, forward trunk flexion, shoulder flexion and anterior pelvic tilt). The spatial distribution of activation of the thoraco-lumbar extensor muscles was assessed bilaterally using high-density electromyography. For each side, the distribution of electromyographic (EMG) amplitude was characterized in terms of intensity, location and size. Indices of asymmetry were calculated from these features and comparisons between groups and tasks were performed using ANOVA. The features that significantly differed between groups were correlated with self-reported measures of pain intensity and other outcome domains. RESULTS Indices of asymmetry did not differ between participants with and without LBP (p > 0.11). The cranio-caudal location of the activation differed between tasks (p < 0.05), but not between groups (p = 0.64). Participants with LBP showed reduced EMG amplitude during anterior pelvic tilt and loading response phase during gait (both p < 0.05). Pearson correlation revealed that greater pain intensity was associated with lower EMG amplitude for both tasks (R<-0.5, p < 0.05). CONCLUSIONS Despite clear differences between tasks, individuals with and without LBP exhibited similar distributions of EMG amplitude during low-effort functional activities, both within and between sides. However, individuals with LBP demonstrated lower activation of the thoraco-lumbar muscles during gait and anterior pelvic tilt, especially those reporting higher pain intensity. These results have implications in the development or refinement of assessment and intervention strategies focusing on motor control in patients with chronic LBP.
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Affiliation(s)
- Francesca Serafino
- Presidio Sanitario San Camillo, Torino, Italy.,Montecatone Rehabilitation Institute, Imola, BO, Italy
| | - Marco Trucco
- Presidio Sanitario San Camillo, Torino, Italy.,Degree course of Physiotherapy, Universitá degli Studi di Torino, Torino, Italy
| | | | - Giacinto Luigi Cerone
- Laboratory for the Engineering of the Neuromuscular System, Politecnico of Torino, Torino, Italy.,PoliTo BIO Med Lab, Politecnico di Torino, Torino, Italy
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Taian Vieira
- Laboratory for the Engineering of the Neuromuscular System, Politecnico of Torino, Torino, Italy.,PoliTo BIO Med Lab, Politecnico di Torino, Torino, Italy
| | - Alessio Gallina
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
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Effects of Prolonged Sitting with Slumped Posture on Trunk Muscular Fatigue in Adolescents with and without Chronic Lower Back Pain. ACTA ACUST UNITED AC 2020; 57:medicina57010003. [PMID: 33374520 PMCID: PMC7822118 DOI: 10.3390/medicina57010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: This study investigated the effects of prolonged sitting on trunk muscular fatigue and discomfort in participants with and without chronic lower back pain (LBP). Material and Methods: This study included 15 patients with LBP and 15 healthy controls. All participants were instructed to sit on a height-adjustable chair with their knee and hip joints bent at 90° for 30 min, in slumped sitting postures. Surface electromyography was used to assess the median frequency of the internal obliques (IO)/transversus abdominis (TrA) and multifidus (MF) muscles. Perceived discomfort was measured using a Borg category ratio-scale. Median frequency of the trunk muscles and perceived discomfort after 30 min of sitting were compared with baseline. Result: There were no significant differences within the group and between both groups in the median frequency of bilateral IO and MF muscles. The LBP group showed significantly greater perceived discomfort after prolonged sitting, as compared to the control group. Conclusions: Prolonged sitting with slumped posture could increase the risk of experiencing lower back discomfort.
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Falla D, Gallina A. New insights into pain-related changes in muscle activation revealed by high-density surface electromyography. J Electromyogr Kinesiol 2020; 52:102422. [DOI: 10.1016/j.jelekin.2020.102422] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/30/2022] Open
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Association of perceived physical overload at work with pain and disability in patients with chronic non-specific low back pain: a 6-month longitudinal study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1586-1593. [DOI: 10.1007/s00586-019-05986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/01/2019] [Accepted: 04/19/2019] [Indexed: 01/20/2023]
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