Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 7 , Pages 1159-1169 , July 2009

Differences in Feedforward Trunk Muscle Activity in Subgroups of Patients With Mechanical Low Back Pain

Presented in part to the American Physical Therapy Association, February 14, 2007, Boston, MA.

  • Sheri P. Silfies, PT, PhD

      Affiliations

    • Rehabilitation Sciences Research Laboratory, Drexel University, Philadelphia, PA
    • Corresponding Author InformationReprint requests to Sheri P. Silfies, PT, PhD, Rehabilitation Sciences Research Laboratory, Drexel University, 245 N. 15th Street, MS 502, Philadelphia, PA 19102-1192
  • ,
  • Rupal Mehta, PT, MS

      Affiliations

    • Rehabilitation Sciences Research Laboratory, Drexel University, Philadelphia, PA
  • ,
  • Sue S. Smith, PT, PhD

      Affiliations

    • Rehabilitation Sciences Research Laboratory, Drexel University, Philadelphia, PA
  • ,
  • Andrew R. Karduna, PhD

      Affiliations

    • Department of Human Physiology, University of Oregon, Eugene, OR

References 

  1. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine. 1996;21:2763–2769
  2. Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol. 2003;13:361–370
  3. Lariviere C, Gagnon D, Loisel P. The comparison of trunk muscles EMG activation between subjects with and without chronic low back pain during flexion-extension and lateral bending tasks. J Electromyogr Kinesiol. 2000;10:79–91
  4. Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001;26:724–730
  5. Silfies SP, Squillante D, Maurer P, Westcott S, Karduna AR. Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin Biomech (Bristol, Avon). 2005;20:465–473
  6. Frank JS, Earl M. Coordination of posture and movement. Phys Ther. 1990;70:855–863
  7. Stokes IA, Fox JR, Henry SM. Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain. Eur Spine J. 2006;15:658–667
  8. Cholewicki J, Silfies SP, Shah RA, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine. 2005;30:2614–2620
  9. Radebold A, Cholewicki J, Panjabi MM, Patel TC. Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine. 2000;25:947–954
  10. Henry SM, Fung J, Horak FB. EMG responses to maintain stance during multidirectional surface translations. J Neurophysiol. 1998;80:1939–1950
  11. Huang QM, Hodges PW, Thorstensson A. Postural control of the trunk in response to lateral support surface translations during trunk movement and loading. Exp Brain Res. 2001;141:552–559
  12. Dickstein R, Shefi S, Marcovitz E, Villa Y. Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients. Arch Phys Med Rehabil. 2004;85:261–267
  13. Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil. 1999;80:1005–1012
  14. Moseley GL, Hodges PW, Gandevia SC. External perturbation of the trunk in standing humans differentially activates components of the medial back muscles. J Physiol. 2003;547:581–587
  15. Urquhart DM, Hodges PW, Story IH. Postural activity of the abdominal muscles varies between regions of these muscles and between body positions. Gait Posture. 2005;22:295–301
  16. Hodges P, Cresswell A, Thorstensson A. Preparatory trunk motion accompanies rapid upper limb movement. Exp Brain Res. 1999;124:69–79
  17. Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. Three dimensional preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture. 2000;11:92–101
  18. van Dieen JH, Thissen CE, van de Ven AJ, Toussaint HM. The electro-mechanical delay of the erector spinae muscle: influence of rate of force development, fatigue and electrode location. Eur J Appl Physiol Occup Physiol. 1991;63:216–222
  19. Aruin AS, Latash ML. Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Exp Brain Res. 1995;103:323–332
  20. Hodges PW, Richardson CA. Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res. 1997;114:362–370
  21. Allison GT, Morris SL, Lay B. Feedforward responses of transversus abdominis are directionally specific and act asymmetrically: implications for core stability theories. J Ortho Sport Phys Ther. 2008;38:228–237
  22. Marshall P, Murphy B. The relationship between active and neural measures in patients with nonspecific low back pain. Spine. 2006;31:E518–E524
  23. Cresswell AG, Oddsson L, Thorstensson A. The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Exp Brain Res. 1994;98:336–341
  24. Goldby LJ, Moore AP, Doust J, Trew ME. A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine. 2006;31:1083–1093
  25. Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine. 2002;27:399–405
  26. Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine. 1996;21:2640–2650
  27. Hodges PW. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res. 2001;141:261–266
  28. Adams MA, Mannion AF, Dolan P. Personal risk factors for first-time low back pain. Spine. 1999;24:2497–2505
  29. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003;13:371–379
  30. Tsao H, Hodges PW. Immediate changes in feedforward postural adjustments following voluntary motor training. Exp Brain Res Experimentelle Hirnforschung. 2007;181:537–546
  31. Borkan J, Van Tulder M, Reis S, Schoene ML, Croft P, Hermoni D. Advances in the field of low back pain in primary care: a report from the fourth international forum. Spine. 2002;27:E128–E132
  32. Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. 2003;28:1363–1371discussion 72
  33. Deyo RA. Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible. Arch Intern Med. 2002;162:1444–1447discussion 7-8
  34. Von Korff M. Acute low back pain improves rapidly, however recovery is not complete and recurrence is common. Aust J Physiother. 2004;50:58
  35. van Dieen JH, Selene LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003;13:333–351
  36. Geyser ME, Ran Avaya M, Haig AJ, et al. A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. J Pain. 2005;6:711–726
  37. Borkan JM, Keeps B, Reis S, Cher kin DC. A report from the second international forum for primary care research on low back pain: reexamining priorities. Spine. 1998;23:1992–1996
  38. Dancers W, O'Sullivan P, Burnett A, Starker L. Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine. 2006;31:2017–2023
  39. Biely S, Smith S, Silfies SP. Clinical instability of the lumbar spine: diagnosis and intervention. Orthop Phys Ther Pract. 2006;18:11–18
  40. Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86:1753–1762
  41. Kulig K, Powers CM, Landed RF, et al. Segmental lumbar mobility in individuals with low back pain: in vivo assessment during manual and self-imposed motion using dynamic MRI. BMC Musculoskelet Disord. 2007;8:8
  42. Hall L, Tsao H, Macdonald D, Completers M, Hodges PW. Immediate effects of co-contraction training on motor control of the trunk muscles in people with recurrent low back pain. J Electromyogr Kinesiol. 2007;In press
  43. Tsao H, Hodges PW. Persistence of improvements in postural strategies following motor control training in people with recurrent low back pain. J Electromyogr Kinesiol. 2008;18:559–567
  44. Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups of patients with acute/sub acute “nonspecific” low back pain: results of a randomized clinical trial. Spine. 2006;31:623–631
  45. Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37:290–302
  46. Moseley GL, Hodges PW, Gandevia SC. Deep and superficial fibers of the lumbar multisided muscle are differentially active during voluntary arm movements. Spine. 2002;27:E29–E36
  47. Qattara M, Busiest S. Posture-kinetic organization during the early phase of voluntary upper limb movement, 1: normal subjects. J Neural Neurosurg Psychiatry. 1988;51:956–965
  48. Mimura M, Panjabi MM, Oland TR, Crisco JJ, Yamamoto I, Vestavia A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine. 1994;19:1371–1380
  49. Blankenbaker DG, Haughton VM, Rogers BP, Meyerand ME, Fine JP. Axial rotation of the lumbar spinal motion segments correlated with concordant pain on discography: a preliminary study. AJR Am J Roentgenol. 2006;186:795–799
  50. Eisenstein S. “Instability” and low back pain: a way out of the semantic maze. In:  Szpalski M,  Gunzburg R,  Pope M editor. Lumbar segmental instability. Philadelphia: Lippincott Williams & Wilkins; 1999;p. 39–44
  51. Panjabi M, Brown M, Lindahl S, Irstam L, Hermens M. Intrinsic disc pressure as a measure of integrity of the lumbar spine. Spine. 1988;13:913–917
  52. Tanaka N, An H, Lim T, Fujiwara A, Jeon C, Haughton V. The relationship between disc degeneration and flexibility of the lumbar spine. Spine J. 2001;1:47–56
  53. McHorney CA, Ware JE. Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study short-form 36-item health survey. Med Care. 1995;33:15–28
  54. Riddle DL, Stratford PW. Roland-Morris scale reliability. Phys Ther. 2002;82:512–515discussion 5-7
  55. Roland M, Fairbank J. The Roland Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25:3115–3124
  56. Stewart AL, Hays RD, Ware JE. The MOS short-form general health survey: reliability and validity in a patient population. Med Care. 1988;26:724–735
  57. Stratford PW, Binkley JM, Riddle DL, Guyatt GH. Sensitivity to change of the Roland Morris back pain questionnaire: part 1. Phys Ther. 1998;78:1186–1196
  58. Ware JE. SF-36 health survey update. Spine. 2000;25:3130–3139
  59. Cholewicki J, Panjabi MM, Khachatryan A. Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture. Spine. 1997;22:2207–2212
  60. Marshall P, Murphy B. The validity and reliability of surface EMG to assess the neuromuscular response of the abdominal muscles to rapid limb movement. J Electromyogr Kinesiol. 2003;13:477–489
  61. Ng JK, Richardson CA. Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects. Arch Phys Med Rehabil. 1996;77:259–264
  62. Aminian K, Ruffieux C, Robert P. Filtering by adaptive sampling (FAS). Med Biol Eng Comput. 1988;26:658–662
  63. Aruin AS, Latash ML. The role of motor action in anticipatory postural adjustments studied with self-induced and externally triggered perturbations. Exp Brain Res. 1995;106:291–300
  64. Portney L, Watkins M. Foundations of clinical research: applications to practice. 2nd ed.. Norwalk: Appleton & Lange; 2000;
  65. Stevens J. Applied multivariate statistics for the social sciences. 4th ed.. Mahwah: Lawrence Erlbaum Associates, Inc; 2002;
  66. Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Rheum. 2007;57:656–665
  67. Mok NW, Brauer SG, Hodges PW. Failure to use movement in postural strategies leads to increased spinal displacement in low back pain. Spine. 2007;32:E537–E543
  68. Allison GT, Henry SM. The influence of fatigue on trunk muscle responses to sudden arm movements, a pilot study. Clin Biomech (Bristol, Avon). 2002;17:414–417
  69. Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res. 2003;151:262–271
  70. McGill S, Juker D, Kropf P. Appropriately placed surface EMG electrodes reflect deep muscle activity (psoas, quadratus lumborum, abdominal wall) in the lumbar spine. J Biomech. 1996;29:1503–1507
  71. Leinonen V, Kankaanpaa M, Luukkonen M, Hanninen O, Airaksinen O, Taimela S. Disc herniation-related back pain impairs feed-forward control of paraspinal muscles. Spine. 2001;26:E367–E372
  72. Hwang JH, Lee YT, Park DS, Kwon TK. Age affects the latency of the erector spinae response to sudden loading. Clin Biomech (Bristol, Avon). 2008;23:23–29
  73. Moseley GL, Nicholas MK, Hodges PW. Does anticipation of back pain predispose to back trouble?. Brain. 2004;127:2339–2347
  74. Panjabi MM. A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction. Eur Spine J. 2006;15:668–676
  75. Riddle DL, Stratford PW, Binkley JM. Sensitivity to change of the Roland Morris back pain questionnaire: part 2. Phys Ther. 1998;78:1197–1207
  76. Cholewicki J, VanVliet JJ. Relative contribution of trunk muscles to the stability of the lumbar spine during isometric exertions. Clin Biomech (Bristol, Avon). 2002;17:99–105
  77. Panjabi MM. The stabilizing system of the spine, part I: function, dysfunction, adaptation, and enhancement. J Spinal Disord. 1992;5:383–389discussion 97
  78. Farfan HF. Mechanical disorders of the low back. Philadelphia: Lea and Febiger; 1973;
  79. Panjabi MM, Oxland TR, Yamamoto I, Crisco JJ. Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves. J Bone Joint Surg Am. 1994;76:413–424
  80. White A, Bernhardt M, Panjabi M. Clinical biomechanics and lumbar segmental instability. In:  Szpalski M,  Gunzburg R,  Pope M editor. Lumbar segmental instability. Philadelphia: Lippincott Williams & Wilkins; 1999;p. 15–25
  81. Horak FB, Shupert CL, Dietz V, Horstmann G. Vestibular and somatosensory contributions to responses to head and body displacements in stance. Exp Brain Res. 1994;100:93–106

 Supported in part by grants from Orthopaedic Section of the American Physical Therapy Association and the US Department of Education, National Institute on Disability and Rehabilitation Research (H133F030024).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

 Device Status Statement: The devices are FDA approved for the indicated usage in the United States.

 Published online June 5, 2009 at www.archives-pmr.org.

PII: S0003-9993(09)00211-1

doi: 10.1016/j.apmr.2008.10.033

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 7 , Pages 1159-1169 , July 2009