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Temporal Patterns of the Trunk Muscles Remain Altered in a Low Back–Injured Population Despite Subjective Reports of Recovery

  • Janice M. Moreside
    Affiliations
    School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada

    School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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  • D. Adam Quirk
    Affiliations
    School of Biomedical Engineering, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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  • Cheryl L. Hubley-Kozey
    Correspondence
    Corresponding author Cheryl L. Hubley-Kozey, PhD, School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, Nova Scotia, Canada B3H 3J5.
    Affiliations
    School of Health and Human Performance, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada

    School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada

    School of Biomedical Engineering, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
    Search for articles by this author
Published:October 17, 2013DOI:https://doi.org/10.1016/j.apmr.2013.10.003

      Abstract

      Objective

      To compare temporal activation patterns from 24 abdominal and lumbar muscles between healthy subjects and those who reported recovery from recent low back injury (LBI).

      Design

      Cross-sectional comparative study.

      Setting

      University neuromuscular function laboratory.

      Participants

      Healthy adult volunteers (N=81; 30 LBI, 51 asymptomatic subjects).

      Interventions

      Trunk muscle electromyographic activity was collected during 2 difficulty levels of a supine trunk stability test aimed at challenging lumbopelvic control.

      Main Outcome Measures

      Principal component (PC) analysis was applied to determine differences in temporal and/or amplitude electromyographic patterns between groups. Mixed-model analyses of variance were performed on PC scores that explained more than 89% of the variance (α=.05).

      Results

      Four PCs explained 89% and 96% of the variance for the abdominal and back muscles, respectively, with both muscle groups having similar shapes in the first 3 PCs. Significant interactions or group main effects were found for all PC scores except PC4 for the back extensors. Overall activation amplitudes for both the abdominal and back muscles (PC1 scores) were significantly (P<.05) higher for the LBI group, with both abdominal and back muscles of the LBI group demonstrating an increased response to the leg-loading phase (PC2 scores) compared with the asymptomatic group. Differences were also found between groups in their preparatory activity (PC3 scores), with the LBI group having a higher early relative amplitude of abdominal and back extensor activity.

      Conclusions

      Despite perceived readiness to return to work and low pain scores, muscle activation patterns remained altered in this LBI group, including reduced synergistic coactivation and increased overall amplitudes as well as greater relative amplitude differences during specific phases of the movement. Electromyographic measures provide objective information to help guide therapy and may assist with determining the level of healing and return-to-work readiness after an LBI.

      Keywords

      List of abbreviations:

      EMG (electromyogram), EO (external oblique), IO (internal oblique), LBI (low back injury), LBP (low back pain), LRA (lower rectus abdominis), MVC (maximum voluntary contraction), PC (principal component), TST (trunk stability test), URA (upper rectus abdominis)
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      Linked Article

      • Trunk Muscle Activation in the Low Back–Injured Population
        Archives of Physical Medicine and RehabilitationVol. 95Issue 5
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          We observed with interest the recent publication by Moreside et al.1 The authors examined muscle activation using surface electromyography to compare patients with and without a history of low back injury. They consider in their conclusion the potential application of these measures to objectively determine healing in the clinical population. Although the authors clearly have used this statistical model in previous publications to compare their electromyographic findings between groups, there are factors impeding the application of this data to clinical populations.
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