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

  • Janice M. Moreside
    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
    Search for articles by this author
  • D. Adam Quirk
    School of Biomedical Engineering, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
    Search for articles by this author
  • Cheryl L. Hubley-Kozey
    Corresponding author Cheryl L. Hubley-Kozey, PhD, School of Physiotherapy, Dalhousie University, 5869 University Ave, Halifax, Nova Scotia, Canada B3H 3J5.
    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:



      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).


      Cross-sectional comparative study.


      University neuromuscular function laboratory.


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


      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).


      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.


      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.


      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)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McGill S.M.
        • Grenier S.G.
        • Kavcic N.
        • Cholewicki J.
        Coordination of muscle activity to assure stability of the lumbar spine.
        J Electromyogr Kinesiol. 2003; 13: 353-359
        • Cholewicki J.
        • McGill S.
        Mechanical stability of the in-vivo lumbar spine: implications for injury and chronic low back pain.
        Clin Biomech (Bristol, Avon). 1996; 11: 1-15
        • Granata K.P.
        • Orishimo K.F.
        Response of trunk muscle coactivation to changes in spinal stability.
        J Biomech. 2001; 34: 1117-1123
        • Hodges P.W.
        • Richardson C.A.
        Inefficient muscular stabilization of the lumbar spine associated with low back pain.
        Spine (Phila Pa 1976). 1996; 21: 2640-2650
        • Mannion A.F.
        Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain.
        J Electromyogr Kinesiol. 1999; 9: 363-377
        • Suzuki N.
        • Endo S.
        A quantitative study of trunk muscle strength and fatigability in the low-back-pain syndrome.
        Spine (Phila Pa 1976). 1983; 8: 69-74
        • Van Dillen L.R.
        • Gombatto S.P.
        • Collins D.R.
        • Engsberg J.R.
        • Sahrmann S.
        Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain.
        Arch Phys Med Rehabil. 2007; 88: 351-360
        • Scholtes S.A.
        • Gombatto S.P.
        • Van Dillen L.R.
        Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests.
        Clin Biomech (Bristol, Avon). 2009; 24: 7-12
        • Ferreira P.H.
        • Ferreira M.L.
        • Hodges P.W.
        Changes in recruitment of the abdominal muscles in people with low back pain.
        Spine (Phila Pa 1976). 2004; 29: 2560-2566
        • Hubley-Kozey C.L.
        • Vezina M.J.
        Differentiating temporal electromyographic waveforms between those with chronic low back pain and healthy controls.
        Clin Biomech (Bristol, Avon). 2002; 17: 621-629
        • O'Sullivan P.B.
        • Twomey L.
        • Allison G.T.
        Altered abdominal muscle recruitment in patients with chronic back pain following a specific exercise intervention.
        J Orthop Sports Phys Ther. 1998; 27: 114-124
        • Zhu X.Z.
        • Parnianpour M.
        • Nordin M.
        • Kahanovitz N.
        Histochemistry and morphology of erector spinae muscle in lumbar disc herniation.
        Spine (Phila Pa 1976). 1989; 14: 391-397
        • Mattila M.
        • Hurme M.
        • Alaranta H.
        • et al.
        The multifidus muscle in patients with lumbar disc herniation. A histochemical and morphometric analysis of intraoperative biopsies.
        Spine (Phila Pa 1976). 1986; 11: 732-738
        • Lee A.S.
        • Cholewicki J.
        • Reeves N.P.
        • Zazulak B.T.
        • Mysliwiec L.W.
        Comparison of trunk proprioception between patients with low back pain and healthy controls.
        Arch Phys Med Rehabil. 2010; 91: 1327-1331
        • Newcomer K.
        • Laskowski E.R.
        • Yu B.
        • Larson D.R.
        • An K.N.
        Repositioning error in low back pain. Comparing trunk repositioning error in subjects with chronic low back pain and control subjects.
        Spine (Phila Pa 1976). 2000; 25: 245-250
        • Radebold A.
        • Cholewicki J.
        • Panjabi M.M.
        • Patel T.C.
        Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain.
        Spine (Phila Pa 1976). 2000; 25: 947-954
        • Hodges P.W.
        • Richardson C.A.
        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
        • Ferguson S.A.
        • Marras W.S.
        • Burr D.L.
        • Davis K.G.
        • Gupta P.
        Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions.
        Clin Biomech (Bristol, Avon). 2004; 19: 992-999
        • Hubley-Kozey C.L.
        • Vezina M.J.
        Muscle activation during exercises to improve trunk stability in men with low back pain.
        Arch Phys Med Rehabil. 2002; 83: 1100-1108
        • D'hooge R.
        • Cagnie B.
        • Crombez G.
        • Vanderstraeten G.
        • Dolphens M.
        • Danneels L.
        Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain.
        Man Ther. 2012; 17: 584-588
        • Macdonald D.A.
        • Dawson A.P.
        • Hodges P.W.
        Behavior of the lumbar multifidus during lower extremity movements in people with recurrent low back pain during symptom remission.
        J Orthop Sports Phys Ther. 2011; 41: 155-164
        • MacDonald D.
        • Moseley G.L.
        • Hodges P.W.
        People with recurrent low back pain respond differently to trunk loading despite remission from symptoms.
        Spine (Phila Pa 1976). 2010; 35: 818-824
        • MacDonald D.
        • Moseley G.L.
        • Hodges P.W.
        Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain.
        Pain. 2009; 142: 183-188
        • Butler H.L.
        • Hubley-Kozey C.L.
        • Kozey J.W.
        Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury.
        J Electromyogr Kinesiol. 2013; 23: 369-377
      1. Hubley-Kozey CL, Moreside JM, Quirk DA. Trunk neuromuscular pattern alterations during a controlled functional task in a low back injured group deemed ready to resume regular activities. Work. 2013 Sep 4. [Epub ahead of print]

        • Marras W.S.
        • Ferguson S.A.
        • Burr D.
        • Schabo P.
        • Maronitis A.
        Low back pain recurrence in occupational environments.
        Spine (Phila Pa 1976). 2007; 32: 2387-2397
        • Axler C.T.
        • McGill S.
        Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge.
        Med Sci Sports Exerc. 1997; 29: 804-810
        • Kavcic N.
        • Grenier S.G.
        • McGill S.M.
        Quantifying tissue loads and spine stability while performing commonly prescribed low back stabilization exercises.
        Spine (Phila Pa 1976). 2004; 29: 2319-2329
        • Reeves P.N.
        • Cholewicki J.
        Modeling the human lumbar spine for assessing spinal loads, stability, and risk of injury.
        Crit Rev Biomed Eng. 2003; 31: 73-139
        • Granata K.P.
        • Marras W.S.
        Cost-benefit of muscle cocontraction in protecting against spinal instability.
        Spine (Phila Pa 1976). 2000; 25: 1398-1404
        • Gardner-Morse M.G.
        • Stokes I.A.F.
        The effects of abdominal muscle coactivation on lumbar spine stability.
        Spine (Phila Pa 1976). 1998; 23: 86-91
        • Vezina M.J.
        • Hubley-Kozey C.L.
        Muscle activation in therapeutic exercises to improve trunk stability.
        Arch Phys Med Rehabil. 2000; 81: 1370-1379
        • Davidson K.L.
        • Hubley-Kozey C.L.
        Trunk muscle responses to demands of an exercise progression to improve dynamic spinal stability.
        Arch Phys Med Rehabil. 2005; 86: 216-223
        • Sahrmann S.
        Diagnosis and treatment of movement impairment syndromes.
        Mosby, St Louis2002
      2. Jackson J.E. A user's guide to principal components. 1st ed. John Wiley & Sons, Hoboken2003
        • Hubley-Kozey C.L.
        • Hanada E.Y.
        • Gordon S.
        • Kozey J.
        • McKeon M.
        Differences in abdominal muscle activation patterns of younger and older adults performing an asymmetric leg-loading task.
        PM R. 2009; 1: 1004-1013
        • Hubley-Kozey C.L.
        • Hatfield G.L.
        • Davidson K.C.
        Temporal coactivation of abdominal muscles during dynamic stability exercises.
        J Strength Cond Res. 2010; 24: 1246-1255
        • Lamoth C.J.
        • Meijer O.G.
        • Daffertshofer A.
        • Wuisman P.I.
        • Beek P.J.
        Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control.
        Eur Spine J. 2006; 15: 23-40
        • Kendall F.P.
        • McCreary E.K.
        Muscles, testing and function.
        3rd ed. Williams & Wilkins, Baltimore1983
        • Butler H.L.
        • Hubley-Kozey C.L.
        • Kozey J.W.
        Characterisation of trunk muscle activation amplitude patterns during a simulated checkstand operation with continuously changing flexor and lateral moment demands.
        Ergonomics. 2010; 53: 685-695
        • Butler H.L.
        • Hubley-Kozey C.L.
        • Kozey J.W.
        Electromyographic assessment of trunk muscle activation amplitudes during a simulated lifting task using pattern recognition techniques.
        J Electromyogr Kinesiol. 2009; 19: e505-e512
        • Brown S.H.M.
        • McGill S.M.
        How the inherent stiffness of the in-vivo human trunk varies with changing magnitudes of muscular activation.
        Clin Biomech (Bristol, Avon). 2008; 23: 15-22
        • McGill S.M.
        • Norman R.W.
        Partitioning of the L4-L5 dynamic moment into disc, ligamentous, and muscular components during lifting.
        Spine (Phila Pa 1976). 1986; 11: 666-678
        • van Dieën J.H.
        • Kingma I.
        Effects of antagonistic co-contraction on differences between electromyography based and optimization based estimates of spinal forces.
        Ergonomics. 2005; 48: 411-426
        • Granata K.P.
        • Wilson S.E.
        Trunk posture and spinal stability.
        Clin Biomech (Bristol, Avon). 2001; 16: 650-659
        • Cholewicki J.
        • Panjabi M.M.
        • Khachatryan A.
        Stabilizing function of trunk flexor-extensor muscles around a neutral spine posture.
        Spine (Phila Pa 1976). 1997; 22: 2207-2212
        • Hicks G.E.
        • Morone N.
        • Weiner D.K.
        Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates.
        Spine (Phila Pa 1976). 2009; 34: 1301-1306
        • Panjabi M.M.
        The stabilizing system of the spine. Part 1. Function, dysfunction, adaptation, and enhancement.
        J Spinal Disord. 1992; 5: 383-389
        • Hu H.
        • Meijer O.G.
        • van Dieen J.H.
        • et al.
        Is the psoas a hip flexor in the active straight leg raise?.
        Eur Spine J. 2011; 20: 759-765
        • Vera-Garcia F.J.
        • Moreside J.M.
        • McGill S.M.
        MVC techniques to normalize trunk muscle EMG in healthy women.
        J Electromyogr Kinesiol. 2010; 20: 10-16
        • National Institute of Occupational Safety and Health
        A work practices guide for manual lifting.
        Dept of Health and Human Services, Cincinnati1981 (Technical report No. 81–122)
        • Magill R.
        Motor learning and control concepts and applications.
        7th ed. McGraw Hill, Boston2004
        • Pitcher M.J.
        • Behm D.G.
        • MacKinnon S.N.
        Reliability of electromyographic and force measures during prone isometric back extension in subjects with and without low back pain.
        Appl Physiol Nutr Metab. 2008; 33: 52-60
        • Butler H.L.
        • Newell R.
        • Hubley-Kozey C.L.
        • Kozey J.W.
        The interpretation of abdominal wall muscle recruitment strategies change when the electrocardiogram (ECG) is removed from the electromyogram (EMG).
        J Electromyogr Kinesiol. 2009; 19: e102-e113

      Linked Article

      • Trunk Muscle Activation in the Low Back–Injured Population
        Archives of Physical Medicine and RehabilitationVol. 95Issue 5
        • Preview
          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.
        • Full-Text
        • PDF