Abstract
Leinonen V, Kankaanpää M, Airaksinen O, Hänninen O. Back and hip extensor activities
during trunk flexion/extension: effects of low back pain and rehabilitation. Arch
Phys Med Rehabil 2000;81:32-7. Objective: To compare lumbar paraspinal, gluteus maximus, and biceps femoris muscle function
during sagittal trunk flexion and extension in patients with chronic low back pain
and healthy control subjects, and to assess the influence of rehabilitation in the
back pain patients. Design: A cross-sectional study comparing chronic low back pain patients and healthy controls,
and a prospective follow-up in back pain patients during rehabilitation. Setting: Physical medicine and rehabilitation clinic. Subjects: Nineteen women with chronic low back pain, and 19 women without pain (controls).
Intervention: Five-week active outpatient rehabilitation (1 hour three times a week) guided by
a physiotherapist, followed by 5-week self-motivated exercise at home. Outcome Measures: Subjects performed sagittal trunk flexion and extension while surface electromyogram
was bilaterally recorded of paraspinal (L1-L2 level), gluteus maximus, and biceps
femoris muscles. The muscle activity was assessed from the average electromyogram
and the relative muscle activation onsets and their duration were calculated. Results: During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously
before gluteus maximus. At the end of flexion and during extension all investigated
muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris
muscles were activated in a similar order in low back pain patients and healthy controls
during flexion and extension. However, the duration of gluteus maximus activity was
shorter in the back pain patients than in controls during the trunk flexion (p < .05), and it ended earlier during extension. Active rehabilitation did not change
the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients,
but in the measurements after rehabilitation the onset of gluteus maximus activity
occurred later in flexion and earlier in extension. Conclusions: The activity of the gluteus maximus muscle during the flexion-extension cycle was
reduced in patients with chronic low back pain. The gluteal muscles should be taken
into consideration in the rehabilitation of these patients. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy
of Physical Medicine and Rehabilitation
Keywords
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 accessOne-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:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The role of dynamic three-dimensional trunk motion in occupationally related low back disorders. The effect of workplace factors, trunk position, and trunk motion characteristics on risk of injury.Spine. 1993; 18: 617-628
- Acute low back pain in industry.Acta Orthop Scand. 1977; : 1-117
- An epidemiologic study of non-occupational lifting as a risk factor for herniated lumbar intervertebral disc.Spine. 1993; 18: 595-602
- Relative lumbar and pelvic motion during loaded spinal flexion/extension.Spine. 1995; 20: 199-204
- The function of the erectores spinae muscles in certain movements and postures in man.J Physiol. 1955; 129: 184-203
- Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls.Arch Phys Med Rehabil. 1991; 72: 1080-1087
- Hip-spine interaction and muscle activation patterns during sagittal trunk movements in low back pain patients.Spine. 1994; 19: 596-603
- The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs.Spine. 1995; 7: 753-758
- Acute low back problems in adults.Clinical Practice Quideline. No. 14. US Department of Health and Human Services, Rockville (MD)1994 (AHCPR Publication No 95-0642)
- Back and hip extensor fatigability in chronic low back pain patients and controls.Arch Phys Med Rehabil. 1998; 79: 412-417
- The Oswestry low back pain disability questionnaire.Physiotherapy. 1980; 66: 271-273
- Graphic representation of pain.Pain. 1976; 2: 175-184
- Muscle fiber directions of iliocostalis and multifidus: male-female differences.J Anat. 1991; 179: 163-167
- Evaluation in physical education.Prentice Hall, Engelwood Cliffs (NJ)1981
- Muscle weakness and inhibition (pseudoparesis) in back pain syndromes.in: Modern manual therapy of the vertebral column. Churchill-Livingston, New York1986: 197-201
- A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain disability.Pain. 1993; 52: 157-168
- Quantification of lumbar function. Part 2: sagittal plane strength in low back pain patients.Spine. 1985; 10: 765-772
- Radiolographic demonstration of paraspinal muscle wasting in patients with chronic low back pain.Br J Rheumatol. 1992; 31: 389-394
- Reflex activation of gluteal muscles in walking.Spine. 1993; 18: 704-708
- Flexion relaxation of the hamstring muscles during lumbar-pelvic rhythm.Arch Phys Med Rehabil. 1997; 78: 486-490
- Hip load moments and muscular activity during lifting.Scand J Rehabil Med. 1984; 16: 103-111
- Evaluation of the function of the gluteus maximus muscle: an electromyographic study.Am J Phys Med. 1986; 47: 182-191
- Normalization of dynamic trunk extensor EMG during stoop lifting.J Biomech. 1993; 26 ([abstract]): 356
- Form and function to the musculoskeletal system as revealed by mathematical analysis of the lumbar spine.Spine. 1995; 20: 1462-1474
- Passive tissues help the back muscles to generate extensor moment during lifting.J Biomech. 1994; 27: 1077-1085
- Transfer of loads between lumbar tissues during the flexion-relaxation phenomenon.Spine. 1994; 19: 2190-2196
- Prolapsed intervertebral disc. A hyperflexion injury.Spine. 1980; 7: 184-191
- Influence of lumbar and hip mobility on the bending stresses acting on the lumbar spine.Clinical Biomech. 1993; 8: 185-192
- Relation between the structure of the annulus fibrosus and the function and failure of the intervertebral disc.Spine. 1980; 5: 106-116
Article info
Publication history
Accepted:
May 13,
1999
Received in revised form:
May 13,
1999
Received:
November 13,
1998
Footnotes
☆Supported by the Finnish Work Environmental Fund, Yrjö Jahnsson Foundation, Eemil Aaltonen Foundation, and Instrumentarium Science Foundation.
☆☆Reprint requests to Ville Leinonen, Department of Physiology, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland.
★No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
★★Suppliers
Identification
Copyright
© 2000 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
