Article| Volume 79, ISSUE 4, P412-417, April 1998

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Back and hip extensor fatigability in chronic low back pain patients and controls

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      Objective: To compare the lumbar paraspinal and gluteus maximus muscle fatigability between chronic low back pain patients and healthy controls by using electromyographic (EMG) spectral analysis during a maximal isometric endurance task.
      Design: A cross-sectional comparative study between chronic low back pain patients and healthy control subjects.
      Setting: Physical medicine and rehabilitation clinic in Finland.
      Subjects: Twenty women with nonspecific chronic low back pain (longer than 3 months) and 15 healthy controls.
      Intervention: Subjects performed maximal voluntary isometric back extensions (MVC) at 30° forward flexion in a specially designed measurement unit. A 50% MVC load was used in isometric endurance test.
      Outcome Measures: Low back pain intensity was assessed by using the visual analogue scale and functional disability by the Oswestry disability index. Time to endurance was measured. Bipolar surface EMG recordings were made over the lumbar paraspinal muscles (L3-L4, L5-S 1) and over the gluteus maximus muscles. Average EMG (aEMG%), and initial spectral median frequency (MFinit) and change over time (MFslope) were computed.
      Results: Pain intensity and functional disability were higher and MVC and time to endurance were lower in the chronic low back pain group (p < .05). Similar muscle activity levels (aEMG%) and MFinit indicated similar muscle loading in both groups at the beginning of the endurance test. EMG spectral decreases (MFslope) indicated that lumbar paraspinal muscle fatigability was similar in both groups. In the chronic low back pain group, the gluteus maximus fatigued faster than in the control group (greater MFslopep < .05). However, the shorter endurance time indicated greater fatigability in the chronic low back pain group in general (p < .05).
      Conclusions: The chronic low back pain patients were weaker and fatigue faster than the healthy control. The EMG fatigue analysis result suggest that the gluteus maximus muscles are more fatigable in chronic low back pain patient than in healthy control subject during a sustained back extension endurance test.
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        • Biering-Sorensen F
        Physical measurements as risk indicators for low trouble over one year period.
        Spine. 1984; 9: 106-119
        • Nicolaisen T
        • Jorgensen K
        Trunk strength, back muscle endurance and low-back trouble.
        Scand J Rehabil Med. 1985; 17: 121-127
        • Hultman G
        • Nordin M
        • Saraste H
        • Ohlsen H
        Body composition, endurance, strength, cross-sectional area, and density of mm erector spinae in men with and without low back pain.
        J Spinal Disord. 1993; 6: 114-123
        • Mayer TG
        • Kondarske G
        • Mooney V
        • Carmichael TW
        • Butsch R
        Lumbar myoelectric spectral analysis for endurance assessment.
        in: A comparison of normals with deconditioned patients. 2nd ed. Spine. 14. 1989: 986-991
        • Roy SH
        • De Luca CJ
        • Casavant DA
        Lumbar muscle fatigue and chronic lower back pain.
        Spine. 1989; 14: 992-1001
        • Biedermann HJ
        • Shanks GL
        • Inglis J
        Median frequency estimates of paraspinal muscles: reliability analysis.
        Electromyogr Clin Neurophysiol. 1990; 30: 83-88
        • Dieen JH van
        • Oude Vrielink HHE
        • Housheer AF
        • Latters FBJ
        • Toussaint HM
        Trunk extensor endurance and its relationship to electromyogram parameters.
        Eur J Appl Physiol. 1993; 66: 388-396
        • Mannion AF
        • Dolan P
        Electromyographic median frequency changes during isometric contraction of the back extensors to fatigue.
        Spine. 1994; 19: 1223-1229
        • Roy SH
        • De Luca CJ
        • Emley M
        • Buijs RJC
        Spectral electromyographic assessment of back muscles in patients with low back pain undergoing rehabilitation.
        Spine. 1995; 20: 38-48
        • Vleeming A
        • Pool-Goudzwaard AL
        • Stoeckart R
        • Wingerden J-P
        • Snijders CJ
        The posterior layer of the thoracolumbar fascia.
        in: Its function in load transfer from spine to legs. 2nd ed. Spine. 7. 1995: 753-758
        • Paquet N
        • Malouin F
        • Richards CL
        Hip-spine movement interaction and muscle activation patterns during sagittal trunk movements in low back pain patients.
        Spine. 1993; 19: 596-603
        • Nelson JM
        • Walmsley RP
        • Stevenson JM
        Relative lumbar and pelvic motion during loaded spinal flexion/extension.
        Spine. 1995; 20: 199-204
        • Deluca C.J.
        Myoelectric manifestations of localized muscular fatigue in humans.
        CRC Crit Rev Biomed Eng. 1983; 11: 251-279
        • Hägg GM
        Interpretation of EMG spectral alterations and alteration indexes at sustained contraction.
        J Appl Physiol. 1992; 73: 1211-1217
        • Lindstrom L.R.
        • Magnusson R.
        • Petersen I
        Muscular fatigue and action potential conduction velocity changes studied with frequency analysis of EMG signal.
        Electromyography. 1970; 4: 341-353
        • Lindström L.R.
        • Kadefors R.
        • Petersen I
        An electromyographic index for localized muscle fatigue.
        J Appl Physiol. 1997; 43: 750-754
        • Deluca CJ
        Use of the surface EMG signal for performance evaluation of back muscles.
        Muscle Nerve. 1993; 16: 210-216
      1. Basmajian JV DeLuca CJ Muscles alive: their functions revealed by electromyography. Williams & Wilkins, Baltimore (MD)1985
        • Hagberg M
        Muscular endurance and surface electromyogram in isometric and dynamic exercise.
        J Appl Physiol Respir Environ Exerc Physiol. 1987; 51: 1-7
        • Garnet D
        • Maton B
        The fatigability of two agonistic muscles in human isometric voluntary submaximal contraction: an EMG study. I assessment of muscular fatigue by means of surface EMG.
        Eur J Appl Physiol. 1989; 58: 361-368
        • Bigos S
        • Braen G
        • Brown K
        • Deyo R
        • Haldeman S
        • Hart J
        • et al.
        Acute low back problems in adults.
        in: Clinical Practice Guideline, No. 14. 2nd ed. AHCPR Publication No. 95-0642. US Department of Health and Human Services, Rockville (MD)1994
        • Fairbank JCT
        • Cooper J
        • Davies J
        • O'Brien JP
        The Oswestry low back pain disability questionnaire.
        Physiotherapy. 1980; 66: 271-273
        • Biedermann H-J
        • Defoa LJ
        • Forrest WJ
        Muscle fiber directions of iliocostalis and multifidus: male-female differences.
        J Anat. 1991; 179: 163-167
        • Stulen FB
        • Deluca CJ
        Frequency parameters of the myoelectric signal as a measure of muscle conduction velocity.
        IEEE Trans BiomedEng. 1981; 28: 515-523
        • Janda V
        Muscle weakness and inhibition (pseudoparesis) in back pain syndromes.
        in: Grieve GP Modern manual therapy of the vertebral column. Churchill-Livingston, New York1986: 197-201
        • Bullock-Saxton JE
        • Janda V
        • Bullock MI
        Reflex activation of gluteal muscles in walking.
        in: An approach to restoration of muscle function for patients with low back pain. 2nd ed. Spine. 6. 1993: 704-708
        • Waddell G
        • Newton M
        • Henderson I
        • Somerville D
        • Main CJ
        A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.
        Pain. 1993; 52: 157-168
        • Mayer TG
        • Smith SS
        • Keeley J
        • Mooney V
        Quantification of lumbar function. Part 2: sagittal plane strength in low back pain patients.
        Spine. 1985; 10: 765-772
        • Cooper RG
        • Stclair Forbes W
        • Jayson MIV
        Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain.
        Br J Rheumatol. 1992; 31: 389-394
        • Cooper RG
        • Stokes MJ
        Load-induced inflexion of the surface electromyographic signal during isometric fatiguing activity of normal human paraspinal muscles.
        Electromyogr Clin Neurophysiol. 1994; 34: 177-184
        • Tsuboi T
        • Satou T
        • Egava K
        • Izumi Y
        • Miyzaki M
        Spectral analysis of electromyogram in lumbar muscles: fatigue induced endurance contraction.
        Eur J Appl Physiol. 1994; 69: 361-366
        • Farfan HF
        Form and function of the musculoskeletal system as revealed by mathematicalanalysis of the lumbar spine.
        in: An essay. 2nd ed. Spine. 20. 1995: 1462-1474
        • Pope M
        • Bevins H
        • Wilder DG
        • Frymoyer JW
        The relationship between anthropometric, postural, muscular and mobility characteristics of males ages 18–55.
        Spine. 1985; 10: 644-648
        • Riihimaki H
        • Wickstrom G
        • Hänninen K
        • Luopajarvi T
        Predictors of Sciatic pain among concrete reinforcement workers and house painters—a five-year follow-up.
        Scand J Work Environ Health. 1989; 15: 415-423
        • Cassissi JE
        • Robinson ME
        • O'Connor P
        • MacMillan M
        Trunk strength and lumbar paraspinal activity during isometric exercise in chronic low back patients and controls.
        Spine. 1993; 18: 245-251