Changes in muscle activation patterns and subjective low back pain ratings during prolonged standing in response to an exercise intervention.
ABSTRACT Low back pain (LBP) development has been associated with occupational standing. Increased hip and trunk muscle co-activation is considered to be predisposing for LBP development during standing in previously asymptomatic individuals. The purpose of this work was to investigate muscle activation and LBP responses to a prescribed exercise program. Pain-developing (PD) individuals were expected to have decreased LBP and muscle co-activation following exercise intervention.
Electromyography (EMG) data were recorded from trunk and hip muscle groups during 2-h of standing. An increase of >10mm on visual analog scale (VAS) during standing was threshold for PD categorization. Participants were assigned to progressive exercise program with weekly supervision or control (usual activity) for 4 weeks then re-tested.
Forty percent were categorized as PD on day 1, VAS=24.2 (±4.0)mm. PD exercisers (PDEX) had lower VAS scores (8.93±3.66 mm) than PD control (PDCON) (16.5±6.3 mm) on day 2 (p=0.007). Male PDEX had decreased gluteus medius co-activation levels (p<0.05) on day 2.
The exercise program proved beneficial in reducing LBP during standing. There were changes in muscle activation patterns previously associated with LBP. Predisposing factors for LBP during standing were shown to change positively with appropriate exercise intervention.
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ABSTRACT: Background: Improving activity and strength of the gluteus medius muscle is a common goal among clinicians aiming to rehabilitate lower extremity and low back injuries. The functional anatomy of the hip is complex, particularly how position-dependent the activity and strength of many muscles surrounding the hip, and the optimal exercise technique to isolate gluteus medius remains controversial. The objective of this study was to quantify the effect of altering hip orientation during side-lying clamshell and hip abduction exercises on the relative muscle activation profiles of gluteus medius and tensor fascae latae. Methods: The ratio of gluteus-medius-to-tensor-fascae-latae peak electromyography signal amplitude of 13 healthy, male participants was compared across variations of the clamshell and abduction exercises. The hip flexion angle was varied from 30, 45, and 60 degrees for the clamshell, while hip rotation orientation was varied from internal, neutral, and external rotation for the abduction exercise. Findings: Varying hip angle – flexion in the clamshell exercise and internal/external rotation in the abduction exercise – did not significantly affect the interplay between gluteus medius and tensor fascae latae activation levels. Both exercises remained gluteus medius-dominant across all variations, but the gluteus-medius-to-tensor-fascae-latae ratio was far greater for the clamshell than abduction exercise; the clamshell may be the preferred rehabilitative exercise to prescribe when minimal tensor fascae latae muscle activation is desired by the clinician. Interpretation: These findings provide information for clinical decision-making pertaining to effective gluteus medius activation in lower extremity and low back exercise rehabilitation programsClinical biomechanics (Bristol, Avon) 09/2014; · 1.76 Impact Factor
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ABSTRACT: OCCUPATIONAL APPLICATIONS Occupational sitting has been associated with an increased risk for developing low back pain. The present investigation examined the effects of asymmetrical sitting surfaces induced by a wallet on acute changes in spine/pelvis posture, interface pressure, and discomfort. Compared to level sitting, sitting on a wallet resulted in greater sagittal and lateral spine flexion, a smaller total contact area with the seat pan, and greater gluteal discomfort. At wallet thicknesses of 22 mm and thicker, seat pan contact pressure area decreased and thoracic spine and pelvic angles deviated laterally compared to the no-wallet condition. At a 32-mm wallet thickness, gluteal discomfort increased. These results indicate that sitting for brief periods (15 minutes) on an uneven seating surface greater than 32 mm in thickness causes postural deviations from neutral spine positions and increases gluteal discomfort. This study supports the removal of rear pocket items, especially larger ones, during sitting.TECHNICAL ABSTRACT Background: Occupations in mobile or office settings can involve prolonged seated exposures, increasing the likelihood of low back pain development. The seat-occupant interface can be impeded by wallets or other objects (cell phones, paper documents, etc.) placed in the rear pocket, potentially increasing the risk of developing low back pain directly (nerve compression) or indirectly (altered kinematics). However, there are no published studies that have examined the effect of an uneven seating surface. Purpose: This study aimed to quantify the outcomes of a non-level sitting surface on trunk kinematics, seat pan pressure distribution, and discomfort. Gender differences in responses were also examined. Methods: Twelve males and 12 females sat for 15 minutes each on 4 wallet thicknesses (0, 12, 22, and 32 mm). Sagittal and frontal plane angles of the thoracic, lumbar spine and the pelvis were measured. Seat pressure distribution (total pressure area) and discomfort using a 100-mm visual analogue scale were also collected for each thickness. Results: In the 22- and 32-mm conditions, there was greater pelvic posterior rotation, pelvic left lateral bending, thoracic flexion, and thoracic right lateral bending compared to the 0-mm condition. Males and females showed differences in the magnitude of lateral bend angles at all spine levels; however, both genders demonstrated the same directions of postural compensation. Total pressure area decreased and gluteal discomfort increased with thicker wallets, reaching significance in the 22- and 32-mm conditions, respectively. Conclusions: Sitting on wallets greater than 32 mm in thickness increased gluteal discomfort reporting after short duration exposures. Asymmetrical sitting promotes non-neutral spine postures and reduces seat pan contact area. Asymmetrical sitting is therefore not recommended, even for short duration exposures.IIE Transactions on Occupational Ergonomics and Human Factors. 04/2014; 2(2).
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ABSTRACT: Sit-stand stools are available for use in industrial settings, but there is a lack of quantitative evidence demonstrating benefits for lower limb, back and/or neck/shoulder outcomes. In this paper we describe an experiment conducted to compare and contrast posture and time-related differences in muscular and vascular outcomes during 34 min of manual repetitive work performed in either standing or sit-standing work posture. We measured vascular parameters in the lower limbs, and muscular parameters in the trunk and neck/shoulder, and discomfort in the three regions as participants accomplished a repetitive box-folding task. Results show that blood flow in the foot (p ¼ 0.022) and ankle mean arterial pressure (p < 0.001) were greater during standing. Left gluteus medius and external oblique activation was higher during standing, while sit-standing work resulted in higher levels of co-activation between the left erector spinae and external oblique muscle pair (p ¼ 0.026). Neck/shoulder muscle activity was not significantly different between the conditions. Reported discomfort did not differ significantly for the trunk and neck/shoulder region, but standing resulted in higher level of reported discomfort in the lower limb. The sit-stand posture used in this experiment appears to prevent the undesirable lower limb outcomes associated with static standing work posture. Relevance to industry: This work demonstrates quantitative evidence to support the potential use of a sitstand stool for industrial work operations, at least over relatively short durations.International Journal of Industrial Ergonomics 01/2015; 45. · 1.21 Impact Factor