Article

Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis

December 1996
Spine 21(22):2640-50

Source
PubMed

Authors:

The University of Queensland

The contribution of transversus abdominis to spinal stabilization was evaluated indirectly in people with and without low back pain using an experimental model identifying the coordination of trunk muscles in response to a disturbances to the spine produced by arm movement. To evaluate the temporal sequence of trunk muscle activity associated with arm movement, and to determine if dysfunction of this parameter was present in patients with low back pain. Few studies have evaluated the motor control of trunk muscles or the potential for dysfunction of this system in patients with low back pain. Evaluation of the response of trunk muscles to limb movement provides a suitable model to evaluate this system. Recent evidence indicates that this evaluation should include transversus abdominis. While standing, 15 patients with low back pain and 15 matched control subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal muscles, lumbar multifidus, and the surface electrodes. Movement in each direction resulted in contraction of trunk muscles before or shortly after the deltoid in control subjects. The transversus abdominis was invariably the first muscle active and was not influenced by movement direction, supporting the hypothesized role of this muscle in spinal stiffness generation. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. Isolated differences were noted in the other muscles. The delayed onset of contraction of transversus abdominis indicates a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.

Reciprocal activation changes of lower extremity muscles caused by the abdominal hollowing maneuver in patients with unilateral lumbar disc herniation: an electromyography study

Article

Full-text available

Jan 2023

Introduction: Decreased or delayed multifidus and transversus abdominis (TrA) activity, transition of the TrA from tonic to phasic activity, and increased activity in the more superficial erector spinae muscles are behaviors unique to people with lumbar radiculopathy. The aim of this study was to investigate whether the isolated AHM could compensate for functional impairments caused by tibialis anterior (TA) muscle weakness due to unilateral L4-L5 radiculopathy. Material and Method: The healthy and affected lower extremities of seventeen patients with unilateral lumbar disc herniation were analyzed. The ratio of TA and medial gastrocnemius (MGC) values that emerged during the activities to the maximum voluntary isometric contraction (MVIC) values of these muscles was called MVIC%. Then the MVIC% values of the TA and MGC were matched and the muscle reciprocal activation ratio was determined ("MVIC%"-TA/"MVIC%"-MGC). While the activities were being performed, the MVIC% values of both muscles were measured separately without performing the AHM and during the AHM. Results: During the tandem walking activity performed with the AHM, the reciprocal activation rates of TA:MGC on the affected and healthy legs converged (p=0.010,d=0.71). Conclusion: According to the results of the study, integration of the AHM into tandem walking activity brought the reciprocal activation rates of both legs closer to each other and enabled them to exhibit similar behaviors, even without adherence to any exercise protocol. Therefore, tandem walking can be selected as an appropriate activity to combine with spinal stabilization exercises performed by unilateral L4-L5 radiculopathy patients using the AHM along with the task.

A Review of Relationship between Fear Avoidance Beliefs and Postural Stability in Non Specific Chronic Low Back Pain

Article

Full-text available

Jan 2013

Introduction: Low back pain (LBP) is one of the most prevalent diseases in most developed and developing countries, affecting 70% to 80% of adults at some time during their lives. Recent evidence suggests that psychosocial factors especially fear-avoidance beliefs (FAB) are important in predicting patients who will progress from an acute to a chronic stage as well as failure of interventions. The aim of this study is to review the Relationship between Fear Avoidance Beliefs and Postural stability in non specific Chronic Low Back Pain (CLBP). Methods: In this narrative article we have searched PubMed, CINHAL, APTA and MEDLINE data bases. The key words included: chronic low back pain, fear avoidance beliefs, posture, stability, balance, motor control, center of pressure and force plate. The inclusion criteria were being related to FAB and postural stability and adults with non specific CLBP, in English language, up to 2013, regardless of their study design. Results: The results showed that psychological factors such as FAB influence the chronicity of LBP, a group of studies indicated that FAB is related to pain and disability. Another group of studies indicated that postural stability is related to pain and disability. The only study on the relationship between postural stability and FAB did not found any significant relationship. Conclusion: FAB is related to pain and disability. Postural stability is related to pain and disability. More studies with stronger methodology such as larger population with control group are needed for evaluating the relationship of FAB and postural control.

Restoration of the Broken Lumbopelvic-hip Neuromuscular Chain and Coordinated Synergistic Activation in Low Back Pain

Article

Aug 2022

The Relationship between Trunk Endurance and Functional Tests in Military Students

Article

Jul 2022

Is Mediolateral Head Motion during the Seated Hip Flexion Test and Indoor Cycling Test Associated with Core Stability?

Article

Dec 2022

THE IDEAL OPERATING POSITION OF THE OPERATOR AND PATIENT – A REVIEW ARTICLE

Article

Nov 2022

The nature of the dental profession and the postures assumed by the dental surgeons during their professional work had a huge impact on the dental surgeon's body and carries with it a high risk of musculoskeletal disorders (MSDs). The purpose of study is to perform the work efciently and effectively by the dentist, to achieve optimum access, visibility, comfort, and control at all times. The study shows that the good ergonomic design of the workplace results in the preventing the musculoskeletal disorders so that the dentist has longer, healthier career, and also enhance the productivity

The Influence of Anticipation of Movement Starting Time on Feedforward Activation of Trunk Muscles During Rapid Shoulder Joint Movements

Article

Full-text available

Nov 2022
J HUM KINET

This study aimed to clarify the differences in the onset of trunk muscle activity with and without anticipation of the movement starting time during rapid shoulder movements. Ten healthy men in a relaxed upright position performed rapid 135° flexion, 135° abduction, and 45° extension of the shoulder on the dominant hand side with and without anticipation of the movement starting time. They moved their shoulder joints following a 3-s countdown and a light stimulus in the anticipation and non-anticipation conditions, respectively. Electromyography of the anterior and posterior quadratus lumborum, transversus abdominis, internal oblique, external oblique, rectus abdominis, lumbar multifidus, lumbar erector spinae on the non-dominant hand side, and the middle deltoid on the dominant hand side were measured. The onset of activity of each trunk muscle relative to the onset of the middle deltoid was calculated. Two-way analysis of variance (eight trunk muscles × two anticipation conditions) was used to compare the onset of electromyographic activity of the trunk muscles in each direction of the shoulder movement. There were significant interactions between the muscles and anticipation conditions during shoulder abduction and extension. The onset of activity in the anterior and posterior quadratus lumborum, transversus abdominis, and internal oblique occurred earlier with anticipation of the movement starting time than without anticipation during shoulder abduction and extension. The anticipation of movement starting time may contribute to a reliable center of mass control within the support base and improve lumbar spine stability by hastening the onset of activity of the deep trunk muscles.

Effects of Combining Core Muscle Activation with Treadmill Walk on Endurance of Trunk Muscles: A Pilot Study

Article

Full-text available

Jan 2022

Olowe Olajide

Background: Abdominal bracing is one of the most effective techniques for core muscle training, which if combined with treadmill walk (TW) could provide trunk muscle endurance Trunk muscle endurance, despite being observed as an important factor and a huge component of core spinal stability, especially in holding up the spine during prolonged functional activity, prevention and rehabilitation of lumbar mechanical problems and performance enhancer in sports, the impacts of combining core muscle activation with TW exercises on trunk muscle endurance has not be succinctly investigated. Aims: The objective of this study was to determine the effect of combining abdominal bracing with TW on trunk muscles endurance. Materials and Methods: Eighteen apparently healthy young adults were randomized into three groups (TW without abdominal bracing, TW combined with abdominal bracing and control). McGill endurance test measures were carried out at baseline and after 6 weeks of intervention. All participants followed the assigned intervention protocols. Results: One way analysis of variance did not show a significant between‑group difference in the postintervention endurance of trunk muscle among the three groups (P > 0.05). In the TW combined with the abdominal bracing group, paired‑t test showed significant within‑group difference in the form of an increase in the holding times (endurance) for the right lateral flexors (t = −3.758, P = 0.013), left lateral flexors (t = −4.096, P = 0.005), and extensors (t = −2.441, P = 0.050). Conclusion: Combining abdominal bracing with TW can be used to improve trunk muscle function through facilitation of trunk muscle endurance.

Translation of surface electromyography to clinical and motor rehabilitation applications: The need for new clinical figures

Article

Full-text available

Mar 2023

Advanced sensors/electrodes and signal processing techniques provide powerful tools to analyze surface electromyographic signals (sEMG) and their features, to decompose sEMG into the constituent motor unit action potential trains, and to identify synergies, neural muscle drive, and EEG–sEMG coherence. However, despite thousands of articles, dozens of textbooks, tutorials, consensus papers, and European and International efforts, the translation of this knowledge into clinical activities and assessment procedures has been very slow, likely because of lack of clinical studies and competent operators in the field. Understanding and using sEMG-based hardware and software tools requires a level of knowledge of signal processing and interpretation concepts that is multidisciplinary and is not provided by most academic curricula in physiotherapy, movement sciences, neurophysiology, rehabilitation, sport, and occupational medicine. The chasm existing between the available knowledge and its clinical applications in this field is discussed as well as the need for new clinical figures. The need for updating the training of physiotherapists, neurophysiology technicians, and clinical technologists is discussed as well as the required competences of trainers and trainees. Indications and examples are suggested and provide a basis for addressing the problem. Two teaching examples are provided in the Supplementary Material.

Improvement in the Contraction of the Transversus Abdominis Following Lumbo-Pelvic Manipulation – A Case Study

Article

Mar 2023

As a clinician, everyone undergoes a difficult time in clinical decision-making when attempting to apply a clinical prediction rule for manipulation (Flynn et al., 2002; Childs et al., 2004) to a patient with a history and physical examination consistent with clinical lumbar instability (Hicks et al., 2005). The effect on neural pathways associated with manipulation has been suggested as one possible mechanism that may improve muscle performance (Pickar, 2002) and patient symptoms. Support exists for an association between spinal manipulation and improved muscle function in the quadriceps (Suter et al., 1999), the erector spinae (Keller and Colloca, 2000), and the deep neck flexors (Sterling et al., 2001). Therefore, it is reasonable to hypothesize that spinal manipulation, by a reflexogenic mechanism, may improve the performance of the deep trunk stabilizers. In turn, improved relaxation and contractility of the lumbar multifidus and the transversus abdominis (TrA) theoretically could lead to improved functional stability of the spine through enhancement of the neurological and active subsystems as defined by Panjabi (1992a, b). This single case study describes changes observed in the TrA musculature pre- to post-manipulation in a patient that presented with a clinical paradox (symptoms suggestive of clinical lumbar instability but also meeting the clinical prediction rule to succeed with lumbar manipulation therapy). Real-time ultrasound imaging (USI) was used to describe the changes in the TrA musculature..

Influence of the Vibration Exposure on Shoulder and Back Extensor Muscles Activity During Forward-head and Over-head Task

Article

Feb 2023

Analysis of trunk rotation during baseball batting with lumbar disc degeneration

Article

Full-text available

Feb 2023

Lower back pain (LBP) is common among baseball players, and the occurrence of lumbar intervertebral disc degeneration is high. The dynamic load on the lumbar spine due to the postures and movements characteristic of baseball is suspected of aggravating LBP caused by degeneration, but the difference in batting action between players with and without degeneration is not known. The purpose of this study was to investigate the difference in batting motion in the presence and absence of lumbar disc degeneration (LDD). The subjects were 18 male baseball players belonging to the University League Division I: seven with disc degeneration and 11 without. The motion task analyzed tee batting. The items examined were the angles of rotation of shoulder, pelvis, hip, and twisting motion; rotation angular velocity; time to maximum angular velocity; and muscle activity potentials of the bilateral latissimus dorsi, erector spinae, multifidus, external oblique, internal oblique, rectus abdominis, and gluteus medius muscles; at each stage of batting action. There were significant differences between the shoulder and pelvis in rotation angle, time to maximum angular velocity, and muscle activity in the presence and absence of LDD, and in the time to maximum angular velocity between the shoulder and pelvis. We infer that these differences are characteristic of batting motion due to LDD.

Evaluation of the abdominal transverse muscle in individuals with low back pain: a literature review

Article

Aug 2022

João Rafael Rocha da Silva

Introduction: Low back pain is the leading cause of years lived with disability in the world. Despite the relevance of the subject in the literature, some authors have criticized and conducted studies without methodological criteria for the evaluation of the transverse abdominis muscle, creating a gap in knowledge and divergences in evidence-based practice. Objective: The aim of the study was to carry out a literature review, looking for studies that observed changes in the Transverse Abdominal muscle in individuals with low back pain. Methods: The following keywords were used as methodology: Low back Pain, Lumbago, Transverse Abdominal, Transversus Abdominis, Transverse Abdominals, In the following databases: Pubmed 137 studies, Web of Science 625 studies, Scopus 228 studies. Inclusion criteria: Studies that evaluated the Transverse Abdominal muscle in individuals with pain were selected for analysis of the results. Exclusion criteria: Studies that evaluated only healthy individuals, studies that addressed treatment or therapeutic intervention, studies conducted before 2016, duplications by authors, or those that did not use evaluation as methodology were excluded. Results: Finding a total of 990 studies, after elimination for duplication, 725 articles After being analyzed and selected by the inclusion and exclusion criteria, 18 studies were selected. Conclusion: The Transverse Abdominal muscle showed changes in its muscle thickness, neuromuscular activation, motor control, between healthy individuals and individuals with low back pain, being evaluated in different postures and populations. It is suggested that the evaluation of the transverse abdominal muscle should be performed in patients with low back pain, as an important dysfunctional diagnostic tool for these patients.

Effect of Progressive Postural Control Exercise Versus Core Stability Exercise in Young Adults with Chronic Low Back Pain: A Randomized Controlled Trial

Article

Full-text available

Dec 2022

Introduction: This study aimed to investigate the effects of progressive postural control exercise (PPCE) vs core stability exercise (CSE) in patients with chronic low back pain (CLBP). Methods: A total of 34 young-adult participants with CLBP were randomly assigned to two groups (the PPCE group and the CSE group). They received instructions for two different exercise training regimens persisting over 8 weeks. Before, after, and at 6 months after the intervention, the participants were evaluated on the basis of pain intensity (VAS), degree of dysfunction (ODI and RMDQ), contractility of transversus abdominis (TrA) and lumbar multifidus (MF), as well as the ability to control static posture. Results: There was no significant difference between the results of the PPCE group and the CSE group. At the 6-month follow-up after the 8-week treatment, the scores of VAS, ODI, and RMDQ in the two groups decreased significantly compared to before (p < 0.05). The percentage change in thickness of bilateral TrA and left MF (p < 0.05) was elevated and the sway area of center of pressure during static stance tasks with eyes opened (p < 0.05) was decreased in both groups. Conclusion: In the short term, PPCE provides positive effects similar to those of core stability exercise in patients with CLBP. The effective mechanism of PPCE might be the consequence of neuromuscular plasticity and adaptation adjustments. PPCE enriches the choices of treatment for CLBP. Clinical trial registration: The trial was registered at www.chictr.org.cn , identifier ChiCTR2100043113.

Is lumbopelvic motor control associated with dynamic stability during gait, strength, and endurance of core musculatures?: The STROBE study

Article

Full-text available

Nov 2022
MEDICINE

Core stability has been described as the product of motor control and muscular capacity of the lumbopelvic-hip complex. Because of the wide range of functions of the lumbopelvic-hip complex, the gold standard for evaluating core stability remains controversial. The Sahrmann core stability test (SCST), used in conjunction with the stabilizer pressure biofeedback unit (PBU), is widely applied to objectively evaluate core stability as this pertains lumbopelvic motor control. However, the association between such control and other elements of core stability including core strength, endurance, and dynamic stability during gait has not been well-studied. We investigated the relationships among the ability to control the lumbopelvic complex, core strength and endurance, and gait parameters. We compared lateral core endurance, hip strengths, and gait parameters (lateral oscillation of the center of mass (COM), the single support time, and the peak ground reaction force) between good and poor core stability groups, as determined by the SCST. In addition, logistic regression analysis was used to determine whether other core stability measures correlated with the core stability status defined by the SCST. Only lateral oscillation of the COM during walking differed significantly between the good and poor core stability groups and was a significant predictor of SCST core stability status. Lumbopelvic motor control, (as defined by the SCST), affects dynamic stability during gait, but not to the strength or endurance of the core musculatures.

ALTERED POSTURAL CONTROL STRATEGIES IN PEOPLE WITH CHRONIC LOW BACK PAIN: AN OVERACTIVE LATISSIMUS DORSI?

Article

Full-text available

Dec 2021

The aim of the research is to examine the possible alterations in the functioning of muscles in chronic low back pain (LBP). Method: In this prospective study 35 people were selected into LBP and control (C) groups after they had completed the Chronic Pain Grade Scale. 12 muscles were measured with surface electromyography during a functional balance task. Results: In rate of muscle recruitment significant increase was found, the LBP group recruited latissimus dorsi muscle (LD) to implement the movement task. During the functional task, the agonist muscles in the LBP group were not recruited as much as in the C group; however, the antagonist muscles were activated more frequently in the LBP group. The activity level of the agonist and stabilizer muscles was higher in the LBP group, whereas the activity level of antagonists was rather lower in the LBP group than in the C one. Conclusion: People with LBP recruit more antagonist muscles but use these muscles at a lower activity level. In the recruitment pattern, the role of LD seems to be dominant. Clinicians should consider the role of LD in LBP during the rehabilitation process. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Comparison of abdominal muscle activity with various verbal instructions and onset activity analysis during draw-in maneuver

Article

Full-text available

Aug 2022

Draw-in is a promising intervention for regaining isolated control of the transverse abdominis (TrA). Exercises to stimulate isolated contractions are needed; however, the appropriate methods are unclear. The objectives of this study were to examine how the muscle activity and muscle activity ratio of abdominal muscles change with various verbal instructions and to determine the onset of the abdominal muscles during drawin. The participants were 21 healthy men. TrA electromyography was performed using fine-wire electrodes, and the internal oblique (IO), external oblique (EO), and rectus abdominis (RA) were determined using surface electrodes. The participants performed seven abdominal exercises according to verbal instructions and isolated voluntary contraction of the TrA for more than 5 sec. The TrA showed higher activity in bracing. IO and EO activities were highest in bracing, whereas RA showed the highest activity in maximum bracing. TrA/IO and TrA/EO were not significantly different between conditions. The results of the onset activity analysis of the abdominal muscles during the draw-in maneuver showed that the TrA was significantly earlier than the other muscles. The activity ratios of TrA to IO and EO were highly individualized and did not differ according to the verbal instruction. Maximum draw-in showed more significant IO activity, and bracing showed co-contraction of the superficial and deep abdominal muscles. During draw-in, the TrA initiated the earliest activity among the abdominal muscles and then isolated activity for 1.1 sec.

The Effect of Abdominal Drawing-in Maneuver with Pressure Biofeedback Unit in Various Postures on Abdominal Muscle Contraction

Article

Jun 2022

Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions

Article

Full-text available

Aug 2022

Background Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles. Objective To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles. Methods In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles. Results AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < 0.01; Cohen's d = −1.13 to −2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position. Conclusion The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.

Effect of Myofascial Release Technique on Lumbar Fascia Thickness and Low Back Pain: A Clinical Trial

Article

Full-text available

Jul 2022

Introduction: This study aims to evaluate the effect of lumbar myofascial release (MFR) technique on pain and thickness of the lumbar fascia tissue in patients with non-specific low back pain. Materials and Methods: In this clinical trial, 20 subjects with non-specific low back pain were treated by MFR on the lumbar region at 4 sessions. Low back pain severity and thickness of the lumbar fascia tissue were assessed by ultrasonographic imaging before and after the intervention. Results: Subjects showed significant reduction in lumbar fascia thickness (P=0.000) and low back pain severity (P=0.000). Conclusion: The lumbar MFR technique is effective in patients with non-specific low back pain due to reducing the lumbar fascia thickness and low back pain.

Motor control of the spine in pregnancy-related lumbopelvic pain: A systematic review

Article

Jul 2022
CLIN BIOMECH

Background Some studies observed differences in motor control of the spine between women with pregnancy-related lumbopelvic pain and matched controls. Understanding alterations in spine motor control may help optimizing treatment in this population. The objective is to determine if there are differences in motor control of the spine in pregnant and post-partum women with and without pregnancy-related lumbopelvic pain. Methods Five databases were searched: MEDLINE, Embase, CINAHL, Web of Science and Evidence-Based Medicine Reviews (last search: February 4th 2021). Observational studies that compared motor control of the lumbopelvic spine (in terms of muscle activation [e.g. using EMG or ultrasound imaging] or kinematics) between women with pregnancy-related lumbopelvic pain and matched controls were included. Risk of bias was assessed with a modified version of STROBE statement for cross-sectional studies. No meta-analysis was performed. Finding Fifteen studies were included. Compared to matched controls, pregnant women with pregnancy-related lumbopelvic pain showed differences in lumbar spine kinematic during walking and lifting, although not consistent between studies. The only consistent results were higher transversus abdominis muscle activation during leg movements in post-partum pregnancy-related lumbopelvic pain. Differences in pelvic floor muscle function was inconsistent. Interpretation This systematic review identified multiple differences in motor control in pregnancy-related lumbopelvic pain population, predominantly in dynamic tasks. However, consistent differences in lumbopelvic spine motor control were rare. More studies are necessary to determine if motor control is different in pregnancy-related lumbopelvic pain to better understand alteration in motor control and to optimize the efficacy of rehabilitation treatments.

Motor Control: A Conceptual Framework for Rehabilitation

Article

Full-text available

Jul 2022

There is a lack of conceptual and theoretical clarity among clinicians and researchers regarding the control of motor actions based on the use of the term “motor control.” It is important to differentiate control processes from observations of motor output to improve communication and to make progress in understanding motor disorders and their remediation. This article clarifies terminology related to theoretical concepts underlying the control of motor actions, emphasizing how the term “motor control” is applied in neurorehabilitation. Two major opposing theoretical frameworks are described (i.e., direct and indirect), and their strengths and pitfalls are discussed. Then, based on the proposition that sensorimotor rehabilitation should be predicated on one comprehensive theory instead of an eclectic mix of theories and models, several solutions are offered about how to address controversies in motor learning, optimality, and adaptability of movement.

Comparison of Abdominal Muscle Activity Between the Abdominal Bracing Technique Emphasizing Inhalation and the General Bracing Technique and Hollowing Technique

Article

Jun 2022

Core training promises more than it can hold: A review of current literature and practical experience ... Kjernemuskeltrening lover mer enn det kan holde: En forsknings- og erfaringsbasert gjennomgang

Article

Jun 2022

Core training promises more than it can hold: A review of current literature and practical experience Introduction: Core training has a significant place in the training program of many athletes, from the recreational exerciser to the elite athlete. But does core training work as intended? Main section: In this article, the authors are critical to the assumptions that core training improves sports performance, while concurrently preventing injuries. Through a literature review and our experiences from working with elite athletes, we question the theoretical framework and documentation of the effects of this type of training, especially for athletes. Summary: Core training is not a defined nor specific training method; it is simply training of a group of muscles. In our opinion, core training has been given far too much importance for athletes at all levels, both as injury prevention and performance-enhancing measures.

Immediate effect of trunk flexion and extension isometric exercise using an external compression device on electromyography of the hip extensor and trunk range of motion of healthy subjects

Article

Full-text available

Jun 2022

Background Sacroiliac joints (SIJs) transmitted trunk load to lower extremities through the lumbopelvis. External compression devices across the SIJs could provide stability to the SIJs. A previous study established that using a device known as Active Therapeutic Movement version 2 (ATM®2) has been developed to improve pain and joint range of motion (ROM) in patients with LBP. However, no study has examined the physiological change in the muscle through ATM®2-based exercise thus far. This study aimed to determine the immediate effects of ATM®2 exercise on the contraction timing, back extension endurance, muscle fatigue, and trunk ROM of lumbar and lower limb muscles in healthy subjects. Methods Thirty-six healthy subjects (mean age = 23.16 ± 2.3) volunteered to participate in this study. Subjects were instructed to perform ROM test using sit and reach test, back extensor endurance test using Biering-Sorensen test, erector spinae (ES), lumbar multifidus (LM) fatigue and onset time of Gluteus maximus (GM) in prone hip extension using electromyography before and after trunk flexion and extension isometric exercises. Results The ROM in trunk flexion showed a significant increase of 7.9% after exercise compared to that before exercise (p < 0.05). Relative GM contraction onset timing significantly decreased after exercise (p < 0.05). The result of the Sorensen test after exercise showed a trend of increase in duration time. Muscle fatigue in the LM, however, showed a significant increase (p < 0.05), whereas muscle fatigue in the ES was reduced without statistical significance. Conclusions The results base on this study showed that exercise-based on ATM®2 is an effective exercise protocol with an effect on the biomechanics of healthy subjects. Clinical trial registration numbers KCT0006728. Clinical trial registration date: 09/11/2021.

A Comprehensive Review of Pain Interference on Postural Control: From Experimental to Chronic Pain

Preprint

Full-text available

May 2022

Motor control, movement impairment and postural control recovery targeted in rehabilitation could be affected by pain. The main objective of this comprehensive review is to provide a synthesis of the effect of experimental and chronic pain on postural control throughout the available literature. After presenting the neurophysiological pathways of pain, we demonstrated that pain, preferentially localized at low back or in the leg induced postural control alteration. While proprioceptive and cortical excitability seems modified with pain, spinal modulation assessment might provide new understanding of the pain phenomenon related to postural control. Literature highlight that the motor control of trunk muscles in patient presenting with low back pain could be dichotomized in two populations, where the first one over-activate trunk muscles, the second one underactivate trunk muscles, and both generating increase of tissues loading. Taking account all this findings , will help clinician to provide adapted treatment for managing both pain and postural control.

Immediate Effect of Trunk Flexion and Extension Isometric Exercise Using an External Compression Device on Electromyography of the Hip Extensor and Trunk Range of Motion of Healthy Subjects

Preprint

Full-text available

Dec 2021

Background: Sacroiliac joints (SIJs) transmitted trunk load to lower extremities through the lumbopelvic. External compression devices across the SIJs could provide stability to the SIJs. A previous study established that using a device known as Active Therapeutic Movement version 2 (ATM®2) has been developed to improve pain and joint range of motion (ROM) in patients with LBP. However, no study has examined the physiological change in the muscle through ATM®2-based exercise thus far. This study aimed to determine the immediate effects of ATM®2 exercise on the contraction timing, back extension endurance, muscle fatigue, and trunk ROM of lumbar and lower limb muscles in healthy subjects. Methods: Thirty-six healthy subjects (mean age=23.16±2.3) volunteered to participate in this study. Subjects were instructed to perform ROM test using sit and reach test, back extensor endurance test using Biering-Sorensen test, erector spinae (ES), lumbar multifidus (LM) fatigue and onset time of Gluteus maximus (GM) in prone hip extension using electromyography before and after trunk flexion and extension isometric exercises. Results: The ROM in trunk flexion showed a significant increase of 7.9% after exercise compared to that before exercise (p<0.05). Relative GM contraction onset timing significantly decreased after exercise (p<0.05). The result of the Sorensen test after exercise showed a trend of increase in duration time. Muscle fatigue in the LM, however, showed a significant increase (p<0.05), whereas muscle fatigue in the ES was reduced without statistical significance. Conclusions: The results base on this study showed a significant increase in the trunk ROM after trunk flexion and extension isometric exercise using an external compression device, while the relative contraction onset timing in the GM was significantly reduced. Furthermore, the muscle endurance test after exercise showed a trend of increase in the duration time with a decreasing trend in muscle fatigue in the ES. Exercise-based on ATM®2 is an effective exercise protocol with an effect on the biomechanics of healthy subjects. · Clinical trial registration numbers : KCT0006728 · Clinical trial registration date : 09/11/2021

Current Perspectives around Core Stability Training in the Sports Performance Domain

Thesis

Full-text available

Nov 2021

Introduction: Exercises designed to improve the function of the core are a centerpiece of many athletic training programs. Current core stability (CS) ideology, testing protocols, and training methods originated from research into low back pain, yet are commonly applied within the sports performance domain. CS is a controversial concept with significant debate around how effective core stability training (CST) is for athletic populations. The majority of CS exercises and assessments currently emphasize muscular endurance. This exclusive focus may not be appropriate when training or monitoring athletes involved in dynamic sporting activities. To improve our understanding on this topic, the goal of this thesis is to investigate current perspectives and viewpoints, relating to CS and CST, held by practitioners in the sports performance domain. Methods: An online questionnaire and semi-structured interview were performed to gather subjective data from industry experts and professionals working with athletes. Both studies were designed to understand current thoughts and opinions around three key themes; current understanding of CS, how CS is being monitored in practice, and how practitioners are training CS. Results: The online questionnaire was completed by 64 respondents, while 10 industry experts were interviewed. There was a lack of a universal language amongst industry professionals when describing CS and many differing opinions related to key CS concepts. An important finding was that very few practitioners are objectively assessing the core, with little consideration given to monitoring maximal core strength. It was found that nearly all participants implement direct CS exercises, however, opinions on how to best train the core varied significantly. The results of this thesis demonstrate wide ranging viewpoints and opinions related to CS and CST amongst industry professionals, despite over 30 years of related research. Discussion and Practical Implications: The findings from this thesis highlight the extent of divided industry perspectives. Specifically, five key areas were identified to improve our understanding in this area. The alignment of terminology and the development of an evidence-based CST framework are needed to streamline coaching practice. Maximal core strength is an underappreciated area and research exploring its relationship to athletic performance is desperately needed. Moreover, the development of cheap field tests to assess this quality are needed. Finally, longer term intervention studies are also required to substantiate the effectiveness of CS programs. Key Words: Core Stability, Core Stability Training, Trunk, Lumbopelvic Control

A Preliminary Study on the Equivalence between Standing Back-Extension and Superman Training in Lumbar Multifidus Exercise

Article

Full-text available

Mar 2022

Objective: To explore the equivalence of an easier and more convenient lumbar multifidus (LM) muscle exercise pattern among standing back-extension, static standing, and superman training. Methods: A total of 26 healthy young volunteers were enrolled, including 14 males and 12 females, aged from 22 to 44 years with an average of 31.77 ± 7.06 years. Ultrasonography was used to measure the thickness of the left LM of the transverse process of the L5 vertebra during static standing, static prone decubitus, standing back-extension, and prone superman training. In this study, measurement data were expressed as Mean ± SD and compared using the t-test. Results: The left LM thickness of the L5 vertebra was 2.92 ± 0.46 cm during static standing and 2.78 ± 0.39 cm during static prone decubitus, showing no statistical difference between the two groups (P > 0.05). The left LM thickness of the L5 vertebra was 3.16 ± 0.51 cm during standing back-extension and 3.33 ± 0.41 cm during the prone superman training, indicating no statistical difference between the two groups (P > 0.05). Conclusions: There is no significant statistical difference in the LM thickness between static standing and static prone decubitus and between standing back-extension and prone superman training, indicating the equivalence of the two methods in LM exercise, providing a simpler and easier way for clinical exercise of lumbodorsal muscles.

Exercise-Based Biopsychosocial Management of Chronic Low Back Pain

Thesis

Full-text available

Nov 2021

Mitchell Gibbs

Chronic low back pain carries a large global burden of disease. Currently, exercise is recognised as a key treatment for chronic low back pain. However, management of chronic low back pain presents exercise-based practitioners with numerous, confusing, and conflicting treatment options. Broadly, these options can be classified under biomedical or biopsychosocial treatment paradigms. An overarching problem within chronic low back pain literature is the understanding of if practitioners are applying best practice approaches, and if not, how this can be improved. Based on these evident gaps in our understanding of the management of chronic low back pain, this thesis investigated the following: How do exercise-based practitioners currently manage chronic low back pain, and what attitudes and beliefs underpin this management? What does a pragmatic biopsychosocial exercise-based approach to chronic low back pain look like, and what role does exercise play in this intervention? Can education targeted at current gaps in practice by exercise-based practitioners, combined with pragmatic understanding of biopsychosocial exercise prescription, improve clinical decision making? This thesis examined chronic low back pain at the level of the patient and of the practitioner. This thesis found exercise not to be a significant factor in the design of combined exercise and education interventions for chronic low back pain. This finding allows practitioners to move away from systemised approaches to exercise for chronic low back pain and explore prescriptions optimal for the individual patient, rather than optimal for back pain in general. However, this thesis also found practitioners with biomedical beliefs, even when concomitant with biopsychosocial beliefs, are less likely to apply these contemporary approaches. Indeed, targeted education does improve clinical decision-making through a reduction in biomedical beliefs, which increases the care provided to patients. This improvement in clinical decision-making through a reduction in biomedical beliefs, and no change to biopsychosocial, may suggest the relative importance of biomedical beliefs on approaches to chronic low back pain.

Effect of external lumbar supports on joint position sense, postural control, and postural adjustment: a systematic review

Article

Full-text available

Mar 2022

Purpose: To review the effects of external lumbar supports on various aspects of sensorimotor function including joint position sense (JPS), postural control, anticipatory postural adjustments (APAs), and compensatory postural adjustments (CPAs). Methods: A systematic literature search was performed in PubMed, EMBASE, Scopus, Ovid, Cochrane library, and Web of Science. Two reviewers selected studies which assessed the effect of lumbosacral orthosis or kinesio-tape on JPS, postural control or APAs/CPAs in subjects with and without low back pain (LBP). The methodological quality of included studies was assessed using a modified version of Downs and Black's checklist. Results: Findings demonstrated moderate effects of lumbosacral orthosis on specific aspects of sensorimotor control including JPS and to a lesser extent standing stability. These domains were not or minimally affected by application of kinesio-tape. Both orthosis and kinesio-tape had negligible effects on APAs and CPAs. Conclusions: The positive effects of lumbar orthosis on JPS or postural control were mostly observed in conditions where sources of proprioceptive feedback are impaired (such as LBP) or absent (standing with eyes closed on an unstable surface). However, evidence does not prove significant positive effects for the application of kinesio-tape to improve sensorimotor control.IMPLICATIONS FOR REHABILITATIONWearing lumbar orthosis leads to an improvement in joint position sense.Postural stability seems to be affected to some extent by utilizing lumbar orthosis.Clinicians can administer orthosis to improve sensorimotor adaptation, especially in conditions with poor proprioception.Kinesio-tape had negligible effects on all domains of sensorimotor control.Improvement of sensorimotor function as a result of application of kinesio-tape is questionable.

The effect of the body type on the electrical activity of the abdominal muscles during gait

Article

Full-text available

Mar 2022

Introduction: muscle performance could be influenced by physical features of the body. The purpose of this study was to investigate the effect of the body type on the electrical activity of the abdominal muscles during gait. Materials and Methods: Heath Carter somatotype method was used to determine body type. The performance of rectus abdominis muscle (RA), internal oblique muscle (IO) and external oblique muscle (EO) was recorded. The mean and the standard deviation were used for description of the data and ANOVA and post-hoc Tukey were utilized for comparison between three body types at the significance level of P<0.05. Results: The results showed that there is a significant difference in the root mean square (RMS) of EO and IO and the average percentage of that is higher in ENDO in comparison with the other two types. Also, the duration of electrical activity (DEA) was only significant for the IO between the endomorphs (ENDO), the mesomorphs (MESO) and the ectomorphs (ECTO) and its mean was higher for the ENDO. Discussion: According to the findings of the study, we could claim that the difference in the performance pattern of the muscles in the abdominal area during gait is influenced by body type.

A Scientometric Review of Reality Capture Applications in The Built Environment.

Conference Paper

Full-text available

Dec 2021

Godfred Fobiri

The drive of digital evolution in 4IR require the availability of digital data. The digital revolution in the Global construction industry is made possible by Building information modeling (BIM). The success of BIM implementation relies on digital data. Reality Capture (RC) has made digital data collection possible by using Laser scans and Photogrammetry. RC can provide real-time, up-to-date digital data of site conditions to enhance project performance evaluation. This paper explores the extent of research on reality capture applications in the Built Environment to establish the roadmap for further investigation. A peer-reviewed journal paper of 193 relating to reality capture applications was retrieved through a bibliometric analysis from the Scopus database and analyzed using Scientometric techniques and a VOSViewer software. The study reveals that RC has been extensively applied to digital documentation of cultural heritage buildings, accuracy assessment, project monitoring, building surveys, Construction site progress monitoring, Quality control assessment, etc. However, there is no empirical evidence on Health & Safety, Cost, Labor productivity, and material monitoring. This area has a more outstanding contribution to the project performance, and more research is imperative to explore RC usage. There is a high degree of disparity among researchers in the study area, and there is the need for deliberate attempts to collaborate research for knowledge transfer and sharing. Low research interest in Africa researchers has contributed to the low adoption in the Africa continents. This research has a high level of usefulness to researchers and policymakers when designing areas for further RC applications. And also enhanced project performance delivery in the 4IR. The study has given the research trend on RC applications and future research directions.

Effects of two training programs on health variables in adults with chronic low back pain: a randomized clinical trial

Article

Jan 2022

Aim: To analyze the effects of two training programs on health variables in adults with low back pain (LBP). Methods: Thirty-eight adults were randomly divided into three groups: resistance training (RG); resistance training with core training (RCG) and control (CG). Results: There were reductions in body mass index (BMI) in RG and RCG, waist circumference in RG and RCG, pain in RG, RCG and CG, CK in RCG, stress in RG and RCG, functional deficiency in RG and RCG and increases in trunk flexor and extensor strength in the RG and RCG. Conclusion: Resistance training, with or without core training exercises, reduced the levels of LBP, functional disability, stress and CK, and increased the strength of trunk flexors and extensors. Trial registration: Brazilian Clinical Trials Registry: ReBEC (RBR-5khzxz)

Effect of varied biofeedback training on transverse abdominis muscle thickness in nonspecific low back pain

Article

Full-text available

Jan 2022

Aim. The dynamic stability of the low back region is governed by the core musculature, namely the transverse abdominis (TrA) and multi_idus. Most rehabilitation professionals believe that selective activation training of the TrA can decrease symptoms in individuals with non‑speci_ic low back pain (NSLBP). In this study we have aimed to analyze the effects of varied biofeedback training of the transverse abdominis muscle on the muscle thickness in LBP individuals. Materials & Methods. Thirty‑four LBP individuals were randomly allotted to varied biofeedback training and core muscle exercise groups for three weeks. The transverse abdominis muscle thickness at rest and during the abdominal drawing‑in maneuver (ADIM) and the TrA activation ratio were measured as outcomes using ultrasonography. Results. Varied biofeedback training for three weeks resulted in a signi_icant increase in the thickness (cm) of the transverse abdominis at rest (0.41 ± 0.06) and abdominal drawing‑in maneuver (0.54 ± 0.05). There was no significant change in the transverse abdominis contraction ratio between the groups. Conclusion. Varied biofeedback training of the transverse abdominis was found to be effective in improving the thickness of the transverse abdominis in the treatment of non‑specific lower back pain. This above _inding may have positive clinical implications in individuals with non‑speci_ic lower back pain

Experimental Study on Construction Planning Through 4D BIM-based Virtual Reality for Light Steel Framing Project

Conference Paper

Full-text available

Dec 2021

The construction industry has actively attempted to tackle the low-productivity issues arising from inefficient construction planning. With new emerging technologies, there is a need to comprehend how construction practitioners perceive the functionality of technology integration in construction planning. This study intended to uncover unique experimental findings by integrating 4D-Building Information Modelling to Virtual Reality (VR) technology during construction planning among construction professionals at Light Steel Framing (LSF) projects in Malaysia. The building industry participants were invited to provide inputs on two different construction planning methods: the conventional and innovative methods. The conventional method involved the participants using traditional platforms such as 2D computer-aided design (CAD) and physical visualisation to complete construction planning-related tasks. Comparatively, the participants need to finish the same tasks but using more innovative platforms such as 4D BIM and a virtual reality (VR) environment. A Charrette Test Method was used to validate the findings, highlighting an improvement in usability (+10.3%), accuracy (+89.1%), and speed (+30%) using 4D BIM with VR compared to the conventional paper-based method. The findings are also validated by a paired t-test, which is supported by the rationality of the same findings. This new blend of technologies—combining 4D BIM and VR in industrialised construction projects—potentially directs future initiatives to drive the efficiency of construction planning in the building lifecycle.

Low Back Pain and Functional Lumbar Segmental Instability

Article

Jan 2022

Simone Molinelli

Industry4.0 Applications for Full Lifecycle Integration of Buildings Proceedings of the 21st International Conference on Construction Applications of Virtual Reality

Book

Full-text available

Jan 2022

Welcome to the 21st International Conference on Construction Applications of Virtual Reality (CONVR 2021). This year we are meeting on-line due to the current Coronavirus pandemic. The overarching theme for CONVR2021 is " Industry4.0 Applications for Full Lifecycle Integration of Buildings". CONVR is one of the world-leading conferences in the areas of virtual reality, augmented reality and building information modelling. Each year, more than 100 participants from all around the globe meet to discuss and exchange the latest developments and applications of virtual technologies in the architectural, engineering, construction and operation industry (AECO). The conference is also known for having a unique blend of participants from both academia and industry. This year, with all the difficulties of replicating a real face to face meetings, we are carefully planning the conference to ensure that all participants have a perfect experience. We have a group of leading keynote speakers from industry and academia who are covering up to date hot topics and are enthusiastic and keen to share their knowledge with you. CONVR participants are very loyal to the conference and have attended most of the editions over the last eighteen editions. This year we are welcoming numerous first timers and we aim to help them make the most of the conference by introducing them to other participants.

Immediate Effect of Trunk Flexion And Extension Isometric Exercise Using An External Compression Device On Electromyography of The Hip Extensor And Trunk Range of Motion Of Healthy Subjects

Preprint

Full-text available

Dec 2021

Background: Low back pain (LBP) is a very common symptom experienced by individuals across all age groups. Previous study established that using a device known as Active Therapeutic Movement version 2 (ATM®2) has been developed to improve pain and joint range of motion (ROM) in patients with LBP. However, no study has examined the physiological change in the muscle through ATM®2-based exercise thus far. This study aimed to determine the immediate effects of ATM®2 exercise on the contraction timing, back extension endurance, muscle fatigue, and trunk ROM of lumbar and lower limb muscles in healthy subjects. Methods: Thirty-six healthy subjects (mean age=23.16±2.3) volunteered to participate in this study. Subjects were instructed to perform ROM test using sit and reach test, back extensor endurance test using Biering-Sorensen test, erector spinae (ES), lumbar multifidus (LM) fatigue and onset time of Gluteus maximus (GM) in prone hip extension using electromyography before and after trunk flexion and extension isometric exercises. Results: The ROM in trunk flexion showed a significant increase by 7.9% after exercise compared to that before exercise (p<0.05). Relative GM contraction onset timing significantly decreased after exercise (p<0.05). The result of the Sorensen test after exercise showed a trend of increase in duration time. Muscle fatigue in the LM, however, showed a significant increase (p<0.05), whereas muscle fatigue in the ES was reduced without statistical significance. Conclusions: The results base on this study showed a significant increase in the trunk ROM after trunk flexion and extension isometric exercise using an external compression device, while the relative contraction onset timing in the GM significantly reduced. Furthermore, the muscle endurance test after exercise showed a trend of increase in the duration time with a decreasing trend in muscle fatigue in the ES. Exercise based on ATM®2 is an effective exercise protocol with an effect on biomechanics of healthy subjects. This exercise may be suitable in clinical practice for patients with LBP, for which long-term effects can be expected.

Effectiveness of the core stabilisation exercise on floor and Swiss ball on individual with non-Specific low back pain

Article

Full-text available

Jul 2016

Objective and Background: We all need the good core stability program to prevent low back pain, to initiate limb movement, for proper utilization of the muscle forces and to enhance performance. And also, there is lack of literature support in normal subject and the benefits of core endurance in everyday activities. To compare the effectiveness of core stability exercise on floor and core stability exercise on Swiss ball in reducing pain and disability. Method: A group of 30 subjects were selected for the study and randomly divided into two equal groups of 15 each. All subjects were selected between the age group of 30-45 years. The groups A subjects were asked to perform core stability exercises on Swiss ball and group B performed same exercises on floor. Both groups were asked to perform 4 types of core stability exercises for 3 days in weeks, for 4 weeks. The pain the disability were compare assessed Pre and Post intervention using VAS and ODI respectively. Result: Two groups were compared for the difference between the post test score of group A and group B were analysed by independent 't'test and the result showed that there was statistically significant difference between the post mean VAS scores values for Group A (Swiss ball) was 2.267 which was lesser than the post-test VAS mean value for Group B (floor mat) 2.933. The p value was > 0.05.Result for post mean ODI scores values between two group also showed statistically significant difference with value for Group A (Swiss ball) was 15.733 which was lesser than the post-test ODI mean value for Group B (floor mat) 24.067. The p value was > 0.05. Conclusion: The Swiss ball exercise showed statistically significant improvement in reducing back pain and disability when compare to the core stability exercise on the floor. Thus, performing core stability exercise on a Swiss ball reduces pain and disability significantly compared to core stability exercise on floor among mechanical low back ache subjects.

The Relationship Between Core Stability & Squat Ratio in Resistance-Trained Males

Article

Full-text available

Apr 2017

Background: The lumbopelvic-hip complex, also referred to as the “core”, is composed of every muscle between the knees and sternum. The back squat (BS) and front squat (FS) are both staple exercises that challenge the core in different ways. Possessing a properly balanced squat ratio (SR = 1-RM FS/1-RM BS; 1-RM = one-repetition maximum) could lead to a more stable core. Objective: This study attempted to determine if there was a meaningful relationship between the SR and core strength (CS) in resistance-trained males. If a strong relation exists between the SR and CS, strength and conditioning professionals would have a readily available assessment tool for examining CS by simply viewing the SR. Method: Twenty-one resistance-trained males (age = 28.3 ± 6.2 years; body mass = 93.1 ± 13.1 kg; height = 181.9 ± 7.6 cm; weight training experience with FS & BS = 6.4 ± 3.7 years) performed CS tests (flexor endurance, extensor endurance, prone bridge, left side-bridge, and right side-bridge), along with a 1-RM in the BS and FS. An aggregate of the CS test times (CSA) was also calculated for comparison with the SR. A Pearson product-moment correlation coefficient (r) was used to compare the SR with the CS tests and the CSA. Results: The CS test results were as follows (secs): flexor endurance 228.2±93.0, extensor endurance 137.0±28.2, prone bridge 166.7±51.3, left side-bridge 97.36±31.0, right side-bridge 100.2±28.3, and CSA 729.8±165.4. The 1-RM BS, 1-RM FS, and SR were: 157.5±29.7 kgs, 132.2±24.3 kgs, and 0.84±0.06 respectively. A moderate correlation was found between total CSA and the SR (r = 0.50, CD2 = 0.25, p<0.05). In addition, a moderate correlation was found between the prone bridge test and the SR (r = 0.49, CD2 = 0.24, p<0.05). A very strong positive correlation was also found between 1-RM BS and 1-RM FS (r = 0.93, CD2 = 0.86, p<0.05). Conclusions: The results of this study suggest that the CSA and prone bridge test are moderately related to the SR. However, the low coefficient of determination between the SR and CS times suggests that the SR is not a suitable estimate of CS. The very strong relationship between the 1-RM FS and 1-RM BS provides strong evidence for the interchangeable use of these modalities within a resistance training protocol.

The Development of a Musculoskeletal Profiling Tool to Guide Entry into Classical Ballet

Thesis

Oct 2022

Moira McCormack

The classical ballet profession requires both athleticism and artistry in a professional dancer with a physique that satisfies the aesthetic demands of the artform. Intensive training starts very young in vocational schools, but injury rates and attrition are high. Based on the consensus of a modified Delphi Survey sent out internationally to enquire about the most frequently selected attributes in the professional dancer, a battery of musculoskeletal assessment tests, some already in use, was selected. A focus group of experts was consulted to advise on suitability for inclusion in the audition profile prior to entry into vocational training. Fourteen range of movement (ROM) and functional movement control (FMC) tests were trialled on eighteen preprofessional ballet students (16 – 17 years) who had newly entered training. Three experienced physiotherapists conducted a repeated assessment, and reliability studies were carried out. Intra- and inter-rater reliability was calculated. The intraclass correlation coefficient (Model 3,1), standard error of measurement and minimal detectable change were used to calculate the intra-rater reliability. The continuous measures were also divided into categories and the alpha coefficient was used. The filmed FMC tests were scored, and the Kappa coefficient was calculated. Intra-rater reliability was moderate to excellent for ROM (ICC = .614 - .970) and substantial to excellent for the FMC (Cohen’s kappa = .670 – 1.000). The inter-rater reliability for hip rotation reached moderate acceptability only on the right (ICC = .515 - .622) and spinal extension in the second round (ICC = .584). When continuous measurements were categorised and the Alpha Coefficient was used, hip rotation was acceptable on both sides and both rounds (.616 - .856). For spinal extension the Alpha Coefficient was acceptable at .748. The inter-rater reliability of the three FMC tests was acceptable (.449 - .820) but the ballet technique-based tests resulted in low agreement with Raters 1 and 3 only, reaching moderate agreement (.410 - .654). The modified plank test was fair to moderate (.347 - .471) in spite of excellent intra-rater reliability (.838 – 1.000). The use of categories when measuring ROM is recommended to improve agreement between raters. Scoring functional movement requires practise by therapists to improve reliability, and familiarity with technical movements in ballet requires physiotherapists to develop specialist skills. Standardised, reliable tests are recommended to capture each physique and its particular combination of attributes, including spine, hip and plantarflexion. Decision making at audition can be supported and facilitated.

Comparison of core stabilization, theraband resistance and combined training on functional endurance and postural control in male patients with multiple sclerosis

Article

Full-text available

Feb 2015

Background and Objective: Multiple sclerosis (MS) is one of the most common diseases in the central nervous system, caused by damage to myelin sheath. This study was done to compare the effect of eight weeks of core stabilization, theraband resistance and combined training on functional endurance and postural control in male patients with MS. Methods: In this quasi-experimental study, 40 male patients with MS were non- randomly divided into three experimental and one control groups (each group, n = 10, age range 25 to 35 years, BMI between 20 and 25, and physical disability scale of 1 to 5.4). Core stabilization, theraband resistance and combined training, balance berg test and 6-minute walk test were performed in order to exercise protocols. Results: Capacity movement and postural control were significantly improved in experimental groups in comparison with control group (P<0.05). The most variability was related to the combination of training program. Conclusion: Eight weeks of core stabilization, theraband resistance and combined training improves functional endurance and postural control in men with MS. Keywords: Multiple sclerosis, Core stabilization, Theraband resistance, Functional Endurance, Postural control

Paraspinal muscles

Chapter

Jan 2022

As the lumbar spine is relatively unstable compared to the thoracic region, it has been hypothesized that spinal stability relies on the proper functioning of the active (muscle), passive (vertebrae, discs, and ligaments), and neural subsystems (peripheral and central nervous systems). Dysfunction in any of the three subsystems may affect the control of spinal stability and increase the risk of injury if the remaining subsystems cannot compensate successfully. Paraspinal muscles play an important role in maintaining spinal stability and mobility. Research has shown that altered morphology or function of paraspinal muscles is closely related to structural (e.g., scoliosis) or clinical (e.g., low back pain, LBP) problems of the spine. Given technological advancements, clinicians can use various types of medical imaging to examine the morphological changes in paraspinal muscles, which may have the potential to inform clinical decision-making (e.g., selection of treatments or prediction of future clinical outcomes). This chapter provides a brief overview of the (1) anatomy and function of key paraspinal muscles; (2) medical imaging of paraspinal muscles; (3) factors affecting the morphometry of paraspinal muscles; (4) relationship between paraspinal muscle morphometry and spinal degeneration; (5) relationship between paraspinal muscle and LBP or LBP-related disability; (6) effects of exercises on paraspinal muscle morphometry; and (7) clinical implications and future research directions.

Neuromuscular Consequences of Lumbopelvic Dysfunction: Research and Clinical Perspectives

Article

Jul 2022

Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.

Investigation of the relationship between the clinical evaluation results of lumbar region muscles with cross-sectional area and fat infiltration

Article

May 2022
J BACK MUSCULOSKELET

Background: The relationship between the endurance of the lumbar paraspinal muscles and morphological changes needs to be clarified. In this context, the importance can be revealed of increasing the endurance level of the paraspinal muscles in the prevention and treatment of low back diseases. Objective: The aim of this study was to examine the relationship between the clinical evaluation results of the cross-sectional area (CSA) and fat infiltration of the lumbar deep paraspinal muscles. Methods: The study included 37 patients with mechanical low back pain (mechanical), 41 patients with lumbar hernia without root compression (discopathy) and 36 healthy individuals as a control group. The functional status of the lumbar deep paraspinal muscles was evaluated clinically with muscle endurance tests. The fat infiltration and CSA of the muscles were evaluated on axial MRI sections at the L3-S1 level. Results: The mean values of the prone bridge, Biering-Sorenson, and trunk flexion tests were seen to be highest in the control group and lowest in the discopathy group (p< 0.001). In all tests, the longest test period was obtained at < 10% fat infiltration and the shortest at > 50% fat infiltration. It was observed that as the amount of fat infiltration of the muscles increased, the test times were shortened. There was no significant relationship between the endurance level and the CSA of the groups. Conclusion: The study results demonstrated that the endurance of the paraspinal muscles is associated with the fat infiltration of the muscles. In patients with chronic low back pain, information about muscle morphology and degeneration can be obtained with simple endurance tests without the need for further measurements. On clinical examination, a weak endurance level of the paraspinal muscles indicates the presence of a low back problem and an increase in the amount of fat infiltration.

Feedforward co-activation of trunk muscles during rapid shoulder movements

Article

Full-text available

May 2022

Background Shoulder movements that involve unilateral and bilateral flexion, extension, abduction, and asymmetrical flexion-extension cause the activity of trunk muscles. There has not been a fixed consensus on the onset of deep trunk muscle activities including the psoas major (PM), quadratus lumborum (QL), transversus abdominis (TrA) and lumbar multifidus (MF) during shoulder movements. The purpose of this study was to measure the onset of electromyographic activity of the deep trunk muscles during rapid shoulder movements and clarify the coordinated activity pattern of the deep trunk muscles during 11 shoulder movements. Methods Thirteen men participated in this study. The onsets of activity of the right deep trunk muscles (PM, QL, TrA, and MF) were measured using fine-wire electrodes and those of the right and left deltoid (anterior, middle, and posterior) and right superficial trunk muscles (rectus abdominis [RA], external [EO], and internal oblique [IO]) were measured using surface electrodes as participants performed six types of unilateral, three types of bilateral, and two types of asymmetrical rapid shoulder movements. We defined feedforward activation as onset of activity of trunk muscle before or within +50 ms onset of the deltoid muscle, and feedback activation as that after +50 ms. A one-way analysis of variance was performed to compare the onset of activity of each muscle during each shoulder movement. Results The mean onset of activity of the PM (26.0 ms), QL (13.1 ms), TrA (-19.7 ms), and MF (20.4 ms) muscles demonstrated feedforward activation during left shoulder flexion. The onset of activity of the TrA (1.6 – 48.7 ms), RA (-1.7 – 17.3 ms), and EO (5.6 – 40.8 ms) muscles demonstrated feedforward activation during left, right, and bilateral shoulder extension. The onset of activity of the PM (22.9 ms), QL (23.0 ms), TrA (18.9 ms), and EO (15.4 ms) demonstrated feedforward activation during left shoulder abduction, while that of the IO (4.4 – 10.9 ms) only demonstrated feedforward activation during right and bilateral shoulder abduction. The onset of activity of the TrA (-27.6 ms), IO (-23.9 ms), MF (33.4 ms), and EO (-17.2 ms) demonstrated feedforward activation during left shoulder flexion-right shoulder extension and left shoulder extension-right shoulder flexion, respectively. Conclusions Rapid shoulder movements occur with coordinated muscle activation of the deep trunk muscles depending on the direction of shoulder movements. Feedforward activation of single or combined deep trunk muscles may facilitate rapid shoulder movements.

Correlation between Pain, Disability and Levels of Disc Herniation in Michigan State University Grade-3 Disc Prolapsed Patients using Magnetic Resonance Imaging: A Cross-sectional Study

Article

Jan 2022

Introduction: Sciatica is considered as a pain with radiation from the back to the dermatome of the nerve root which gets compressed. Clinical decision making for the diagnosis and treatment of the patients with sciatica need the support from the imaging of the spine. Magnetic Resonance Imaging (MRI) is the best modality for screening the spine. Aim: To identify the relationship between pain, disability and levels of disc herniation in grade-3 disc prolapsed patients. Materials and Methods: The present study was a cross- sectional study, which was conducted in the King Khalid Hospital, Hail, Saudi Arabia from November 2019 to May 2020. In this study, 57 patients were included and their consent was obtained. Patients reported their intensity of back and leg pain in Visual Analogue Scale (VAS) and recorded their disability in the Roland Morris Disability Questionnaire (RMDQ-Arabic version). Clinical examination of the spine and the lower extremity was done, followed by MRI for all the patients. The degree of the disc displacement and nerve root compression was graded according to the Michigan State University (MSU) classification of disc herniation. Documented data was statistically analysed using Statistical Package for the Social Sciences (SPSS) 20.0 version with the Pearson’s correlation. Results: Correlation between the pain intensity (VAS), Functional Disability (RMDQ) and grade-3 disc herniation in MRI were measured with Pearson correlation coefficient. Grade-3 disc herniation had weak correlation with pain intensity (r= -0.147) and also with functional disability (r= 0.155). In these patients, pain intensity and functional disability also showed weak correlation disability (r=0.293). Conclusion: Level of the disc herniation shows weak correlation with both intensity of pain and functional disability; thus, it is advisable to correlate the clinical symptom of the patients with MRI to decide the therapeutic intervention.

Motor skill training versus strength and flexibility exercise in people with chronic low back pain: Preplanned analysis of effects on kinematics during a functional activity

Article

Jan 2022
CLIN BIOMECH

Background People with chronic low back pain display the altered movement pattern where the lumbar spine moves more readily into its available range of motion relative to other joints. A logical approach to treatment, therefore, would be to improve this pattern during functional activities. Methods 154 participants were randomized to receive 6 weeks of motor skill training or strength and flexibility exercise. Participants in the motor skill training group received person-specific training to modify their altered movement pattern during functional activities. Participants in the strength and flexibility group received exercises for trunk strength and trunk and lower-limb flexibility. At baseline, post-treatment and 6-months after treatment participants performed a test of picking up an object using their preferred pattern. Three-dimensional marker co-ordinate data were collected. A mixed-model repeated measures analysis of variance was used to examine the treatment group and time effects. Findings Motor skill training: Baseline early excursion values [mean (confidence interval)] were as follows: knee = 11.1°(8.0,4.1), hip = 21.2°(19.2,23.1), lumbar = 11.3°(10.4,12.3). From baseline to post-treatment significant improvements in early excursion included: knee = +18.6°(15.4,21.8), hip = +10.8°(8.8,12.8), and lumbar = −2.0°(−0.1,-4.0). There were no significant changes from post-treatment to 6-month follow-up. Strength and flexibility exercise: Baseline early excursion values were as follows: knee = 8.9°(5.8,11.9), hip = 20.8°(18.9,22.8), and lumbar = 11.2°(10.3,12.2) early excursion. There were no significant changes for knee, hip, and lumbar early excursion. Interpretation Motor skill training was more effective than strength and flexibility exercise at changing and maintaining change to the altered movement pattern during a functional activity test of picking up an object.

Comparison of Abdominal Muscle Activation During Lifting with Stabilization Method

Article

Nov 2021

The Stabilizing System of the Spine. Part I. Function, Dysfunction, Adaptation, and Enhancement

Article

Full-text available

Jan 1993
J Spinal Disord

Manohar M Panjabi

Presented here is the conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems. The vertebrae, discs, and ligaments constitute the passive subsystem. All muscles and tendons surrounding the spinal column that can apply forces to the spinal column constitute the active subsystem. The nerves and central nervous system comprise the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals, and directs the active subsystem to provide the needed stability. A dysfunction of a component of any one of the subsystems may lead to one or more of the following three possibilities: (a) an immediate response from other subsystems to successfully compensate, (b) a long-term adaptation response of one or more subsystems, and (c) an injury to one or more components of any subsystem. It is conceptualized that the first response results in normal function, the second results in normal function but with an altered spinal stabilizing system, and the third leads to overall system dysfunction, producing, for example, low back pain. In situations where additional loads or complex postures are anticipated, the neural control unit may alter the muscle recruitment strategy, with the temporary goal of enhancing the spine stability beyond the normal requirements.

The Spine as an Arch A New Mathematical Model

Article

Full-text available

Apr 1989

Richard Aspden

A new model is presented for the static behavior of the human spine that considers it to work as an arch rather than the traditional view of a cantilever. This theory is based on limit criteria, derived from plasticity theory, which determine bounds within which the structure is mechanically stable and thereby enables the prediction of failure when these criteria are not satisfied. It is shown that theorems developed for the plastic analysis of masonry arches can be simply adapted for the spine. An analysis is performed of three postures and associated loads described in the literature. The forces and intradiscal pressures are calculated and shown to be in good agreement with published measurements. The results show that compressive stresses in the spine are not as high as was previously calculated and that the curvature of the spine is necessary for its load-bearing function. Preservation of the lumbar lordosis, in conjunction with intra-abdominal pressure, strengthens the spine and is crucial to protect the spine from injury when lifting heavy loads.

The Abdominal Mechanism

Article

Full-text available

Jun 1985

The abdominal mechanism, utilizing intraabdominal pressure, has been described and numericized. Simulations show that the lumbodorsal fascia under control of the abdominal muscles contributes to reduce the stress at the intervertebral joint. The musculature of the lumbar spine is of primary importance in the control of the efficiency of the spinal mechanism. The system of loading, which results in observable physiologic response, maintains the compressive load at virtually 90 degrees at the bisector of the disc for all weights and all angles of forward flexion.

The Optimum Spine

Article

Full-text available

Jul 1986

System theory is used to describe the mechanism of the lumbar spine. The role of the spine in vertebrate evolution is presented. The importance of the intervertebral joint for the survival of the species is shown to be crucial. The mechanical behavior of the joint is derived, and from this the corresponding spinal motion and muscular responses is calculated. It is shown that physiologic behavior implies that the stress at the intervertebral joints is equalized and minimized. From this simple condition, the motion of the spine in the sagittal plane is calculated. From the analysis of sagittal plane motion together with a knowledge of the energy transfer through the intervertebral joint, a new theory of locomotion is derived. This theory of locomotion differs in important respects from current theories, but nevertheless explains available experimental data. This unified theory of the function of the human spine permits the determination of the level of safe loads that can be lifted and transported. It predicts the conditions of load transfer through a joint. It proposes a new approach to the mechanism of arthritis and to the repair of fractures.

Trunk loading and expectation

Article

Full-text available

Apr 1987

Much of the epidemiological literature has reported that there is a link between sudden unexpected load handling and the risk of a low back injury. However, few biomechanical studies have investigated the effect of this type of loading on trunk muscular response. An experiment was performed to test the hypothesis that sudden unexpected loads would create excessive forces upon the trunk due to the overcompensation of the trunk muscles, and to quantify the degree of overcompensation. Twelve male subjects were asked to hold a box in a static lift position while weights ranging from 2-27 to 907kg were dropped into the box from a constant height. Under some conditions (expected) the subjects were permitted to observe the weight drop while under other conditions (unexpected) the subjects were deprived of visual and auditory cues during the weight drop. Several components of the trunk response were observed. Mean muscle forces for the unexpected condition exceeded those in the expected condition by nearly two-and-a-half times, and peak muscle forces in the unexpected condition were on average 70% greater. In addition, the unexpected condition produced longer periods of force exertion, as well as more rapid increases in trunk force development. Generally, it was found that during sudden unexpected loading the trunk response resembled an expected loading of twice the weight value. These findings may provide guidelines for work situations where unexpected loading conditions are common.

The influence of sudden perturbations on trunk muscle activity and intra abdominal pressure while standing

Article

Full-text available

Feb 1994

Unexpected ventral and dorsal perturbations and expected, self-induced ventral perturbations were delivered to the trunk by suddenly loading a vest strapped to the torso. Six male subjects were measured for intra-abdominal pressure (IAP) and intra-muscular electromyography of the transversus abdominis (TrA), obliquus internus abdominis (OI), obliquus externus abdominis (OE) and rectus abdominis (RA) muscles. Erector spinae (ES) activity was recorded using surface electromyography. Displacements of the trunk and head were registered using a video-based system. Unexpected ventral loading produced activity in TrA, OI, OE and RA, and an IAP increase well in advance of activity from ES. Expected ventral loading produced pre-activation of all muscles and an increased IAP prior to the perturbation. The TrA was always the first muscle active in both the unexpected and self-loading conditions. Of the two ventral loading conditions, forward displacement of the trunk was significantly reduced during the self-loading. Unexpected dorsal loading produced coincident activation of TrA, OI, OE, RA and ES. These results indicate a response of the trunk muscles to sudden expected and unexpected ventral loadings other than the anticipated immediate extensor torque production through ES activation. It is suggested that the increase in IAP is a mechanism designed to improve the stability of the trunk through a stiffening of the whole segment.

Intra-abdominal pressure changes during natural movements in man

Article

Aug 1978

The weight of the upper part of the trunk is partially transmitted to the pelvis via the vertebral column. If the muscle walls around the abdominal cavity are contracted, a high pressure can be generated within the cavity (greater than 200 mmHg). The abdominal space can them transmit part of weight to, e.g., the upper part of the body, Intra-abdominal pressure recordings have been performed during locomotion and other natural movements with intragastric pressure recordings. With each step, there is a phasic variation in pressure, with its peak coinciding with that of the peak vertical force exerted by the leg against the ground. The peak values increase progressively with the speed of walking/running up to a mean of 38 mmHg and with trough values of 16 mmHg. The phasic variations with each step is due to a phasic activation of the abdominal muscles, with an EMG activity starting 50 ms or more before foot contact. If an extra load is put on the back, the posture changes and at the highest speed of running the pressure values are significantly higher than without this additional load. After a jump down from a moderate height of 0.4 m, the average increase is 89 mmHg and can often exceed 100 mmHg. These pressure changes are large and will presumably act to unload the spine under the prevailing biomechanical conditions and, in addition, there will no doubt be an effect on the circulatory system.

Electromechanical delay in skeletal muscle under normal movement conditions

Article

Aug 1979

Electromechanical delays (EMD), the time from onset of EMG activity to change in acceleration or deceleration of the forearm, were studied in concentric and eccentric contractions of biceps and triceps brachii muscles. Horizontal flexion and extension movements were performed at varying speeds by 10 subjects. EMD time in concentric contractions for biceps was 41 +/- 13 ms and for triceps was 26 +/- 11 ms and was not influenced by the velocity of the movement. In eccentric contractions at the slow velocity the biceps EMD time was 38 +/- 13 ms and shortened to 28 +/- 10 ms at the faster velocity. The eccentric triceps EMD, however, was not significantly altered by movement velocity and averaged 30 +/- 7 ms. The data provided support for the hypothesis that stretching of the series elastic component, to a point where muscle force can be detected, is the primary determinant of the EMD phenomenon. However, there are complex interactions of the effects on EMD of muscle fiber type composition, whether the contraction is concentric or eccentric, and the velocity of the movement as well as possible gamma system influence. These complications require that consideration of electromechanical delay be made when phasic relationships between muscle force or joint torque generation from different muscles are inferred from EMGs.

Observation on Interabdominal Pressure and Patterns of Abdominal Intra-muscular Activity in Man

Article

May 1992

The aim was to investigate possible relationships between activities of the individual muscles of the ventrolateral abdominal wall and the development of pressure within the abdominal cavity. Intra-muscular activity was recorded bilaterally from transversus abdominis, obliquus internus, obliquus externus and rectus abdominis with fine-wire electrodes guided into place using real-time ultrasound. Intra-abdominal pressure was measured intragastrically using a micro tip pressure transducer. Six males were studied during loading and movement tasks with varied levels of intra-abdominal pressure. During both maximal voluntary isometric trunk flexion and extension, transversus abdominis activity and intra-abdominal pressure remained constant, while all other abdominal muscles showed a marked reduction during extension. When maximal isometric trunk flexor or extensor torques were imposed upon a maximal Valsalva manoeuvre, transversus abdominis activity and intra-abdominal pressure remained comparable within and across conditions, whereas obliquus internus, obliquus externus and rectus abdominis activities either markedly increased (flexion) or decreased (extension). Trunk twisting movements showed reciprocal patterns of activity between the left and right sides of transversus abdominis, indicating an ability for torque development. During trunk flexion--extension, transversus abdominis showed less distinguished changes of activity possibly relating to a general stabilizing function. In varied pulsed Valsalva manoeuvres, changes in peak intra-abdominal pressure were correlated with mean amplitude electromyograms of all abdominal muscles, excluding rectus abdominis. It is concluded that the co-ordinative patterns shown between the muscles of the ventrolateral abdominal wall are task specific based upon demands of movement, torque and stabilization. It appears that transversus abdominis is the abdominal muscle whose activity is most consistently related to changes in intra-abdominal pressure.

Variations in balance and body sway in middle-aged adults. Subjects with healthy backs compared with subjects with low-back dysfunction

Article

Apr 1991

In a preliminary investigation of 45 middle aged adult subjects, 20 with low-back pain (LBP) and 25 with healthy backs (HB), balance responses (body sway) were measured under different sensory conditions with computerized force plate stabilometry. Compared with HB subjects, in the most stable and then the least stable balance positions, the LBP subjects demonstrated significantly greater postural sway, kept their center of force (COF) significantly more posterior, and were significantly less likely to be able to balance on one foot with eyes closed. Based on subjective observations, the LBP subjects were more likely to fulcrum about the hip and back to maintain uprightness in challenging balance tasks compared with healthy controls who maintained their fulcrum for the COF around the ankle. Research is needed to determine the incidence of balance problems in LBP patients compared with controls. Effective physical therapy assessment and treatment of LBP patients may require attention to postural alignment, strength, flexibility, joint stability, balance reactions, and postural strategies.

Anthropometric Characteristics, Passive Hip Flexion, and Spinal Mobility in Relation to Back Pain in Athletes

Article

Jun 1990

Anthropometric characteristics, passive hip flexion, and spinal mobility were examined and back pain was registered in 116 top Swedish male athletes representing four different sports (wrestling, gymnastics, soccer, tennis). Differences in stature, body weight, passive hip flexion, mobility of the spine in forward flexion, and asymmetry of the back were found when each group of athletes was compared with the rest of the athletes. These differences could be explained by a natural selection of individuals with the physical constitution required for the sport concerned, but they may also be a long-term effect of training. A small sacral inclination, defined as the sacrohorizontal angle, correlated significantly with back pain.

Roy SH, De Luca CJ, Casavant DA. Lumbar muscle fatigue and chronic lower back pain. Spine 14: 992-1001

Article

Oct 1989

There currently is a clinical need for an objective technique to assess muscle dysfunction associated with chronic lower back pain. A Back Analysis System for objectively measuring local fatigue in the back extensor muscles is presented. The reliability and validity of this technique was evaluated by testing chronic low-back pain patients and control subjects without back pain. Concurrent surface electromyograms (EMG) were detected from multiple back muscles during sustained isometric contractions at different force levels of trunk extension. Median frequency parameters of the EMG power density spectrum were monitored to quantify localized muscle fatigue. Results indicated: 1) high reliability estimates for repeated trials; 2) significant differences (P less than 0.05) in median frequency parameters between lower back pain patients and control subjects for specific combinations of contractile force level and muscle site tested; 3) Median Frequency parameters correctly classified lower back pain and control subjects using a two-group discriminant analysis procedure. The applicability of this technique as a treatment outcome measure and diagnostic screening method for lower back pain patients is discussed.

Nonoperative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy

Article

May 1989

The functional outcome of patients with lumbar herniated nucleus pulposus without significant stenosis was analyzed in a retrospective cohort study. Inclusion criteria were as follows: 1) a chief complaint of leg pain, primarily; 2) a positive straight leg raising (SLR) at less than 60 degrees reproducing the leg pain; 3) a computed tomography (CT) scan demonstrating a herniated nucleus pulposus without significant stenosis by a radiologist's reading, which was also confirmed by the authors; 4) a positive electromyogram (EMG) demonstrating evidence of radiculopathy; and 5) response to a follow-up questionnaire. All patients had undergone an aggressive physical rehabilitation program consisting of back school and stabilization exercise training. Of a total of 347 consecutively identified patients, 64 patients with an average follow-up time of 31.1 months met the inclusion criteria and constituted the study population. They were sent questionnaires that inquired about activity level, pain level, work status, and further medical care. The patients with neurologic loss, extruded discs, and those seeking a second opinion regarding surgery were identified and subgrouped. Results for the total group included 90% good or excellent outcome with a 92% return to work rate. For the subgroups with extruded discs and second opinions, 87% and 83% had good or excellent outcomes, respectively, all (100%) of whom returned to work. Sick leave time for these subgroups was 2.9 months (+/- 1.4 months) and 3.4 months (+/- 1.7 months), respectively. These results compared favorably with previously published surgical studies. Four of six patients who required surgery were found to have stenosis at operation.(ABSTRACT TRUNCATED AT 250 WORDS)

The Abdominal Muscles and Vertebral Stability

Article

Jul 1987

It has been suggested that the muscles of the anterolateral abdominal wall increase the stability of the lumbar region of the vertebral column by tensing the thoracolumbar fascia and by raising intra-abdominal pressure. In this report these new mechanisms are reviewed and their contribution to vertebral stability assessed. The thoracolumbar fascia consists of two principal layers of dense fibrous tissue that attach the abdominal muscles to the vertebral column. Each of these layers was dissected in fresh and fixed material and samples chosen for light and scanning electron microscopy to study the arrangement of the component fibers. Computed axial tomography in volunteers showed the changes in spatial organization that occur during flexion of the back and during the Valsalva maneuver. The fascia was then tensed experimentally in isolated unfixed motion segments. The results suggested that the stabilizing action of the thoracolumbar fascia is less than had been thought previously but was consistent with calculations based on the more accurate structural and mechanical information that had been derived from the current study. Abdominal muscle contraction was simulated in whole cadavers in both the flexed and lateral bending positions to compare the stabilizing effect of the thoracolumbar fascia and intra-abdominal pressure mechanisms. These definitive experiments showed that the resistance to bending in the sagittal plane offered by the abdominal muscles acting through fascial tension was of a similar magnitude to that offered by a raised intra-abdominal pressure, both being relatively small in the fully flexed position. The stabilizing influence of the middle layer of the thoracolumbar fascia in lateral bending was clearly demonstrated and warrants further study in vivo.

Increased inhibitory effects on close synergists during muscle fatigue in the decerebrate cat

Article

Mar 1988
BRAIN RES

We compared the magnitude of reflex inhibition induced in the soleus muscle by contraction or stretch of the medial gastrocnemius (MG), before, during, and after electrically induced fatigue of the MG. Our findings are that MG fatigue is accompanied by a substantial increase in soleus inhibition, which then recovers with MG rest. This increased inhibition may explain, at least in part, the decline in motoneuron discharge rate that has been described in fatiguing human muscle.

Reassessment of the role of intra-abdominal pressure in spinal compression

Article

Dec 1987

Biomechanical models used to estimate loads on the lumbar spine often predict internal low back forces for heavy lifts that exceed known tissue tolerances, yet the particular lift caused no apparent damage to the lifter. To deal with this paradox, many researchers have incorporated some form of spinal compression alleviation from intra-abdominal pressure (IAP). The purpose of this work was to re-examine some of the issues involved in the feasibility of IAP to reduce spinal loads during stressful lifts. Questions remain over the trade-off between the beneficial tensile force on the spine, exerted via the diaphragm and pelvic floor when IAP is produced, and the undesirable compressive effects of abdominal muscular force required to maintain the pressure within the abdomen. Various strategies of modelling IAP and its effects on low back loading were employed, Three major differences between this and most previous models of IAP effects were the attempt to quantify the size of abdominal muscle forces and the utilization of a considerably smaller diaphragm cross-sectional area and corresponding IAP moment arm. Abdominal EMG recorded from rectus abdominis, external oblique and internal oblique generally indicated low levels of activity throughout the high loading phase of the lifts. However, model output predicted that the compressive forces generated by the abdominal wall musculature were larger than the beneficial action of those forces thought to alleviate spinal compression via IAP. These results suggest that modelling IAP as a force vector which produces a trunk extensor moment and lumbar disc compression alleviation, without accounting for the compressive effects of abdominal muscle forces required to produce the IAP, is incorrect. This does not exclude a possible role of IAP in assisting the trunk during loading, only that the role of IAP is not modelled properly at present. IAP may indeed play a role in spinal stabilization as yet not well understood.

Postural adjustments preceding rapid arm movements in Parkinsonian subjects

Article

Apr 1987
NEUROSCI LETT

The electromyographic (EMG) responses in postural (thigh and trunk) and agonist (shoulder) muscles were examined in standing parkinsonian subjects and healthy controls prior to visual reaction time and self-paced rapid arm flexion movements. Recruitment of postural muscles typically preceded arm displacement in normals, but was less frequent, of shorter duration, and characterized by multiple EMG bursts which extended to the agonist in parkinsonians. Moreover, parallel delays in EMG recruitment times relative to the visual signal for both postural and agonist muscles were observed in akinetic patients. These abnormalities suggest that the basal ganglia may serve a preparatory motor function, by linking synergistic muscles through a common selection process.

Effects of arm acceleration and behavioral conditions on the organization of postural adjustments during arm flexion

Article

Feb 1987

Nine standing subjects performed unilateral arm flexion movements over an eight-fold range of speeds, under two behavioral conditions. In the visually-guided condition, a visual target informed subjects about the correct movement speed. Seven subjects also made movements of different speeds during a self-paced condition, without a visual target. Angular displacement and acceleration of the arm, and EMG activity from the hamstrings (HM), erector spinae (ES) and the anterior deltoid (AD) muscles were measured. The following results were observed. Mean rectified amplitudes of EMG activity in HM and ES were typically correlated with the average arm acceleration and presumably the disturbance to posture and/or balance. HM and ES amplitudes were correlated for only six subjects. Functions relating the ratios of HM/ES EMG amplitudes to acceleration varied between subjects. HM onset latencies were highly variable for slow movements and usually lagged movement. For movements above a threshold-like point in acceleration, HM latencies were correlated with arm acceleration and recruited before movement. ES latencies were constant for fast movements, and negatively correlated with acceleration for slower movements. The recruitment order of HM and AD was influenced by the behavioral condition but not by arm acceleration for fast movements. HM and AD were recruited coincidentally for visually-guided movements, while for self-paced movements, HM was recruited before AD. We conclude that for the arm flexion task: HM and ES are not tightly coupled; both behavioral and mechanical conditions affect the recruitment of postural muscles; and postural and focal components of the movement are probably organized by parallel processes.

Reflex Inhibition of the Quadriceps Elicited from a Subperiosteal Tumour of the Femur

Article

Feb 1969
Acta Orthop Scand

Bertil Stener

Physical Measurements as Risk Indicators for Low-Back Trouble Over a One-Year Period

Article

Apr 1984

Fin Biering-Sørensen

Of all 30-, 40-, 50-, and 60-year-old inhabitants of Glostrup, a suburb of Copenhagen, 82% (449 men and 479 women) participated in a general health survey, which included a thorough physical examination relating to the lower back. The examination was constituted of anthropometric measurements, flexibility/elasticity measurements of the back and hamstrings, as well as tests for trunk muscle strength and endurance. The reproducibility of the tests was found to be satisfactory. Twelve months after the physical examination 99% of the participants completed a questionnaire sent by mail concerning low back trouble (LBT) in the intervening period. The prognostic value of the physical measurements was evaluated for first-time experience and for recurrence or persistence of LBT by analyses of the separate measurements and discriminant analyses. The main findings were that good isometric endurance of the back muscles may prevent first-time occurrence of LBT in men and that men with hypermobile backs are more liable to contract LBT. Recurrence or persistence of LBT was correlated primarily to the interval since last LBT-episode: the more LBT, the shorter the intervals had been. Weak trunk muscles and reduced flexibility/elasticity of the back and hamstrings were found as residual signs, in particular, among those with recurrence or persistence of LBT in the follow-up year.

Directional specificity of postural muscles in feedfoward postural reactions during fast voluntary arm movements

Article

Feb 1995

Healthy subjects performed bilateral fast shoulder movements in different directions while standing on a force platform. Anticipatory postural adjustments were seen as changes in the electrical activity of postural muscles as well as displacements of the center of pressure and center of gravity. Postural muscle pairs of agonist-antagonist commonly demonstrated triphasic patterns starting prior to the first electromyographic (EMG) burst in the prime-mover muscle. Proximal postural muscles demonstrated the largest anticipatory increase in the background activity during movements in one of the two opposite directions (forward or backwards). These changes progressively decreased when movements deviated from the preferred direction and frequently disappeared during movements in the opposite direction. The patterns in distal muscles varied across subjects and could demonstrate larger anticipatory changes during movements forward and backwards as compared to movements in intermediate directions. Bilateral addition of inertial loads to the wrists did not change the general anticipatory patterns, while making some of their features more pronounced. Anticipatory postural adjustments were followed by later changes in the activity of postural muscles, also reflected in the mechanical variables. Changes in leg joint angles revealed a "hip-ankle strategy" during shoulder flexions and an "ankle strategy" during shoulder extensions. The study demonstrates different behaviors of proximal and distal muscles during anticipatory postural adjustments in preparation for fast arm movements. We suggest that the proximal muscles produce a general pattern of postural adjustments, while distal muscles take care of fine adjustments that are more likely to vary across subjects.

Taimela S, Österman K, Alaranta H, Soukka A, Kujala UM. Long psychomotor reaction time in patients with chronic low back pain: Preliminary report. Arch Phys Med Rehabil 74: 1161-4

Article

Dec 1993
ARCH PHYS MED REHAB

The hypothesis in this study was that slow psychomotor reaction time is related to low-back pain. A total of 73 people with chronic low-back pain (CLBP) were studied. Simple reaction time (SRT) and choice reaction time (CRT) were measured. CRT was also fractionated into decision and movement times. Each four variables measured were analyzed by using analysis variants and covariants with two grouping factors (CLBP and gender) with age and height serving as covariates. The CLBP group had longer SRT, decision time, and total CRT than the control group on average. The results did not conflict with our hypothesis. Slow psychomotor speed of reaction may be one factor in the development of CLBP, or slow reaction in CLBP may have resulted from fear responses, depression, or anxiety. Longitudinal studies are needed in the cause-and-effect evaluation of the relation between speed of reaction and CLBP.

On the Reflex Effects from the Knee Joint of the Cat

Article

Nov 1960

The reflex effects on extensors and flexors of the knee joint have been studied in response to various stimulations of the knee joint capsule and the medial collateral ligament. The joint receptors were activated by increasing the intra-articular pressure or by pinching the anterior aspect of the knee joint capsule. This stimulation caused an inhibition of the knee extensors and a facilitation of the knee flexors in both the decerebrated and decerebrated and spinalized preparation. Activation of the receptors in the medial collateral ligament was likewise found to produce a flexor facilitation in the decerebrated and spinalized animal, effects that sometimes could be produced even in the decerebrated animal.

Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis

Abstract

No full-text available

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