Sharon M. Henry

Surface EMG electrodes do not accurately record from lumbar multifidus muscles

OBJECTIVE This study investigated whether electromyographic signals recorded from the skin surface overlying the multifidus muscles could be used to quantify their activity. DESIGN Comparison of electromyography signals recorded from electrodes on the back surface and from wire electrodes within four different slips of multifidus muscles of three human subjects performing isometric tasks that loaded the trunk from three different directions. BACKGROUND It has been suggested that suitably placed surface electrodes can be used to record activity in the deep multifidus muscles. METHODS We tested whether there was a stronger correlation and more consistent regression relationship between signals from electrodes overlying multifidus and longissimus muscles respectively than between signals from within multifidus and from the skin surface electrodes over multifidus. RESULTS The findings provided consistent evidence that the surface electrodes placed over multifidus muscles were more sensitive to the adjacent longissimus muscles than to the underlying multifidus muscles. The R(2) for surface versus intra-muscular comparisons was 0.64, while the average R(2) for surface-multifidus versus surface-longissimus comparisons was 0.80. Also, the magnitude of the regression coefficients was less variable between different tasks for the longissimus versus surface multifidus comparisons. CONCLUSIONS Accurate measurement of multifidus muscle activity requires intra-muscular electrodes. RELEVANCE Electromyography is the accepted technique to document the level of muscular activation, but its specificity to particular muscles depends on correct electrode placement. For multifidus, intra-muscular electrodes are required.

Decrease in trunk muscular response to perturbation with preactivation of lumbar spinal musculature

Study Design. An experimental study of healthy subjects’ trunk muscle responses to force perturbations at differing angles and steady state efforts. Objectives. To determine whether increased preactivation of muscles was associated with decreased likelihood of muscular activation in response to a transient force perturbation. Summary of Background Data. Trunk stability (ability to return to equilibrium position after a perturbation) requires the stiffness of appropriately activated muscles to prevent buckling and consequent “self-injury.” Therefore, greater trunk muscle preactivation might decrease the likelihood of reflex muscle responses to small perturbations. Methods. Each of 13 subjects stood in an apparatus with the pelvis immobilized. A harness around the thorax provided a preload and a force perturbation by a horizontal cable and a movable pulley attached to one of five anchorage points on a wall track surrounding the subject at angles of 0°, 45°, 90°, 135°, and 180° to the forward direction. Subjects first equilibrated with a preload effort of nominally 20% or 40% of their maximum extension effort. Then a single full sine-wave force perturbation pulse of nominal amplitude, 7.5% or 15% of maximum effort, duration 80 milliseconds or 300 milliseconds, was applied at a random time, with three repeated trials of each test condition. The applied force (via a load cell) and the electromyographic activity of six right and left pairs of trunk muscles were recorded. Muscle responses were detected by two methods. 1) Shewhart method: electromyographic signal greater than “baseline” values by more than three standard deviations, and 2) Mean Electromyographic Difference method: mean electromyographic signal in a time window 25 to 150 milliseconds after the force perturbation greater than that in a 25- to 150-millisecond window before the perturbation. Results. Lower preload efforts were associated with more muscle responses (overall mean response detection rate = 33% at low preload and 25% at high preload). Using the Shewhart method, there were significant differences by effort (P < 0.05) for all abdominal muscles and for all left dorsal muscles except multifidus. Using the Mean Electromyographic Difference method, there were significant differences by effort (P < 0.05) for the same dorsal muscles, but only for one of the abdominal muscles. Conclusions. Findings are consistent with the hypothesis that the spine can be stabilized by the stiffness ofactivated muscles, obviating the need for active muscle responses to perturbations.

Control of stance during lateral and anterior/posterior surface translations

The purpose of this study was to compare and contrast postural responses to lateral and A/P surface translations by quantifying joint positions, bilateral three-dimensional (3-D) ground reaction forces, and lower limb and trunk muscle electromyographic (EMG) activity. Subjects stood on a movable platform which was randomly translated in four different directions. The kinematic patterns in response to lateral and anterior/posterior (A/P) surface translations were similar in that there was a sequential displacement and reversal of the shank/thigh and then trunk segments. While the body center of mass (CoM) was displaced equally in response to lateral and A/P translations, equilibrium was maintained by redistributing the vertical forces and changing the shear forces exerted against the support surface. These force responses were bilaterally symmetrical for A/P translations but not for lateral translations. With respect to EMG activity, the first muscle activated was the proximal tensor fascia latae for lateral translations whereas the distal muscles were recruited first for A/P translations. Results from this study suggest that control of postural equilibrium may be similar for A/P and lateral translations, although specific differences in patterns may reflect various biomechanical constraints of the trunk and the lower extremities associated with the two planes of movement.

Reduced thoracolumbar fascia shear strain in human chronic low back pain

BackgroundThe role played by the thoracolumbar fascia in chronic low back pain (LBP) is poorly understood. The thoracolumbar fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the thoracolumbar fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP).MethodsWe tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the thoracolumbar fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity.ResultsThoracolumbar fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p < .01). There was no evidence that this difference was sex-specific (group by sex interaction p = .09), although overall, males had significantly lower shear strain than females (p = .02). Significant correlations were found in male subjects between thoracolumbar fascia shear strain and the following variables: perimuscular connective tissue thickness (r = -0.45, p <.001), echogenicity (r = -0.28, p < .05), trunk flexion range of motion (r = 0.36, p < .01), trunk extension range of motion (r = 0.41, p < .01), repeated forward bend task duration (r = -0.54, p < .0001) and repeated sit-to-stand task duration (r = -0.45, p < .001).ConclusionThoracolumbar fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in thoracolumbar fascia shear strain that may also play a role in altered connective tissue function.

Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain.

BackgroundAlthough the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.MethodsIn each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.ResultsThere were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had ~25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p < 0.01 and p < 0.001 respectively).ConclusionThis is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.

Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain

Trunk stability requires muscle stiffness associated with appropriate timing and magnitude of activation of muscles. Abnormality of muscle function has been implicated as possible cause or consequence of back pain. This experimental study compared trunk muscle activation and responses to transient force perturbations in persons with and without self-reported history of low back pain. The objective was to determine whether or not history of back pain was associated with (1) altered anticipatory preactivation of trunk muscles or altered likelihood of muscular response to a transient force perturbation and (2) altered muscle activation patterns during a ramped effort. Twenty-one subjects who reported having back pain (LBP group) and twenty-three reporting no recent back pain (NLBP group) were tested while each subject stood in an apparatus with the pelvis immobilized. They performed ‘ramped-effort’ tests (to a voluntary maximum effort), and force perturbation tests. Resistance was provided by a horizontal cable from the thorax to one of five anchorage points on a wall track to the subject’s right at angles of 0°, 45°, 90°, 135° and 180° to the forward direction. In the perturbation tests, subjects first pulled against the cable to generate an effort nominally 15% or 30% of their maximum extension effort. The effort and the EMG activity of five right/left pairs of trunk muscles were recorded, and muscle responses were detected. In the ramped-effort tests the gradient of the EMG–effort relationship provided a measure of each muscle’s activation. On average, the LBP group subjects activated their dorsal muscles more than the NLBP group subjects in a maximum effort task when the EMG values were normalized for the maximum EMG, but this finding may have resulted from lesser maximum effort generated by LBP subjects. Greater muscle preactivation was recorded in the LBP group than the NLBP group just prior to the perturbation. The likelihood of muscle responses to perturbations was not significantly different between the two groups. The findings were consistent with the hypothesis that LBP subjects employed muscle activation in a quasi-static task and preactivation prior to a perturbation in an attempt to stiffen and stabilize the trunk. However, interpretation of the findings was complicated by the fact that LBP subjects generated lesser efforts, and it was not known whether this resulted from anatomical differences (e.g., muscle atrophy) or reduced motivation (e.g., pain avoidance).

Abdominal muscle activation increases lumbar spinal stability: Analysis of contributions of different muscle groups

BACKGROUND Antagonistic activation of abdominal muscles and increased intra-abdominal pressure are associated with both spinal unloading and spinal stabilization. Rehabilitation regimens have been proposed to improve spinal stability via selective recruitment of certain trunk muscle groups. This biomechanical analytical study addressed whether lumbar spinal stability is increased by such selective activation. METHODS The biomechanical model included anatomically realistic three-layers of curved abdominal musculature, rectus abdominis and 77 symmetrical pairs of dorsal muscles. The muscle activations were calculated with the model loaded with either flexion, extension, lateral bending or axial rotation moments up to 60 Nm, along with intra-abdominal pressure up to 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight. After solving for muscle forces, a buckling analysis quantified spinal stability. Subsequently, different patterns of muscle activation were studied by forcing activation of selected abdominal muscles to at least 10% or 20% of maximum. FINDINGS Spinal stability increased by an average factor of 1.8 with doubling of intra-abdominal pressure. Forcing at least 10% activation of obliques or transversus abdominis muscles increased stability slightly for efforts other than flexion, but forcing at least 20% activation generally did not produce further increase in stability. Forced activation of rectus abdominis did not increase stability. INTERPRETATION Based on analytical predictions, the degree of stability was not substantially influenced by selective forcing of muscle activation. This casts doubt on the supposed mechanism of action of specific abdominal muscle exercise regimens that have been proposed for low back pain rehabilitation.

People with chronic low back pain exhibit decreased variability in the timing of their anticipatory postural adjustments

Variability in the constituents of movement is fundamental to adaptive motor performance. A sustained decrease in the variability of anticipatory postural adjustments (APAs) occurs when performing cued arm raises following acute, experimentally induced low back pain (LBP; Moseley & Hodges, 2006). This observation implies that these changes in variability may also be relevant to people with chronic LBP. To confirm that this reduced variability in the timing of APAs is also evident in people with chronic LBP, the authors examined the standard deviations of electromyographic onset latencies from the bilateral internal oblique (IO) and erector spinae muscles (in relation to deltoid muscle onset) when 10 people with chronic LBP and 10 people without LBP performed 75 trials of rapid arm raises. The participants with LBP exhibited significantly less variability of their IO muscle onset latencies, confirming that the decreased variability of postural coordination that is evident following acutely induced LBP is also evident in people with chronic LBP. Thus, people with chronic LBP may be less capable of adapting their APAs to ensure postural stability during movement.

Distinguishable groups of musculoskeletal low back pain patients and asymptomatic control subjects based on physical measures of the NIOSH low back atlas

Study Design The authors performed an empirical prospective study of 115 patients referred to physical therapy for low back pain and 112 control subjects of similar age and gender. Objectives The authors defined and compared subgroups based on physical tests and described demographic and psychosocial characteristics by group. Summary of Background Data Prospective studies of intervention for persons with low back pain are limited by inability to randomize subjects into distinguishable groups. Previous attempts have not been empirical and have not focused on musculoskeletal LBP. Methods Ten physical therapists administered 52 tests and 6 questionnaires to subjects in seven different clinics. Data were subjected to reliability and cluster and comparative analyses. Results Tests were reliable. Groups were distinguished by measures of symmetry, flexibility, strength, and dynamic mobility. Conclusion Distinguishable groups can be determined; decreased trunk mobility characterized all groups of patients and imbalances in muscle length, strength, and symmetry described specific groups of subjects with and without low back pain.

The influence of fatigue on trunk muscle responses to sudden arm movements, a pilot study

OBJECTIVE To examine fatigue induced changes in trunk muscle latencies following trunk muscle fatigue. DESIGN A repeated measures within subject design.Background. Trunk muscle responses to sudden movements is of interest in clinical biomechanics and motor control. METHODS Electromyographic profiles were recorded from transversus abdominis (finewire), internal oblique, rectus abdominis and external oblique and longissimus at the level of the 3rd lumbar vertebrae bilaterally. Four asymptomatic subjects performed arm-raising task using a visual cue before and after an isometric fatiguing trunk extension task. RESULTS Feed-forward responses were not detected in all muscles for every trial. In general, following fatigue trunk muscle onset latencies occur earlier (left, P=0.0016; right, P=0.0475). CONCLUSIONS Trunk muscle fatigue alters anticipatory postural adjustments in normal subjects. It remains unclear if there is a pattern for specific muscles changes between individuals and if these are reflected in individuals with low back pain. RELEVANCE Trunk muscle fatigue and altered trunk muscles latencies to movement perturbations have been associated with low back pain. These findings suggest that there may be a link between centrally mediated response to isometric muscle fatigue and anticipatory motor control strategies.