Stephan Kopinski

Neuromuscular trunk activation patterns in back pain patients during one-handed lifting

AIM To analyze neuromuscular activity patterns of the trunk in healthy controls (H) and back pain patients (BPP) during one-handed lifting of light to heavy loads. METHODS After assessment of back pain (graded chronic pain scale according to von Korff) all subjects (n = 43) performed a warm-up (treadmill walking). Next, subjects were instructed to lift 3 × a 20 kg weight placed in front of them (with both hand) onto a table (height: 0.75 m). Subsequently, all subjects lifted with one hand (left-side, 3 repetitions) a weight of 1 kg (light), 10 kg (middle) and 20 kg (heavy) in random order from the ground up onto the table left of them. Trunk muscle activity was assessed with a 12-lead EMG (6 ventral/6 dorsal muscles; 4000 Hz). EMG-RMS (%) was averaged over the 3 repetitions and analyzed for the whole one-handed lifting cycle, then normalized to RMS of the two-handed lifting. Additionally, the mean (normalized) EMG-RMS of four trunk areas [right/left ventral area (VR/VL); right/left dorsal area (DR/DL)] was calculated. Data were analyzed descriptively (mean ± SD) followed by student’s t-test comparing H and BPP (α = 0.05). With respect to the unequal distribution of subjects in H and BPP, a matched-group analysis was conducted. Seven healthy controls were gender- and age-matched (group Hmatched) to the 7 BPP. In addition, task failure was calculated and compared between H/Hmatched vs BPP using χ2. RESULTS Seven subjects (3m/4f; 32 ± 7 years; 171 ± 7 cm; 65 ± 11 kg) were assigned to BPP (pain grade ≥ 2) and 36 (13m/23f; 28 ± 8 years; 174 ± 10 cm; 71 ± 12 kg) to H (pain grade ≤ 1). H and BPP did not differ significantly in anthropometrics (P > 0.05). All subjects were able to lift the light and middle loads, but 57% of BPP and 22% of H were not able to lift the heavy load (all women). χ2 analysis revealed statistically significant differences in task failure between H vs BPP (P = 0.03). EMG-RMS ranged from 33% ± 10%/30% ± 9% (DL, 1 kg) to 356% ± 148%/283% ± 80% (VR, 20 kg) in H/BPP with no statistical difference between groups regardless of load (P > 0.05). However, the EMG-RMS of the VR was greatest in all lifting tasks for both groups and increased with heavier loads. CONCLUSION Heavier loading leads to an increase (2- to 3-fold) in trunk muscle activity with comparable patterns. Heavy loading (20 kg) leads to task failure, especially in women with back pain.

Neuromuscular response of the trunk to sudden gait disturbances: Forward vs. backward perturbation.

The study aimed to analyse neuromuscular activity of the trunk comparing four different perturbations during gait. Thirteen subjects (28±3yrs) walked (1m/s) on a split-belt treadmill, while 4 (belt) perturbations (F1, F2, B1, B2) were randomly applied. Perturbations differed, related to treadmill belt translation, in direction (forward (F)/backward (B)) and amplitude (20m/s(2) (1)/40m/s(2) (2)). Trunk muscle activity was assessed with a 12-lead-EMG. EMG-RMS [%] (0-200ms after perturbation; normalized to RMS of normal gait) was analyzed for muscles and four trunk areas (ventral left/right; dorsal left/right). Ratio of ventral:dorsal muscles were calculated. Muscle onset [ms] was determined. Data analysis was conducted descriptively, followed by ANOVA (post hoc Tukey-Kramer (α=0.05)). All perturbations lead to an increase in EMG-RMS (428±289%). F1 showed the lowest and F2 the highest increase for the flexors. B2 showed the highest increase for the extensors. Significant differences between perturbations could be observed for 6 muscles, as well as the 4 trunk areas. Ratio analysis revealed no significant differences (range 1.25 (B1) to 1.71 (F2) between stimuli. Muscle response time (ventral: 87.0±21.7ms; dorsal: 88.4±17.0ms) between stimuli was only significant (p=0.005) for the dorsal muscles. Magnitude significantly influences neuromuscular trunk response patterns in healthy adults. Regardless of direction ventral muscles always revealed higher relative increase of activity while compensating the walking perturbations.

Unexpected walking perturbations: Reliability and validity of a new treadmill protocol to provoke muscular reflex activities at lower extremities and the trunk

Instrumented treadmills offer the potential to generate standardized walking perturbations, which are particularly rapid and powerful. However, technical requirements to release adequate perturbations regarding timing, duration and amplitude are demanding. This study investigated the test-retest reliability and validity of a new treadmill perturbation protocol releasing rapid and unexpected belt perturbations to provoke muscular reflex responses at lower extremities and the trunk. Fourteen healthy participants underwent two identical treadmill walking protocols, consisting of 10 superimposed one-sided belt perturbations (100ms duration; 2m/s amplitude), triggered by a plantar pressure insole 200ms after heel contact. Delay, duration and amplitude of applied perturbations were recorded by 3D-motion capture. Muscular reflex responses (within 200ms) were measured at lower extremities and the trunk (10-lead EMG). Data was analyzed descriptively (mean±SD). Reliability was analyzed using test-retest variability (TRV%) and limits of agreement (LoA, bias±1.96∗SD). Perturbation delay was 202±14ms, duration was 102±4ms and amplitude was 2.1±0.01m/s. TRV for perturbation delay, duration and amplitude ranged from 5.0% to 5.7%. LoA reached 3±36ms for delay, 2±13ms for duration and 0.0±0.3m/s for amplitude. EMG amplitudes following perturbations ranged between 106±97% and 909±979% of unperturbed gait and EMG latencies between 82±14ms and 106±16ms. Minor differences between preset and observed perturbation characteristics and results of test-retest analysis prove a high validity with excellent reliability of the setup. Therefore, the protocol tested can be recommended to provoke muscular reflex responses at lower extremities and the trunk in perturbed walking.

Ultrasound Applied to Subcutaneous Fat Tissue Measurements in International Elite Canoeists.

Subcutaneous adipose tissue (SAT) measurements with ultrasound have recently been introduced to assess body fat in elite athletes. However, appropriate protocols and data on various groups of athletes are missing. We investigated intra-rater reliability of SAT measurements using ultrasound in elite canoe athletes. 25 international level canoeists (18 male, 7 female; 23±4 years; 81±11 kg; 1.83±0.09 m; 20±3 training h/wk) were measured on 2 consecutive days. SAT was assessed with B-mode ultrasound at 8 sites (ISAK): triceps, subscapular, biceps, iliac crest, supraspinal, abdominal, front thigh, medial calf, and quantified using image analysis software. Data was analyzed descriptively (mean±SD, [range]). Coefficient of variation (CV%), intraclass correlation coefficient (ICC, 2.1) and absolute (LoA) and ratio limits of agreement (RLoA) were calculated for day-to-day reliability. Mean sum of SAT thickness was 30.0±19.4 mm [8.0, 80.1 mm], with 3.9±1.8 mm [1.2 mm subscapular, 8.0 mm abdominal] for individual sites. CV for the sum of sites was 4.7%, ICC 0.99, LoA 1.7±3.6 mm, RLoA 0.940 ( *  /÷1.155). Measuring SAT with ultrasound has proved to have excellent day-to-day reliability in elite canoe athletes. Recommendations for standardization of the method will further increase accuracy and reproducibility.