Effects of Volitional Spine Stabilization on Trunk Control During Asymmetric Lifting Task in Patients With Recurrent Low Back Pain

Abstract

Study Design: Prospective, concurrent-cohort study. Objectives: To determine the effects of volitional preemptive abdominal contraction (VPAC) on trunk control during an asymmetric lift in patients with recurrent low back pain (rLBP) and compare with matched controls. Methods: Thirty-two rLBP patients and 37 healthy controls performed asymmetric lifting with and without VPAC. Trunk, pelvis, and hip biomechanical along with neuromuscular activity parameters were obtained using 3-dimensional motion capture and electromyography system. Hypotheses were tested using analysis of variance. Results: The VPAC resulted in significantly reduced muscle activity across all trunk extensor muscles in both groups (M ± SD, 6.4% ± 8.2% of maximum contraction; P ≤ .005), and reduced trunk side flexion (1.4° ± 5.1° smaller; P ≤ .005) and hip abduction (8.1° ± 21.1° smaller; P ≤ .003). rLBP patients exhibited reduced muscle activity in external oblique (12.3% ± 5.5% of maximum contraction; P ≤ .012), as well as decreased hip flexion (4.7°, P ≤ .008) and hip abduction (5.2°, P ≤ .001) at the final position of lifting in comparison with healthy controls. Conclusions: The results of this study defend the recommendation that the use of a VPAC increase spine stability during an asymmetrical loading task. Our results provide an indication that a VPAC strategy that is achieved during an asymmetric lifting decreases exposure for lumbar spine injury and instability. Spine care providers and ergonomists can use this information when designing neuromuscular control training programs, both for healthy individuals aimed at prevention of injury, as well as those with a history of rLBP, aimed at full functional recovery and protection from future injury.

Musculature adaption in patients with lumbosacral transitional vertebrae: a matched-pair analysis of 46 patients

“…Core trunk and low back muscle atrophy has been shown to be associated with LBP and, with less strong evidence, with degenerative disc disease and spinal stenosis [6][7][8][9]. As the posterior muscles of the lumbar spine provide stability to the lumbar vertebral segments and control movement of the lumbar spine, muscular integrity plays an important role in the maintenance of global spinal alignment [10,11].…”

Hip biomechanics in patients with low back pain, what do we know? A systematic review

“…The LBP group had a higher pain score on commencement (first 10 min mark) of the prolonged stand and steadily increased over the entirety of the stand, while the group without LBP displayed a relatively stable pain score ( p < 0.001) Crosbie et al, 2013 [ 56 ] Australia To compare temporal and spatial coordination of rotations in the transverse and frontal planes of the low thoracic and lumbar spinal regions during walking at preferred and fast speeds in participants with and without a history of recurrent LBP LBP n = 19, without LBP n = 19 Age LBP: 34.0 ± 13.3 years, without LBP: 28.6 ± 5.4 years Sex: LBP 12 female, 7 male, without LBP 13 female, 6 male Pain: 2.8 ± 2.2, measured by the Visual analog scale (0–10) Disability: 4.2 (0–19 [range]), measured by the Roland Morris disability questionnaire (0–24) Trunk segmental movements recorded using a multisensor, 6-df electromagnetic tracking device ROM of trunk, pelvis, and hip joints assessed using a digital anatomical landmark For ROM, the only between-group difference was a smaller pelvic side flexion at preferred speed in patients with LBP (without LBP 8.9 ± 2.9º, LBP 7.3 ± 2º, p < 0.05) Walking speed in patients with LBP was smaller than in participants without LBP ( p = 0.02) Considering the movement coordination between segments, the phase lag at intersegmental lower thoracic and lumbar for axial rotation was significantly less in patients with LBP (21% ± 14.7) than in participants without LBP (2.8% ± 9.8) at a preferred speed ( p < 0.05). Phase lag at intersegmental side flexion and axial rotation was significantly less in patients with LBP (- 9% ± 9.3) than in participants without LBP (0% ± 11.2) at a preferred speed ( p < 0.05) The movements of the pelvis during axial rotation were significantly greater in patients with LBP (preferred speed 0.99 ± 0.01 m/s, fast speed 0.98 ± 0.01 m/s) than in participants without LBP (preferred speed 0.98 ± 0.05 m/s, fast speed 0.96 ± 0.05 m/s, p < 0.05) Haddas et al, 2019 [ 57 ] United States To determine the effects of volitional preemptive abdominal contraction and recurrent LBP on trunk mechanics and neuromuscular control during an asymmetrical 1-m box-lift task LBP n = 32, without LBP n = 37 Age LBP: 21.6 ± 2.2 years, without LBP: 20.4 ± 4.2 years Pain: in the same day 2.0 ± 0.9, in the last week 3.9 ± 1.5, worst pain in the last week 4.8 ± 1.9, measured by the Visual analog scale (1–10) EMG of external oblique and gluteus maximus muscle, 3D spine and pelvic joint kinematics using a Vicon motion during asymmetric lifting The LBP group demonstrated reduced EMG activity for the external oblique muscle (80.6 ± 5.5% maximum voluntary contraction) at the initial position of the lifting compared to participants without LBP (92.9 ± 5.6% maximum voluntary contraction, p = 0.01). Furthermore, the LBP group performed the lift with smaller glute...…”

“…Of the 54 studies included, nine assessed range of motion [ 22 – 26 , 28 – 30 , 72 ], 16 assessed kinematics [ 35 – 43 , 45 – 50 , 68 ], four strength [ 31 – 34 ], seven electromyography [ 17 , 18 , 27 , 51 – 54 ], and 18 assessed more than one outcome (six assessed kinematics and range of motion [ 44 , 56 , 59 , 60 , 63 , 69 ], three range of motion and electromyography [ 58 , 65 , 66 ], two strength and range of motion [ 67 , 71 ], one strength, range of motion, and electromyography [ 16 ], one electromyography and kinematics [ 55 ], two electromyography and kinematics [ 57 , 61 ], one electromyography, kinematics, and strength [ 62 ] and two kinematics and strength[ 64 , 70 ].…”

“…Biomechanical kinematic assessments were performed using 3-dimensional systems [ 35 , 37 , 39 , 41 , 42 , 45 , 46 , 57 , 59 , 69 ], force platform [ 36 , 37 , 44 , 55 , 62 , 70 ], cameras [ 38 , 40 , 43 , 44 , 64 ] and sensors [ 49 , 50 , 56 , 60 , 63 , 68 ]. Hip movements were assessed during functional activities such as sit-to-stance-to-sit [ 36 ], sit-to-stand [ 37 , 49 ], walking [ 46 , 56 , 59 , 65 ], among others [ 35 , 40 , 44 , 49 , 57 , 60 , 64 , 68 , 69 ]. The results showed that during sit-to-stand, patients with chronic LBP had limited trunk flexion [ 37 ] and patients with subacute LBP had reduced task execution time [ 36 , 49 ].…”

Trunk Dynamic Stability Assessment for Individuals With and Without Nonspecific Low Back Pain During Repetitive Movement

“…Previous research has identified repetitive trunk flexion-extension (FE) movement as one of the key factors (Marras, 2000;Weiner et al, 2006). This activity, which is dependent on multiple control parameters, including speed, physical load, and symmetry/asymmetry, increases the susceptibility of workers to injuries, particularly LBP, and instigates numerous management challenges within work settings (Frymoyer et al, 1980;Haddas et al, 2019;Hendershot et al, 2011). Research also suggests that the control parameters associated with this activity impact the underlying active, passive, and neuromuscular control subsystems whose contribution regulates the dynamic stability of the trunk (Hoffman & Gabel, 2013).…”