Using neuromuscular electrical stimulation in conjunction with ultrasound imaging technique to investigate lumbar multifidus muscle activation deficit

Wattananon, Peemongkon; Sungnak, Panakorn; Songjaroen, Sranya; Kantha, Phunsuk; Hsu, Wei-Li; Wang, Hsing‐Kuo

doi:10.1016/j.msksp.2020.102215

Cited by 7 publications

(27 citation statements)

References 22 publications

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“…The body landmarks (Fig. 1 A) including lumbar spinous process of L1-L5, L4-5 facet joint (2 cm lateral to lower half of spinous process of L4), and NMES electrode placement (the first two point at 3 cm lateral to the L3 and L5 spinous processes on tested side and another two points at 2 cm away from spinous processes on the opposite side that cause two diagonal lines intersecting at the LM) were identified 15 . The L4-5 facet joint landmark was used to place the RUSI transducer to measure LM thickness (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The NMES (Sonopuls-490 combination therapy, Enraf–Nonius BV, Netherlands) with 5 × 5 hydrogel surface electrodes were used to stimulate right LM. The NMES was set using interferential mode at 6000 Hz, amplitude modulated 20–50 Hz with scanning mode 15 . These settings aimed to minimize the effect of nerve accommodation and provide electrical signals similar to those observed during a normal voluntary contraction 27 – 29 .…”

Section: Methodsmentioning

confidence: 99%

“…A MATLAB program version R2014a (The MatWorks Inc, MA, USA) was used for data analysis. The LM thickness during resting, MVIC, and combined NMES with MVIC were used to calculate percentage of LM activation (LM ACT ) using following equation 15 . …”

Section: Methodsmentioning

confidence: 99%

“…Lack of lumbar stability will result in increased shear force during prolonged mal-alignment posture or repeated lumbar movement leading to soft tissue injury 10 , 11 . In addition, persisting muscle activation deficit may further cause neuromuscular control maladaptation, particularly in movement control impairment (MCI) subgroup 12 – 15 . One preliminary study demonstrated that this subgroup still has LM activation deficit 15 .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, persisting muscle activation deficit may further cause neuromuscular control maladaptation, particularly in movement control impairment (MCI) subgroup 12 – 15 . One preliminary study demonstrated that this subgroup still has LM activation deficit 15 . Accordingly, physical therapy intervention should be designed to address the LM activation deficit to restore muscle function.…”

Section: Introductionmentioning

confidence: 99%

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Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

Songjaroen

Sungnak

Piriyaprasarth

et al. 2021

Sci Rep

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Motor control exercise (MCE) is commonly prescribed for patients with low back pain. Although MCE can improve clinical outcomes, lumbar multifidus muscle (LM) activation remains unchanged. Neuromuscular electrical stimulation (NMES) can be used to re-activate motor units prior to MCE which should result in increased LM activation. Therefore, this study aimed to explore the immediate effects of NMES combined with MCE on LM activation and motor performance. Twenty-five participants without low back pain (NoLBP) and 35 participants with movement control impairment (MCI) were recruited. Participants with MCI were further randomized to combined NMES with MCE (COMB) or sham-NMES with MCE (MCE) group. Ultrasound imaging was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and NMES with MVIC. These data were used to calculate LM activation. Quadruped rocking backward was used to represent motor performance. LM activation and motor performance were measured at baseline and after one-session of intervention. Results showed that both COMB and MCE groups had significantly lower (P < 0.05) LM activation compared with NoLBP group at baseline. Additionally, both COMB and MCE groups demonstrated significant improvement (P < 0.05) in motor performance while COMB group demonstrated significantly greater improvement (P < 0.05) in LM activation compared with MCE group. Individuals with MCI still have persisting LM activation deficit. Our key findings suggest that combined NMES and MCE may have better ability to improve LM activation in individuals with MCI. These findings would support the utility of NMES to induce a priming effect before MCE.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

Songjaroen

Sungnak

Piriyaprasarth

et al. 2021

Sci Rep

Self Cite

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Individuals With Impaired Lumbopelvic Control Demonstrate Lumbar Multifidus Muscle Activation Deficit Using Ultrasound Imaging in Conjunction With Electrical Stimulation: A Cross-sectional Study

Sungnak

Songjaroen

Krityakiarana

et al. 2022

Archives of Physical Medicine and Rehabilitation

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Cortical excitability and multifidus activation responses to transcranial direct current stimulation in patients with chronic low back pain during remission

Wattananon,

Thu,

Maharjan

et al. 2023

Sci Rep

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Evidence indicates that patients with chronic low back pain (CLBP) have lumbar multifidus muscle (LM) activation deficit which might be caused by changes in cortical excitability. Anodal transcranial direct current stimulation (a-tDCS) can be used to restore cortical excitability. This study aimed to (1) determine the immediate effects of a-tDCS on the cortical excitability and LM activation and (2) explore the relationship between cortical excitability and LM activation. Thirteen participants with CLBP during remission and 11 healthy participants were recruited. Cortical excitability (peak-to-peak motor evoked potential amplitude; P2P and cortical silent period; CSP) and LM activation were measured at pre- and post-intervention. We found significant difference (P < 0.05) in P2P between groups. However, no significant differences (P > 0.05) in P2P, CSP and LM activation were found between pre- and post-intervention in CLBP. The CLBP group demonstrated significant correlation (P = 0.05) between P2P and LM activation. Although our finding demonstrates change in P2P in the CLBP group, one-session of a-tDCS cannot induce changes in cortical excitability and LM activation. However, moderate to strong correlation between P2P and LM activation suggests the involvement of cortical level in LM activation deficit. Therefore, non-significant changes could have been due to inadequate dose of a-tDCS.

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Using neuromuscular electrical stimulation in conjunction with ultrasound imaging technique to investigate lumbar multifidus muscle activation deficit

Cited by 7 publications

References 22 publications

Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

Individuals With Impaired Lumbopelvic Control Demonstrate Lumbar Multifidus Muscle Activation Deficit Using Ultrasound Imaging in Conjunction With Electrical Stimulation: A Cross-sectional Study

Cortical excitability and multifidus activation responses to transcranial direct current stimulation in patients with chronic low back pain during remission

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