What is the Best Surface EMG Measure of Lumbar Flexion-Relaxation for Distinguishing Chronic Low Back Pain Patients From Pain-free Controls?

Neblett, Randy; Brede, Emily; Mayer, Tom G.; Gatchel, Robert J.

doi:10.1097/ajp.0b013e318267252d

Cited by 46 publications

(53 citation statements)

References 36 publications

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“…Although other authors have detected lower flexion relaxation ratios together with lower lumbar flexibility in a group of chronically disabled work-related spinal disorder patients all under 60 years of age, such discrepancies between study results seems reasonable because one would expect higher back extensor muscle activity to overcome gravity in a more erect maximum flexion position (i.e. lower flexion relaxation ratio) [ 5 , 6 , 11 , 13 , 50 ]. These work-related spinal disorder patients were suffering from relevant kinesiophobia, which was found to be associated with a reduction of lumbar flexion [ 51 ].…”

Section: Discussionmentioning

confidence: 81%

Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients

Kienbacher

Fehrmann

Habenicht

et al. 2016

J NeuroEngineering Rehabil

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BackgroundThe root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from standing has repeatedly been recommended to objectively assess muscle function in chronic low back pain patients. However, literature addressing older patients is sparse. This cross sectional study sought to examine differences in neuromuscular activation between age groups (>60 versus 40-60 versus <40 years) and sexes during a standardized trunk flexion-extension task.MethodsA total of 216 patients (62 older, 84 middle-aged, 70 younger) performed maximum trunk extensions followed by trunk flexion extension testing thereby holding static positions at standing, half, and full trunk flexion. The lumbar extensor muscle activity and 3d-accelerometric signals intended to monitor hip and trunk position angles were recorded from the L5 (multifidus) and T4 (semispinalis thoracis) levels. Permutation ANOVA with bootstrapped confidence intervals were performed to examine for age and gender related differences. Ridge-regressions investigated the impact of physical-functional and psychological variables to the half flexion relaxation ratio (i.e. muscle activity at the half divided by that in maximum flexion position).ResultsMaximum back extension torque was slightly but significantly higher in youngest compared to oldest patients if male and females were pooled. Normalized RMS-SEMG revealed highest lumbar extensor muscle activity at standing in the oldest and the female groups. Patients over 60 years showed lowest activity changes from standing to half (increments) and from half to the maximum flexion position (decrements) leading to a significantly lower half flexion relaxation ratio compared to the youngest patients. These oldest patients demonstrated the highest hip and lowest lumbothoracic changes of position angles. Females had higher regional hip and gross trunk ranges of movement compared to males. Lumbothoracic flexion and the muscle activity at standing had a significant impact on the half flexion relaxation ratio.ConclusionsThe neuromuscular activation pattern and the kinematics in this trunk flexion-extension task involving static half flexion position changed according to age and sex. The test has a good potential to discriminate between impaired and unimpaired neuromuscular regulation of back extensors in cLBP patients, thereby allowing the design of more individualized exercise programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0121-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 81%

Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients

Kienbacher

Fehrmann

Habenicht

et al. 2016

J NeuroEngineering Rehabil

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“…Consequently the HFR and the increments of lumbar muscle amplitude from standing to maximum flexion in older females were rather similar to those from the younger individuals. Neblett et al [ 9 ] postulated that the impaired flexion relaxation reflex and the restricted lumbar range of motion in a group of young and middle age back pain patients were related to previously performed surgery causing extensive damage such as muscle injury, scaring, and degeneration. One possible explanation for our result is that similar underlying processes in these patients and the older healthy male individuals from the current study might be responsible for the changes of the neuromuscular activation pattern.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it was recommended that such measurement results are used to assess treatment outcome in low back pain patients [ 7 ]. However, these findings need to be confirmed for older healthy populations [ 4 , 5 , 7 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Age and gender related neuromuscular changes in trunk flexion-extension

Kienbacher

Paul

Habenicht

et al. 2015

Journal of NeuroEngineering and Rehabilitation

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BackgroundThe root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from a standing position and task specific spine ranges of motion objectively assess muscle function in healthy young and middle age individuals. However, literature on neuromuscular activation and associated spine and hip kinematics in older individuals is sparse. This cross sectional study sought to examine the sex and age (<40 versus >60 years) related differences in the neuromuscular activation profiles of the lumbar extensors and the related spine and hip kinematics from healthy individuals during a standardized trunk flexion-extension task.MethodsTwenty five older (13 females, 60–90 years) and 24 younger (12 females, 18–40 years) healthy individuals performed trunk flexion-extension testing by holding static positions at half-flexion way and full range of motion between standing and maximum trunk flexion. The associated lumbar extensor muscle activity was derived from measurements at standing, half, and maximum flexion positions. The range of motion at the hip and lumbar spine was recorded using 3d accelerometers attached to the skin overlying the multifidus and semispinalis thoracis muscles lateral to the L5 and T4 spinous processes, respectively. Statistical calculations were performed using a permutation ANOVA with bootstrap confidence intervals.ResultsThe muscle activity in the half related to the maximum flexion position (half flexion relaxation ratio) was significantly smaller in older males when compared with younger males. Moreover, measurements revealed smaller activity changes from standing to the half and from half to the maximum flexion position in older compared to younger individuals. Older males displayed smaller gross trunk range of motion from standing to maximum flexion than any other group.ConclusionsGender and normal aging significantly affect both the activation patterns of the lumbar extensor muscles and the kinematics of the trunk during a standardized trunk flexion-extension task. Measurement results from healthy young and middle age individuals should not be used for the assessment of individuals older than 60 years of age.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-12-3) contains supplementary material, which is available to authorized users.

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“…Therefore, static sEMG tests are considered to be more useful for visualizing the muscular signals from a resting state. Static sEMG showed high reliability in the test-retest measurements of spinal fatigue [10] and it exhibited reliability and validity in distinguishing healthy and back pain patients [11]. However, static sEMG has been studied mainly in patients with back pain, and there is a lack of research on the relationship with the evaluation tools used to evaluate pain in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Reliability and validity of new evaluation methods using static surface electromyography in persons with neck pain

Kim

Yun

et al. 2019

PTRS

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The aim of this study was to evaluate the validity and reliability of using static surface electromyography (sEMG) on persons with neck pain and in healthy adults. Design: Cross-sectional study. Methods: Twenty-two female participants with neck pain and thirty healthy adults in the age group of 20-65 years were recruited in this study. To evaluate the validity and reliability of sEMG in subjects with neck pain, the subjects'characteristics were recorded and the Visual Analog Scale (VAS) and Neck Disability Index (NDI) were examined in addition to sEMG and algometer tests being carried out on the subjects. The site for using the sEMG and algometer was the upper trapezius. sEMG test-retest reliability was measured by intraclass correlation coefficients (ICCs). Independent t-tests were used to analyze the differences in the dependent variables between subjects with neck pain and healthy adults. The Pearson correlation coefficient was used to examine the linear relationship between measured variables. Results: sEMG and algometer tests were reliable according to the test-retest reliability results in subjects with neck pain and healthy adults (ICC=0.815-0.979). The results of this study showed that there were significant differences in respect to age, VAS, sEMG and algometer tests between persons with neck pain and healthy adults (p<0.05). The VAS and NDI were statistically correlated with sEMG and algometer results (p<0.05). Conclusions: In this study, we investigated the clinical usefulness of the static sEMG test in evaluating the pain scale of persons with neck pain with high reliability and validity.

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What is the Best Surface EMG Measure of Lumbar Flexion-Relaxation for Distinguishing Chronic Low Back Pain Patients From Pain-free Controls?

Cited by 46 publications

References 36 publications

Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients

Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients

Age and gender related neuromuscular changes in trunk flexion-extension

Reliability and validity of new evaluation methods using static surface electromyography in persons with neck pain

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