Experimental Brain Research

, Volume 151, Issue 2, pp 262–271 | Cite as

Experimental muscle pain changes feedforward postural responses of the trunk muscles

  • Paul W. HodgesEmail author
  • G. Lorimer Moseley
  • Anna Gabrielsson
  • Simon C. Gandevia
Research Article


Many studies have identified changes in trunk muscle recruitment in clinical low back pain (LBP). However, due to the heterogeneity of the LBP population these changes have been variable and it has been impossible to identify a cause-effect relationship. Several studies have identified a consistent change in the feedforward postural response of transversus abdominis (TrA), the deepest abdominal muscle, in association with arm movements in chronic LBP. This study aimed to determine whether the feedforward recruitment of the trunk muscles in a postural task could be altered by acute experimentally induced LBP. Electromyographic (EMG) recordings of the abdominal and paraspinal muscles were made during arm movements in a control trial, following the injection of isotonic (non-painful) and hypertonic (painful) saline into the longissimus muscle at L4, and during a 1-h follow-up. Movements included rapid arm flexion in response to a light and repetitive arm flexion-extension. Temporal and spatial EMG parameters were measured. The onset and amplitude of EMG of most muscles was changed in a variable manner during the period of experimentally induced pain. However, across movement trials and subjects the activation of TrA was consistently reduced in amplitude or delayed. Analyses in the time and frequency domain were used to confirm these findings. The results suggest that acute experimentally induced pain may affect feedforward postural activity of the trunk muscles. Although the response was variable, pain produced differential changes in the motor control of the trunk muscles, with consistent impairment of TrA activity.


Motor control Experimental pain Postural control Trunk muscles Stability 



We thank Liset Pengel for assistance with data analysis. Financial support was provided by the National Health and Medical Research Council of Australia.


  1. Arena JG, Sherman RA, Bruno GM, Young TR (1989) Electromyographic recordings of 5 types of low back pain subjects and non-pain controls in different positions. Pain 37:57–65CrossRefPubMedGoogle Scholar
  2. Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P (1996) The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study. Pain 64:231–240CrossRefPubMedGoogle Scholar
  3. Aruin AS, Latash ML (1995) Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Exp Brain Res 103:323–332PubMedGoogle Scholar
  4. Bendat JS, Piersol AG (1966) Measurement and analysis of random data. John Wiley and Sons, New YorkGoogle Scholar
  5. Benvenuti F, Panzer V, Thomas S, Hallet M (1990) Kinematic and EMG analysis of postural adjustments associated with fast elbow movements. In: Brandt T, Paulus W, Bles W, Dietrerich M, Krafczyk S, Straube A (eds) Disorders of posture and gait. Georg Thieme, Stuttgart, pp 72–75Google Scholar
  6. Bijur P, Silver W, Gallagher E (2001) Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 8:1153–1157PubMedGoogle Scholar
  7. Collins GA, Cohen MJ, Naliboff BD, Schandler SL (1982) Comparative analysis of paraspinal and frontalis EMG, heart rate and skin conductance in chronic low back pain patients and normals to various postures and stresses. Scand J Rehabil Med 14:39–46PubMedGoogle Scholar
  8. Cresswell AG, Grundstrom H, Thorstensson A (1992) Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand 144:409–418PubMedGoogle Scholar
  9. Cresswell AG, Oddsson L, Thorstensson A (1994) The influence of sudden perturbations on trunk muscle activity and intra-abdominal pressure while standing. Exp Brain Res 98:336–341PubMedGoogle Scholar
  10. Daggfeldt K, Thorstensson A (1997) The role of intra-abdominal pressure in spinal unloading. J Biomech 30:1149–1155PubMedGoogle Scholar
  11. Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL (1997) Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 73:431–445PubMedGoogle Scholar
  12. Gallagher E, Bijur P, Latimer C, Silver W (2002) Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med 20:287–290CrossRefPubMedGoogle Scholar
  13. Gandevia SC, Allen GM, Butler JE, Taylor JL (1996) Supraspinal factors in human muscle fatigue: evidence for suboptimal output from the motor cortex. J Physiol (Lond) 490:529–536Google Scholar
  14. Graven-Nielsen T, McArdle A, Phoenix J, Arendt-Nielsen L, Jensen T, Jackson M, Edwards R (1997) In vivo model of muscle pain: quantification of intramuscular chemical, electrical, and pressure changes associated with saline-induced muscle pain in humans. Pain 69:136–143Google Scholar
  15. Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine 19:165–177PubMedGoogle Scholar
  16. Hides JA, Richardson CA, Jull GA (1996) Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 21:2763–2769PubMedGoogle Scholar
  17. Hodges P (2001) Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res 141:261–266CrossRefPubMedGoogle Scholar
  18. Hodges PW, Bui B (1996) A comparison of computer based methods for the determination of onset of muscle contraction using electromyography. Electroencephalogr Clin Neurophysiol 101:511–519PubMedGoogle Scholar
  19. Hodges P, Gandevia S (2000a) Activation of the human diaphragm during a repetitive postural task. J Physiol (Lond) 522:165–175Google Scholar
  20. Hodges P, Gandevia S (2000b) Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol 89:967–976PubMedGoogle Scholar
  21. Hodges PW, Richardson CA (1996) Inefficient muscular stabilisation of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 21:2640–2650CrossRefPubMedGoogle Scholar
  22. Hodges PW, Richardson CA (1997) Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res 114:362–370PubMedGoogle Scholar
  23. Hodges PW, Richardson CA (1998) Delayed postural contraction of transversus abdominis associated with movement of the lower limb in people with low back pain. J Spin Disord 11:46–56Google Scholar
  24. Hodges PW, Richardson CA (1999) Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil 80:1005–1012PubMedGoogle Scholar
  25. Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A (2000) Three dimensional preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture 11:92–101PubMedGoogle Scholar
  26. Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A (2001) In vivo measurement of the effect of intra-abdominal pressure on the human spine. J Biomech 34:347–353PubMedGoogle Scholar
  27. Janda V (1978) Muscles, central nervous motor regulation and back problems. In: Korr IM (ed) The neurobiologic mechanisms in manipulative therapy. Plenum, New York, pp 27–41Google Scholar
  28. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richarson C (2002) A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine (in press)Google Scholar
  29. Katz J, Melzack R (1999) Measurement of pain. Surg Clin North Am 79:231–252PubMedGoogle Scholar
  30. Kellgren JH (1938) Observations on referred pain arising from muscle. Clin Sci 3:175–190Google Scholar
  31. King JC, Lehmkuhl DL, French J, Dimitrijevic M (1988) Dynamic postural reflexes: comparison in normal subjects and patients with chronic low back pain. Curr Concepts Rehabil Med 4:7-11Google Scholar
  32. Kuukkanen T, Malkia E (1998) Effects of a three-month active rehabilitation program on psychomotor performance of lower limbs in subjects with low back pain: a controlled study with a nine-month follow-up. Percept Mot Skills 87:739–753PubMedGoogle Scholar
  33. Lee WA, Buchanan TS, Rogers MW (1987) Effects of arm acceleration and behavioural conditions on the organisation of postural adjustments during arm flexion. Exp Brain Res 66:257–270PubMedGoogle Scholar
  34. Lorenz J, Bromm B (1997) Event-related potential correlates of interference between cognitive performance and tonic experimental pain. Psychophysiology 34:436–445PubMedGoogle Scholar
  35. Lund JP, Donga R, Widmer CG, Stohler CS (1991) The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69:683–694PubMedGoogle Scholar
  36. Luoto S, Hurri H, Alaranta H (1995) Reaction time in patients with chronic low back pain. Eur J Phys Med Rehabil 5:47–50Google Scholar
  37. Luoto S, Aalto H, Taimela S, Hurri H, Pyykko I, Alaranta H (1998) One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects. A controlled study with follow-up. Spine 23:2081–2089CrossRefPubMedGoogle Scholar
  38. Luoto S, Taimela S, Hurri H, Alaranta H (1999) Mechanisms explaining the association between low back trouble and deficits in information processing. A controlled study with follow-up. Spine 24:255–261CrossRefPubMedGoogle Scholar
  39. Mannion AF, Muntener M, Taimela S, Dvorak J (1999) A randomized clinical trial of three active therapies for chronic low back pain. Spine 24:2435–2448CrossRefPubMedGoogle Scholar
  40. Matre DA, Sinkjaer T, Svensson P, Arendt-Nielsen L (1998) Experimental muscle pain increases the human stretch reflex. Pain 75:331–339PubMedGoogle Scholar
  41. Moseley GL, Hodges PW, Gandevia SC (2002) Deep and superficial fibers of lumbar multifidus are differentially active during voluntary arm movements. Spine 27: E29–36CrossRefPubMedGoogle Scholar
  42. Nouwen A, VanAkkerveeken PF, Versloot JM (1987) Patterns of muscular activity during movement in patients with chronic low back pain. Spine 12:777–782PubMedGoogle Scholar
  43. O'Sullivan PB, Twomey LT, Allison GT (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22:2959–2967CrossRefPubMedGoogle Scholar
  44. Panjabi MM (1992) The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. J Spin Disord 5:383–389Google Scholar
  45. Radebold A, Cholewicki J, Panjabi MM, Patel TC (2000) Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine 25:947–954PubMedGoogle Scholar
  46. Rantanen J, Hurme M, Falck B, Alaranta H, Nykvist F, Lehto M, Einola S, Kalimo H (1993) The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine 18:568–574PubMedGoogle Scholar
  47. Richardson CA, Jull GA, Hodges PW, Hides JA (1999) Therapeutic exercise for spinal segmental stabilisation in low back pain: scientific basis and clinical approach. Churchill Livingstone, EdinburghGoogle Scholar
  48. Richardson CA, Snijders CJ, Hides JA, Damen L, Pas MS, Storm J (2002) The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine 27:399–405CrossRefPubMedGoogle Scholar
  49. Roy SH, DeLuca CJ, Casavant DA (1989) Lumbar muscle fatigue and chronic low back pain. Spine 14:992–1001PubMedGoogle Scholar
  50. Shirado O, Ito T, Kaneda K, Strax TE (1995) Flexion-relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain. Am J Phys Med Rehabil 74:139–144PubMedGoogle Scholar
  51. Sihvonen T, Lindgren KA, Airaksinen O, Manninen H (1997) Movement disturbances of the lumbar spine and abnormal back muscle electromyographic findings in recurrent low back pain. Spine 22:289–295CrossRefPubMedGoogle Scholar
  52. Snijders CJ, Vleeming A, Stoeckart R, Mens JMA, Kleinrensink GJ (1995) Biomechanical modelling of sacroiliac joint stability in different postures. Spine State Art Rev 9:419–432Google Scholar
  53. Svensson P, Arendt-Nielsen L, Houe L (1995) Sensory-motor interactions of human experimental unilateral jaw muscle pain: a quantitative analysis. Pain 64:241–249CrossRefGoogle Scholar
  54. Svensson P, De Laat A, Graven-Nielsen T, Arendt-Nielsen L (1998) Experimental jaw-muscle pain does not change heteronymous H-reflexes in the human temporalis muscle. Exp Brain Res 121:311–318PubMedGoogle Scholar
  55. Svensson P, Miles TS, Graven-Nielsen T, Arendt-Nielsen L (2000) Modulation of stretch-evoked reflexes in single motor units in human masseter muscle by experimental pain. Exp Brain Res 132:65–71CrossRefPubMedGoogle Scholar
  56. Tesh KM, ShawDunn J, Evans JH (1987) The abdominal muscles and vertebral stability. Spine 12:501–508PubMedGoogle Scholar
  57. Valeriani M, Restuccia D, Di Lazzaro V, Oliviero A, Profice P, Le Pera D, Saturno E, Tonali P (1999) Inhibition of the human primary motor area by painful heat stimulation of the skin. Clin Neurophysiol 110:1475–1480PubMedGoogle Scholar
  58. Venna S, Hurri H, Alaranta H (1994) Correlation between neurological leg deficits and reaction time of upper limbs among low-back pain patients. Scand J Rehabil Med 26:87–90PubMedGoogle Scholar
  59. Wilder DG, Aleksiev AR, Magnusson ML, Pope MH, Spratt KF, Goel VK (1996) Muscular response to sudden load. A tool to evaluate fatigue and rehabilitation. Spine 21:2628–2639PubMedGoogle Scholar
  60. Zedka M, Prochazka A (1997) Phasic activity in the human erector spinae during repetitive hand movements. J Physiol (Lond) 504:727–734Google Scholar
  61. Zedka M, Chan M, Prochazka A (1999a) Voluntary control of painful muscles in humans. Soc Neurosci Abstr 25:2181Google Scholar
  62. Zedka M, Prochazka A, Knight B, Gillard D, Gauthier M (1999b) Voluntary and reflex control of human back muscles during induced pain. J Physiol (Lond) 520:591–604Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Paul W. Hodges
    • 1
    • 3
    Email author
  • G. Lorimer Moseley
    • 1
    • 2
  • Anna Gabrielsson
    • 4
  • Simon C. Gandevia
    • 3
  1. 1.Department of PhysiotherapyThe University of QueenslandBrisbane, QLD 4072Australia
  2. 2.Department of PhysiotherapyRoyal Brisbane HospitalBrisbaneAustralia
  3. 3.Prince of Wales Medical Research Institute and University of New South WalesSydneyAustralia
  4. 4.Department of Community Medicine and Rehabilitation PhysiotherapyUmeå UniversityUmeåSweden

Personalised recommendations