Abstract
This prospective study aimed to examine whether patients with lumbar disc herniation, before and after surgery, showed impaired recovery from fatigue measured with EMG and subjective ratings as compared to healthy subjects. Forty-three patients due for, and after, lumbar disc surgery and 60 healthy subjects were fatigued using a modified Sørensen’s test. Recovery of back extensor muscles was assessed using electromyography and the Borg scale ratings at 1, 2, 3, and 5 minutes of recovery, and was further analyzed using an exponential time-dependence model. The patients completed four questionnaires: the Oswestry, the Roland-Morris, a self-efficacy scale and the SF-36. The exponential time-dependence model was successful for 14 of the 43 patients and 57 of the 60 healthy subjects. The patients for whom the model succeeded had significantly better scores on the questionnaires than those for whom the model was unsuccessful. Specific items related to standing and lifting were identified. The patients’ recovery was impaired compared to the healthy subjects, as determined by use of the exponential time-dependence model. The combination of fatigue and recovery measures was reflected in the questionnaire scores and is therefore important for evaluating patients with lumbar disc herniation.
Similar content being viewed by others
References
Adams MA, Mannion AF, Dolan P (1999) Personal risk factors for first-time low back pain. Spine 24:2497–2505
Alfonsi R, Pavesi R, Merlo IM, Gelmetti A, Zambarbieri D, Lago P, Arrigo A, Reggiani C, Moglia A (1999) Hemoglobin near-infrared spectroscopy and surface EMG study in muscle ischaemia and fatiguing isometric contraction. J Sports Med Phys Fitness 39:83–92
Allman BL, Rice CL (2002) Neuromuscular fatigue and aging: central and peripheral factors. Muscle Nerve 25:785–796
Biering-Sørensen F (1984) Physical measurements as risk indicators for low-back trouble over a one-year period. Spine 9:106–119
Borg G (1998) Borg’s perceived exertion and pain scales. Human Kinetics, Champaign, Ill.
Broman H, Bilotto G, De Luca CJ (1985) Myoelectric signal conduction velocity and spectral parameters: influence of force and time. J Appl Physiol 58:1428–1437
Dedering Å, Németh G, Harms-Ringdahl K (1999) Correlation between electromyographic spectral changes and subjective assessment of lumbar muscle fatigue in subjects without pain from the lower back. Clin Biomech 14:103–111
Dedering Å, Roos af Hjelmsäter M, Elfving B, Harms-Ringdahl K, Németh G (2000) Between days reliability of subjective and objective assessments of lumbar muscle fatigue. J Electromyogr Kinesiol 10:151–158
Dedering Å, Oddsson LIE, Harms-Ringdahl K, Németh G (2002) Electromyography and ratings of lumbar muscle fatigue using a four-level staircase protocol. Clin Biomech 17:171–176
De Luca CJ (1993) Use of surface EMG signal for performance evaluation of back muscles. Muscle Nerve 16:210–216
Dolan P, Adams MA (1998) Repetitive lifting tasks fatigue the back muscles and increase the bending moment acting on the lumbar spine. J Biomech 31:713–721
Dolan P, Mannion AF, Adams MA (1994) Passive tissues help the back muscles to generate extensor moments during lifting. J Biomech 27:1077–1085
Dolan P, Greenfield K, Nelson RJ, Nelson IW (2000) Can exercise therapy improve the outcome of microdiscectomy? Spine 25:1523–1532
Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N (2002) Young investigator award 2001 winner: risk factors for lumbar disc degeneration. A 5-year prospective MRI study in asymptomatic individuals. Spine 27:125–134
Elfving B, Liljequist D, Dedering Å, Németh G (2002) Recovery of EMG median frequency after lumbar muscle fatigue analysed with an exponential time dependence model. Eur J Appl Physiol 88:85–93
Enoka RM (1995) Mechanisms of muscle fatigue: central factors and task dependency. J Electromyogr Kinesiol 5:141–149
Estlander A-M, Vanharanta H, Moneta GB, Kaivanto K (1994) Anthropometric variables, self-efficacy beliefs, and pain and disability ratings on the isokinetic performance of low back pain patients. Spine 19:941–947
Fairbank JCT, Davies JB, Couper J, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273
Fleiss JL (1986) The design and analysis of clinical experiments, 1st edn. Wiley, New York, p 21
Fulco CS, Rock PB, Muza SR, Lammi E, Cymerman A, Butterfield G, Moore LG, Braun B, Lewis S (1999) Slower fatigue and faster recovery of the adductor pollicis muscle in women matched for strength with men. Acta Physiol Scand 167:133–139
Häkkinen K (1993) Neuromuscular fatigue and recovery in male and female athletes during heavy resistance exercise. Int J Sports Med 14:53–59
Hara Y, Findley T, Sugimoto A, Hanayama K (1998) Muscle fiber conduction velocity (MFCV) after fatigue in elderly subjects. Electromyogr Clin Neurophysiol 38:427–435
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 19:165–172
Hoogendoorn WE, Bongers PM, de Vet HC, Douwes M, Koes B, Miedema MC, Bouter LM (2000) Flexion and rotation of the trunk and lifting at work are risk factors for low back pain. Spine 25:3087–3092
Johansson E, Lindberg P (1998) Subacute and chronic low back pain. Reliability and validity of a Swedish version of the Roland and Morris disability questionnaire. Scand J Rehabil Med 30:139–143
Kollmitzer J, Oddsson LIE, Ebenbichler GR, Giphart JE, De Luca CJ (2002) Postural control during lifting. J Biomech 35:585–594
Kroon GW, Naeije M (1988) Recovery following exhaustive dynamic exercise in the human biceps muscle. Eur J Appl Physiol 58:228–232
Kroon GW, Naeije M (1991) Recovery of the human biceps electromyogram after heavy eccentric, concentric or isometric exercise. Eur J Appl Physiol 63:444–448
Kuorinka I (1988) Restitition of EMG spectrum after muscular fatigue. Eur J Appl Physiol 57:311–315
Larivière C, Arsenault AB, Gravel D, Gagnon D, Loisel P (2001) Median frequency of the electromyographic signal: effect of time-window location on brief step contractions. J Electromyogr Kinesiol 11:65–71
Larivière C, Gagnon D, Loisel P (2002a) A biomechanical comparison of lifting techniques between subjects with and without chronic low back pain during freestyle lifting and lowering tasks. Clin Biomech 17:89–98
Larivière C, Arsenault AB, Gravel D, Gagnon D, Loisel P (2002b) Evaluation of measurement strategies to increase the reliability of EMG indices to assess back muscle fatigue and recovery. J Electromyogr Kinesiol 12:91–102
Linnamo V, Häkkinen K, Komi PV (1998) Neuromuscular fatigue and recovery in maximal compared to explosive strength loading. Eur J Appl Physiol 77:176–181
Luoto S, Heliövaara M, Hurri HO, Alaranta HT (1995) Static back endurance and the risk of low-back pain. Clin Biomech 10:323–324
Lu WW, Luk KD, Cheung KMC, Wong YW, Leong JCY (2001) Back muscle contraction patterns of patients with low back pain before and after rehabilitation treatment: an electromyographic evaluation. J Spinal Disord 14:277–282
Mannion AF (1999) Fiber type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. J Electromyogr Kinesiol 9:363–377
Mannion AF, Dolan P (1994) Electromyographic median frequency changes during isometric contraction of the back extensors to fatigue. Spine 19:1223–1229
Mannion AF, Dolan P, Adams MA (1996) Psychological questionnaires: do abnormal scores precede or follow first-time low back pain. Spine 21:2603–2611
Mannion AF, Dumas GA, Cooper RG, Espinosa FJ, Faris MW (1997) Muscle fiber size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences. J Anat 190:505–513
Mannion AF, Dumas GA, Stevenson JM, Cooper RG (1998) The influence of muscle fiber size and type distribution on electromyographic measures of back muscle fatiguability. Spine 23:576–584
Matsui H, Ohmori K, Kanamori M, Ishihara H, Tsuji H (1998) Significance of scoliotic list in operated patients with lumbar disc herniation. Spine 23:338–342
Moffroid MT, Reid S, Henry SM, Haugh LD, Ricamato A (1994) Some endurance measures in persons with chronic low back pain. J Orthop Sports Phys Ther 20:81–87
Németh G, Ohlsén H (1985) In vivo moment arm lengths for hip extensor muscles at different angles of hip flexion. J Biomech 18:129–140
Noble BJ, Borg GAV, Jacobs I, Ceci R, Kaiser P (1983) A category-ratio perceived exertion scale: relationship to blood and muscle lactates and heart rate. Med Sci Sports Exerc 15:523–528
Peach JP, McGill SM (1998) Classification of low back pain with the use of spectral electromyogram parameters. Spine 23:1117–1123
Peach JP, Gunning J, McGill SM (1998) Reliability of spectral EMG parameters of healthy back extensors during submaximum isometric fatiguing contractions and recovery. J Electromyogr Kinesiol 8:403–410
Pincus T, Vlaeyen JWS, Kendall NAS, Von Korff MR, Kalauokalani DA, Reis S (2002) Cognitive-behavioral therapy and psychosocial factors in low back pain. Directions for the future. Spine 27:E133–E138
Poppel MNM van , Koes B, van der Ploeg T, Smid T, Bouter LM (1998) Lumbar supports and education for the prevention of low back pain in industry. A randomized controlled trial. JAMA 279:1789–1794
Prather H, Foye PM, Cianca JC (2002) Industrial medicine and acute musculoskeletal rehabilitation. 1. Diagnosing and managing the injured worker with low back pain. Arch Phys Med Rehabil 83:S3–6, S33–39
Rodriquez AA, Agre JC, Knudtson ER, Franke TM, Ng AV (1993) Acoustic myography compared to electromyography during isometric fatigue and recovery. Muscle Nerve 16:188–192
Roland M, Morris R (1983) A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144
Roy SH, De Luca CJ, Snyder-Mackler L, Emley MS, Crenshaw RL, Lyons JP (1990) Fatigue, recovery and low back pain in varsity rowers . Med Sci Sports Exerc 22:463–469
Sbriccoli P, Felici F, Rosponi A, Aliotta A, Castellano V, Mazzà C, Bernardi M, Marchetti M (2001) Exercise induced muscle damage and recovery assessed by means of linear and non-linear sEMG analysis and ultrasonography. J Electromyogr Kinesiol 11:73–83
Simond G, Bendahan D, Cozzone PJ (2001) Time averaging and fitting of nonlinear metabolic changes: the issue of the time index choice applied to [31P] MRS investigation of muscle energetics. J Magn Reson 149:1–7
Sullivan M, Karlsson J, Ware J (1995) The Swedish SF-36 health survey I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med 41:1358
Svensson E (1998) Application of a rank-invariant method to evaluate reliability of ordered categorical assessments. J Epidemiol Biostat 3:403–409
Taimela S, Kankaanpää M, Airaksinen O (1998) A submaximal back extension endurance test utilising subjective perception of low back fatigue. Scand J Rehabil Med 30:107–112
Tho KS, Németh G, Lamontagne M, Eriksson E (1997) Electromyographic analysis of muscle fatigue in anterior cruciate ligament deficient knees. Clin Orthop142–151
Thorstensson A, Carlsson H (1987) Fibre types in human lumbar muscles. Acta Physiol Scand 131:195–202
Vestergaard-Poulsen P, Thomsen C, Sinkjaer T, Henriksen O (1995) Simultaneous [31P]-NMR spectroscopy and EMG in exercising and recovering human skeletal muscle: a correlation study. J Appl Physiol 79:1469–1478
Vroomen PCAJ, de Krom MCTFM, Knottnerus JA (1999) Diagnostic value of history and physical examination in patients suspected of sciatica due to disc herniation: a systematic review. J Neurol 246:899–906
Yoshihara K, Shirai Y, Nakayama Y, Uesaka S (2001) Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine 26:622–626
Zhao W-P, Kawaguchi Y, Matsui H, Kanamori M, Kimura T (2000) Histohemistry and morphology of the multifidus muscle in lumbar disc herniation. Comparative study between the diseased and normal sides. Spine 25:2191–2199
Zhu X-Z, Parnianpour M, Nordin M, Kahanovitz N (1989) Histochemistry and morphology of erector spinae muscle in lumbar disc herniation. Spine 14:391–397
Acknowledgements
Paul Stephansson, M.Sc. E.E., is gratefully thanked for mathematical advice and discussion. This study was financially supported by grants from the Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dedering, Å., Elfving, B. & Németh, G. EMG recovery and ratings after back extensor fatigue in patients with lumbar disc herniation and healthy subjects. Eur J Appl Physiol 92, 150–159 (2004). https://doi.org/10.1007/s00421-004-1065-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00421-004-1065-x