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Delayed response in rectus abdominis muscle following a step perturbation in subjects with and without recurrent low back pain

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Abstract

Background

Delayed trunk and lower limb muscle activation is associated with balance loss and fall injuries in subjects with recurrent low back pain (LBP).

Purpose

This study was conducted to compare differences in the onset of muscle contractions of the trunk and lower limb muscles following a treadmill-induced step perturbation between subjects with and without LBP.

Methods

Eighty-three right limb dominant individuals (43 subjects with LBP and 40 control subjects) were exposed to the perturbation (0.31 m/s velocity for 0.2 m). The electromyography (EMG) reaction times were analyzed during the first step following the perturbation. The EMG electrodes were placed on both sides of the trunk and lower limbs, including the rectus abdominis (RA), erector spinae (ES), tibialis anterior (TA), and gastrocnemius (GA) muscles.

Results

The group x muscle interaction was statistically significant (F = 9.44, p = 0.003). The TA muscle activation was significantly delayed compared to the RA, ES, and GA. There was a significant interaction on side x muscle (F = 4.14, p = 0.04). The RA muscles were significantly delayed on the non-dominant (t = − 3.35, p = 0.001) and dominant (t = − 2.53, p = 0.01) sides in the LBP group.

Conclusion

The LBP group demonstrated a delayed reaction time on the RA muscles, which indicated poor trunk control relative to the lower limbs. The delayed bilateral RA muscle might indicate possible coordination problems relative to the ES and lower limb muscles, which may lead to potential fall hazards.

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References

  1. Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    PubMed  PubMed Central  Google Scholar 

  2. Sung PS, Maxwell MJ (2017) Kinematic chain reactions on trunk and dynamic postural steadiness in subjects with recurrent low back pain. J Biomech 59:109–115. https://doi.org/10.1016/j.jbiomech.2017.06.001

    Article  PubMed  Google Scholar 

  3. Tsao H, Galea MP, Hodges PW (2008) Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 131:2161–2171. awn154 [pii]. https://doi.org/10.1093/brain/awn154

  4. D'Hooge R, Hodges P, Tsao H, Hall L, Macdonald D, Danneels L (2013) Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J Electromyogr Kinesiol 23:173–181. S1050-6411(12)00163-0 [pii]. https://doi.org/10.1016/j.jelekin.2012.09.003

  5. Silfies SP, Squillante D, Maurer P, Westcott S, Karduna AR (2005) Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin Biomech (Bristol, Avon) 20:465–473

    Article  PubMed  Google Scholar 

  6. Dankaerts W, O'Sullivan PB, Burnett AF, Straker LM (2007) The use of a mechanism-based classification system to evaluate and direct management of a patient with non-specific chronic low back pain and motor control impairment--a case report. Man Ther 12:181–191. S1356–689X(06)00075-0 [pii]. https://doi.org/10.1016/j.math.2006.05.004

  7. Laird RA, Kent P, Keating JL (2012) Modifying patterns of movement in people with low back pain -does it help? A systematic review. BMC Musculoskelet Disord 13:169. https://doi.org/10.1186/1471-2474-13-169

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brumagne S, Janssens L, Janssens E, Goddyn L (2008) Altered postural control in anticipation of postural instability in persons with recurrent low back pain. Gait Posture 28:657–662. S0966-6362(08)00110-0 [pii]. https://doi.org/10.1016/j.gaitpost.2008.04.015

  9. Sung PS, Danial P (2018) Trunk reaction time and kinematic changes following slip perturbations in subjects with recurrent low back pain. Ann Biomed Eng 46:488–497. https://doi.org/10.1007/s10439-017-1972-8

    Article  PubMed  Google Scholar 

  10. Prins MR, Griffioen M, Veeger TTJ, Kiers H, Meijer OG, van der Wurff P, Bruijn SM, van Dieen JH (2018) Evidence of splinting in low back pain? A systematic review of perturbation studies. Eur Spine J 27:40–59. https://doi.org/10.1007/s00586-017-5287-0

    Article  PubMed  Google Scholar 

  11. Leinonen V, Airaksinen M, Taimela S, Kankaanpaa M, Kukka A, Koivisto T, Airaksinen O (2007) Low back pain suppresses preparatory and triggered upper-limb activation after sudden upper-limb loading. Spine (Phila Pa 1976) 32:E150–155. https://doi.org/10.1097/01.brs.0000256886.94791.94

  12. Jacobs JV, Henry SM, Nagle KJ (2010) Low back pain associates with altered activity of the cerebral cortex prior to arm movements that require postural adjustment. Clin Neurophysiol 121:431–440. https://doi.org/10.1016/j.clinph.2009.11.076

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sung PS, Spratt KF, Wilder DG (2004) A possible methodological flaw in comparing dominant and nondominant sided lumbar spine muscle responses without simultaneously considering hand dominance. Spine (Phila Pa 1976) 29:1914–1922. 00007632-200409010-00016 [pii]

  14. Abboud J, Lardon A, Boivin F, Dugas C, Descarreaux M (2016) Effects of muscle fatigue, creep, and musculoskeletal pain on neuromuscular responses to unexpected perturbation of the trunk: a systematic review. Front Hum Neurosci 10:667. https://doi.org/10.3389/fnhum.2016.00667

    Article  PubMed  Google Scholar 

  15. van Dieen JH, Reeves NP, Kawchuk G, van Dillen LR, Hodges PW (2019) Analysis of motor control in patients with low back pain: a key to personalized care? J Orthop Sports Phys Ther 49:380–388. https://doi.org/10.2519/jospt.2019.7916

    Article  PubMed  Google Scholar 

  16. Reeves NP, Cholewicki J, van Dieen JH, Kawchuk G, Hodges PW (2019) Are stability and instability relevant concepts for back pain? J Orthop Sports Phys Ther. https://doi.org/10.2519/jospt.2019.8144

  17. Ghamkhar L, Kahlaee AH (2015) Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: a systematic review. PM R 7:519–526. https://doi.org/10.1016/j.pmrj.2015.01.013

    Article  PubMed  Google Scholar 

  18. Haddas R, Sawyer SF, Sizer PS, Brooks T, Chyu MC, James CR (2016) Effects of volitional spine stabilization and lower extremity fatigue on knee and ankle during landing performance in a recurrent low back pain population. J Sport Rehab. https://doi.org/10.1123/jsr.2015-0171

  19. Brophy R, Silvers HJ, Gonzales T, Mandelbaum BR (2010) Gender influences: the role of leg dominance in ACL injury among soccer players. Br J Sports Med 44:694–697. bjsm.2008.051243 [pii]. https://doi.org/10.1136/bjsm.2008.051243

  20. Andersen TE, Floerenes TW, Arnason A, Bahr R (2004) Video analysis of the mechanisms for ankle injuries in football. Am J Sports Med 32:69S-79S

    Article  PubMed  Google Scholar 

  21. Ciccone DS, Just N, Bandilla EB (1996) Non-organic symptom reporting in patients with chronic non-malignant pain. Pain 68:329–341

    Article  CAS  PubMed  Google Scholar 

  22. Sung PS, Danial P (2017) Gender difference of shoulder-pelvic kinematic integration for trunk rotation directions in healthy older adults. Clin Biomech (Bristol, Avon) 50:56–62. https://doi.org/10.1016/j.clinbiomech.2017.09.014

    Article  PubMed  Google Scholar 

  23. Sung PS, Ham YW (2010) Comparing postural strategy changes following adapted versus non-adapted responses in subjects with and without spinal stenosis. Man Ther 15:261–266. S1356-689X(10)00005-6 [pii]. https://doi.org/10.1016/j.math.2010.01.004

  24. Kajrolkar T, Yang F, Pai YC, Bhatt T (2014) Dynamic stability and compensatory stepping responses during anterior gait-slip perturbations in people with chronic hemiparetic stroke. J Biomech 47:2751–2758. https://doi.org/10.1016/j.jbiomech.2014.04.051

    Article  PubMed  Google Scholar 

  25. Pai YC, Yang F, Bhatt T, Wang E (2014) Learning from laboratory-induced falling: long-term motor retention among older adults. Age (Dordr) 36:9640. https://doi.org/10.1007/s11357-014-9640-5

    Article  PubMed  Google Scholar 

  26. Solnik S, DeVita P, Rider P, Long B, Hortobagyi T (2008) Teager-Kaiser Operator improves the accuracy of EMG onset detection independent of signal-to-noise ratio. Acta Bioeng Biomech 10:65–68

    PubMed  PubMed Central  Google Scholar 

  27. Hodges PW, Bui BH (1996) A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. Electroencephalogr Clin Neurophysiol 101:511–519

    CAS  PubMed  Google Scholar 

  28. Sung PS, Park MS (2022) Ankle reaction times with tray usage following a slip perturbation between subjects with and without chronic low back pain. Gait Posture 97:196–202. https://doi.org/10.1016/j.gaitpost.2022.07.260

    Article  PubMed  Google Scholar 

  29. Portney LG, Watkins MP (2009) Foundations of clinical research Applications to practice, 3rd edn. Pearson Education Inc., Upper Saddle

    Google Scholar 

  30. Jubany J, Marina M, Angulo-Barroso R (2017) Electromyographic and kinematic analysis of trunk and limb muscles during a holding task in individuals with chronic low back pain and healthy controls. PM R. https://doi.org/10.1016/j.pmrj.2017.04.008

    Article  PubMed  Google Scholar 

  31. Troy KL, Donovan SJ, Grabiner MD (2009) Theoretical contribution of the upper extremities to reducing trunk extension following a laboratory-induced slip. J Biomech 42:1339–1344. https://doi.org/10.1016/j.jbiomech.2009.03.004

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tong MH, Mousavi SJ, Kiers H, Ferreira P, Refshauge K, van Dieen J (2017) Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis. Arch Phys Med Rehab 98:120–136. https://doi.org/10.1016/j.apmr.2016.05.016

    Article  Google Scholar 

  33. Schouppe S, Clauwaert A, Van Oosterwijck J, Van Damme S, Palmans T, Wiersema JR, Sanchis-Sanchez E, Danneels L (2020) Does experimentally induced pain-related fear influence central and peripheral movement preparation in healthy people and patients with low back pain? Pain 161:1212–1226. https://doi.org/10.1097/j.pain.0000000000001813

    Article  PubMed  Google Scholar 

  34. Sung PS, O’Sullivan E, Park MS (2021) The reaction times and symmetry indices in the bilateral trunk and limb muscles in control subjects and subjects with low back pain that persisted two months or longer. Eur Spine J. https://doi.org/10.1007/s00586-021-06797-1

    Article  PubMed  Google Scholar 

  35. McDowell C, Smyk M, Sung PS (2018) Compensatory strategy between trunk-hip kinematics and reaction time following slip perturbation between subjects with and without chronic low back pain. J Electromyogr Kinesiol 43:68–74. https://doi.org/10.1016/j.jelekin.2018.09.005

    Article  PubMed  Google Scholar 

  36. Sung PS, Danial P (2018) Trunk sway response to consecutive slip perturbations between subjects with and without recurrent low back pain. Musculoskelet Sci Pract 33:84–89. https://doi.org/10.1016/j.msksp.2017.12.005

    Article  PubMed  Google Scholar 

  37. You J, Chou Y, Lin C, Su F (2001) Effect of slip on movement of body center of mass relative to base of support. Clin Biomech (Bristol, Avon) 16:167–173

    Article  CAS  PubMed  Google Scholar 

  38. Marigold DS, Patla AE (2002) Strategies for dynamic stability during locomotion on a slippery surface: effects of prior experience and knowledge. J Neurophysiol 88:339–353. https://doi.org/10.1152/jn.00691.2001

    Article  PubMed  Google Scholar 

  39. Milosevic M, Shinya M, Masani K, Patel K, McConville KM, Nakazawa K, Popovic MR (2016) Anticipation of direction and time of perturbation modulates the onset latency of trunk muscle responses during sitting perturbations. J Electromyogr Kinesiol 26:94–101. https://doi.org/10.1016/j.jelekin.2015.12.003

    Article  PubMed  Google Scholar 

  40. Mueller J, Engel T, Mueller S, Stoll J, Baur H, Mayer F (2017) Effects of sudden walking perturbations on neuromuscular reflex activity and three-dimensional motion of the trunk in healthy controls and back pain symptomatic subjects. PLoS ONE 12:e0174034. https://doi.org/10.1371/journal.pone.0174034

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank participants at Central Michigan University and Dr. DC Lee at BioCAT Inc. for his technical assistance for data analyses and contributions to the study. This study was supported by the Scholarship Council, Lilly Faculty Scholarship Award at Indiana Wesleyan University (2573877).

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Authors and Affiliations

  1. Department of Physical Therapy, Indiana Wesleyan University, 4201 South Washington Street, Marion, IN, 46953, USA

    Paul S. Sung

  2. Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, 7, Keunjaebong-Gil, Hwaseong-Si, Gyeonggi-Do, 18450, Republic of Korea

    Moon Soo Park

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Sung, P.S., Park, M.S. Delayed response in rectus abdominis muscle following a step perturbation in subjects with and without recurrent low back pain. Eur Spine J 32, 1842–1849 (2023). https://doi.org/10.1007/s00586-023-07639-y

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