Changes in muscle activation patterns and subjective low back pain ratings during prolonged standing in response to an exercise intervention

BackgroundLow back pain (LBP) development has been associated with occupational standing. Increased hip and trunk muscle co-activation is considered to be predisposing for LBP development during standing in previously asymptomatic individuals. The purpose of this work was to investigate muscle activation and LBP responses to a prescribed exercise program. Pain-developing (PD) individuals were expected to have decreased LBP and muscle co-activation following exercise intervention.MethodsElectromyography (EMG) data were recorded from trunk and hip muscle groups during 2-h of standing. An increase of >10 mm on visual analog scale (VAS) during standing was threshold for PD categorization. Participants were assigned to progressive exercise program with weekly supervision or control (usual activity) for 4 weeks then re-tested.ResultsForty percent were categorized as PD on day 1, VAS = 24.2 (±4.0) mm. PD exercisers (PDEX) had lower VAS scores (8.93 ± 3.66 mm) than PD control (PDCON) (16.5 ± 6.3 mm) on day 2 (p = 0.007). Male PDEX had decreased gluteus medius co-activation levels (p < 0.05) on day 2.DiscussionThe exercise program proved beneficial in reducing LBP during standing. There were changes in muscle activation patterns previously associated with LBP. Predisposing factors for LBP during standing were shown to change positively with appropriate exercise intervention.     

Differential patterns of muscle modification in women with episodic and chronic tension-type headache revealed using surface electromyographic analysis

Tension-type headache (TTH) is a prototypical disorder in which muscular factors play a key role in the pathogenesis. This study was designed to understand muscular dysfunction in patients with episodic (ETTH) and chronic TTH (CTTH) using surface electromyography analysis (SEMG). Women with frequent ETTH (n = 14), CTTH (n = 14) and age-matched controls (n = 13) were recruited. SEMG data were recorded from the masseter, sternocleidomastoid, and upper trapezius muscles during maximum voluntary contraction and sustained voluntary isometric clenching, the neck flexion endurance test and shoulder elevation for 30 s. The root mean square (RMS) and median frequency (MDF) of the SEMG signal were measured throughout the test. The fatigue index, which is the MDF slope during sustained muscle contraction, decreased significantly faster in the ETTH and CTTH groups compared with that in the control (p < 0.05). The mean absolute RMS and relative percentage values at the initial and final period during sustained isometric contraction decreased significantly in the CTTH group (p < 0.05). Furthermore, headache clinical parameters (frequency and duration) were negatively correlated with the amplitude values (p < 0.05). A different muscle firing pattern or some muscle modifications in patients with CTTH may reflect reorganization of the motor-control strategy.     

The effect of heel lifts on trunk muscle activation during gait: A study of young healthy females

Heel lifts are a treatment option for low back pain (LBP), whilst high-heeled shoes have been linked to LBP development. This study evaluated the effects of in-shoe 20 mm high bilateral heel lifts on trunk muscle activity. Activity of the erector spinae (ErSp), internal oblique and external oblique muscles was evaluated using surface electromyography in 15 young (20.7 ± 0.9 years) healthy female participants. Measures were taken during overground gait, both immediately and following two days habituation to the heel lifts. Immediately following the addition of the heel lifts, levels of ErSp muscle activity in the 5% epoch following heel strike increased by 19.2% (p < 0.05). Following habituation, levels of ErSp muscle activity in the 5% epoch prior to heel strike increased by 24.1% (p < 0.05), and a 14 ms (p < 0.001) earlier onset of ErSp muscle activity prior to heel strike was observed. These results indicate the heel lifts altered muscle activity reactively around heel strike (i.e. greater activity after heel strike) immediately after application and proactively (i.e. earlier onsets and greater activity prior to heel strike) after short term habituation. When put in context of previous research on trunk muscle activity in LBP populations, these changes may be important considerations for the aetiology, treatment and prevention of LBP.     

Evaluating the effect of electrode location on surface EMG amplitude of the m. erector spinae p. longissimus dorsi

Variations in surface electromyography (SEMG) amplitude have been shown to be dependent on the dislocation of recording electrodes. Yet no literature is available about the effect of electrode dislocation on SEMG amplitude of the lower back muscles. In this project, the aim was to determine this effect by investigating changes in the SEMG root mean square (RMS), induced by a well-defined dislocation of the recording electrodes. Bipolar SEMG of the longissimus dorsi (LD) muscles was measured in 16 healthy subjects undertaking five functional tasks (standing, forward flexion, re-extension, unsupported sitting and arm/leg lifting), and for eight of those subjects the experiment was repeated within two weeks. Intra-class correlation coefficients (ICCs) were used to show the reliability of the RMS in relation to electrode dislocation, the repeatability of the tasks, and the test–retest reliability. Results showed that: (1) lateral dislocation causes a significant decrease (18%, p < 0.001) in RMS; (2) longitudinal dislocation does not change the RMS; and (3) the variability caused by electrode dislocation is comparable to the variability caused by repetitions of tasks or by electrode repositioning. Our conclusion is that positioning in the mediolateral direction should be exact to minimize changes in SEMG amplitude due to dislocation. However, precise longitudinal electrode positioning seems to be less critical in experimental setups which measure the SEMG of the lower back muscles.     

Standardized activities of daily living in presence of sub-acute low-back pain: A pilot study

The aim of this pilot study was to investigate how sub-acute low-back pain (LBP) patients differed with respect to control in movements and muscle activation during standardized tasks representing daily living activities, and explore relationships between cognition and measured motor performance. Linear and nonlinear parameters were computed from kinetics, kinematics and muscle activity recorded for 12 sub-acute patients and 12 healthy matched controls during trunk flexion, sit-to-stand from a chair and lifting a box. Cognitive variables were collected to explore relationships with biomechanical parameters. For trunk flexion, left external abdominal oblique muscle activity level was lower for patients compared with controls (p < 0.05), whereas sample entropy (complexity) was higher (p < 0.05). Normalized mutual information was lower for patients compared with controls for left and right erector spinae (p < 0.05). Level of activity of left external abdominal oblique correlated negatively with cognitive ignoring and positively with catastrophizing (p ? 0.05), and catastrophizing also correlated positively with functional connectivity of abdominal muscles (p < 0.05). Signs of reorganization in muscle activation pointed towards different synergistic actions in trunk muscles in sub-acute LBP patients compared with controls. The interplay with maladaptive cognition suggested that in the subacute stage of LBP, both biomechanical and cognitive factors should be taken into account.     

The role of trunk muscles in sitting balance control in people with low back pain

The purpose of this study was to examine the muscular activities and kinetics of the trunk during unstable sitting in healthy and LBP subjects. Thirty-one healthy subjects and twenty-three LBP subjects were recruited. They were sat on a custom-made chair mounted on a force plate. Each subject was asked to regain balance after the chair was tilted backward at 20°, and then released. The motions of the trunk and trunk muscle activity were examined. The internal muscle moment and power at the hip and lumbar spine joints were calculated using the force plate and motion data. No significant differences were found in muscle moment and power between healthy and LBP subjects (p > 0.05). The duration of contraction of various trunk muscles and co-contraction were significantly longer in the LBP subjects (p < 0.05) when compared to healthy subjects, and the reaction times of the muscles were also significantly reduced in LBP subjects (p < 0.05). LBP subjects altered their muscle strategies to maintain balance during unstable sitting, but these active mechanisms appear to be effective as trunk balance was not compromised and the internal moment pattern remained similar. The changes in muscle strategies may be the causes of LBP or the result of LBP with an attempt to protect the spine.     

Altered preparatory pelvic control during the sit-to-stance-to-sit movement in people with non-specific low back pain

People with non-specific low back pain (LBP) show hampered performance of dynamic tasks such as sit-to-stance-to-sit movement. However, the underlying mechanisms remain obscure. Therefore, the aim of this study was to assess if proprioceptive impairments influence the performance of the sit-to-stance-to-sit movement.First, the proprioceptive steering of 20 healthy subjects and 106 persons with mild LBP was identified during standing using muscle vibration. Second, five sit-to-stance-to-sit repetitions on a stable support and on foam were performed as fast as possible. Total duration, phase duration, center of pressure (COP) displacement, pelvic and thoracic kinematics were analyzed.People with LBP used less lumbar proprioceptive afference for postural control compared to healthy people (P < 0.0001) and needed more time to perform the five repetitions in both postural conditions (P < 0.05). These time differences were determined in the stance and sit phases (transition phases), but not in the focal movement phases. Moreover, later onsets of anterior pelvic rotation initiation were recorded to start both movement sequences (P < 0.05) and to move from sit-to-stance on foam (P < 0.05).Decreased use of lumbar proprioceptive afference in people with LBP seemed to have a negative influence on the sit-to-stance-to-sit performance and more specifically on the transition phases which demand more control (i.e. sit and stance). Furthermore, slower onsets to initiate the pelvis rotation to move from sit-to-stance illustrate a decrease in pelvic preparatory movement in the LBP group.     

Active pauses induce more variable electromyographic pattern of the trapezius muscle activity during computer work

The aim of this laboratory study was to evaluate effects of active and passive pauses and investigate the distribution of the trapezius surface electromyographic (SEMG) activity during computer mouse work. Twelve healthy male subjects performed four sessions of computer work for 10 min in one day, with passive (relax) and active (30% maximum voluntary contraction of shoulder elevation) pauses given every 2 min at two different work paces (low/high). Bipolar SEMG from four parts of the trapezius muscle was recorded. The relative rest time was higher for the lower parts compared with the upper of the trapezius (p < 0.01). The centroid of exposure variation analysis (EVA) along the time axis was lower during the computer work with active pause compared with passive one (p < 0.05). The results of this study revealed (i) lower rest time for the upper parts of trapezius compared with the lower parts, in line with previous clinical findings, (ii) active pauses contributed to a more variable muscle activity pattern during computer work that might have functional implications with respect to work-related musculoskeletal disorders.     

Kinematic chain reactions on trunk and dynamic postural steadiness in subjects with recurrent low back pain

Although subjects with recurrent low back pain (LBP) demonstrate altered trunk control, the kinematic and kinetic responses of the trunk have not been carefully investigated. This study was conducted to compare the standing time, spine range of motion (ROM), and dynamic postural steadiness index (DPSI) based on visual condition between subjects with and without recurrent LBP during upright one leg standing. Sixty-three individuals participated in the study, including 34 control subjects and 29 subjects with recurrent LBP. The DPSI was a composite of the medio-lateral (MLSI), anterior-posterior (APSI), and vertical steadiness indices (VSI) on a force platform. The control group demonstrated longer standing time (s) during the eyes-open condition than the LBP group (26.82 ± 6.03 vs. 19.87 ± 9.36; t = 2.96, p = 0.01). Regarding spine ROM, visual condition was significantly different between groups (F = 7.09, p = 0.01) and demonstrated interactions with spine region and group (F = 5.53, p = 0.02). For the kinetic measures, there was a significant interaction between visual conditions and indices (F = 25.30, p = 0.001). In the LBP group, the DPSI was significantly correlated with the MLSI (r = 0.59, p = 0.002), APSI (r = 0.44, p = 0.03), and VSI (r = 0.98, p = 0.01) in the eyes-closed condition. Overall, the results of this study indicated that the LBP group decreased thorax and lumbar spine rotations during the eyes-closed condition. The LBP group also demonstrated positive correlations with the kinetic indices, enhancing dynamic postural steadiness in the eyes-closed condition in order to possibly avoid pain or further injury. This dynamic postural steadiness strategy is necessary to improve kinetic and kinematic chain reactions in the LBP group. This compensatory pattern supports the development of optimal postural correction strategies to prevent LBP recurrence and might represent a chain reaction to protect trunk control without visual input.     

Comparison between muscle activation measured by electromyography and muscle thickness measured using ultrasonography for effective muscle assessment

In this study, we aimed to compare the intrarater reliability and validity of muscle thickness measured using ultrasonography (US) and muscle activity via electromyography (EMG) during manual muscle testing (MMT) of the external oblique (EO) and lumbar multifidus (MF) muscles. The study subjects were 30 healthy individuals who underwent MMT at different grades. EMG was used to measure the muscle activity in terms of ratio to maximum voluntary contraction (MVC) and root mean square (RMS) metrics. US was used to measure the raw muscle thickness, the ratio of muscle thickness at MVC, and the ratio of muscle thickness at rest. One examiner performed measurements on each subject in 3 trials. The intrarater reliabilities of the % MVC RMS and raw RMS metrics for EMG and the % MVC thickness metrics for US were excellent (ICC = 0.81–0.98). There was a significant difference between all the grades measured using the % MVC thickness metric (p < 0.01). Further, this % MVC thickness metric of US showed a significantly higher correlation with the EMG measurement methods than with the others (r = 0.51–0.61). Our findings suggest that the % MVC thickness determined by US was the most sensitive of all methods for assessing the MMT grade.     

Neuromuscular activation of vastus intermedius muscle during fatiguing exercise

The purpose of this study was to investigate neuromuscular activation of the vastus intermedius (VI) muscle during fatiguing contraction. Seven healthy men performed sustained isometric knee extension exercise at 50% of maximal voluntary contraction until exhaustion. During the fatiguing task, surface electromyograms (EMGs) were recorded from four muscle components of the quadriceps femoris muscle group: VI; vastus lateralis (VL); vastus medialis (VM); and rectus femoris (RF) muscles. For the VI muscle, our recently developed technique was used. Root mean square (RMS) and median frequency (MF) of the surface EMG signal were calculated and these variables were then normalized by the value at the beginning of the task. Normalized RMS of the VI muscle resembled those of the other three muscles at all given times. At 95% of exhaustion time, normalized MF of the VI muscle was significantly higher than that of the VL muscle (p < 0.05). These results suggested that neuromuscular activation is not consistent between the VI and VL muscles at the exhaustion for isometric submaximal contraction and this could reflect the dissimilar intramuscular metabolism between these muscles.     

Performance based on sEMG activity is related to psychosocial components: Differences between back and abdominal endurance tests

The influence of psychosocial components on back and abdominal endurance tests in patients with persistent non-specific low back pain should be investigated to ensure the correct interpretation of these measures. Three-hundred and thirty-two patients (291 men and 41 women) from 19 to 63 years performed an abdominal and back muscle endurance test after completing some psychosocial questionnaires. During the endurance tests, surface electromyography signals of the internal obliques, the external obliques, the lumbar multifidus and the iliocostalis were recorded. Patients were dichotomized as underperformers and good performers, by comparing their real endurance time, to the expected time of endurance derived from the normalized median frequency slope. Independent t-tests were performed to examine the differences on the outcome of the questionnaires. In the back muscle endurance test, the underperformers had significantly lower (p < 0.05) scores on some of the physical subscales of the SF-36. The underperformers group of the AE test scored significantly higher on the DRAM MZDI (p = 0.018) and on the PCS scale (p = 0.020) and showed also significantly lower scores on the SF-36 (p < 0.05). Back muscle endurance tests are influenced by physical components, while abdominal endurance tests seem influenced by psychosocial components.     

An investigation of the simultaneously recorded occlusal contact and surface electromyographic activity of jaw-closing muscles for patients with temporomandibular disorders and a scissors-bite relationship

Surface electromyographic (SEMG) activity of the masseter and anterior temporalis (TA) muscles has been reported to be associated with occlusion and orofacial pain. However, our recent report did not reveal an association between the side of orofacial pain and the side showing higher or lower level of SEMG activity of masseter or TA. The present purpose was to re-test this association in patients who had unilateral scissors-bite relationship. Thirty-two unilateral scissors-bite femalepatients complaining of unilateral orofacial pain (n = 15) or TMJ sounds (n = 17) were enrolled to simultaneously record contacts, force distribution of occlusion, and SEMG activity of masseter and TA during centric maximal voluntary clenching (MVC). The results indicated that neither orofacial pain nor the TMJ sounds had an association with the masseter’s SEMG values, while scissors-bite had (P < 0.05). A lower SEMG value for masseter was found on the scissors-bite side where there was a smaller number of contacts and a lower biting force distribution (P < 0.05). No such association was revealed in TA. In conclusion, in patients with unilateral TMD symptom(s) and scissors-bite, the jawclosing muscles’ SEMG activity during centric MVC was associated with the scissors-bite rather than the symptoms of orofacial pain or TMJ sounds.     

Kinematic analyses of trunk stability in one leg standing for individuals with recurrent low back pain

This prospective study examined normalized stability differences based on dominance side and visual feedback. Subjects with low back pain (LBP) (n = 26; 9 men, 17 women) and without LBP (n = 28; 11 men, 17 women) participated in this study. All subjects were asked to maintain single leg standing balance with the contralateral hip flexed 90° for 25 s. The outcome measures included normalized holding duration and stability. The combined rotation (R_xyz) was also calculated to compare the upper and lower thorax and lumbar axes relative to the core spine axis. The holding duration was significantly different between groups (T = ?2.21, p = 0.03). The subjects without recurrent LBP (control group) demonstrated longer hold duration times (24.60 ± 4.2 s) than the subjects with recurrent LBP (21.2 ± 7.1 s). For the normalized hold duration, there was a significant difference between groups based on visual input (F = 7.13, p = 0.009). There was also a significant difference in standing stability based on visual input (F = 93.93, p = 0.0001) and trunk area (F = 101.51, p = 0.0001). In addition, the normalized stability was significantly different based on dominance and visual input (F = 11.28, p = 0.002). Therefore, trunk stability could prompt an uncoordinated bracing effect with poor proprioception from injury to passive structures or due to interference of pain during central processing of information in subjects with recurrent LBP.     

The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot

Loss of hand function and finger dexterity are main disabilities in the upper limb after stroke. An electromyography (EMG)-driven hand robot had been developed for post-stroke rehabilitation training. The effectiveness of the hand robot assisted whole upper limb training was investigated on persons with chronic stroke (n = 10) in this work. All subjects attended a 20-session training (3–5 times/week) by using the hand robot to practice object grasp/release and arm transportation tasks. Significant motor improvements were observed in the Fugl-Meyer hand/wrist and shoulder/elbow scores (p < 0.05), and also in the Action Research Arm Test and Wolf Motor Function Test (p < 0.05). Significant reduction in spasticity of the fingers as was measured by the Modified Ashworth Score (p < 0.05). The training improved the muscle co-ordination between the antagonist muscle pair (flexor digitorum (FD) and extensor digitorum (ED)), associated with a significant reduction in the ED EMG level (p < 0.05) and a significant decrease of ED and FD co-contraction during the training (p < 0.05); the excessive muscle activities in the biceps brachii were also reduced significantly after the training (p < 0.05).     

Surface electromyography activity of the rectus abdominis,internal oblique,and external oblique muscles during forced expiration in healthy adults

We aimed to characterize rectus abdominis, internal oblique, and external oblique muscle activity in healthy adults under expiratory resistance using surface electromyography. We randomly assigned 42 healthy adult subjects to 3 groups: 30%, 20%, and 10% maximal expiratory intraoral pressure (PEmax). After measuring 100% PEmax and muscle activity during 100% PEmax, the activity and maximum voluntary contraction of each muscle during the assigned experimental condition were measured. At 100% PEmax, the external oblique (p < 0.01) and internal oblique (p < 0.01) showed significantly elevated activity compared with the rectus abdominis muscle. Furthermore, at 20% and 30% PEmax, the external oblique (p < 0.05 and < 0.01, respectively) and the internal oblique (p < 0.05 and < 0.01, respectively) showed significantly elevated activity compared with the rectus abdominis muscle. At 10% PEmax, no significant differences were observed in muscle activity.Although we observed no significant difference between 10% and 20% PEmax, activity during 30% PEmax was significantly greater than during 20% PEmax (external oblique: p < 0.05; internal oblique: p < 0.01). The abdominal oblique muscles are the most active during forced expiration. Moreover, 30% PEmax is the minimum intensity required to achieve significant, albeit very slight, muscle activity during expiratory resistance.     

Electromyographic mapping of the erector spinae muscle with varying load and during sustained contraction

The purpose of the study was to explore changes in the spatial distribution of erector spinae electromyography amplitude during static, sustained contractions and during contractions of increasing load. Surface electromyographic (EMG) signals were detected from nine healthy subjects using a grid of 13 × 5 electrodes placed unilaterally over the lumbar erector spinae musculature. Subjects stood in a 20° forward flexed position and performed: (1) six 20-s long contractions with loads ranging from 2.5 kg to 12.5 kg (2.5 kg increments) and (2) a 6 min sustained contraction with 7.5 kg load. Root mean square (RMS) and mean power spectral frequency (MNF) were computed from the recorded EMG signals. EMG RMS increased (P < 0.0001) and MNF remained constant during contractions of increased load. During the sustained contraction, MNF decreased (P < 0.0001) and RMS did not change over time. The centroid (center of activity) of the RMS map shifted caudally (P < 0.0001) with time during the sustained contraction but did not change with varying load. These results suggest a change in the distribution of erector spinae muscle activity with fatigue and a uniform distribution of muscle activation across loads.     

Electromyographic evaluation of upper limb muscles involved in armwrestling sport simulation during dynamic and static conditions

ObjectiveTo evaluate the electromyographic activity of the Pectoralis Major (PM), Biceps Brachii (BB), Pronator Teres (PT) and Flexor Carpi Ulnaris (FCU) muscles involved in simulated armwrestling.MethodsTen trained volunteers were selected to perform the armwrestling movement, during dynamic tests with 40% and 80% of maximum voluntary load (MVL) and static tests in the initial, intermediary and final positions. Electromyographic and force data were normalized for analyses.ResultsIn dynamic tests with 40% MVL, electric activity of the PT muscle was greater than FCU (p < 0.01) and BB (p < 0.05) muscles, and with 80% MVL, PM and PT muscles were the most active. In static tests, electric activity increased from the initial to final positions for the PM muscle (p < 0.05), while it decreased for the BB and PT muscles (p < 0.001 and p < 0.05, respectively). No significant changes were observed for force and no correlation was found with the simultaneous electric activity.ConclusionsIt can be concluded that the PM and FCU muscles participate as agonists in the simulated armwrestling whereas the BB and PT muscles seem to perform secondary functions. Electric activity showed to be dependent on the load and on the position of the upper limb, but not on the force produced during the movement.     

Isometric back muscle endurance: An EMG study on the criterion validity of the Ito test

The validity of the Sorensen test as a measure for back muscle endurance is controversial due to a possible impact of hip extensor muscles. The aim of this study was to investigate the criterion validity of an alternative test (Ito test) compared to the Sorensen test. Both procedures were performed by 29 healthy subjects (11 women) for 5 s and until exhaustion (randomized order). EMG activity was measured from 3 lumbar back and 3 hip extensor muscles. Muscular involvement in test positions was calculated as percentage of maximal voluntary contraction (MVC). Muscle fatigue was determined by the normalized regression coefficient of the median frequencies of the EMG power spectrum (NMF_slope). Prediction of holding time by NMF_slope values was investigated using regression analysis. In the test positions, the hamstring muscles were activated to a higher MVC percentage in the Sorensen than in the Ito test, while the iliocostalis muscle was less activated. Similarly, the iliocostalis (p = 0.006) and the multifidi muscles (p = 0.03) significantly contributed to predict holding time in the Ito test, whereas the multifidi muscles (p = 0.001) and the semitendinosus muscle (p = 0.046) did so in the Sorensen test. The results of this study indicate that the Ito test might present a valuable alternative for testing back muscle endurance in LBP patients.