Trunk muscle reflexes are elicited by small continuous perturbations in healthy subjects and patients with low-back pain

Low-back pain (LBP) has been recognized as the leading cause of disability worldwide. Lumbar instability has been considered as an important mechanism of LBP and one potential contributor to lumbar stability is trunk muscle reflex activity. However, due to the differences in experimental paradigms used to quantify trunk mechanics and trunk reflexes it remains unclear as to what extent the reflex pathway contributes to overall lumbar stability. The goal of this work was to determine to what extent reflexes of various trunk muscles were elicited by the small continuous perturbations normally used to quantify trunk mechanics. Electromyographic (EMG) activity was measured bilaterally from 3 trunk extensor muscles and 3 trunk flexor muscles at four epochs: 25–50 ms, 50–75 ms, 75–100 ms and 100–125 ms following each perturbation. Reflex activity was seen in all muscles as 34 of the 48 muscle-epoch combinations showed a significant reflex response to either perturbations in the forward or backward direction. However, the reflex EMG activity did not correlate with mechanical estimates of the reflex response. Thus, even though reflexes are indeed elicited by the small perturbations used to quantify trunk mechanics, their exact contribution to overall lumbar stability remains unknown.     

Anticipation of direction and time of perturbation modulates the onset latency of trunk muscle responses during sitting perturbations

Trunk muscles are responsible for maintaining trunk stability during sitting. However, the effects of anticipation of perturbation on trunk muscle responses are not well understood. The objectives of this study were to identify the responses of trunk muscles to sudden support surface translations and quantify the effects of anticipation of direction and time of perturbation on the trunk neuromuscular responses. Twelve able-bodied individuals participated in the study. Participants were seated on a kneeling chair and support surface translations were applied in the forward and backward directions with and without direction and time of perturbation cues. The trunk started moving on average approximately 40 ms after the perturbation. During unanticipated perturbations, average latencies of the trunk muscle contractions were in the range between 103.4 and 117.4 ms. When participants anticipated the perturbations, trunk muscle latencies were reduced by 16.8 ± 10.0 ms and the time it took the trunk to reach maximum velocity was also reduced, suggesting a biomechanical advantage caused by faster muscle responses. These results suggested that trunk muscles have medium latency responses and use reflexive mechanisms. Moreover, anticipation of perturbation decreased trunk muscles latencies, suggesting that the central nervous system modulated readiness of the trunk based on anticipatory information.     

Influence of back muscle fatigue on lumbar reflex adaptation during sudden external force perturbations

There is still conflicting evidence about the influence of fatigue on trunk reflex activity. The aim of this study was to measure response latency and amplitude changes of lumbar and abdominal muscles after heavy external force perturbation applied to the trunk in the sagittal plane before and after back muscle fatigue, in expected and unexpected conditions. Ten healthy subjects in a semi-seated position, torso upright in a specific apparatus performed an intermittent back muscle fatigue protocol. EMG reflex activity of erector spinae (ES) and external oblique muscles were recorded in unexpected and in expected (self pre-activation) conditions. After fatigue, the normalized reflex amplitude of ES increased in expected and unexpected conditions (P < 0.05) while ES response latency was slightly decreased. Reflexes latencies for ES were systematically shorter (P < 0.05) of 25% in expected compared to unexpected conditions. These findings suggest that a large external force perturbation would elicit higher paraspinal magnitude responses and possible earlier activation in order to compensate the loss of muscular force after fatigue. Because of the seated position the postural adjustments were probably not triggered and thus explain the lack of abdominal activation. The self-anticipated pre-activation in order to counteract perturbations was not affected by fatigue illustrating the natural muscular activation to maintain trunk stability.     

An effective balancing response to lateral perturbations at pelvis level during slow walking requires control in all three planes of motion

In this study we investigated balancing responses to lateral perturbations during slow walking (0.85 m/s). A group of seven healthy individuals walked on an instrumented treadmill while being perturbed at the level of waist at left heel strike in outward and inward lateral directions. Centre of mass (COM) and centre of pressure (COP), rotation of pelvis around vertical axis, step lengths, step widths and step times were assessed. The results have shown that beside control of COP in lateral direction, facilitated by adequate step widths, control of COP in sagittal direction, slowing down movement of COM was present after commencement of lateral perturbations. Sagittal component of COM was significantly retarded as compared to unperturbed walking for both inward (4.32 ± 1.29 cm) and outward (9.75 ± 2.17 cm) perturbations. This was necessary since after an inward perturbation first step length (0.29 ± 0.04 m compared to 0.52 ± 0.02 m in unperturbed walking) and step time (0.45 ± 0.05 s compared to 0.61 ± 0.04 s in unperturbed walking) were shortened while after an outward perturbation first two step lengths (0.36 ± 0.05 m and 0.32 ± 0.11 m compared to 0.52 ± 0.03 m in unperturbed walking) were shortened that needed to be accommodated by the described modulation of COP in sagittal plane. In addition pronounced pelvis rotation assisted in bringing swing leg to new location. The results of this study show that counteracting lateral perturbations at slow walking requires adequate response in all three planes of motion.     

Are regions of the lumbar multifidus differentially activated during walking at varied speed and inclination?

PurposeLumbar multifidus is a complex muscle with multi-fascicular morphology shown to be differentially controlled in healthy individuals during sagittal-plane motion. The normal behaviour of multifidus muscle regions during walking has only received modest attention in the literature. This study aimed to determine activation patterns for deep and superficial multifidus in young adults during walking at different speeds and inclination.MethodsThis observational cohort study evaluated ten healthy volunteers in their twenties (three women, seven men) as they walked on a treadmill in eight conditions; at 2 km/h and 4 km/h, each at 0, 1, 5, and 10% inclination. Intramuscular EMG was recorded from the deep and superficial multifidus unilaterally at L5. Activity was characterized by: amplitude of the peak of activation, position of peak within the gait cycle (0–100%), and duration relative to the full gait cycle.ResultsAcross all conditions superficial multifidus showed higher normalised EMG amplitude (p < 0.01); superficial multifidus peak amplitude was 232 ± 115% higher when walking at 4 km/h/10%, versus only 172 ± 77% higher for deeper region (p < 0.01). The percentage of the gait cycle where peak EMG amplitude was detected did not differ between regions (49 ± 13%). Deep multifidus duration of activation was longer when walking at the faster vs slower speed at all inclinations (p < 0.01), which was not evident for superficial multifidus (p < 0.05). Thus, a significantly longer activation of deep multifidus was observed compared to superficial multifidus when walking at 4 km/h (p < 0.05).ConclusionsDifferential activation within lumbar multifidus was shown in young adults during walking. The prolonged, more tonic activation of deep relative to superficial regions of multifidus during gait supports a postural function of deeper fibres.     

Decreased fibularis reflex response during inversion perturbations in FAI subjects

Investigate reflex responses in muscles throughout the lower limb and low back during sudden inversion perturbations in individuals with and without Functional Ankle Instability (FAI) while walking. Forty subjects participated in the study. Surface electromyogram recordings were obtained from the fibularis (FIB), gluteus medius (GM), erector spinae (ES), and sternocleidomastoid (SCM) of the injured/matched side as well as the uninjured/matched contralateral side (FIB_CLS, GM_CLS, or ES_CLS). Latency and amplitude data were collected while subjects were walking on a custom-built perturbation walkway. The onset of the short-latency stretch reflex of the FIB was significantly later in the injured side of the FAI individuals when compared to the control group (P = 0.009). Both the short and long latency reflex amplitude was significantly smaller in the FIB muscle in the FAI group than in the control group (P < 0.008). No significant differences in latency or amplitude reflex responses were identified between the two groups in the GM, ES, FIB_CLS, GM_CLS, or ES_CLS (P > .05). Interpretation of these results indicate that during a dynamic perturbation task individuals with FAI demonstrate longer fibularis muscle latencies on the injured side while no significant changes in the proximal muscle groups. Additionally, short and long latency reflex amplitude was significantly decreased in FAI individuals.     

Intramuscular fine-wire electromyography during cycling: Repeatability,normalisation and a comparison to surface electromyography

This study investigated (a) the feasibility and repeatability of intramuscular fine-wire electromyographic (fEMG) recordings from leg muscles during the repetitive, high-velocity cycling movement, (b) the influence of amplitude normalization technique on repeatability and statistical sensitivity, (c) the influence of test-retest interval duration on repeatability, and (d) differences between fEMG and surface EMG (sEMG) recordings of cycling. EMG activity of leg muscles was recorded using surface and fine-wire electrodes during one (n = 12, to investigate statistical sensitivity and compare sEMG and fEMG) or two sessions (T1 and T2, 5–20 days apart, n = 10, to investigate repeatability). fEMG recordings were feasible and there was high repeatability of fEMG recordings normalised to maximum measured EMG amplitude (MAX); mean coefficients of multiple correlation (CMC) ranged from .83 ± .13 to .88 ± .07. Data normalised to maximal (MVC) or submaximal contractions (sMVC) were less repeatable (p < .01). Statistical sensitivity was also greatest for data normalised to MAX (p < .01). Repeatability of fEMG increased with greater test-retest intervals (p < .01). The global pattern of muscle recruitment was consistent between sEMG and fEMG but sEMG recordings were characterized by additional myoelectric content. These findings support and guide the use of fEMG techniques to investigate leg muscle recruitment during cycling.     

Whole-body vibration induces distinct reflex patterns in human soleus muscle

The neuronal mechanisms underlying whole body vibration (WBV)-induced muscular reflex (WBV-IMR) are not well understood. To define a possible pathway for WBV-IMR, this study investigated the effects of WBV amplitude on WBV-IMR latency by surface electromyography analysis of the soleus muscle in human adult volunteers. The tendon (T) reflex was also induced to evaluate the level of presynaptic Ia inhibition during WBV. WBV-IMR latency was shorter when induced by low- as compared to medium- or high-amplitude WBV (33.9 ± 5.3 ms vs. 43.8 ± 3.6 and 44.1 ± 4.2 ms, respectively). There was no difference in latencies between T-reflex elicited before WBV (33.8 ± 2.4 ms) and WBV-IMR induced by low-amplitude WBV. Presynaptic Ia inhibition was absent during low-amplitude WBV but was present during medium- and high-amplitude WBV. Consequently, WBV induces short- or long-latency reflexes depending on the vibration amplitude. During low-amplitude WBV, muscle spindle activation may induce the short- but not the long-latency WBV-IMR. Furthermore, unlike the higher amplitude WBV, low-amplitude WBV does not induce presynaptic inhibition at the Ia synaptic terminals.     

EMG synchrony to assess impaired corticomotor control of locomotion after stroke

Adapting one’s gait pattern requires a contribution from cortical motor commands. Evidence suggests that frequency-based analysis of electromyography (EMG) can be used to detect this cortical contribution. Specifically, increased EMG synchrony between synergistic muscles in the Piper frequency band has been linked to heightened corticomotor contribution to EMG. Stroke-related damage to cerebral motor pathways would be expected to diminish EMG Piper synchrony. The objective of this study is therefore to test the hypothesis that EMG Piper synchrony is diminished in the paretic leg relative to nonparetic and control legs, particularly during a long-step task of walking adaptability. Twenty adults with post-stroke hemiparesis and seventeen healthy controls participated in this study. EMG Piper synchrony increased more for the control legs compare to the paretic legs when taking a non-paretic long step (5.02 ± 3.22% versus 0.86 ± 2.62%), p < 0.01) and when taking a paretic long step (2.04 ± 1.98% versus 0.70 ± 2.34%, p < 0.05). A similar but non-significant trend was evident when comparing non-paretic and paretic legs. No statistically significant differences in EMG Piper synchrony were found between legs for typical walking. EMG Piper synchrony was positively associated with walking speed and step length within the stroke group. These findings support the assertion that EMG Piper synchrony indicates corticomotor contribution to walking.     

Anticipatory postural adjustments to arm movement reveal complex control of paraspinal muscles in the thorax

Anatomical and empirical data suggest that deep and superficial muscles may have different functions for thoracic spine control. This study investigated thoracic paraspinal muscle activity during anticipatory postural adjustments associated with arm movement. Electromyographic (EMG) recordings were made from the right deep (multifidus/rotatores) and superficial (longissimus) muscles at T5, T8, and T11 levels using fine-wire electrodes. Ten healthy participants performed fast unilateral and bilateral flexion and extension arm movements in response to a light. EMG amplitude was measured during 25 ms epochs for 150 ms before and 400 ms after deltoid EMG onset. During arm flexion movements, multifidus and longissimus had two bursts of activity, one burst prior to deltoid and a late burst. With arm extension both muscles were active in a single burst after deltoid onset. There was differential activity with respect to direction of trunk rotation induced by arm movement. Right longissimus was most active with left arm movements and right multifidus was most active with right arm movements. All levels of the thorax responded similarly. We suggest that although thoracic multifidus and longissimus function similarly to control sagittal plane perturbations, these muscles are differentially active with rotational forces on the trunk.     

Cryotherapy and ankle bracing effects on peroneus longus response during sudden inversion

Cryotherapy and ankle bracing are often used in conjunction as a treatment for ankle injury. No studies have evaluated the combined effect of these treatments on reflex responses during inversion perturbation. This study examined the combined influence of ankle bracing and joint cooling on peroneus longus (PL) muscle response during ankle inversion. A 2 × 2 RM factorial design guided this study; the independent variables were: ankle brace condition (lace-up brace, control), and treatment (ice, control), and the dependent variables studied were PL stretch reflex latency (ms), and PL stretch reflex amplitude (% of max). Twenty-four healthy participants completed 5 trials of a sudden inversion perturbation to the ankle/foot complex under each ankle brace and cryotherapy treatment condition. No two-way interaction was observed between ankle brace and treatment conditions on PL latency (P = 0.283) and amplitude (P = 0.884). The ankle brace condition did not differ from control on PL latency and amplitude. Cooling the ankle joint did not alter PL latency or amplitude compared to the no-ice treatment. Ankle bracing combined with joint cooling does not have a deleterious effect on dynamic ankle joint stabilization during an inversion perturbation in normal subjects.     

EMG normalization to study muscle activation in cycling

The value of electromyography (EMG) is sensitive to many physiological and non-physiological factors. The purpose of the present study was to determine if the torque–velocity test (T–V) can be used to normalize EMG signals into a framework of biological significance. Peak EMG amplitude of gluteus maximus (GMAX), vastus lateralis (VL), rectus femoris (RF), biceps femoris long head (BF), gastrocnemius medialis (GAS) and soleus (SOL) was calculated for nine subjects during isometric maximal voluntary contractions (IMVC) and torque–velocity bicycling tests (T–V). Then, the reference EMG signals obtained from IMVC and T–V bicycling tests were used to normalize the amplitude of the EMG signals collected for 15 different submaximal pedaling conditions. The results of this study showed that the repeatability of the measurements between IMVC (from 10% to 23%) and T–V (from 8% to 20%) was comparable. The amplitude of the peak EMG of VL was 99 ± 43% higher (p < 0.001) when measured during T–V. Moreover, the inter-individual variability of the EMG patterns calculated for submaximal cycling exercises differed significantly when using T–V bicycling normalization method (GMAX: 0.33 ± 0.16 vs. 1.09 ± 0.04, VL: 0.07 ± 0.02 vs. 0.64 ± 0.14, SOL: 0.07 ± 0.03 vs. 1.00 ± 0.07, RF: 1.21 ± 0.20 vs. 0.92 ± 0.13, BF: 1.47 ± 0.47 vs. 0.84 ± 0.11). It was concluded that T–V bicycling test offers the advantage to be less time and energy-consuming and to be as repeatable as IMVC tests to measure peak EMG amplitude. Furthermore, this normalization method avoids the impact of non-physiological factors on the amplitude of the EMG signals so that it allows quantifying better the activation level of lower limb muscles and the variability of the EMG patterns during submaximal bicycling exercises.     

Intra- and interday reliability of voluntary and electrically stimulated isometric contractions of the quadriceps femoris

The reliability of voluntary and electrically stimulated isometric contractions of m. quadriceps femoris of male participants (n = 10; age 30 ± 8 years; height 1.79 ± 0.05 m; body mass 79.4 ± 8.3 kg) was investigated using ratio limits of agreement (LoA) on a time scale common to examine recovery from muscle damaging exercise. No systematic changes in reliability occurred over time (baseline versus 2, 24, 48, and 72 h). Maximal voluntary contraction (MVC) and interpolated twitch technique (ITT) showed no mean bias (P > 0.05) with 95% LoA of ±12.7 and ±5.4, respectively. Resting twitch and potentiated doublet peak force showed no mean bias (P > 0.05). However, 95% LoA were smaller for the doublet (±13.9) than the twitch (±32.0). Twitch and doublet rates showed similar trends. Ratio of low (20 Hz) to high (50 Hz) frequency forces showed no mean bias (P > 0.05) and 95% LoA of (±9.2). However, there was significant mean bias (P < 0.05) and wider 95% LoA for peak force, contraction and relaxation parameters of the low and high frequency forces. In conclusion, MVC, ITT, potentiated doublet and the ratio of low to high frequency forces are recommended to most reliably examine functional muscle recovery between 2 and 72 h after damaging exercise.     

Upper limb and trunk muscle activation during an unexpected descent on the outstretched hands in young and older women

Falling on the outstretched hands (FOOSH), a protective mechanism to arrest the body and avoid injury, requires upper limb and trunk motor control for effective body descent. The purpose of this study was to investigate muscle activity during three phases of an unexpected FOOSH in healthy older and younger women. Twenty young (mean age 22.9 yrs, SD ± 3.7) and 20 older females (mean age 68.1 yrs, SD ± 5.0) performed five trials of unexpected FOOSHs. Surface electromyography (EMG) determined muscle activations for left shoulder girdle, elbow and abdominal muscles during an unexpected FOOSH. Root mean squared EMG data were calculated during three phases: (1) baseline (BL; 500 ms prior to release), (2) the preparatory phase (PRE; time between release and impact) (mean 257 ± 37 ms) and post-impact (POST; 200 ms after impact). A mixed MANOVA determined differences between phases and age groups. There was a significant multivariate interaction effect of age and time phase on muscle activity (p = 0.001). Younger women had significantly higher internal oblique/transversus abdominus activity during PRE (p = 0.006) as well as variations in muscle activity of shoulder girdle and elbow muscles. The age differences observed may lead to poorer preliminary trunk activation and greater arm bracing in older women, potentially increasing risk of fallrelated injury.     

Acute effects of whole body vibration on directionality and reaction time latency of trunk muscles: The importance of rest and implications for spine stability

Workplace exposure to whole body vibration (WBV) has been identified as one of the major physical risk factors encountered by the population. There are indications that, subsequent to a perturbation, impaired reflex response could allow for destabilization of the spine, possibly leading to injury. The purpose of this study was to investigate if WBV alters reflex response of trunk muscles and if the direction of perturbation (flexion or extension or lateral) and delay between exposure and perturbation influences the response. The results indicate that EMG latency was increased more in the vibration condition than in sitting without vibration. Significant effects with respect to directionality were observed in Erector Spinae muscles. The EMG latency reduced from the effect of perturbation after a 20 s rest period. Even though the EMG latency did not fully return to its Pre-test state, the present results still show that recovery from the acute effects of WBV is possible with a rest period.     

Tendon reflex is suppressed during whole-body vibration

In this study we have investigated the effect of whole body vibration (WBV) on the tendon reflex (T-reflex) amplitude. Fifteen young adult healthy volunteer males were included in this study. Records of surface EMG of the right soleus muscle and accelerometer taped onto the right Achilles tendon were obtained while participant stood upright with the knees in extension, on the vibration platform. Tendon reflex was elicited before and during WBV. Subjects completed a set of WBV. Each WBV set consisted of six vibration sessions using different frequencies (25, 30, 35, 40, 45, 50 Hz) applied randomly. In each WBV session the Achilles tendon was tapped five times with a custom-made reflex hammer. The mean peak-to-peak (PP) amplitude of T-reflex was 1139.11 ± 498.99 µV before vibration. It decreased significantly during WBV (p < 0.0001). The maximum PP amplitude of T-reflex was 1333 ± 515 μV before vibration. It decreased significantly during WBV (p < 0.0001). No significant differences were obtained in the mean acceleration values of Achilles tendon with tapping between before and during vibration sessions. This study showed that T-reflex is suppressed during WBV. T-reflex suppression indicates that the spindle primary afferents must have been pre-synaptically inhibited during WBV similar to the findings in high frequency tendon vibration studies.     

Adaptations of upper trapezius muscle activity during sustained contractions in women with fibromyalgia

The study compared the distribution of electromyographic (EMG) signal amplitude in the upper trapezius muscle in 10 women with fibromyalgia and in 10 healthy women before and after experimentally-induced muscle pain. Surface EMG signals were recorded over the right upper trapezius muscle with a 10 × 5 grid of electrodes during 90° shoulder abduction sustained for 60 s. The control subjects repeated the abduction task following injections of isotonic and hypertonic (painful) saline into the upper trapezius muscle. The EMG amplitude was computed for each electrode pair and provided a topographical map of the distribution of muscle activity. The pain level rated by the patients at the beginning of the sustained contraction was 5.9 ± 1.5. The peak pain intensity for the control group following the injection of hypertonic saline was 6.0 ± 1.6. During the sustained contractions, the EMG amplitude increased relatively more in the cranial than caudal region of the upper trapezius muscle for the control subjects (shift in the distribution of EMG amplitude: 2.3 ± 1.3 mm; P < 0.01). The patient group showed lower average EMG amplitude than the controls during the contraction (P < 0.05) and did not show different changes in EMG amplitude between different regions of the upper trapezius. A similar behavior was observed for the control group following injection of hypertonic saline. The results indicate that muscle pain prevents the adaptation of upper trapezius activity during sustained contractions as observed in non-painful conditions, which may induce overuse of similar muscle compartments with fatigue.     

Postural reactions following forward platform perturbation in young,middle-age,and old adults

The aim of the study was to examine how individuals of different ages react to forward balance perturbations. Thirty-six volunteers, divided into four groups [young (YA), middle-age (MA₄₀ and MA₅₀), and old (OA) adults], stood on a platform that was either kept stationary, moved backward, or moved forward. EMG onset, EMG time-to-peak, iEMG, and agonist–antagonist co-activation, as well as cumulative angular excursion, maximum center of mass (CM) backward displacement, and CM time-to-reversal were assessed after forward translations. Postural synergies were assessed using principal component analysis (PCA). The results showed that OA activated their muscles later than YA [TA = 25 ms, RF = 17 ms] and OA and MA₅₀ reached the peak of activation later than YA [MA₅₀:TA = 23 ms, RF = 32 ms, OA:TA = 28 ms, RF = 21 ms]. Moreover, OA kept a higher level of activation longer than all younger groups. No differences among groups were observed in co-activation, kinematic, and PCA variables. We conclude that changes in temporal EMG patterns can be seen in the fifth decade. However, such changes have no effect on the CM horizontal displacement and CM time-to-reversal after perturbation, which cannot be justified by the use of different postural synergies, suggesting that temporal aspects of muscle activation could play a minor role in controlling excessive CM displacements after perturbations.     

Dynamic head-neck stabilization and modulation with perturbation bandwidth investigated using a multisegment neuromuscular model

The human head-neck system requires continuous stabilization in the presence of gravity and trunk motion. We investigated contributions of the vestibulocollic reflex (VCR), the cervicocollic reflex (CCR), and neck muscle co-contraction to head-in-space and head-on-trunk stabilization, and investigated modulation of the stabilization strategy with the frequency content of trunk perturbations and the presence of visual feedback.We developed a multisegment cervical spine model where reflex gains (VCR and CCR) and neck muscle co-contraction were estimated by fitting the model to the response of young healthy subjects, seated and exposed to anterior-posterior trunk motion, with frequency content from 0.3 up to 1, 2, 4 and 8 Hz, with and without visual feedback.The VCR contributed to head-in-space stabilization with a strong reduction of head rotation (<8 Hz) and a moderate reduction of head translation (>1 Hz). The CCR contributed to head-on-trunk stabilization with a reduction of head rotation and head translation relative to the trunk (<2 Hz). The CCR also proved essential to stabilize the individual intervertebral joints and prevent neck buckling. Co-contraction was estimated to be of minor relevance. Control strategies employed during low bandwidth perturbations most effectively reduced head rotation and head relative displacement up to 3 Hz while control strategies employed during high bandwidth perturbations reduced head global translation between 1 and 4 Hz. This indicates a shift from minimizing head-on-trunk rotation and translation during low bandwidth perturbations to minimizing head-in-space translation during high bandwidth perturbations. Presence of visual feedback had limited effects suggesting increased usage of vestibular feedback.