Investigations of back muscle fatigue by simultaneous 31P MRS and surface EMG measurements.

Investigations of back muscle fatigue are important for understanding the role of muscle strain in the development of low back pain. The aim of this contribution is to review the two main techniques used for in vivo investigations of metabolic and electrophysiological changes, namely magnetic resonance phosphorous spectroscopy ((31)P MRS) and surface electromyography (SEMG), and to report some of our recent results on simultaneous measurements using these techniques during isometric back-muscle contraction in volunteers. Since it appears that electrophysiological and metabolic factors are simultaneously involved in the processes of fatigue and muscle recovery during load application, simultaneous acquisition of complete information is quite promising for obtaining new insights into the metabolic origin of electrophysiological changes or vice versa. Performing these measurements simultaneously, however, is more intricate owing to the occurrence of signal artifacts caused by mutual signal interferences of both techniques. Besides these mutual disturbances, further experimental difficulties are related to spatial limitations within the bore of clinical whole-body high-field magnetic resonance (MR) systems (1.5 T) and the sensitivity of MR measurements to motion-induced artifacts. Our own experimental results are presented, and problems that occur using both techniques simultaneously, as well as possibilities to resolve them, are discussed. The results shed light on the interrelation of electrophysiological and metabolic changes during fatigue of the back muscle while performing an exercise.     

Reliability of EMG spectral parameters in repeated measurements of back muscle fatigue.

The change in median frequency of the power spectrum of the electromyographic (EMG) signal may be used as a measure of muscle fatigue. The reliability of the median frequency parameters was investigated for EMG-recording sites at L1 and L5 right and left on the erector spinae. The reliability of subjective fatigue ratings of the back muscles (Borg CR-10 scale) and of maximal trunk extension torque (MVC) was also investigated. Eleven subjects with healthy backs performed a 45-s isometric trunk extension at 80% of MVC twice a day, on three different days. Two-factor analysis of variance was made to obtain the different variances from which the standard error of measurement (SEM) and the intra class correlation coefficient (ICC) were calculated. The SEM within-day was somewhat lower than that between-days. Both were about the same at all four electrode sites. The 95% confidence interval for the studied variables was for the initial median frequency +/- 10 Hz, for the slope +/- 0.4-0.5%/s, for the MVC +/- 36 Nm and for the Borg ratings +/- 1.6. We conclude that, with the presently used method, changes or differences within these limits should be regarded as normal variability. The slope may be of limited value because of its large variability. Whether the low intraclass correlation coefficient for the EMG parameters in the presently studied test group implies a low potential in discriminating subjects with back pain can not be decisively concluded.     

Network modeling and analysis of lumbar muscle surface EMG signals during flexion–extension in individuals with and without low back pain

In this paper, we propose modeling the activity coordination network between lumbar muscles using surface electromyography (sEMG) signals and performing the network analysis to compare the lumbar muscle coordination patterns between patients with low back pain (LBP) and healthy control subjects. Ten healthy subjects and eleven LBP patients were asked to perform flexion–extension task, and the sEMG signals were recorded. Both the subject-level and the group-level PC_fdr algorithms are applied to learn the sEMG coordination networks with the error-rate being controlled. The network features are further characterized in terms of network symmetry, global efficiency, clustering coefficient and graph modules. The results indicate that the networks representing the normal group are much closer to the order networks and clearly exhibit globally symmetric patterns between the left and right sEMG channels. While the coordination activities between sEMG channels for the patient group are more likely to cluster locally and the group network shows the loss of global symmetric patterns. As a complementary tool to the physical and anatomical analysis, the proposed network analysis approach allows the visualization of the muscle coordination activities and the extraction of more informative features from the sEMG data for low back pain studies.     

EMG muscle scanning: comparison to attached surface electrodes.

Electromyographic (EMG) muscle scanning measures brief samples of integrated muscle action potentials from individual muscles using a hand-held scanner with post-style electrodes. This "scanning" technique is widely used by biofeedback practitioners to quickly assess muscle activity in the diagnosis of musculoskeletal disorders. In an effort to compare muscle scanning with the established technique using attached surface electrodes, ten healthy subjects (25-35 years old) were scanned using 2-second sampling at five bilateral muscle sites while simultaneously monitoring the same sites with surface electrodes. This was repeated using 10-second scanning samplings. Pearson's product-moment correlations between scanning for 2 seconds and prolonged surface recording at all sites were 0.54-0.89. Scanning for 10 seconds improved the correlations to 0.68-0.91. EMG scanning for 2 seconds compares favorably with attached surface electrode recording. Comparisons are further improved by 10-second scans.     

Evaluation of measurement strategies to increase the reliability of EMG indices to assess back muscle fatigue and recovery.

The purpose of this study was to assess different measurement strategies to increase the reliability of different electromyographic (EMG) indices developed for the assessment of back muscle impairments. Forty male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three sessions at least 2 days apart within 2 weeks. Surface EMG signals were recorded from four pairs (bilaterally) of back muscles (multifidus at the L5 level, iliocostalis lumborum at L3, and longissimus at L1 and T10) while the subjects performed, in a static dynamometer, two static trunk extension tasks at 75% of the maximal voluntary contraction separated by a 60 s rest period: (1) a 30 s fatigue task and (2) a 5 s recovery task. Different EMG indices (based on individual muscles or averaged across bilateral homologous muscles or across all muscles) were computed to evaluate muscular fatigue and recovery. Intra-class correlation coefficient (ICC) and standard error of measurement (SEM) in percentage of the grand mean were calculated for each EMG variable. Reliable EMG indices are achieved for both healthy and chronic low back pain subjects when (1) electrodes are positioned on medial back muscles (multifidus at the L5 level and longissimus at L1) and (2) measures are averaged across bilateral muscles and/or across two fatigue tests performed within a session. The most reliable EMG indices were the bilateral average of medial back muscles (ICC range: 0.68-0.91; SEM range: 5-35%) and the average of all back muscles (ICC range: 0.77-0.91; SEM range: 5-30%). The averaging of measures across two fatigue tests is predicted to increase the reliability by about 13%. With regards to EMG indices of fatigue, the identification of the most fatigable muscle also lead to satisfactory results (ICC range: 0.74-0.79; SEM range: 21-26%). The assessment of back muscle impairments through EMG analysis necessitates the use of multiple electrodes to achieve reliable results.     

The effectiveness of EMG biofeedback training in low back pain.

Eighteen patients with chronic low back pain (lbp) of muscle tension origin were given an EMG biofeedback training. Compared to seven controls they showed a significant decrease during training in muscle tension and subsequently in pain. However, at follow-up EMG levels dropped to the initial (high) level. Pain scores of patients with high pain decrements during training showed further improvement during follow-up, which was not the case with patients showing less substantial improvement. The importance of cognitions was discussed.     

Use of antagonist muscle EMG in the assessment of neuromuscular health of the low back

Background

Non-specific low back pain (LBP) has been one of the most frequently occurring musculoskeletal problems. Impairment in the mechanical stability of the lumbar spine has been known to lower the safety margin of the spine musculature and can result in the occurrence of pain symptoms of the low back area. Previously, changes in spinal stability have been identified by investigating recruitment patterns of low back and abdominal muscles in laboratory experiments with controlled postures and physical activities that were hard to conduct in daily life. The main objective of this study was to explore the possibility of developing a reliable spine stability assessment method using surface electromyography (EMG) of the low back and abdominal muscles in common physical activities.

Methods

Twenty asymptomatic young participants conducted normal walking, plank, and isometric back extension activities prior to and immediately after maintaining a 10-min static upper body deep flexion on a flat bed. EMG data of the erector spinae, external oblique, and rectus abdominals were collected bilaterally, and their mean normalized amplitude values were compared between before and after the static deep flexion. Changes in the amplitude and co-contraction ratio values were evaluated to understand how muscle recruitment patterns have changed after the static deep flexion.

Results

Mean normalized amplitude of antagonist muscles (erector spinae muscles while conducting plank; external oblique and rectus abdominal muscles while conducting isometric back extension) decreased significantly (P < 0.05) after the 10-min static deep flexion. Normalized amplitude of agonist muscles did not vary significantly after deep flexion.

Conclusions

Results of this study suggest the possibility of using surface EMG in the evaluation of spinal stability and low back health status in simple exercise postures that can be done in non-laboratory settings. Specifically, amplitude of antagonist muscles was found to be more sensitive than agonist muscles in identifying changes in the spinal stability associated with the 10-min static deep flexion. Further research with various loading conditions and physical activities need to be performed to improve the reliability and utility of the findings of the current study.     

表面肌电信号的下肢痉挛信号的特征分析与识别

脑卒中患者康复治疗中会引起下肢肌肉痉挛,这种现象给患者的康复训练过程带来极大的危害,因此能够在训练过程中识别痉挛并及时中断训练具有重要的实际意义。本研究通对下肢表面肌电信号的采集,采用基于形状的模版匹配法来识别痉挛信号,并以皮尔逊相关系数来分析表征下肢痉挛信号的相关性大小。分析结果表明,通过仿真验证了模版匹配法在个人痉挛信号识别中的准确性,显示了在泛用痉挛信号识别中的可行性。     

Assessment of muscle fatigue in low level monotonous task performance during car driving.

Knowledge of the muscle activation and the development of muscle fatigue may provide more inside in the effects of long-term driving in the occurrence of health problems in the neck/shoulder/back area. The basic assumption behind fatigue detection with electromyography (EMG) is an increase in the EMG amplitude and a decrease of the mean frequency (MF). This study aimed at checking this assumption in monotonous task performance with low level activity during car driving. Surface electromyography was captured from left and right trapezius and deltoid muscles, during a repetitive, non-continuous, driving task (gearing and steering) and the active parts were separated from the non-active parts. Muscle stiffness was reported by more than half of the subjects after a 1 h drive. Only for the active parts a significant decrease of the MF was seen. But also the EMG amplitude decreased significantly. Two possible mechanisms are posted in literature for this finding: no extra recruitment of motor units (MU) and potentiation of muscle fibers. Literature also hypothesizes that low-force occupational work engages only a fraction of the MU available for recruitment and that these units are selectively type I muscle fibers (Cinderella fibers). Initiators of this phenomenon are probably the time lag between activations and the stress from driving and vibration exposure.     

EMG muscle scanning: Stability of hand-held surface electrodes

Electromyographic (EMG) muscle scanning measures 2-second samples of integrated muscle action potentials from individual neck and back muscles using a hand-held scanner with post-style surface electrodes separated by a fixed distance. This scanning technique is widely used to expeditiously assess muscle activity in the diagnosis of musculoskeletal disorders. In order to determine if the 2-second sample is sufficiently representative of electrical activity at a specific muscle site, the stability of the signal received by the hand-held scanner was measured bilaterally at six neck and back muscle sites over 40 seconds (20 2-second integration periods) in five seated subjects. Taking the overall average EMG activity as the true value, the mean number of 2-second integration periods required to achieve <5% standard error was calculated to be 1.47 for the 60 muscles tested. Only three sites required more than five integration periods. The validity of EMG scanning as a diagnostic tool is enhanced by longer integration periods     

EMG muscle scanning: stability of hand-held surface electrodes

Electromyographic (EMG) muscle scanning measures 2-second samples of integrated muscle action potentials from individual neck and back muscles using a hand-held scanner with post-style surface electrodes separated by a fixed distance. This "scanning" technique is widely used to expeditiously assess muscle activity in the diagnosis of musculoskeletal disorders. In order to determine if the 2-second sample is sufficiently representative of electrical activity at a specific muscle site, the stability of the signal received by the hand-held scanner was measured bilaterally at six neck and back muscle sites over 40 seconds (20 2-second integration periods) in five seated subjects. Taking the overall average EMG activity as the "true" value, the mean number of 2-second integration periods required to achieve less than 5% standard error was calculated to be 1.47 for the 60 muscles tested. Only three sites required more than five integration periods. The validity of EMG scanning as a diagnostic tool is enhanced by longer integration periods.     

EMG muscle scanning: Comparison to attached surface electrodes

Electromyographic (EMG) muscle scanning measures brief samples of integrated muscle action potentials from individual muscles using a hand-held scanner with post-style electrodes. This scanning technique is widely used by biofeedback practitioners to quickly assess muscle activity in the diagnosis of musculoskeletal disorders. In an effort to compare muscle scanning with the established technique using attached surface electrodes, ten healthy subjects (25–35 years old) were scanned using 2-second sampling at five bilateral muscle sites while simultaneously monitoring the same sites with surface electrodes. This was repeated using 10-second scanning samplings. Pearson's product-moment correlations between scanning for 2 seconds and prolonged surface recording at all sites were 0.54–0.89. Scanning for 10 seconds improved the correlations to 0.68–0.91. EMG scanning for 2 seconds compares favorably with attached surface electrode recording. Comparisons are further improved by 10-second scans.     

Spectral analysis of the EMG and diaphragmatic muscle fatigue during periodic breathing in infants

Periodic breathing occurs commonly in full-term and preterm infants. The mechanisms which switch breathing on and off within a cycle of periodic breathing are not certain. Since immature infants may experience diaphragmatic muscle fatigue, one potential switching mechanism is fatigue. Power spectra of the electromyogram, uncontaminated by the electrocardiograph artifact, were studied for evidence of diaphragmatic muscle fatigue during spontaneous periodic breathing in infants. A fall in the high-frequency (103-600 Hz) power and an increase in the low-frequency (23-47 Hz) power during periodic as compared with normal breathing would indicate fatigue. This effect was not observed in any of the infants studied. Hence, there is no evidence that periodic breathing is the result of diaphragmatic muscle fatigue. This finding suggests that the effect of drugs such as theophylline in eliminating periodic breathing may be unrelated to the fact that they also reduce fatigue.     

The effectiveness of EMG biofeedback training in low back pain

Eighteen patients with chronic low back pain(lbp) of muscle tension origin were given an EMG biofeedback training. Compared to seven controls they showed a significant decrease during training in muscle tension and subsequently in pain. However, at follow-up EMG levels dropped to the initial(high) level. Pain scores of patients with high pain decrements during training showed further improvement during follow-up, which was not the case with patients showing less substantial improvement. The importance of cognitions was discussed.We wish to express our thanks to Marijke Höweler-van Dalen for supervising this investigation, to Arnold Goedhart for statistical advice, to Dr. Orlebeke for his critical remarks, and to Dr. Penders for referring the patients in Amsterdam. We are particularly indebted to the general practitioners Paul Kreutzer and Jan Huls for referring the Andijk patients. Without their support this investigation would not have been possible.     

Test-retest reliability of wavelet - and Fourier based EMG (instantaneous) median frequencies in the evaluation of back and hip muscle fatigue during isometric back extensions.

The present study aimed at assessing the test–retest reliability of wavelet – and Fourier derived (instantaneous) median frequencies of surface electromyographic (EMG) measurements of back and hip muscles during isometric back extensions. Twenty healthy subjects (10 males and 10 females) performed a modified Biering-Sørensen test on two separate days, with a 1-week interval between the two tests. Surface EMG measurements were bilaterally performed from the latissimus dorsi, the thoracic and lumbar parts of the longissimus thoracis, the thoracic and lumbar parts of the iliocostalis lumborum, the multifidus, the gluteus maximus and the biceps femoris. In addition, three-dimensional kinematic data were recorded of the subjects’ lumbar vertebrae. The (instantaneous) median frequencies were calculated from the EMG signals using continuous wavelet (IMDF) – and short-time Fourier transforms (MDF). Linear regressions performed on the IMDF and MDF data as a function of time yielded slopes (IMDF_slope and MDF_slope) and intercepts (IMDF_init and MDF_init) of the regression lines. Test–retest reliability was assessed on the normalized slopes and intercept parameters by means of intraclass correlation coefficients (ICC) and standard errors of measurements expressed as percentages of the mean values (% SEM). The results of IMDF_slope and MDF_slope parameters indicated ICCs for back and hip muscles between .443 and .727 for IMDF_slope, values between .273 and .734 for MDF_slope, % SEM between 7.6% and 58.9% for IMDF_slope and % SEM between 8.2% and 25.3% for MDF_slope, respectively. The ICCs for IMDF_init and MDF_init parameters varied between .376 and .907 for IMDF_init and between .383 and .883 for MDF_init, and % SEM ranged from 2.7% to 6.3% for IMDF_init and from 2.6% to 4.7% for MDF_init, respectively. These results indicate that both wavelet – and Fourier based (instantaneous) median frequency parameters generally are reliable in the analysis of back and hip muscle fatigue during a modified Biering-Sørensen test.     

Respiratory muscle activity measured with a noninvasive EMG technique: technical aspects and reproducibility.

A new method is being developed to investigate airway obstruction in young children by means of noninvasive electromyography (EMG) of diaphragmatic and intercostal muscles. The purpose of this study was to evaluate the reproducibility of the EMG measurements. Eleven adults, 39 school children (20 healthy, 19 asthmatic), and 16 preschool children were studied during tidal breathing on separate occasions: two for adults with a time interval of 3 wk and three for children with time intervals of 1 and 24 h. Single electrodes were placed on the second intercostal space left and right of the sternum and at the height of the frontal and the dorsal diaphragm. Bipolar electrode pairs were placed on the rectus abdominis muscle. A newly designed digital physiological amplifier without any analog filtering was used to measure the EMG signals. Except for the average dorsal diaphragm EMG derivation in healthy school children on the second occasion, a significant correlation between the mean peak-to-peak inspiratory activity of average diaphragmatic and intercostal EMG was found in the different age groups on the different measurement occasions (P < 0.05). To assess the repeatability, we described the agreement between the repeated measurements within the same subjects. No significant differences were found between the measurements on the separate occasions. Our observations indicate that the EMG signals derived from the diaphragm and intercostal muscles are, in different age groups with and without asthma, reproducible during tidal breathing.     

The methods of surface EMG analysis

The use of surface emg as a tool for quantification is described. First, the specific advantages of the surface emg are discussed. Techniques for analysis of the emg signal which estimate and detect the action potentials of the individual motor units and estimate some global properties of muscle activity are reviewed. A survey of data on relations between the properties of motor unit action potential, the properties of motor unit activity and the results of signal processing are given.     

Assessment of work-related muscle strain by using surface EMG during test contractions interposed between work periods of simulateted mushroom picking

Surface electromyograms(EMG) during test contractions (TCs) were studied to assess the muscle strain in simulated mushroom picking. Additionally, the duration of the TC for the effective assessment was investigated. Nine female subjects performed standardized shoulder abduction and a stooped posture for one minute as TCs. Each experiment consisted of a 60-min rest, three work periods (W1-W3), a 30-min rest, and two work periods (W4 and W5) separated by a 30-min rest period. The duration of each work period was about 20 min. A total of 18 TCs was performed between the work periods and every 10 minutes in the rest periods. EMGs were recorded from the trapezius, infraspinatus, deltoid, and erector spinae muscles. The amplitude of EMG (AEMG) and mean power frequency (MPF) of EMG were calculated. Each TC was divided equally into three parts. Ratings of perceived exertion (RPE) in the neck, shoulder and low-back were reported during TCs. The work increased RPE of all the parts. AEMG and RPE were increased and MPF was decreased by W1, W2 and W3 in the neck and shoulder muscles. MPF of the erector spinae was increased by the work. The results were not affected by the duration of TCs and the parts during the TCs. AEMG and MPF fluctuated before W1 although the changes of RPE were small. Averaging several TCs was recommended to get stable results from TCs. EMG changes and appropriate TC conditions were discussed in relation to the adaptation in fatiguing contractions.     

Filtering the surface EMG signal: Movement artifact and baseline noise contamination

The surface electromyographic (sEMG) signal that originates in the muscle is inevitably contaminated by various noise signals or artifacts that originate at the skin-electrode interface, in the electronics that amplifies the signals, and in external sources. Modern technology is substantially immune to some of these noises, but not to the baseline noise and the movement artifact noise. These noise sources have frequency spectra that contaminate the low-frequency part of the sEMG frequency spectrum. There are many factors which must be taken into consideration when determining the appropriate filter specifications to remove these artifacts; they include the muscle tested and type of contraction, the sensor configuration, and specific noise source. The band-pass determination is always a compromise between (a) reducing noise and artifact contamination, and (b) preserving the desired information from the sEMG signal. This study was designed to investigate the effects of mechanical perturbations and noise that are typically encountered during sEMG recordings in clinical and related applications. The analysis established the relationship between the attenuation rates of the movement artifact and the sEMG signal as a function of the filter band pass. When this relationship is combined with other considerations related to the informational content of the signal, the signal distortion of filters, and the kinds of artifacts evaluated in this study, a Butterworth filter with a corner frequency of 20 Hz and a slope of 12 dB/oct is recommended for general use. The results of this study are relevant to biomechanical and clinical applications where the measurements of body dynamics and kinematics may include artifact sources.