title: Trunk muscle activation in low-back pain patients, an analysis of the literature.
abstract: This paper provides an analysis of the literature on trunk muscle recruitment in low-back pain patients. Two models proposed in the literature, the pain-spasm-pain model and the pain adaptation model, yield conflicting predictions on how low- back pain would affect trunk muscle recruitment in various activities. The two models are outlined and evidence for the two from neurophsysiological studies is reviewed. Subsequently, specific predictions with respect to changes in activation of the lumbar extensor musculature are derived from both models. These predictions are compared to the results from 30 clinical studies and three induced pain studies retrieved in a comprehensive literature search. Neither of the two models is unequivocally supported by the literature. These data and further data on timing of muscle activity and load sharing between muscles suggest an alternative model to explain the alterations of trunk muscle recruitment due to low-back pain. It is proposed that motor control changes in patients are functional in that they enhance spinal stability.
authors.affiliation: Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Free University Amsterdam, Van der Boechorststraat 9, NL-1081 BT, Amsterdam, The Netherlands. j_h_van_dieen@fbw.vu.nl
authors.forename: Jaap H
authors.initials: JH
authors.lastname: van Dieën
authors.forename: Luc P J
authors.initials: LP
authors.lastname: Selen
authors.forename: Jacek
authors.initials: J
authors.lastname: Cholewicki
mesh_terms: D000222:Adaptation, Physiological; D004576:Electromyography; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology*; D009119:Muscle Contraction; D018482:Muscle, Skeletal / Q000503:physiopathology*; D013035:Spasm / Q000503:physiopathology