Trunk muscle recruitment patterns in specific chronic low back pain populations.
BACKGROUND
It is hypothesized that injury or degeneration of osteoligamentous spinal structures would require compensation by trunk musculature and alterations in motor control to maintain spine stability. While, biomechanical modeling has supported this hypothesis, studies of muscle recruitment patterns in chronic low back pain patients both with and without significant osteoligamentous damage have been limited. This study utilized a non-randomized case-control design to investigate trunk muscle recruitment patterns around the neutral spine position between subgroups of patients with chronic mechanical low back pain and asymptomatic controls.


METHODS
Twenty subjects with chronic low back pain attributed to clinical lumbar instability were matched to 20 asymptomatic controls. In addition 12 patients with non-specific chronic low back pain were studied. Surface EMG from five trunk muscles was analyzed to determine activation levels and patterns of recruitment during a standing reach under two different loading conditions.


RESULTS
The chronic low back pain group with symptoms attributed to clinical instability demonstrated significantly higher activation levels of the external oblique and rectus abdominus muscles and lower abdominal synergist ratios than the control group. No significant differences were found between patient subgroups.


CONCLUSIONS
While these data demonstrate altered muscle recruitment patterns in patients with chronic low back pain, the changes are not consistent with Panjabi's theory suggesting that these alterations are driven by passive subsystem damage. However, the higher activation of global abdominal musculature and altered synergist patterns may represent a motor control pattern that has consequences for continued dysfunction and chronic pain.
Silfies
Sheri P
SP
Rehabilitations Sciences Biomechanics Laboratory, Drexel University, 245 North 15th Street, Philadelphia, PA 19102-1192, USA. silfies@drexel.edu
Squillante
Dawn
D
Maurer
Philip
P
Westcott
Sarah
S
Karduna
Andrew R
AR
D000009:Abdominal Muscles / Q000294:innervation* / Q000503:physiopathology*; D000222:Adaptation, Physiological / Q000502:physiology; D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology*; D008297:Male; D009119:Muscle Contraction; D011999:Recruitment, Neurophysiological / Q000502:physiology*