Sports Medicine Research: In the Lab & In the Field: Don’t Delay, Act(ivate) Now (Sports Med Res)


Monday, April 16, 2018

Don’t Delay, Act(ivate) Now

Altered trunk muscle recruitment patterns during lifting in individuals in remission from recurrent low back pain

Suehiro T, Ishida H, Kobara K, Osaka H, Watanabe S. J Electromyogr Kinesiol. 2018 ahead of print. 

Take Home Message: People with remission of recurrent low back pain had delayed onset of the lumbar multifidus, internal oblique and transverse abdominis muscles during a lifting task compared with their healthy counterparts.
Low back pain (LBP) is a debilitating condition and many patients recover but end up caught in a cycle of symptom resolution followed by symptom recurrence. Adults with LBP have altered trunk muscle recruitment patterns. However, it is unknown if these altered patterns persist when people become asymptomatic. If so, they potentially explain why these people are at risk for the recurrence of LBP. The authors of this study compared trunk muscle onset time and muscle activation of trunk muscles during a lifting task between individuals in remission from LBP and asymptomatic individuals. Twenty-five participants with remission of recurrent LBP and 20 healthy controls lifted a 5kg box while the authors assessed the onset and amount of muscle activation in the transverse abdominis, internal and external oblique, lumbar multifidus, erector spinae and anterior deltoid muscles. The authors calculated relative onset by subtracting the trunk muscle onset time from the anterior deltoid onset time (milliseconds). Individuals with LBP remission had delayed onset of the transverse abdominis, internal obliques and multifidus compared with the control group. Furthermore, people with LBP remission had greater abdominal and back muscle activation, specifically the erector spinae compared with the control group.

The results of this study show that individuals who are asymptomatic with recurrent LBP have altered trunk muscle recruitment patterns during a lifting task compared with healthy controls. While these individuals were in a period of symptom resolution, the fear of experiencing pain during this task, along with altered proprioception may explain the changes in recruitment patterns. Similarly, the increase in erector spinae activation could compensate for the transverse abdominis, internal obliques, and multifidus failing to activate in a timely manner to stabilize the trunk during movement. It would be interesting to see if clinical trials support targeting these altered recruitment patterns among patients at risk for recurrent LBP. In the meantime, these findings provide support for continuing lumbopelvic-hip exercises even after symptom resolution in individuals suffering from LBP.

Questions for Discussion: How often do you continue your rehabilitation exercises after patients present with a resolution of symptoms? Do you incorporate lifting tasks, or similar tasks mimicking activities of daily living into your rehabilitation? Similarly, with these exercises and tasks, do you encourage your patients to pre-emptively engage the transverse abdominis and other trunk musculature prior to initiating movement?

Written by: Kyle Morris
Reviewed by: Jeffrey Driban

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Sarah said...

Great review Kyle! I found this article to be very interesting, especially when it measured the onset of activation compared to the deltoids. Overall, when thinking about rehabilitation and the etiology of LBP it often times tends to resolve itself before we have a clear understanding of what the problem may be. Therefore, rehabilitation following the resolution of LBP is difficult to maintain, although ultimately what you would do in rehabilitation may be what prevents another episode from occurring. In an athletic setting I think it is easy to remember to incorporate exercise specific loading tasks but you potentially risk overlooking the importance of everyday lifting tasks. At least educating individuals on the importance of this could potentially help to prevent injury in the future as well. I always try to verbally and tactilely encourage activation of the TrA and other lumbopelvic hip complex musculature.

Kyle said...

Thank you, Sarah! I agree with what you've said as well. Based on the results of this article, individuals with LBP still have deficits while in remission, stressing the importance of continuing exercises after the symptom resolution. This is also a bit of info that I feel clinicians should educate their patients with. Similarly, if you incorporate lifting tasks such as the one utilized in the study, encourage them to perform an ADIM at the start to efficiently complete the task.

Kate Hill said...

Kyle really informative review! I thought this article was very interesting and I liked your question about how long we do rehabilitation after a remission of LBP. I think for someone who has LBP especially non-specific doing exercises is not really a fix, but more of a life style change and exercises should be done continuously in order to try and prevent another episode from reoccurring. It is more of a management of LBP rather than a treatment.

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