Sports Medicine Research: In the Lab & In the Field: Tactile Feedback: Is it Really as Good as We Think? (Sports Med Res)

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Tuesday, April 17, 2018

Tactile Feedback: Is it Really as Good as We Think?

Effects of tactile feedback on lumbar multifidus muscle activity in asymptomatic healthy adults and patients with low back pain

Wang-Price S, Zafereo J, Brizzolara K, Anderson E. Journal of Bodywork and Movement Therapies. 2017; 1-7

Take Home Message: Continuous and direct tactile feedback on the lumbar multifidus fails to facilitate muscle activation in people with and without low back pain.

https://www.flickr.com/photos/esthermax/30936542550
People with low back pain have smaller and more atrophied lumbar multifidus muscles on the involved side. Clinicians often include lumbar multifidus activation training in rehabilitation programs and use multiple strategies to teach and facilitate lumbar multifidus activation; including, tactile feedback through direct hand contact of the clinician.  Surprisingly, there is little evidence that tactile feedback improves lumbar multifidus activation. The authors conducted a descriptive study to investigate the association between tactile feedback and lumbar multifidus activation at rest and during a contracted state in healthy people and those with low back pain. The authors recruited 20 adults with low back pain and 20 healthy adults from a physical therapy clinic and affiliated institutions. Muscle activation was measured using surface electromyography with electrodes placed at the level of the L5 spinous process. The authors normalized muscle activation to a maximal voluntary isometric contraction, which they assessed while the participant performed a bilateral arm lift. The authors measured each participant three times while resting in the prone position, with and without the applied direct continuous contact for 5 seconds. Each participant then performed five contralateral arm lifts in the prone position, lasting 8 seconds with just verbal feedback and then with verbal and tactile feedback. The authors found that all people in the study, regardless of low back pain, had less lumbar multifidus activation when using tactile feedback during a rested (14% vs 17%) and contracted state (30% vs 32%). Despite, the lack of benefit many participants thought the tactile feedback was helpful (healthy: 35%, people with low back pain: 50%).

This study is important because the authors suggest that direct-contact tactile feedback may be ineffective for increasing activation of the lumbar multifidus. This article also shows the disconnect between what is happening and what people perceive because many participants thought the tactile feedback helped them better activate the lumbar multifidus. Although direct contact tactile feedback was used in this study a more applicable application of tactile feedback is light tapping or deep pressure. It would be interesting to replicate this study with intermittent-tapping tactile feedback. Furthermore, it may be beneficial to randomize the order of the trials to ensure that issues like muscle fatigue don’t alter the results. In the meantime, clinicians should incorporate some repetitions of tactile feedback into their rehabilitation programs for low back pain so the patient perceives the benefit, followed by repetitions without tactile feedback.

Questions for Discussion: Do you think the outcome would be different for a recreationally active asymptomatic and low back pain population? Do you think that multiple trials of direct contact tactile feedback would better activate the lumbar multifidus? Do you use direct contact tactile feedback in your rehabilitation of low back pain? If so would you consider altering the technique or otherwise not using it after reading this article?

Written by: Kaitlyn Hill
Reviewed by: Jeffrey Driban

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1 comments:

Juli Jimenez said...

Great summary Kaitlyn. Thank you for sharing!
You mentioned that light tapping or deep pressure is more applicable application of tactile feedback. I am curious as to why the pressure of the feedback would affect muscle activation? I also think there would be a stronger activation in an asymptomatic athletic population when compared to a LBP group. I currently would use tactile feedback in rehabilitation for LBP patients to help them understand where I want them to feel the activation. I would be open to using other techniques but would like to know more about which ones show the highest activation.

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