during lifting in individuals in remission from recurrent low back pain
K, Osaka H, Watanabe S. J Electromyogr
Kinesiol. 2018 ahead of print.
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.
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.
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?
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.
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.
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.