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

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

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


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%).

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.

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?

by: Kaitlyn Hill
by: Jeffrey Driban