Document Type: Original Articles
Department of Physical Therapy, Ahvaz Junndishapur University of Medical Sciences, Ahvaz, Iran
MSc of Biomechanics Engineering, Musculoskeletal Rehabilitation Research Center, Ahvaz Junndishapur University of Medical Sciences, Ahvaz, Iran
Background: While various studies have examined motor control differences between subjects with and without low back pain (LBP), only a few have investigated the muscle recruitment pattern in classified LBP patients during functional activity. The aim of this study was to investigate the firing pattern of the main muscles involved in sit-to-stand (STD) and stand-to-sit (STS) tasks in two prevalent LBP subgroups based on movement system impairment (MSI) classification. Methods: A total of 37 women between 18 and 50 years of age voluntarily participated in this cross-sectional study. They were divided into three groups (15 healthy, 15 lumbar extension rotation syndrome (LERS), and seven lumbar flexion rotation syndrome (LFRS)). Surface electromyography was recorded bilaterally from the trunk stabilizer muscles—i.e. the internal oblique (IO), lumbar erector spine (ES), and hip mobilizer muscles—and the medial (MH) and lateral (LH) hamstring muscles during STD and STS tasks. The variations in EMG onset muscle timing and asymmetry in side-to-side muscle timing were measured. Results: The firing sequence during the STD task showed no significant difference among groups. However, in the healthy and LFR groups the trunk stabilizer muscles were activated before the hip mobilizer muscles, and in the LERS group an insignificant delay was shown in the onset of the ES activity. There was no significant difference of bilateral muscle timing during STD. In the STS task no consistent order of pattern was found even in the healthy group. The bilateral muscle timing of IO (mean difference, -427.00; P=0.021) and ES (mean difference, 1964.57; P=0.000) had significant difference in the LFRS group during STS. Conclusion: The cumulative effects of recruitment pattern impairment may contribute to continuing the cycle of lumbar movement impairments and subsequent persistence of LBP.
- Van Dillen LR, Gombatto SP, Collins DR, Engsberg JR, Sahrmann SA. Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain. Archives of physical medicine and rehabilitation. 2007;88(3):351-60.
- Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. Bmj. 2008;337:a171.
- Macedo LG, Saragiotto BT, Yamato TP, Costa LO, Menezes Costa LC, Ostelo RW, et al. Motor control exercise for acute nonâspecific low back pain. The Cochrane Library. 2016.
- Dillingham T. Evaluation and management of low back pain: an overview. State of the art reviews. 1995;9:559-74.
- Werneke MW, Hart DL. Categorizing patients with occupational low back pain by use of the Quebec Task Force Classification system versus pain pattern classification procedures: discriminant and predictive validity. Physical therapy. 2004;84(3):243-54.
- Moffroid MT, Haugh LD, Henry SM, Short B. Distinguishable groups of musculoskeletal low back pain patients and asymptomatic control subjects based on physical measures of the NIOSH Low Back Atlas. Spine. 1994;19(12):1350-8.
- Cieza A, Stucki G, Weigl M, Disler P, Jackel W, van der Linden S, et al. ICF Core Sets for low back pain. Journal of Rehabilitation Medicine. 2004;36(0):69-74.
- Van Dillen LR SS, Norton BJ, Caldwell CA, McDonnell MK, Bloom NJ. Movement system impairment-based categories for low back pain: stage 1 validation. Journal of Orthopaedic & Sports Physical Therapy. 2003;3( 33):126-42.
- Hoffman SL, Harris-Hayes M, Van Dillen LR. Differences in activity limitation between 2 low back pain subgroups based on the movement system impairment model. PM&R. 2010;2(12):1113-8.
- Sahrmann S. Movement system impairment syndromes of the extremities, cervical and thoracic spines: Elsevier Health Sciences; 2010.
- Sahrmann S. Diagnosis and treatment of movement impairment syndromes: Elsevier Health Sciences; 2002.
- Harris-Hayes M, Van Dillen LR, Sahrmann SA. Classification, treatment and outcomes of a patient with lumbar extension syndrome. Physiotherapy Theory and Practice. 2005;21(3):181-96.
- Karayannis NV, Jull GA, Hodges PW. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC musculoskeletal disorders. 2012;13(1):24.
- Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. Journal of Electromyography and Kinesiology. 2003;13(4):361-70.
- Tateuchi H, Taniguchi M, Mori N, Ichihashi N. Balance of hip and trunk muscle activity is associated with increased anterior pelvic tilt during prone hip extension. Journal of electromyography and kinesiology. 2012;22(3):391-7.
- Page P, Frank C, Lardner R. Assessment and treatment of muscle imbalance: the Janda approach: Human kinetics; 2010.
- Van Dillen LR, Norton BJ, Sahrmann SA, Evanoff BA, Harris-Hayes M, Holtzman GW, et al. Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. Manual therapy. 2016;24:52-64.
- Lomaglio MJ, Eng JJ. Muscle strength and weight-bearing symmetry relate to sit-to-stand performance in individuals with stroke. Gait & posture. 2005;22(2):126-31.
- Dall PM, Kerr A. Frequency of the sit to stand task: an observational study of free-living adults. Applied ergonomics. 2010;41(1):58-61.
- Pai Y, Rogers MW. Segmental contributions to total body momentum in sit-to-stand. Medicine and Science in Sports and Exercise. 1991;23(2):225-30.
- Andersson EI, Lin CC, Smeets RJ. Performance tests in people with chronic low back pain: responsiveness and minimal clinically important change. Spine. 2010;35(26):E1559-E63.
- Zijlstra A, Mancini M, Lindemann U, Chiari L, Zijlstra W. Sit-stand and stand-sit transitions in older adults and patients with Parkinsonâs disease: event detection based on motion sensors versus force plates. Journal of neuroengineering and rehabilitation. 2012;9(1):75.
- Pai Y, Rogers MW. Control of body mass transfer as a function of speed of ascent in sit-to-stand. Medicine and Science in Sports and Exercise. 1990;22(3):378-84.
- Millington PJ, Myklebust BM, Shambes GM. Biomechanical analysis of the sit-to-stand motion in elderly persons. Archives of Physical Medicine and Rehabilitation. 1992;73(7):609-17.
- Ikeda ER, Schenkman ML, Riley PO, Hodge WA. Influence of age on dynamics of rising from a chair. Physical Therapy. 1991;71(6):473-81.
- Hughes M, Weiner D, Schenkman M, Long R, Studenski S. Chair rise strategies in the elderly. Clinical biomechanics. 1994;9(3):187-92.
- Goulart FR-d-P, Valls-Sole J. Patterned electromyographic activity in the sit-to-stand movement. Clinical neurophysiology. 1999;110(9):1634-40.
- Choi B. Activation of the vastus medialis oblique and vastus lateralis muscles in asymptomatic subjects during the sit-to-stand procedure. Journal of physical therapy science. 2015;27(3):893-5.
- Claeys K, Dankaerts W, Janssens L, Brumagne S. Altered preparatory pelvic control during the sit-to-stance-to-sit movement in people with non-specific low back pain. Journal of Electromyography and Kinesiology. 2012;22(6):821-8.
- Hemming R. Regional spinal kinematics and muscle activity in non-specific chronic low back pain during functional tasks: evaluation of a sub-classification approach: Cardiff University; 2015.
- Van Dillen LR, Sahrmann SA, Wagner JM. Classification, intervention, and outcomes for a person with lumbar rotation with flexion syndrome. Physical therapy. 2005;85(4):336-51.
- Shum GL, Crosbie J, Lee RY. Effect of low back pain on the kinematics and joint coordination of the lumbar spine and hip during sit-to-stand and stand-to-sit. Spine. 2005;30(17):1998-2004.
- Kim S-h, Kwon O-y, Park K-n, Kim M-H. Comparison of erector spinae and hamstring muscle activities and lumbar motion during standing knee flexion in subjects with and without lumbar extension rotation syndrome. Journal of Electromyography and Kinesiology. 2013;23(6):1311-6.
- Gombatto SP, Norton BJ, Sahrmann SA, Strube MJ, Van Dillen LR. Factors contributing to lumbar region passive tissue characteristics in people with and people without low back pain. Clinical Biomechanics. 2013;28(3):255-61.
- Norton BJ SS, Van Dillen LR. Differences in measurements of lumbar curvature related to gender and low back pain. Journal of Orthopaedic & Sports Physical Therapy. 2004;34(9):524.
- Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry disability index, the Roland-Morris disability questionnaire, and the Quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine. 2006;31(14):E454-E9.
- Fritz JM, Irrgang JJ. A comparison of a modified Oswestry low back pain disability questionnaire and the Quebec back pain disability scale. Physical therapy. 2001;81(2):776-88.
- Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90-4.
- Ng JK, Richardson CA. Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects. Archives of physical medicine and rehabilitation. 1996;77(3):259-64.
- Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain. Archives of physical medicine and rehabilitation. 2009;90(7):1159-69.
- Goss CM. Muscles aliveâtheir functions revealed by electromyography. By JV Basmajian. 1962. XI+ 267 pages, 126 figures. $8.50. The Williams & Wilkins Company, Baltimore. Wiley Online Library; 1963.
- Hodges PW, Bui BH. A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1996;101(6):511-9.
- Kim MH, Chung HY, Yoo WG, Choi BR. EMG and kinematics analysis of the trunk and lower extremity during the sit-to-stand task while wearing shoes with different heel heights in healthy young women. Human movement science. 2011;30(3):596-605.
- Kim M-h, Yoo W-g, Choi B-r. Differences between two subgroups of low back pain patients in lumbopelvic rotation and symmetry in the erector spinae and hamstring muscles during trunk flexion when standing. Journal of Electromyography and Kinesiology. 2013;23(2):387-93.