In a study published in "Clinical Biomechanics" in 1995, researchers measured lumbar extensor muscle endurance along with abdominal muscle strength and endurance, physical activity levels, waist girth and other parameters in asymptomatic people. Formal analysis, Is the Subject Area "Electromyography" applicable to this article? Task failure was defined as a deviation from the target inclination of 1 degree for more than 3 s. Every five minutes, subjects rated their perceived exertion (RPE) experienced during the sustained sitting on a scale ranging from 6–20 (Borg, 1982). Because muscles other than the lumbar extensors (ie, gluteals, biceps femoris) are primarily responsible for the initiation of trunk extension from the fully flexed position, 20 it was hypothesized that these muscles would not be maximally activated during the MVIC test because of the biomechanical position required during VARC exercise. [11] where a significant shift in lumbar muscle activation during dynamic tasks was seen in healthy controls, but not in cLBP. the lumbar extensor muscles alone (McNeil1 et al., 1980). Reduced temporal variability in muscle activity has been shown to induce local muscle fatigue even under isometric muscle contractions at a very low level [26]. Isolated lumbar exercise has demonstrated effectiveness in 80% of patients. This will increase the effort of the extensor muscles of the spine. They are also known as the sacrospinalis group of muscles. https://doi.org/10.1371/journal.pone.0213778.t004. However, differences in the task makes direct comparisons difficult. How to Do a Crunch Without Hurting the Neck or Lower Back. Physical Therapy First's John Baur demonstrates a seated stretch for the lumbar extensor muscles Compared to HCs, the patients with cLBP seems to have reduced temporal variability in lumbar muscle activation during the quiet sitting. A Shapiro-Wilk W-test for normality was performed on all dependent variables before statistical analysis. Alternate sides and try for 5 or more repetitions per side. Click through the PLOS taxonomy to find articles in your field. A) and B) demonstrates the position of the trunk and pelvis inclinometers, one in the lower part of the thoracic spine, and one on the sacrum. Objective: To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP). Some studies considered the McKenzie’s extension exercises as passive and presumably opined that it may not counter the back muscles’ inhibition and atrophy resulting from long-term LBP [16–18], however, a study by Fiebert and Keller among apparently healthy individuals demonstrated that the McKenzie’s extension exercises were not truly passive for lumbar back extensor muscles. Yes It can be used to isolate and develop the spine and hip extensors. The patients with cLBP had on average a significantly shorter sitting time than HCs. Participants were asked not to perform any back-straining exercises 48h prior to examination and not to use any medications except for Paracetamol or Ibuprofen preparations during one week before participation. The purpose of this study was to investigate muscle activity variability within and between the right and left side of lumbar muscles in patients with chronic low back pain (cLBP) compared to healthy controls (HCs) during sustained quiet sitting. Conceptualization, Our study investigated the spatial RMS distribution during sitting in one single position/task, and we recognize that comparing the spatial RMS distribution within participants between tasks with fairly similar postures would increase the validity of these analyses. This is also in agreement with our previous observations during prolonged (not quiet) standing, where patients with cLBP changed standing posture more frequent than HCs [21]. They are exercise that you need to go slow with, starting out with very light loads. The subjective influence of sitting was evaluated by the rating of perceived exertion and the amount of LBP on a numeric pain rating scale. of deconditioning of the extensor muscles of the lumbar spine (lumbar extensor musculature i.e. Therefore, absolute RMS data are also presented. Methodology, However, no study has been directed to examine this and at predicting lumbar extensor muscle strength from these morphological indices. https://doi.org/10.1371/journal.pone.0213778, Editor: Juliane Müller, Hochschule Trier, GERMANY, Received: August 24, 2018; Accepted: March 1, 2019; Published: March 14, 2019. The alternating frequency was not different between patients with cLBP and in HCs, (p = 0.56). This study examined the role of trunk extensor muscles in the thoracic and lumbar regions during postural adjustments in the freely standing cat. The figure shows the change in average RMS during sitting in cLBP patients (red) and healthy controls (green). Weakness in these muscles can contribute to low back pain and injuries. here. The perception of muscle fatigue, musculoskeletal pain and discomfort in the postural control system are believed to initiate such changes in posture [24] and it is not likely that this increased variation would cause the discomfort and pain. Moreover, due to test protocol risks, persons with abnormal blood pressure were also excluded from the study. Between-sides alternating activation was computed, as well as temporal- and spatial variability within the electrode grids through the coefficient of variation and correlations between RMS distributions. Back extensor muscles are the main supportive muscles, which extend the spine and maintain the posture. The change of the average EMG amplitude during sustained sitting can provide a representative and therefore possibly more stable representation of the activation changes of the whole muscle group [11, 20]. Moreover, the change in maximal RMS during MVC performed before and after the sitting was not different in patients with cLBP and HCs, indicating that reduced performance in patients during MVC might not solely be as a result of pain avoidance behavior. Writing – original draft, Our finding of little variation of RMS distribution over time although increase of variation of position lend some support to the theory that patients with cLBP may have difficulty to deactivate lumbar muscles despite changing sitting position, and result in constant low level isometric activity resulting in local muscle fatigue and possibly leading to musculoskeletal pain. The exact mechanism for alternating activation is not clear, although feedback from local muscle fatigue via afferents to α-motoneurones (via interneurons) has been mentioned as a plausible mechanism [32]. Altered neuromuscular function in patients with cLBP has been shown during different tasks [11–15]. These muscles include the large paired muscles in the lower back, called erector spinae, which help hold up the spine, and gluteal muscles. Study design: A prospective single-arm trial. The purpose of this study was to investigate muscle activity variability within and between the right and left side of lumbar muscles in patients with chronic low back pain (cLBP) compared to healthy controls (HCs) during sustained quiet sitting. None of the calculated EMG variables differed significantly between the electrode-grids placed on the left and right side of the back. Copyright: © 2019 Ringheim et al. Poor endurance of the trunk muscles may induce strain on the passive structures of the lumbar spine, leading eventually to low back pain. The researchers found that the spinal-loading patterns of the kettlebell swing are different from some other weight-lifting techniques. Fat content of lumbar extensor muscles and low back disability: a radiographic and clinical comparison Author ALARANTA, H 1; TALLROTH, K 1; SOUKKA, A 1; HELIÖVAARA, M [1] Invalid foundation, orthopaedic hosp., 00280 Helsinki, Finland Source. The second highest value was used due to the possible effects of transient artifacts in the signals on the peak RMS value. Project administration, As instructed, during this quiet sitting task, both the HCs and the patients with cLBP had very little variation in their posture. We found that muscle tone, stiffness, and elasticity of the left and right lumbar extensor myofascia in patients with chronic low back pain were very reliable among different operators. Compared to HCs, the patients with cLBP had lower temporal (p = 0.03) and similar spatial muscle activity variability during sitting, despite a more variable sitting position. Thus, data were additionally analyzed when … Although the effect of performing stabilization exercise with increased lumbar lordosis on multifidus activation and longissimus thoracis is unknown in CLBP. The belief that pain and tightness in the low back is from weakness in the abdominal muscles leads many people to focus their attention on strengthening the front of the core. Back extensor muscle strength was evaluated using a MedX lumbar extension machine. Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. As almost all variables turned out to have a non-normal distribution, non-parametric statistics were applied. Lumbar extensor muscle fibre angles. Saved captured images were then analysed using Matlab (Version 1.9.1 MathWorks, Inc., Natrick, MA, USA). This contrasts the findings of Falla et al. Over time, a muscle injury that has not been managed correctly may lead to an overall imbalance in the spine. In his book "Low Back Disorders," biomechanics expert Stuart McGill, Ph.D., recommends an exercise called the "bird dog." Moreover, Falla et al [11] showed a significant shift in lumbar muscle activation during dynamic tasks in healthy controls, but not in cLBP. Citation: Ringheim I, Indahl A, Roeleveld K (2019) Reduced muscle activity variability in lumbar extensor muscles during sustained sitting in individuals with chronic low back pain. Conclusion: Our findings indicate a significant positive correlation between the volume of extensor muscles in the lower half of the lumbar spine and sagittal curvature in the same region. The distribution of histochemically identified muscle fibre types was studied in biopsy samples from the two main muscles in the lumbar region of the human erector spinae, the multifidus and the longissimus, in 16 healthy subjects (nine males and seven females, age 20–30 years). A target position from the inclinometer at Th 12 was given on a computer screen. Muscle strength declines and accelerates further with age. Back extensor muscles are the main supportive muscles, which extend the spine and maintain the posture. Summary of Background Data. Patients with cLBP seem therefore to have a normal (postural) strategy while sitting, and this strategy probably does not contribute largely to the LBP for patients included in this study. Eight patients with cLBP (~40%) and one HC ended the sitting task before the scheduled 30 minutes due to experienced perceived exertion, pain and discomfort in the sitting position. Results from muscle activation during MVC before and after the sitting are shown in Table 4. A beginner should seek advice from a trainer experienced with kettlebells. 1993, Vol 6, Num 2, pp 137-140 ; ref : 9 ref. Surface electromyographic (EMG) signals were collected bilaterally from the lumbar muscles with 2 high density surface EMG grids of 9x14 electrodes. Discover a faster, simpler path to publishing in a high-quality journal. Fig. However, in the lumbar region nearly 70 muscles of variable size are contributing to several possible actions and hence exert various forces and actions on the spinal motion segments [17]. We hypothesized that patients with cLBP would have less variable muscle activation and would be more affected by the sustained sitting showing in more signs of muscle fatigue, reduced sitting time and increased pain. Pain can be triggered by some combination of overuse, muscle strain, and/or injuries to the muscles, ligaments, and discs that support the spine. To avoid false interpretations of the test results, it may be necessary to perform some preliminary tests. Benson et al. This was statistically significant (p-values ≤ 0.05) in all directions except for the anterior-posterior direction of the pelvis (p = 0.25). Data curation, The finding that voluntary submaximal isometric activity of the trunk extensor muscles increases lumbar PA stiffness is important because clinicians frequently report increased activity in this muscle group during their manual examination of a patient. Writing – review & editing, Affiliation Back extensor muscle strength was evaluated using a MedX lumbar extension machine. Aage Indahl, For strong extension of the back, the hip extensors must stabilize the pelvis toward the thighs. Information of lumbar muscle fatigue, variation in muscle activation and gender differences during sustained sitting from the 32 HCs has previously been published [20]. CODEN JSDIEW ISSN Some authorities1–3 suggest that muscle is a potential source of low back pain. Background . The patients with cLBP in our study had similar manifestations of local muscle fatigue in the EMG signal during the sitting (similar increase in RMS) which may explain the observed similar alternating activation. This did not result in increased muscle fatigue indicated by EMG, but the patients with cLBP reported higher levels of RPE during- and more LBP after the sitting and as a consequence ended the sitting earlier than HCs (p < 0.01). Karin Roeleveld, Roles The significance level for all tests was set to p < 0.05, and comparisons were performed two tailed. During low force activities, reduced trunk motor variability is associated with increased muscle fatigue, decreased endurance and increased pain and may therefore play a role in the cause of cLBP [10, 11]. The estimated rate of decline of lumbar extensor muscle isometric strength per decade from the sixth to eight decade in this study is approximately 40% and … https://doi.org/10.1371/journal.pone.0213778.t002, https://doi.org/10.1371/journal.pone.0213778.t003. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This also hampers the interpretation of group comparisons of normalized RMS values, since the normalized RMS values in patients with cLBP most likely are overestimated. Conceptualization, The Oswestry Disability Index (ODI, 0-100) and Visual Analog Scale (VAS, 0-10) of lower back pain were determined. Supervision, To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP). The transition zone muscles display a change in spatial tuning with stance distance, responding to many directions of translation at short distances and focusing to respond best to contralateral translations at the long stance distance. A significant increase in RMS and RPE was observed in both patients with cLBP and HCs indicating an on-going fatiguing process during sitting. Activation patterns of the lumbar musculature and the hip extensor muscles during dynamic trunk extension exercise have not been extensively studied. [1,2] Previous studies recorded an approximately 50% decline in lumbar extensor muscle strength from … Do Ab Exercises Keep the Belly Flat During Pregnancy? The lower back (where most back pain occurs) includes the five vertebrae in the lumbar region and supports much of the weight of the upper body. Using the muscles of your back and hips, lift your torso and straighten your back, then lower your upper body to the starting position. No, Is the Subject Area "Muscle contraction" applicable to this article? The average lumbar extensor muscle tone and stiffness were significantly higher in patients with chronic low back pain than those in healthy controls. As we bend down, they eccentrically contract to slow our descent into flexion; and as we return to an upright position, they must concentrically … RESULTS: The mean CSAs of the LEM at each level (L1/2-L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. 7 The difficulty in fully understanding the neuromuscular characteristics of the lumbar musculature is because of the complex anatomic structure of the sacroiliac joint that creates a hip-spine interaction during movement.8, 9 The … During the sitting, only very small changes in position were observed (all changes for trunk and pelvis position < 2.1°). The extensor muscles are attached to back of the spine and enable standing and lifting objects. No, Is the Subject Area "Lower back pain" applicable to this article? Conceptualization, The spaces between the vertebrae are maintained by intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. For each bipolar signal, the root mean square (RMS) and median frequency (MDF) were calculated in 1s non-overlapping epochs. Yes Therefore, rather than structural derangement, a functional disturbance in the complex system that coordinates the network of paraspinal muscles could be the background for non-specific LBP [5]. They argue that failure of muscles to protect passive structures from excessive loading may result in damage to these painsensitive structures and produce pain.4Enhancing muscle endurance, therefore, may help to reduce low back pain. Yes The patients with cLBP had lower maximal RMS during MVC before and after the sitting (p ≤ 0.05). Cognitive behavioural interventions seem effective in reducing disability and pain in non-specific LBP [36], and understanding the mechanisms by which psychological factors can affect the development of cLBP are wanted [37]. The frequency of the alternating activation between left and right lumbar muscles was used to quantify the variability in muscle activity between sides as previously described in detail [20]. The average lumbar extensor muscle tone and stiffness were significantly higher in patients with chronic low back pain than those in healthy controls. The increased movement variation could be caused by other, non-investigated muscle groups contributing to back extension. If the hip extensors cannot provide this stabilization, the pelvis will be pulled upward by the back extensors into a position of back extension. Clinical Biomechanics: Static Back Endurance and the Risk of Low-Back Pain, Spine: Trunk Muscle Weakness as a Risk Factor for Low Back Pain. Although we asked the participants not to use any medications except for Paracetamol or Ibuprofen preparations one week before examination and we have the impression that our participants in general are very dutiful, we cannot guarantee that they did not do so. Increased lumbar lordosis through postural cueing results in increase in lumbar multifidus muscle without much increase in other extensor. Three minutes rest was taken between the 3 trials. The RMS distribution changes over time were quantified by the correlation coefficients between RMS values of different epochs. Lumbar extensor weakness was the only test statistically associated with development of low back pain. sitting and standing in different ways) in daily life. Compared with concentric contractions, muscle soreness was significantly increased at … The study found that people with lower strength in the extensors compared with their flexors were at increased risk for low back pain. While maintaining a level and motionless spine, simultaneously extend your right arm ahead of you and your left leg behind you. Vertebrae are the structural constituents of the spine.There are 33 vertebrae in total; seven cervical vertebrae in the neck, twelve thoracic vertebrae in the torso and five lumbar vertebrae in the lower back. Supervision, Low maximal RMS during the MVC performed before the sustained sitting, and low EMG and high RPE was observed in patients with cLBP at the start of the sitting (Table 4). Moreover, the force level of the contraction can be a considerable factor for alternate activity, and the muscle activation level observed in our study may have been too high for true alternating activation to occur. Lumbar extensor muscle strength is dependent on many factors and accurate strength prediction so far has not been completely accounted for. Inge Ringheim, Writing – review & editing, Affiliation When performed correctly, kettlebell swings cause rapid activation and relaxation cycles of the lumbar spine extensors. The extensor hallucis longus is a thin muscle, situated between the tibialis anterior and the extensor digitorum longus, that functions to extend the big toe and dorsiflects the foot, and assists with foot eversion and inversion. No, Is the Subject Area "Pelvis" applicable to this article? However, detailed informa- tion is lacking about changes in back muscle strength after lumbar fusion surgery and about the quantitative effects of postoperative exercise programs. The sitting position was controlled by two inclinometers placed on the back at the Th.12 and S1-level (Fig 1). To perform the bird dog, assume a position on your hands and knees with your knees directly under your hips and your hands directly under your shoulders. No, Is the Subject Area "Myalgia" applicable to this article? The Oswestry Disability Index (ODI, 0-100) and Visual Analog Scale (VAS, 0-10) of lower back pain were determined. Root mean square values (RMS) over 1-sec epochs of all bipolar EMG leadings were obtained. Some studies considered the McKenzie’s extension exercises as passive and presumably opined that it may not counter the back muscles’ inhibition and atrophy resulting from long-term LBP [16–18], however, a study by Fiebert and Keller among apparently healthy individuals demonstrated that the McKenzie’s extension exercises were not truly passive for lumbar back extensor muscles. With that in mind, if someone has back issues, they might not be something to consider. Whether or not persons with cLBP also have altered side-to-side alternating activation and temporal and spatial variation during sustained sitting is unknown. For each grid and all epochs, the overall grid average was obtained. Ultrasound measurements 3 cm lateral of the spinous process at the L3-L4 level were used to determine the subcutaneous soft tissue and fascia thickness. Kettlebell swings require close attention to technique to avoid injury. Evidence suggests that muscle endurance is lower for people with low back pain than for individuals without low back pain. There were no group differences in the change of absolute RMS (p = 0.56), relative RMS (p = 0.17) or MDF (p = 0.38) during the sitting (Table 2). in lumbar extensor power and size. Yes On average, the LBP patients had significant shorter sitting time (median (IQR) HC; 30 (0), cLBP; 20 (23), (p ≤ 0.01). No, Is the Subject Area "Fatigue" applicable to this article? Therefore, especially the results with low statistical significance should be taking with care and seen in view of other studies in the literature. Both groups had reduced RMSMVC after the sitting, significant for the patients with cLBP (p = 0.04). 12.1 Classification of spinal deformities (Modified from Itoi E.[24] with permission) 12.1.6 Kyphosis and Back Extensor Strength Spinal column is supported and moved with four major muscle groups including extensors, flexors, lateral flexors, and rotators [28]. Therefore, the purpose of the present study was to investigate temporal and spatial muscle activation variability within, and alternating activation between the right and left sides of lumbar muscles in patients with cLBP compared to healthy control persons with HDsEMG during sustained quiet sitting. e0213778. Eighteen patients (13 males and 5 females) with cLBP and 32 healthy controls (HCs; 16 males and 16 females) in the age range 29 to 53 years were included in the study (Table 1). Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway, Roles They are also known as the sacrospinalis group of muscles. Lumbar/Core Strength and Stability Exercises Athletic Medicine Introduction Low back pain can be the result of many different things. It is an indication of altered voluntary drive, and may be an avoidance behavior due to pain expectancy during muscle contraction. An interpretation of the increased ratings of perceived exertion at the start of the sitting could be that patients with cLBP already at the start of the sitting were experiencing muscle fatigue. theses pertaining to healthy individuals: 1) that the trunk flexor-extensor muscle coactivation is present around a neutral spine posture, 2) that the coactivation is increased when the subject carries a load; and 3) that the coactivation provides the needed mechanical stability to the lumbar spine. The slope of a linear regression of the changes in grid averaged RMS and MDF values during sustained sitting were obtained (RMSslope and MDFslope) to quantify systematic changes over time. Yes Lumbar extensor muscle fibre angles and thoracolumbar curvatures changes in ageing may interact with age and gender.  Gently pull in the lower stomach muscles to activate the core muscles and protect the spine. During sitting, both patients with cLBP and HCs had little variation in the RMS distribution over time (high CCTMED; around 0.9) in lumbar muscles (Table 3). Yes The average lumbar extensor muscle tone and stiffness were significantly higher in patients with chronic low back pain than those in healthy controls. To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP). Low back pain (LBP) is a common health complaint with a global lifetime prevalence of about 40% [1]. A commendable direction for future studies is to evaluate the effect of cognitive behavioural interventions on motor control, muscle activation and psychological systems during activities requiring low-level load (e.g. Osteoporotic women have been found to have significantly lower back extensor strength than healthy women [ 29 ], and back extensor strength demonstrated a negative correlation with kyphosis [ 30 , 31 ]. Some of those HC participants, therefore probably have had LBP during their life, like most of the healthy general population. 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