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Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain

SILFIES SP; MEHTA R; SMITH SS; KARDUNA AR
ARCH PHYS MED REHABIL , 2009, vol. 90, n° 7, p. 1159-1169
Doc n°: 143932
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.apmr.2008.10.033
Descripteurs : CE51 - LOMBALGIE
Article consultable sur : http://www.archives-pmr.org

OBJECTIVE: To investigate alterations in trunk muscle timing patterns in
subgroups of patients with mechanical low back pain (MLBP). Our hypothesis was
that subjects with MLBP would demonstrate delayed muscle onset and have fewer
muscles functioning in a feedforward manner than the control group. We further
hypothesized that we would find differences between subgroups of our patients
with MLBP, grouped according to diagnosis (segmental instability and
noninstability). DESIGN: Case-control. SETTING: Laboratory. PARTICIPANTS:
Forty-three patients with chronic MLBP (25 instability, 18 noninstability) and 39
asymptomatic controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
Surface electromyography was used to measure onset time of 10 trunk muscles
during a self-perturbation task. Trunk muscle onset latency relative to the
anterior deltoid was calculated and the number of muscles functioning in
feedforward determined. RESULTS: Activation timing patterns (P<.01; eta=.50;
1-beta=.99) and number of muscles functioning in feedforward (P=.02; eta=.30;
1-beta=.83) were statistically different between patients with MLBP and controls.
The control group activated the external oblique, lumbar multifidus, and erector
spinae muscles in a feedforward manner. The heterogeneous MLBP group did not
activate the trunk musculature in feedforward, but responded with significantly
delayed activations. MLBP subgroups demonstrated significantly different timing
patterns. The noninstability MLBP subgroup activated trunk extensors in a
feedforward manner, similar to the control group, but significantly earlier than
the instability subgroup. CONCLUSIONS: Lack of feedforward activation of selected
trunk musculature in patients with MLBP may result in a period of inefficient
muscular stabilization. Activation timing was more impaired in the instability
than the noninstability MLBP subgroup. Training specifically for recruitment
timing may be an important component of the rehabilitation program.

Langue : ANGLAIS

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