Back Muscle Activation Patterns in Chronic Low Back Pain During Walking: A “Guarding” Hypothesis

Objectives:To investigate whether patients with chronic low back pain (CLBP) show “guarded” movements during walking. It is hypothesized that guarding will be reflected by increased lumbar muscle activity during all periods of stride and secondary, relatively lesser relaxation during periods of swing compared with double support. Furthermore, it is hypothesized that higher levels of perceived fear and disability are related to increased muscle activity and less relative relaxation. Materials and Methods:In a cross-sectional study 63 patients with CLBP and 33 healthy controls walked on a treadmill at 3.8 km/h. Surface electromyography (sEMG) data of the erector spinae were obtained and smoothed rectified sEMG (SRE) values were calculated per period of swing and double support. The ratio of SRE values in swing to double support was used as a measure of relative relaxation (SRE ratio). In addition, the relationship between SRE values, the Roland Morris Disability Questionnaire, and the Tampa Scale for Kinesiophobia was analyzed in patients with CLBP. Results:Mean SRE values were significantly higher in patients with CLBP than in controls both during periods of double support and swing. SRE ratios were not significantly different between groups. Results showed no influence of disability or fear of movement on either SRE values or ratios. Discussion:In patients with CLBP, increased lumbar muscle activity during all periods of stride, with comparable alteration between swing and double support, suggests difficulties with total muscle relaxation. On the basis of this evaluation, it is concluded that patients with CLBP show a guarding mechanism during walking. No relationship is found between perceived fear, disability, and muscle activity.

[1]  J. Knottnerus,et al.  Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms , 2003, European journal of pain.

[2]  G. Crombez,et al.  The Tampa Scale for Kinesiophobia: further examination of psychometric properties in patients with chronic low back pain and fibromyalgia , 2004, European journal of pain.

[3]  G. Hagg,et al.  Static work loads and occupational myalgia a new explanation model , 1991 .

[4]  H. Hermens,et al.  Assessment of activities of daily living with an ambulatory monitoring system: a comparative study in patients with chronic low back pain and nonsymptomatic controls , 2002, Clinical rehabilitation.

[5]  B. Freriks,et al.  Development of recommendations for SEMG sensors and sensor placement procedures. , 2000, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[6]  David K. Ahern,et al.  Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls , 1988, Pain.

[7]  J. Knottnerus,et al.  The association of physical deconditioning and chronic low back pain: A hypothesis-oriented systematic review , 2006, Disability and rehabilitation.

[8]  M. Hasenbring,et al.  Attentional control of pain and the process of chronification. , 2000, Progress in brain research.

[9]  Edward D Lemaire,et al.  Electromyographic and kinematic nondisabled gait differences at extremely slow overground and treadmill walking speeds. , 2005, Journal of rehabilitation research and development.

[10]  Winfried Banzer,et al.  Influences of Nonspecific Low Back Pain on Three-Dimensional Lumbar Spine Kinematics in Locomotion , 2001, Spine.

[11]  P. Watson,et al.  Evidence for the Role of Psychological Factors in Abnormal Paraspinal Activity in Patients with Chronic Low Back Pain , 1997 .

[12]  Andreas Daffertshofer,et al.  How do persons with chronic low back pain speed up and slow down? Trunk-pelvis coordination and lumbar erector spinae activity during gait. , 2006, Gait & posture.

[13]  Low back muscle activity and pelvic rotation during walking , 2004, Anatomy and Embryology.

[14]  D. Winter,et al.  EMG profiles during normal human walking: stride-to-stride and inter-subject variability. , 1987, Electroencephalography and clinical neurophysiology.

[15]  G. Jull,et al.  The effect of musculoskeletal pain on motor activity and control. , 2001, The journal of pain : official journal of the American Pain Society.

[16]  J. Groothoff,et al.  Reliability and stability of the Roland Morris Disability Questionnaire: intra class correlation and limits of agreement , 2004, Disability and rehabilitation.

[17]  A. T. Nelson,et al.  Sagittal plane analysis of head, neck, and trunk kinematics and electromyographic activity during locomotion. , 2001, The Journal of orthopaedic and sports physical therapy.

[18]  R. Wagenaar,et al.  Disorders in trunk rotation during walking in patients with low back pain: a dynamical systems approach. , 2001, Clinical biomechanics.

[19]  P. Hodges,et al.  Changes in three dimensional lumbo-pelvic kinematics and trunk muscle activity with speed and mode of locomotion. , 2005, Clinical biomechanics.

[20]  J. Knottnerus,et al.  Do Patients With Chronic Low Back Pain Have a Lower Level of Aerobic Fitness Than Healthy Controls?: Are Pain, Disability, Fear of Injury, Working Status, or Level of Leisure Time Activity Associated With the Difference in Aerobic Fitness Level? , 2006, Spine.

[21]  J. Sluiter,et al.  Fear of movement and (re)injury in chronic musculoskeletal pain: Evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples , 2007, Pain.

[22]  J. Hidler,et al.  Biomechanics of overground vs. treadmill walking in healthy individuals. , 2008, Journal of applied physiology.

[23]  L Vogt,et al.  Comparison of angular lumbar spine and pelvis kinematics during treadmill and overground locomotion. , 2002, Clinical biomechanics.

[24]  U. Croce,et al.  A kinematic and kinetic comparison of overground and treadmill walking in healthy subjects. , 2007, Gait & posture.

[25]  J. Hart,et al.  Neuromuscular consequences of low back pain and core dysfunction. , 2008, Clinics in sports medicine.

[26]  M. Levin,et al.  Pelvis-Thorax Coordination in the Transverse Plane During Walking in Persons With Nonspecific Low Back Pain , 2002, Spine.

[27]  Chris J. Main,et al.  Guarded Movements:: Development of Chronicity , 1996 .

[28]  Alexander Petrovitch,et al.  Trunk muscle activation patterns during walking at different speeds. , 2007, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[29]  M. Pierrynowski.  Biomechanics of overground vs. treadmill walking in healthy individuals , 2009 .

[30]  L. Selen,et al.  Trunk muscle activation in low-back pain patients, an analysis of the literature. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[31]  A. Mannion.  Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. , 1999, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[32]  A. Mannion,et al.  Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients , 2000, European Spine Journal.

[33]  D K Ahern,et al.  Reliability of lumbar paravertebral EMG assessment in chronic low back pain. , 1986, Archives of physical medicine and rehabilitation.

[34]  W. Forrest,et al.  Power Spectrum Analyses of Electromyographic Activity: Discriminators in the Differential Assessment of Patients with Chronic Low‐Back Pain , 1991, Spine.

[35]  A comparison of outcome measures for use with back pain patients: results of a feasibility study. , 1993, Journal of manipulative and physiological therapeutics.

[36]  P J Watson,et al.  Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio. , 1997, Clinical biomechanics.

[37]  A. Daffertshofer,et al.  Effects of chronic low back pain on trunk coordination and back muscle activity during walking: changes in motor control , 2006, European Spine Journal.

[38]  Lars Arendt-Nielsen,et al.  The influence of low back pain on muscle activity and coordination during gait: a clinical and experimental study , 1996, Pain.

[39]  Philip Rowe,et al.  Three dimensional, lumbar spinal kinematics during gait, following mild musculo-skeletal low back pain in nurses , 1996 .

[40]  P. Hodges,et al.  Pain and motor control of the lumbopelvic region: effect and possible mechanisms. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[41]  A. Pedotti,et al.  Electromyographic signals during gait: Criteria for envelope filtering and number of strides , 1998, Medical and Biological Engineering and Computing.

[42]  J. Knottnerus,et al.  Physical activity in daily life in patients with chronic low back pain. , 2001, Archives of physical medicine and rehabilitation.

[43]  A. Thorstensson,et al.  Lumbar back muscle activity in relation to trunk movements during locomotion in man. , 1982, Acta physiologica Scandinavica.

[44]  R. Westgaard,et al.  Electromyographic evaluation of muscular work pattern as a predictor of trapezius myalgia. , 1993, Scandinavian journal of work, environment & health.

[45]  J. Vlaeyen,et al.  The role of fear of movement/(re)injury in pain disability , 1995, Journal of Occupational Rehabilitation.

[46]  A. Haig,et al.  A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls. , 2005, The journal of pain : official journal of the American Pain Society.

[47]  P. O'Sullivan.  Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. , 2005, Manual therapy.

[48]  G. Crombez,et al.  Confirmatory Factor Analysis of the Tampa Scale for Kinesiophobia: Invariant Two-Factor Model Across Low Back Pain Patients and Fibromyalgia Patients , 2004, The Clinical journal of pain.

[49]  S. Simon.  Gait Analysis, Normal and Pathological Function. , 1993 .

[50]  M Stokes,et al.  Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on the technique. , 2005, Manual therapy.

[51]  K. Pfeifer,et al.  Neuromuscular control of walking with chronic low-back pain. , 2003, Manual therapy.