Muscle activation timing and balance response in chronic lower back pain patients with associated radiculopathy.

BACKGROUND: Patients with chronic low back pain and associated radiculopathy present with neuromuscular symptoms both in their lower back and down their leg; however, investigations of muscle activation have so far been isolated to the lower back. During balance perturbations, it is necessary that lower limb muscles activate with proper timing and sequencing along with the lower back musculature to efficiently regain balance control. METHODS: Patients with chronic low back pain and radiculopathy and matched controls completed a series of balance perturbations (rapid bilateral arm raise, unanticipated and anticipated sudden loading, and rapid rise to toe). Muscle activation timing and sequencing as well as kinetic response to the perturbations were analyzed. FINDINGS: Patients had significantly delayed lower limb muscle activation in rapid arm raise trials as compared to controls. In sudden loading trials, muscle activation timing was not delayed in patients; however, some differences in posterior chain muscle activation sequencing were present. Patients demonstrated less anterior-posterior movement in unanticipated sudden loading trials, and greater medial-lateral movement in rise to toe trials. INTERPRETATION: Patients with low back pain and radiculopathy demonstrated some significant differences from control participants in terms of muscle activation timing, sequencing, and overall balance control. The presence of differences between patients and controls, specifically in the lower limb, indicates that radiculopathy may play a role in altering balance control in these patients.

Effect of short-term application of kinesio tape on the flexion-relaxation phenomenon, trunk postural control and trunk repositioning in healthy females.

This study was designed to investigate the potential effects of kinesio tape on the flexion-relaxation phenomenon, trunk postural control and trunk position sense when applied for a short period (30 min) to the low back of healthy female participants. Twenty-four participants were assigned to one of two groups: kinesio tape applied in either the recommended stretched or non-stretched (control) manner over the low back. Tests were performed at three time points (pre-tape, with tape, post-tape) to assess low-back muscle flexion-relaxation, position sense during active trunk repositioning and trunk postural control during seated balance. Results demonstrated that wearing kinesio tape did not affect the angle at which the erector spinae muscles became silent during trunk flexion (flexion-relaxation). Trunk repositioning error increased when wearing kinesio tape in both the stretched and non-stretched manner, and this increased error persisted after the tape was removed. Seated balance control improved when wearing kinesio tape in both the stretched and non-stretched manner, and these improvements persisted after the tape was removed. In conclusion, these findings do not support the general suggestions that short-term use of kinesio tape on the low-back region alter low-back muscle activation and enhance tasks related to proprioception, at least under these taping conditions in a group of healthy females.

Neuromuscular ultrasound imaging in low back pain patients with radiculopathy.

BACKGROUND: Patients suffering from chronic low back pain with associated radiculopathy (LBP-R), or sciatica, experience neuromuscular symptoms in the lower back and leg; however, research to date has focussed solely on the lower back. OBJECTIVES: To expand neuromuscular research of LBP-R patients into the lower limb, using ultrasound imaging. DESIGN: Case control study comparing LBP-R patients to matched healthy controls. METHODS: LBP-R patients with disc bulge or herniation (L3/L4 to L5/S1) resulting in unilateral radiculopathy (n = 17) and healthy matched controls (n = 17) were recruited. High-resolution ultrasound imaging was used to investigate sciatic nerve structure, as well as the quality (relative magnitude of fat/fibrosis infiltration) and contraction (muscle thickening) of associated musculature in the lower back (paraspinals) and lower limb (biceps femoris, gastrocnemius, soleus). RESULTS: LBP-R patients had swollen sciatic nerves (increased cross sectional area), but this was not associated with evidence of reduced lower limb muscle quality. As compared to controls, LBP-R patients demonstrated less soleus muscle thickening during submaximal contraction; however, there were no impairments in the hamstring or lower back musculature. CONCLUSIONS: Ultrasound imaging was an effective method to detect sciatic nerve swelling in mild to moderately affected LBP-R patients. Nerve swelling was not associated with poorer muscle quality, nor consistently impaired muscle contraction.

Deficits in foot skin sensation are related to alterations in balance control in chronic low back patients experiencing clinical signs of lumbar nerve root impingement.

Chronic low back pain (LBP) patients with radiculopathy, or sciatica, experience pain, tingling or numbness radiating down their leg due to compression of the lumbar nerve root. The resulting reduction in somatosensory information from the foot sole may contribute to deficits in standing balance control. This work was designed to investigate the relationship between foot skin sensitivity and standing balance control in chronic LBP patients with associated radiculopathy. Patients (n=9) and matched healthy controls (n=9) were recruited to the study, and were tested for balance control in both quiet standing as well as during rapid arm raise perturbation trials on a force plate. Foot skin sensitivity was tested bilaterally for vibratory threshold (3, 40 and 250 Hz) and touch (monofilament) threshold. Results demonstrate that patients had reduced sensitivity to 250 Hz vibration in their affected compared to unaffected foot (at the great toe and heel), as well as compared to controls (at the great toe), but there were no differences with lower frequency vibratory testing or with monofilament testing. While there were no significant between-group differences in balance measures, moderate statistically significant correlations between 250 Hz sensitivity and quiet standing balance parameters were uncovered. Thus, patients demonstrate reduced high-frequency vibratory sensitivity at the foot sole, and correlations with quiet standing balance measures indicate a connection between these foot skin sensitivity deficits and alterations in balance control. Clinically, this identifies high frequency vibration testing as an important measure of skin sensitivity in patients with radiculopathy.

Exploring the effect of repeated-day familiarization on the ability to generate reliable maximum voluntary muscle activation.

Maximum voluntary isometric contractions (MVCs) are commonly used to normalize electromyography (EMG) data and must be reliable even if the individual has no prior experience performing MVCs. This study explored the effect of familiarization over three testing sessions on MVC performance and reliability by comparing muscle activation during standardized maximal and sub-maximal muscle contractions. Participants were recruited into two groups: (1) individuals who regularly engaged in upper body resistance training; (2) individuals with little or no prior experience in upper body resistance training. EMG was collected from two pairs of muscles; biceps brachii and triceps brachii from the arm, and erector spinae and external oblique from the trunk. The trunk muscles were chosen as muscles that are less frequently activated in isolation in day-to-day life. It was found that there were no significant improvements in MVC performance or within-day reliability over the three testing sessions for both resistance trained and non-resistance trained groups. Resistance-trained individuals showed a trend to be more reliable within-day than non-resistance trained participants. Day-to-day MVC reliability, particularly of the erector spinae muscle, was limited in some participants. This suggests that further efforts are needed to improve our capability of reliably eliciting muscle activation MVCs for EMG normalization, especially for muscles that are less frequently activated in isolation.