Specificity of a back muscle roman chair exercise in healthy and back pain subjects.

PURPOSE: Roman chair exercises are popular for improving back muscle endurance but do not specifically target back muscles. This study aimed to determine whether an adaptation of the Roman chair exercise would induce more fatigue in back muscles than in hip extensors. METHODS: For this study, 16 healthy subjects and 18 patients with nonspecific chronic low back pain performed trunk flexion-extension cycles until exhaustion in a Roman chair with hips flexed at 40°. Surface EMG signals were recorded bilaterally on four back muscles and two hip extensors (gluteus maximus and biceps femoris). Motion analysis of the trunk segments (pelvis, lumbar, and thoracic spines) was also carried out. RESULTS: In both groups, EMG revealed clear evidence of muscle fatigue for the gluteus maximus, less clear evidence of fatigue for the lower back muscles, and motor unit recruitment (without fatigue) for the upper back muscles and biceps femoris. A change of muscle activation pattern was emphasized throughout the exercise bout, with some lower back muscles showing an increase followed by a decrease or leveling off of activation and with upper back muscles showing an increased activation at the end. Kinematic analyses revealed a progressive decrease (11°) in the lumbar range of motion (ROM) and a progressive increase in hip (2°) and thoracic (7°) ROM during the exercise bout. CONCLUSIONS: Roman chairs allow more freedom to change the kinematics of the spine during the exercise (less lumbar and more thoracic motion) to delay lower back muscle fatigue by sharing the load between the lower and upper back muscles. Even with adaptations to reduce hip extensors fatigue, this may make this exercise not as specific as wanted for fatiguing lower back muscles.

Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain.

STUDY DESIGN: An experimental and comparative study of chronic low back pain (CLBP) patients and healthy controls. OBJECTIVE: To use a motivation-independent electromyography (EMG) based test of back muscle capacity to determine whether back muscle deconditioning is present in CLBP patients and whether it is related to pain-related psychological variables. SUMMARY OF BACKGROUND DATA: The verification of the deconditioning syndrome in CLBP patients might be biased by the use of performance-based measures to assess physical fitness, especially in patients having fear of injury. Also, the use of lumbar-specific measures of physical fitness, such as back muscle strength and endurance, might be more sensitive to physical deconditioning than more general assessments such as aerobic capacity. METHODS: A time-limited submaximal fatigue test was performed by 27 nonspecific CLBP subjects (14 men) who had not had any surgery, and 31 healthy controls (17 men) while surface EMG signals were collected from back muscles. Motivation-independent EMG indices, which are sensitive to muscle fatigue or to activation patterns, were then computed and entered as input into previously developed regression equations to predict endurance (PTend) and strength (PStrength). Between-group comparisons were completed with patients divided in subgroups based on a median split of pain intensity, fear of movement, or pain catastrophizing scores. RESULTS: Differences between healthy and CLBP subgroups were mainly observed when patients were divided using pain catastrophizing scores (PCS). High-PCS patients showed significantly lower PTend than low-PCS patients. Various EMG indices showed comparable results to PTend. However, some of them also pointed out that the PCS-low patients were more fatigue-resistant and showed different activation patterns comparatively to healthy subjects. CONCLUSION: These results suggest that physical deconditioning that is specific to back muscle capacity was present in a subgroup of patients while the opposite was observed in another subgroup, pain catastrophizing being related to this outcome. These findings support previous theoretical models of pain/disability.

The effect of sex and chronic low back pain on back muscle reflex responses.

Different back muscle reflex assessment protocols have shown abnormally longer reflex latency responses of back muscles in chronic low back pain (CLBP). However, many confounding variables are difficult to control, such as the load magnitude and the preactivation of trunk muscles. The aims of this study were to evaluate, in 30 subjects with CLBP and 30 healthy controls, the activation levels of back muscles during pre-loading and their reflex responses to sudden loading. After subjected to six practice perturbations, 20 sudden and unexpected forward perturbations of the trunk were applied in 30 CLBP subjects (14 women) and 31 controls (17 women), while attempting to minimize the confounding effect of preactivation level and perturbation amplitude. Reflex latency and amplitudes were computed from the surface EMG signals of four back muscles (bilaterally at L5, L3, L1, T10 vertebral levels). EMG was also collected from abdominal muscles. Subjects with CLBP significantly increased the preactivation of back muscles (abdominal preactivation the same) relative to controls while no sex effect was observed. While adjusting statistically for these differences, reflex amplitude was significantly higher in subjects with CLBP and men, compared to healthy controls and women, respectively. Interestingly, contrary to most of the literature available, no between-group effects were detected for reflex latency, which could potentially be explained by an appropriate control of confounding variables, but this remains to be clarified in future research.

Specificity of a back muscle exercise machine in healthy and low back pain subjects.

PURPOSE: To determine whether dynamic back muscle endurance exercises in a semisitting position induce more fatigue in back muscles than that in hip extensors in healthy controls as well as in patients with nonspecific chronic low back pain. METHODS: Sixteen healthy volunteers and 18 volunteers with nonspecific chronic low back pain performed trunk flexion-extension cycles until exhaustion at 60% of their strength in a machine designed for back exercise in a semisitting position with knees' angle at 135 degrees . The number of cycles and perceived muscle fatigue (Borg CR-10 scale) at five areas (upper and lower back, gluteus, hamstrings, and quadriceps) were used as fatigue criteria. EMG signals were recorded bilaterally on four back muscles, two hip extensors (gluteus maximus and biceps femoris), and the vastus medialis. The slope values of the instantaneous median frequency values computed over time were retained as EMG indices of fatigue. RESULTS: The number of cycles was equivalent in healthy controls (n = 23 +/- 13) and patients with back pain (n = 27 +/- 16). EMG indices of fatigue disclosed evidence of muscle fatigue in all the back muscles and the vastus medialis, contrary to hip extensors. EMG revealed significantly more muscle fatigue of lower back muscles, which was further corroborated by the Borg scale assessment. No between-group difference was obtained in any EMG comparison. CONCLUSION: These results showed that this type of exercise machine can specifically train the back muscles, and this as much in subjects with nonspecific chronic low back pain as in healthy controls. This has implications for the training of back muscle endurance, especially in patients with back pain for whom poor back muscle endurance is sometimes of concern.

Electromyographic assessment of back muscle weakness and muscle composition: reliability and validity issues.

OBJECTIVE: To assess the reliability and construct validity of various electromyographic indices developed to assess back muscle weakness and muscle fiber composition. DESIGN: A prospective study with repeated measures performed on 3 days along with comparisons of groups presenting different back strength and/or back muscle fiber composition. SETTING: A biomechanics laboratory within a rehabilitation center. PARTICIPANTS: Forty male volunteers (20 healthy, 20 with chronic low back pain) were assessed on 3 different days to assess reliability and to make group comparisons. Thirteen healthy women were also assessed once to obtain a third group with known lower strength and different back muscle fiber composition. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Surface electromyography was recorded for 4 pairs of homologous back muscles while the subjects performed, on a dynamometer, static trunk extension efforts. Electromyographic parameters were computed to assess muscle weakness and muscle fiber composition. The reliability of the data collected across the 3 sessions and comparisons between groups were determined. RESULTS: Electromyographic parameters generally showed good to excellent reliability, but were insensitive to differences in back muscle strength and did not appear to be related to muscle composition. Some trends were observed in the electromyographic parameters across the force levels, but the large interindividual variability impeded statistical comparisons. CONCLUSIONS: The assessment of muscle weakness and muscle fiber composition through electromyographic analysis does not appear feasible, at least on an individual basis, for the muscles of the back.