Abstract
One of the early signs of Multiple Sclerosis (MS) is weakness on one side of the body, which may contribute to walking impairments experienced by more than 75% of patients with MS. Poor balance, muscle weakness, and less fatigue resistance also contribute to reduced walking capacity and physical activity levels within this population. Trunk control is a key component of balance to ensure safe and efficient walking. PURPOSE:To investigate the activity of trunk muscle groups (flexors, extensors, lateral flexors) during walking in patients with MS. METHODS:Eight patients (4 men) with relapsing-remitting MS (aged 44.9 ± 8.6 years) and eight (4 men) healthy controls (aged 37.9 ± 8.4 years) walked on a treadmill for 15 min at a self-selected speed, during which [18F]-Fluorodeoxyglucose ([18F]-FDG), a glucose analog, was injected. Immediately after walking, Positron Emission Tomography / Computed Tomography imaging was performed. Muscle activity was quantified by Standardized Uptake Value (SUV), with higher uptake signifying greater activity. RESULTS:Between the MS and control groups, no differences in total (P = 0.65) or individual (P > 0.2) trunk muscle activity were found. Healthy controls showed no differences between sides of the trunk muscle groups (P > 0.21). However, side-to-side differences were identified in the MS group: lateral flexor muscle group (SUV: 0.82 SD 0.20, 0.68 SD 0.14, P < 0.01), external (SUV: 0.76 SD 0.19, 0.62 SD 0.11, P = 0.04) and internal (SUV: 0.86 SD 0.20, 0.68 SD 0.11, P = 0.02) obliques, as well as the rectus abdominis (SUV: 0.79 SD 0.26, 0.70 SD 0.17, P = 0.04). CONCLUSIONS:This data indicates that patients with MS have imbalanced activation of the trunk muscles during walking, with the less-affected side being activated more. This activation pattern suggests a compensatory mechanism used by patients with MS in order to maintain balance and postural control, which may contribute to the increased energy cost of walking reported in patients with MS. Based on these findings, trunk muscle activity should be evaluated during physical rehabilitation to identify and target factors contributing to impaired walking ability in patients with MS. Funded by MS Society (PP 1907), NIH/NCATS Colorado CTSI # UL1 TR000154
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