Motor Training of the Lumbar Paraspinal Muscles Induces Immediate Changes in Motor Coordination in Patients With Recurrent Low Back Pain

Abstract

Recurrent low back pain (LBP) is associated with altered motor coordination of the lumbar paraspinal muscles. Whether these changes can be modified with motor training remains unclear. Twenty volunteers with unilateral LBP were randomly assigned to cognitively activate the lumbar multifidus independently from other back muscles (skilled training) or to activate all paraspinal muscles with no attention to any specific muscles (extension training). Electromyographic (EMG) activity of deep (DM) and superficial multifidus (SM) muscles were recorded bilaterally using intramuscular fine-wire electrodes and that of superficial abdominal and back muscles using surface electrodes. Motor coordination was assessed before and immediately after training as onsets of trunk muscle EMG during rapid arm movements, and as EMG amplitude at the mid-point of slow trunk flexion-extension movements. Despite different intentions of the training tasks, the pattern of activity was similar for both. After both training tasks, activation of the DM and SM muscles was earlier during rapid arm movements. However, during slow trunk movements, DM and SM activity was increased, and EMG activity of the superficial trunk muscles was reduced only after skilled training. These findings show the potential to alter motor coordination with motor training of the lumbar paraspinal muscles in recurrent LBP. Changes in motor coordination differed between skilled and extension training during slows trunk movements. As identical patterns of muscle activity were observed between training protocols, the results suggest that training-induced changes in motor coordination are not simply related to the muscle activation, but appear to be related to the task.