Abstract
The purpose of the study was to investigate the athletic-based specificity of muscle strength and neuromuscular control of spine stability in chronic non-specific low-back pain (LBP). Thirty elite athletes and 29 age-matched non-athletes with (15 athletes and 15 non-athletes) and without LBP (15 athletes and 14 non-athletes) participated in the study. Muscle strength was measured during maximal isometric trunk flexion and trunk extension contractions. The neuromuscular control of spine stability was analyzed by determining trunk stiffness, trunk damping, and onset times of the lumbar and thoracic erector spinae muscles after sudden perturbations (quick release experiments) as well as maximum Lyapunov exponents (local dynamic stability) using non-linear time series analysis of repetitive lifting movements. LBP was assessed using the visual analog scale. We found lower maximal trunk extension moments (p = 0.03), higher trunk damping (p = 0.018) and shorter onset times (p = 0.03) of the investigated trunk muscles in LBP patients in both athletes and non-athletes. Trunk stiffness and the local dynamic stability did not show any differences (p = 0.136 and p = 0.375, respectively) between LBP patients and healthy controls in both groups. It can be concluded that, despite the high-level of training in athletes, both athletes and non-athletes with LBP showed the same deconditioning of the lumbar extensor muscles and developed similar strategies to ensure spine stability after sudden perturbations to protect the spine from pain and damage. The findings highlight that specific training interventions for the trunk muscles are not only crucial for individuals of the general population, but also for well-trained athletes.
Highlights
Low-back pain (LBP) is a worldwide-recognized problem that has become one of the major issues for public health systems with dramatic consequences for the quality of life of the affected patients (Deyo et al, 2006; Louw et al, 2007)
We found a significant pain effect on the maximum isometric trunk extension moments in all three investigated trunk positions, indicating a lower extension strength in low-back pain (LBP) patients compared to healthy controls (p = 0.013–0.023; effect size η2 = 0.091– 0.108) (Table 2)
We found in athletes and non-athletes lower muscle strength of the trunk extensors during maximal isometric contractions and properly adapted neuromuscular spine control after the quick release perturbation in our LBP patients
Summary
Low-back pain (LBP) is a worldwide-recognized problem that has become one of the major issues for public health systems with dramatic consequences for the quality of life of the affected patients (Deyo et al, 2006; Louw et al, 2007). It affects up to 84% of the general population in a lifetime (i.e., ranging from 51 to 84%; Manchikanti et al, 2009; Taylor et al, 2014), having a great impact on health care cost (Hammill et al, 2008; Balagué et al, 2012). LBP affects individuals of the general population and specific subgroups like elite athletes. Non-specific LBP can have dramatic consequences on athletic performance, ranging from chronic injuries to absenteeism from training and competition (Mortazavi et al, 2015). Pain of the lower back has been shown to be one of the most common reasons among male professional football players for missed playing time (Bono, 2004)
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