Abstract
BackgroundTo investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations.MethodsCase series (uncontrolled longitudinal study). Thirty chronic patients with LBP (21 women and 19 men, mean age 42.6 ± 8.6 years, mean weight 73 ± 14 kg, mean height 174 ± 10 cm) were included. The intervention consisted in a 5-day program including therapeutic education sessions (360 min), supervised abdominal and back muscle strength exercises (240 min), general aerobic training (150 min), stretching (150 min), postural education (150 min) and aqua therapy (150 min). Feedforward activation level and reflex amplitude determined by surface electromyographic activity triggered by postural perturbations were recorded from abdominal and paraspinal muscles in unexpected and expected conditions. Subjects were tested before, just after and again one month after the rehabilitation program.ResultsNo main intervention effect was found on feedforward activation levels and reflex amplitudes underlining the absence of changes in the way patients with LBP reacted across perturbation conditions. However, we observed a shift in the behavioral strategy between conditions, in fact feedforward activation (similar in both conditions before the program) decreased in the unexpected condition after the program, whereas reflex amplitudes became similar in both conditions.ConclusionsThe results suggest that a short-term rehabilitation program modifies trunk behavioral strategies during postural perturbations. These results can be useful to clinicians for explaining to patients how to adapt to daily life activities before and after rehabilitation.
Highlights
To investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations
The various pain models applied in studies on trunk muscle control are still insufficiently predictive of these behavioral changes [4] and the notion that neuromuscular changes can be functional in order to maintain stability and reduce loading on injured tissues, remains an hypothesis
Onset of reflex response was automatically calculated using custom algorithms in Scilab and we considered that a muscle response occurred when EMG signal ≥ threshold of 3 standard deviations above baseline [34]
Summary
To investigate the impact of a short-term multimodal rehabilitation program for patients with low back pain (LBP) on trunk muscle reflex responses and feedforward activation induced by postural perturbations. Feedforward activation of trunk muscles disappears or is delayed in rapid arm movements in patients with chronic LBP [12,13] but exhibits a greater activation before transient force perturbations [14]. The various pain models applied in studies on trunk muscle control are still insufficiently predictive of these behavioral changes [4] and the notion that neuromuscular changes can be functional in order to maintain stability and reduce loading on injured tissues, remains an hypothesis
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