Temporal Patterns of the Trunk Muscles Remain Altered in a Low Back–Injured Population Despite Subjective Reports of Recovery

Abstract

ObjectiveTo compare temporal activation patterns from 24 abdominal and lumbar muscles between healthy subjects and those who reported recovery from recent low back injury (LBI). DesignCross-sectional comparative study. SettingUniversity neuromuscular function laboratory. ParticipantsHealthy adult volunteers (N=81; 30 LBI, 51 asymptomatic subjects). InterventionsTrunk muscle electromyographic activity was collected during 2 difficulty levels of a supine trunk stability test aimed at challenging lumbopelvic control. Main Outcome MeasuresPrincipal component (PC) analysis was applied to determine differences in temporal and/or amplitude electromyographic patterns between groups. Mixed-model analyses of variance were performed on PC scores that explained more than 89% of the variance (α=.05). ResultsFour PCs explained 89% and 96% of the variance for the abdominal and back muscles, respectively, with both muscle groups having similar shapes in the first 3 PCs. Significant interactions or group main effects were found for all PC scores except PC4 for the back extensors. Overall activation amplitudes for both the abdominal and back muscles (PC1 scores) were significantly (P<.05) higher for the LBI group, with both abdominal and back muscles of the LBI group demonstrating an increased response to the leg-loading phase (PC2 scores) compared with the asymptomatic group. Differences were also found between groups in their preparatory activity (PC3 scores), with the LBI group having a higher early relative amplitude of abdominal and back extensor activity. ConclusionsDespite perceived readiness to return to work and low pain scores, muscle activation patterns remained altered in this LBI group, including reduced synergistic coactivation and increased overall amplitudes as well as greater relative amplitude differences during specific phases of the movement. Electromyographic measures provide objective information to help guide therapy and may assist with determining the level of healing and return-to-work readiness after an LBI.