Bilateral Lumbar Erector Spinae Research Articles

A Study on the Comfort Level of Standing Chairs Based on Pressure Sensors and sEMG

This study explores the health consequences of prolonged sitting by introducing a standing chair and examining the effects of seat tilt angles on comfort. Using synchronized pressure distribution testing and surface electromyographic (sEMG) signal analysis, we assessed pressure and sEMG responses at tilt angles of 0°, 20°, and 40° during tasks such as computer work, writing, and ironing. Initial measurements with body pressure distribution sensors targeted the buttocks and feet, while surface electromyographic equipment captured signals from the bilateral lumbar erector spinae, vastus lateralis, and gastrocnemius muscles. MATLAB processing facilitated the analysis of integrated electromyographic values and mean power frequencies, elucidating the effects of tilt angles on comfort. Our research findings indicate that a 20° tilt angle significantly enhances comfort during computer and writing tasks and noticeably increases the comfort of the erector spinae muscles during ironing. Conversely, a 0° tilt angle is more beneficial for the vastus lateralis and gastrocnemius muscles. These results underscore the importance of selecting appropriate tilt angles to improve comfort across various tasks. Furthermore, integrating pressure sensors and surface electromyographic signals enables a comprehensive evaluation of chair ergonomic quality, offering valuable insights for chair design optimization.

496 Erector Spine Plane Block Improves Analgesia After Minimally Invasive Awake Spine Surgery

INTRODUCTION: There is an emerging interest in lumbar spine surgery under spinal anesthesia (SA). Bilateral lumbar erector spinae plane (ESP) blocks are also described as a useful regional anesthetic technique to reduce post-operative pain after lumbar surgery. METHODS: A retrospective chart review was performed analyzing time in OR, first pain score in PACU after spinal wore off, pain scores throughout POD0, opioid requirements, PONV requiring rescue agent, and length of stay in patients that underwent spine surgery under SA before our practice adopted ESP blocks for back surgery versus patients that received an ESP block. For patients that received an ESP block, the injection was performed after skin closure above the level of the surgical intervention. Under ultrasound guidance, the erector spinae muscle layer was visualized and the block was performed with 15 ml of 0.5% bupivacaine mixed with 15 ml of liposomal bupivacaine (30 ml of local anesthetic per side). RESULTS: There was no significant difference in age, sex, ASA class, and BMI. Perioperative opioid use on POD0 was more than double in those not receiving a block (p = 0.0032). First pain score in recovery following conclusion of the spinal was greater than those who had received the intervention, p = 0.0209. Median length of stay in days was the same with a larger range in the non-intervention group. Incidence of nausea/vomiting was decreased in the group receiving ESP blocks. CONCLUSIONS: An ESP block can be used as an adjunct for minimally invasive spine surgery for enhancing recovery. Preliminary data suggests there is a trend for lower incidence of PONV as well as average pain scores on POD0 and a significant decrease in perioperative opioid use, increased same-day discharges, and improved pain scores upon conclusion of SA.

The Pain Intensity/Quality and Pain Site Association with Muscle Activity and Muscle Activity Distribution in Patients with Chronic Low Back Pain: Using a Generalized Linear Mixed Model Analysis.

Background Pain can alter muscle activity, although it is not clear how pain intensity and site location affect muscle activity. This study aimed to reveal the complex associations among the pain site, pain intensity/quality, muscle activity, and muscle activity distribution. Methods Electromyographic signals were recorded from above a bilateral lumbar erector spinae muscle with a four-channel electrode in 23 patients with chronic low back pain while they performed a lumbar bending and returning task. We calculated the average value of muscle activity during the extension phase (agonist activity) and the centroid of muscle activity, as well as the distance between the centroid of muscle activity and pain site. We also assessed the pain site and pain intensity/quality by the interview and questionnaire method. A generalized linear mixed model analysis was performed to determine the relationships among pain intensity/quality, pain site, and muscle activity. Results The results showed that muscle activity during the extension phase was significantly negatively associated with neuropathic pain and “pain caused by light touch.” In addition, the distance between the centroid of muscle activity and pain site during the extension phase was significantly positively associated with intermittent pain, “throbbing pain,” “splitting pain,” “punishing-cruel,” and “pain caused by light touch.” Conclusions Our findings suggest the existence of a motor adaptation that suppresses muscle activity near the painful area as the pain intensity increases. Furthermore, the present study indicates that the presence or absence of this motor adaptation depended on the pain quality.

Immediate effects of myofascial release on neuromechanical characteristics in female and male patients with low back pain and healthy controls as assessed by tensiomyography. A controlled matched-pair study

BackgroundLow back pain (LBP) is a major health issue in most industrialised countries. Lumbodorsal fascia has been advocated as a potential source of pain in the lumbopelvic region. Myofascial release constitutes a manual therapeutic approach focussing on the restoration of altered soft tissue function. No previous study has focused on quantifying neuromechanical effects of myofascial release on LBP patients through tensiomyography. The purpose of this study was to quantify immediate neuromechanical alterations of myofascial release on patients with LBP and healthy controls through tensiomyography parameters. MethodsThe participants' (n = 30) bilateral lumbar erector spinae muscles were assessed via tensiomyography before and after a 6-min myofascial release treatment of the lumbodorsal fascia to evaluate the muscles' mechanical characteristics. Subjects with LBP (n = 15) were eligible to partake if they reported having had LBP for most days in the past 12 weeks. Muscle displacement (Dm [mm]), velocity of contraction (Vc [mm/s]), and lateral symmetry (Ls [%]) were assessed through tensiomyography testing. FindingsStatistical analyses revealed a significant increase for velocity of contraction in the right (p = .021) and left (p = .041) lumbar erector spinae for the subjects with LBP but not for the healthy controls (both p > .14). InterpretationWe suggested that myofascial release alters neuromechanical characteristics in subjects with LBP. Tensiomyography may be implemented in clinical settings to monitor intervention effects of the myofascial system, especially the tensiomyography parameter velocity of contraction.

Changes in lumbar kinematics and trunk muscle electromyographic activity during baseball batting under psychological pressure

ABSTRACT Psychological pressure during sports competition disturbs the ideal physical movement and causes injury. Baseball batting frequently causes trunk injuries. This study aimed to examine the influence of psychological pressure on the lumbar kinematics and trunk muscle activity during the baseball batting. Fourteen collegiate baseball players participated in this study. The participants performed bat swings under three different psychological conditions (non-pressure, pressure, and emphasized pressure). The lumbar kinematics and trunk muscle activity were measured during each bat swing. One- and two-way analyses of variance were performed to compare the lumbar kinematics and trunk muscle activity among different psychological pressure conditions. The lumbar flexion angle throughout the bat swing in the swing phase, from the moment of ground contact of the lead foot to the moment of ball contact, was significantly larger under the pressure and emphasized pressure conditions than under the non-pressure condition (P<0.05). The bilateral lumbar erector spinae (LES) activities in the swing and follow-through phases were significantly higher under the emphasized pressure condition than under the non-pressure condition (P<0.05). These results indicate that the baseball batting under psychological pressure influenced the lumbar kinematics and bilateral LES activities and may be related to the development of low back pain.

A prospective randomized double-blind trial of the efficacy of a bilateral lumbar erector spinae block on the 24h morphine consumption after posterior lumbar inter-body fusion surgery

BackgroundSpine surgery is associated with considerable postoperative pain and can be challenging to treat. A loco-regional technique suitable for spine surgery should cover the dorsal root of the spinal nerves at the levels where surgery is performed. The erector spinae block is a loco-regional technique with promising results and was recently described at the thoracic level. There are no randomized trials of this technique on a lumbar level. This study tests the hypothesis that the 24-h postoperative morphine consumption is significantly lower in patients undergoing posterior lumbar inter-body fusion surgery with a lumbar erector spinae (LUMBES) block when compared with a sham block.MethodsThis prospective randomized double-blind multicenter study will randomly allocate 80 adult patients undergoing elective posterior lumbar inter-body fusion surgery during general anesthesia to one of two groups as follows: (1) bilateral erector spinae block (20 mL 0.25% levobupivacaine) or (2) bilateral sham block (20 mL NaCl 0.9%). Our primary endpoint is 24-h postoperative morphine consumption. Secondary endpoints include 72-h morphine consumption, intraoperative sufentanil dosage, postoperative pain scores at regular time intervals both at rest and during movement, time to first postoperative mobilization, and the Quality of Recovery 40 survey score.DiscussionThe LUMBES trial is a pragmatic clinical study that will provide evidence of whether a bilateral lumbar erector spinae block is effective in reducing 24-h postoperative morphine consumption in patients undergoing lumbar inter-body fusion surgery. If this hypothesis is confirmed, this finding could contribute to more widespread implementation of this technique.Trial registrationLocal ethics committee B300201837508, ClinicalTrials.gov identifier: NCT03825198. Registered on 31 Jan 2019.

Effect of abduction and external rotation of the hip joint on muscle onset time during prone hip extension with knee flexion.

[Purpose] This study investigated the effect of hip position on muscle onset time during prone hip extension with knee flexion. [Subjects] The study included 21 healthy male volunteers. [Methods] Muscle onset times of the right gluteus maximus, right hamstrings, bilateral lumbar erector spinae, and bilateral lumbar multifidus were measured using surface electromyography during right hip extension with knee flexion in the prone position. Measurements were made with the hip in 3 positions: (1) neutral, (2) abduction, and (3) abduction and external rotation. [Results] Gluteus maximus onset relative to the hamstrings was significantly earlier with hip abduction and with hip abduction and external rotation compared with that with the hip in the neutral position. Gluteus maximus onset relative to the hamstrings was significantly earlier with hip abduction and external rotation compared with that with hip abduction. The bilateral multifidus and left lumbar erector spinae onset times relative to the hamstrings were significantly earlier with hip abduction and external rotation compared with those with hip abduction and with the hip in the neutral position. [Conclusion] Abduction and external rotation of the hip during prone hip extension with knee flexion is effective for advancing the onset times of the gluteus maximus, bilateral multifidus, and contralateral lumbar erector spinae.

Influence of Hip Joint Position on Muscle Activity during Prone Hip Extension with Knee Flexion.

[Purpose] This study investigated the selective activation of the gluteus maximus during a prone hip extension with knee flexion exercise, with the hip joint in different positions. [Subjects] The subjects were 21 healthy, male volunteers. [Methods] Activities of the right gluteus maximus, right hamstrings, bilateral lumbar erector spinae, and bilateral lumbar multifidus were measured using surface electromyography during a prone hip extension with knee flexion exercise. Measurements were made with the hip joint in each of 3 positions: (1) a neutral hip joint position, (2) an abduction hip joint position, and (3) an abduction with external rotation hip joint position. [Results] Gluteus maximus activity was significantly higher when the hip was in the abduction with external rotation hip joint position than when it was in the neutral hip joint and abduction hip joint positions. Gluteus maximus activity was also significantly higher in the abduction hip joint position than in the neutral hip joint position. Hamstring activity was significantly lower when the hip was in the abduction with external rotation hip joint position than when it was in the neutral hip joint and abduction hip joint positions. [Conclusion] Abduction and external rotation of the hip during prone hip extension with knee flexion exercise selectively activates the gluteus maximus.

Altered flexion-relaxation responses exist during asymmetric trunk flexion movements among persons with unilateral lower-limb amputation

Repetitive exposures to altered gait and movement following lower-limb amputation (LLA) have been suggested to contribute to observed alterations in passive tissue properties and neuromuscular control in/surrounding the lumbar spine. These alterations, in turn, may affect the synergy between passive and active tissues during trunk movements. Eight males with unilateral LLA and eight non-amputation controls completed quasi-static trunk flexion–extension movements in seven distinct conditions of rotation in the transverse plane: 0° (sagittally-symmetric), ±15°, ±30°, and ±45° (sagittally-asymmetric). Electromyographic (EMG) activity of the bilateral lumbar erector spinae and lumbar kinematics were simultaneously recorded. Peak lumbar flexion and EMG-off angles were determined, along with the difference (“DIFF”) between these two angles and the magnitude of peak normalized EMG activities. Persons with unilateral LLA exhibited altered and asymmetric synergies between active and passive trunk tissues during both sagittally-symmetric and -asymmetric trunk flexion movements. Specifically, decreased and asymmetric passive contributions to trunk movements were compensated with increases in the magnitude and duration of active trunk muscle responses. Such alterations in trunk passive and active neuromuscular responses may result from repetitive exposures to abnormal gait and movement subsequent to LLA, and may increase the risk for LBP in this population.

The influence of increasing sacroiliac joint force closure on the hip and lumbar spine extensor muscle firing pattern

The prone hip extension (PHE) test is commonly used in the evaluation of lumbo-pelvic dysfunction. It has been suggested that altered motor control identified by the PHE test can be improved with the application of compression force across the pelvis, to increase force closure on the sacroiliac joint (SIJ). This repeated measure study design investigated the effect of three levels of pelvis compression (0 N, 50 N, 100 N) on the muscle firing pattern during the PHE test in 20 asymptomatic male subjects tested on two occasions 4-weeks apart. The right gluteus maximus, right semitendinosus and bilateral lumbar erector spinae were analyzed using surface electromyography (EMG). Subjects were instructed to perform right hip extension in prone position while maintaining knee-extension in each measurement condition. Compared with the onset of the semitendinosus muscle, gluteus maximus became active 263.3 ± 99.5 ms later with no pelvic compression, 183.5 ± 77.9 ms later with 50 N compression, 91.5 ± 49.7 ms later with 100 N compression. While significant differences ( α = 0.05) were found in EMG onset for gluteus maximus under different levels of pelvis compression, this was not the case for the erector spinae, which had an inconsistent pattern of temporal onset and was not influenced by the level of pelvis compression force.