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Asymmetry of lumbar muscles fatigability with non-specific chronic low back pain patients

  • Kevin Rose-DulcinaEmail author
  • Stéphane Armand
  • Dennis E. Dominguez
  • Stéphane Genevay
  • Nicolas Vuillerme
Original Article

Abstract

Purpose

Non-specific chronic low back pain (NSCLBP) patients present with reduced back extensor muscle endurance which could be explained by the higher fatigability of their lumbar muscles. However, studies investigating lumbar muscle fatigability have shown contradictory findings. Furthermore, none investigated potential asymmetry in lumbar muscle fatigability, despite neuromuscular asymmetry being reported as a risk factor for NSCLBP. The present study’s primary purpose was to determine whether NSCLBP patients presented with higher lumbar muscle fatigability and fatigability asymmetry than asymptomatic participants.

Methods

Thirty NSCLBP patients and 23 asymptomatic participants performed the Sorensen test. The median frequencies from the electromyographs of the right and left erector spinae longissimus (ESL) and lumbar multifidus (LMF) were measured during the test. A linear regression was performed on the median frequencies on each muscle. Slope and initial median frequency were extracted to characterize fatigability. Asymmetry was quantified by the absolute differences between right-side and left-side muscle pairs.

Results

NSCLBP patients presented significantly poorer back extensor muscle endurance than asymptomatic participants. No differences were found between NSCLBP patients and asymptomatic participants in terms of fatigability or fatigability asymmetry for either the ESL or LMF. The initial median frequency in both muscles was significantly lower among NSCLBP patients.

Conclusions

The present study showed that NSCLBP patients did not present higher fatigability or higher fatigability asymmetry in lumbar muscles than asymptomatic participants. The heterogeneity of the NSCLBP population, due to the absence of any specific etiology, may explain these findings.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Non-specific chronic low back pain Muscle fatigability Neuromuscular asymmetry Electromyography Back extensor muscles endurance 

Notes

Acknowledgements

This work was partly supported by the French National Research Agency in the framework of the “Investissements d’Avenir” program (ANR-10-AIRT-05 and ANR-15-IDEX-02), by Institut Universitaire de France and the Geneva University Hospitals.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6140_MOESM1_ESM.pptx (135 kb)
Supplementary file1 (PPTX 134 kb)

References

  1. 1.
    Vos T, Abajobir AA, Abbafati C et al (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet 390:1211–1259.  https://doi.org/10.1016/S0140-6736(17)32154-2 CrossRefGoogle Scholar
  2. 2.
    Hartvigsen J, Hancock MJ, Kongsted A et al (2018) What low back pain is and why we need to pay attention. Lancet.  https://doi.org/10.1016/S0140-6736(18)30480-X Google Scholar
  3. 3.
    Balagué F, Mannion AF, Pellisé F, Cedraschi C (2012) Non-specific low back pain. Lancet 379:482–491.  https://doi.org/10.1016/S0140-6736(11)60610-7 CrossRefGoogle Scholar
  4. 4.
    Clark S, Horton R (2018) Low back pain: a major global challenge. Lancet.  https://doi.org/10.1016/S0140-6736(18)30725-6 Google Scholar
  5. 5.
    Steele J, Bruce-Low S, Smith D (2014) A reappraisal of the deconditioning hypothesis in low back pain: review of evidence from a triumvirate of research methods on specific lumbar extensor deconditioning. Curr Med Res Opin 30:1–47.  https://doi.org/10.1185/03007995.2013.875465 CrossRefGoogle Scholar
  6. 6.
    Hides J, Gilmore C, Stanton W, Bohlscheid E (2008) Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 13:43–49.  https://doi.org/10.1016/j.math.2006.07.017 CrossRefGoogle Scholar
  7. 7.
    Barker KL, Shamley DR, Jackson D (2004) Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain. Spine (Phila Pa 1976) 29:E515–E519.  https://doi.org/10.1097/01.brs.0000144405.11661.eb CrossRefGoogle Scholar
  8. 8.
    Beneck GJ, Kulig K (2012) Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain. Arch Phys Med Rehabil 93:300–306.  https://doi.org/10.1016/j.apmr.2011.09.017 CrossRefGoogle Scholar
  9. 9.
    Mannion AF, Käser L, Weber E et al (2000) Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients. Eur Spine J 9:273–281.  https://doi.org/10.1007/s005860000189 CrossRefGoogle Scholar
  10. 10.
    Johanson E, Brumagne S, Janssens L et al (2011) The effect of acute back muscle fatigue on postural control strategy in people with and without recurrent low back pain. Eur Spine J 20:2152–2159.  https://doi.org/10.1007/s00586-011-1825-3 CrossRefGoogle Scholar
  11. 11.
    Rossi DM, Morcelli MH, Cardozo AC et al (2015) Discriminant analysis of neuromuscular variables in chronic low back pain. J Back Musculoskelet Rehabil 28:239–246.  https://doi.org/10.3233/BMR-140509 CrossRefGoogle Scholar
  12. 12.
    Kolur MK, Norasteh AA, Daneshmandi H (2011) Electromyographic fatigue evaluation of back and hip extensor muscles and its relationship with anthropometric characteristic of athletes with chronic low back pain. Med Dello Sport 64:435–448Google Scholar
  13. 13.
    McKeon MD, Albert WJ, Neary JP (2006) Assessment of neuromuscular and haemodynamic activity in individuals with and without chronic low back pain. Dyn Med 5:6.  https://doi.org/10.1186/1476-5918-5-6 CrossRefGoogle Scholar
  14. 14.
    Severijns D, Zijdewind I, Dalgas U et al (2017) The assessment of motor fatigability in persons with multiple sclerosis: a systematic review. Neurorehabil Neural Repair 31:413–431CrossRefGoogle Scholar
  15. 15.
    Biering-Sørensen F (1984) Physical measurements as risk indicators for low-back trouble over a one-year period. Spine 9:106–119CrossRefGoogle Scholar
  16. 16.
    Kankaanpää M, Colier WN, Taimela S et al (2005) Back extensor muscle oxygenation and fatigability in healthy subjects and low back pain patients during dynamic back extension exertion. Pathophysiology 12:267–273.  https://doi.org/10.1016/j.pathophys.2005.09.013 CrossRefGoogle Scholar
  17. 17.
    Larivière C, Bilodeau M, Forget R et al (2010) Poor back muscle endurance is related to pain catastrophizing in patients with chronic low back pain. Spine (Phila Pa 1976) 35:E1178–E1186.  https://doi.org/10.1097/BRS.0b013e3181e53334 CrossRefGoogle Scholar
  18. 18.
    Renkawitz T, Boluki D, Grifka J (2006) The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. Spine J 6:673–683.  https://doi.org/10.1016/j.spinee.2006.03.012 CrossRefGoogle Scholar
  19. 19.
    Solomonow M, Zhou BH, Harris M et al (1998) The ligamento-muscular stabilizing system of the spine. Spine (Phila Pa 1976) 23:2552–2562CrossRefGoogle Scholar
  20. 20.
    Magnusson ML, Aleksiev A, Wilder DG et al (1996) European Spine society–the acromed prize for spinal research 1995. Unexpected load and asymmetric posture as etiologic factors in low back pain. Eur Spine J 5:23–35CrossRefGoogle Scholar
  21. 21.
    Lu WW, Luk KDK, Cheung KMC et al (2001) Back muscle contraction patterns of patients with low back pain before and after rehabilitation treatment: an electromyographic evaluation. J Spinal Disord 14:277–282.  https://doi.org/10.1097/00002517-200108000-00001 CrossRefGoogle Scholar
  22. 22.
    Kim M, Yoo W, Choi B, (2013) Differences between two subgroups of low back pain patients in lumbopelvic rotation and symmetry in the erector spinae and hamstring muscles during trunk flexion when standing. J Electromyogr Kinesiol 23:387–393.  https://doi.org/10.1016/j.jelekin.2012.11.010 CrossRefGoogle Scholar
  23. 23.
    Van Dillen LR, Sahrmann SA, Norton BJ et al (2003) Movement system impairment-based categories for low back pain: stage 1 validation. J Orthop Sport Phys Ther 33:126–142.  https://doi.org/10.2519/jospt.2003.33.3.126 CrossRefGoogle Scholar
  24. 24.
    Tsuboi T, Satou T, Egawa K et al (1994) Spectral analysis of electromyogram in lumbar muscles: fatigue induced endurance contraction. Eur J Appl Physiol 69:361–366CrossRefGoogle Scholar
  25. 25.
    Rose-Dulcina K, Vuillerme N, Tabard-Fougère A et al (2018) Identifying subgroups of patients with chronic nonspecific low back pain based on a multifactorial approach: protocol for a prospective study. JMIR Res Protoc 7:e104.  https://doi.org/10.2196/resprot.9224 CrossRefGoogle Scholar
  26. 26.
    Vogler D, Paillex R, Norberg M et al (2008) Validation transculturelle de l’Oswestry disability index en français. Ann Readapt Med Phys 51:379–385.  https://doi.org/10.1016/j.annrmp.2008.03.006 CrossRefGoogle Scholar
  27. 27.
    French DJ, Noël M, Vigneau F et al (2005) L’Échelle de dramatisation face à la douleur PCS-CF Adaptation canadienne en langue française de l’échelle «Pain Catastrophizing Scale». Can J Behav Sci 37:181–192.  https://doi.org/10.1037/h0087255 CrossRefGoogle Scholar
  28. 28.
    Bull FC, Maslin TS, Armstrong T (2009) Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health 6:790–804CrossRefGoogle Scholar
  29. 29.
    Latimer J, Maher CG, Refshauge K, Colaco I (1999) The reliability and validity of the Biering-Sorensen test in asymptomatic subjects and subjects reporting current or previous nonspecific low back pain. Spine (Phila Pa 1976) 24:2085–2089.  https://doi.org/10.1097/00007632-199910150-00004 CrossRefGoogle Scholar
  30. 30.
    Kankaanpää M, Laaksonen D, Taimela S et al (1998) Age, sex, and body mass index as determinants of back and hip extensor fatigue in the isometric Sorensen back endurance test. Arch Phys Med Rehabil 79:1069–1075.  https://doi.org/10.1016/S0003-9993(98)90173-3 CrossRefGoogle Scholar
  31. 31.
    Dedering Å, Németh G, Harms-Ringdahl K (1999) Correlation between electromyographic spectral changes and subjective assessment of lumbar muscle fatigue in subjects without pain from the lower back. Clin Biomech 14:103–111.  https://doi.org/10.1016/S0268-0033(98)00053-9 CrossRefGoogle Scholar
  32. 32.
    Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G (2000) Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol 10:361–374.  https://doi.org/10.1016/S1050-6411(00)00027-4 CrossRefGoogle Scholar
  33. 33.
    Bandpei MAM, Rahmani N, Majdoleslam B et al (2014) Reliability of surface electromyography in the assessment of paraspinal muscle fatigue: an updated systematic review. J Manipulative Physiol Ther 37:510–521CrossRefGoogle Scholar
  34. 34.
    Moffroid MT (1997) Endurance of trunk muscles in persons with chronic low back pain: assessment, performance, training. J Rehabil Res Dev 34:440–447Google Scholar
  35. 35.
    Coorevits P, Danneels L, Cambier D et al (2008) Assessment of the validity of the Biering-Sørensen test for measuring back muscle fatigue based on EMG median frequency characteristics of back and hip muscles. J Electromyogr Kinesiol 18:997–1005.  https://doi.org/10.1016/j.jelekin.2007.10.012 CrossRefGoogle Scholar
  36. 36.
    Larivière C, Arsenault AB, Gravel D et al (2003) Surface electromyography assessment of back muscle intrinsic properties. J Electromyogr Kinesiol 13:305–318.  https://doi.org/10.1016/S1050-6411(03)00039-7 CrossRefGoogle Scholar
  37. 37.
    Burden A (2010) How should we normalize electromyograms obtained from healthy participants? What we have learned from over 25years of research. J Electromyogr Kinesiol 20:1023–1035.  https://doi.org/10.1016/j.jelekin.2010.07.004 CrossRefGoogle Scholar
  38. 38.
    Hasenbring MI, Plaas H, Fischbein B, Willburger R (2006) The relationship between activity and pain in patients 6 months after lumbar disc surgery: do pain-related coping modes act as moderator variables? Eur J Pain 10:701–709.  https://doi.org/10.1016/j.ejpain.2005.11.004 CrossRefGoogle Scholar
  39. 39.
    Süüden E, Ereline J, Gapeyeva H, Pääsuke M (2008) Low back muscle fatigue during Sørensen endurance test in patients with chronic low back pain: relationship between electromyographic spectral compression and anthropometric characteristics. Electromyogr Clin Neurophysiol 48:185–192Google Scholar
  40. 40.
    Oliver CW, Tillotson KM, Jones APC et al (1996) Reproducibility of lumbar paraspinal surface electromyogram power spectra. Clin Biomech 11:317–321.  https://doi.org/10.1016/0268-0033(96)00020-4 CrossRefGoogle Scholar
  41. 41.
    Kupa EJ, Roy SH, Kandarian SC, De Luca CJ (2017) Effects of muscle fiber type and size on EMG median frequency and conduction velocity. J Appl Physiol 79:23–32.  https://doi.org/10.1152/jappl.1995.79.1.23 CrossRefGoogle Scholar
  42. 42.
    Stolen FB, De Luca CJ (1981) Frequency Parameters of the Myoelectric Signal as a Measure of Muscle Conduction Velocity. IEEE Trans Biomed Eng BME-28:515–523. https://doi.org/10.1109/TBME.1981.324738
  43. 43.
    De Luca CJ, Sabbahi MA, Roy SH (1986) Median frequency of the myoelectric signal–effects of hand dominance. Eur J Appl Physiol Occup Physiol 55:457–464.  https://doi.org/10.1007/BF00421637 CrossRefGoogle Scholar
  44. 44.
    Müller R, Strässle K, Wirth B (2010) Isometric back muscle endurance: An EMG study on the criterion validity of the Ito test. J Electromyogr Kinesiol 20:845–850.  https://doi.org/10.1016/j.jelekin.2010.04.004 CrossRefGoogle Scholar
  45. 45.
    Mannion AF, O’Riordan D, Dvorak J, Masharawi Y (2011) The relationship between psychological factors and performance on the Biering-Sørensen back muscle endurance test. Spine J 11:849–857.  https://doi.org/10.1016/j.spinee.2011.08.004 CrossRefGoogle Scholar
  46. 46.
    Stokes IAF, Henry SM, Single RM (2003) Surface EMG electrodes do not accurately record from lumbar multifidus muscles. Clin Biomech 18:9–13.  https://doi.org/10.1016/S0268-0033(02)00140-7 CrossRefGoogle Scholar
  47. 47.
    Arokoski JPA, Kankaanpää M, Valta T et al (1999) Back and hip extensor muscle function during therapeutic exercises. Arch Phys Med Rehabil 80:842–850.  https://doi.org/10.1016/S0003-9993(99)90237-X CrossRefGoogle Scholar
  48. 48.
    Dankaerts W, O’Sullivan P, Burnett A et al (2006) Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine (Phila Pa 1976) 31:698–704.  https://doi.org/10.1097/01.brs.0000202532.76925.d2 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Willy Taillard Laboratory of KinesiologyGeneva University Hospitals and Geneva UniversityGeneva 14Switzerland
  2. 2.Univ. Grenoble Alpes, AGEISGrenobleFrance
  3. 3.LAI Jean-Raoul ScherrerUniversity of GenevaGenevaSwitzerland
  4. 4.Division of Orthopedics and Trauma Surgery, Faculty of MedicineGeneva University HospitalsGenevaSwitzerland
  5. 5.Division of Rheumatology, Faculty of MedicineGeneva University HospitalsGenevaSwitzerland
  6. 6.French University InstituteParisFrance

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