nelson-wong csm 2010
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Changes in Muscle Activation Patterns and
Subjective Low Back Pain Ratings
During Standing in Response to an Exercise
Intervention
Erika Nelson-Wong and Jack Callaghan
Presented at the Combined Sections Meeting of the APTA - February 19, 2010
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Background and Rationale
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Background and Rationale
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Background and Rationale
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Purpose
Investigate the impact of a commonly used PT
exercise intervention on LBP development,clinical and biomechanical risk factors during
a prolonged standing task.
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Prolonged Testing Methods
2 Hour Prolonged Exposure
15 min
VAS VAS VAS VASVAS VASVASVAS VAS
Start of Session: End of Session:
Continuous EMG,Motion Analysis &
Kinetic Data Collection
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Participants 43 volunteers
22 male, 21 female
Age: 22.7 3.4 years BMI: 23.8 3.2 kg/m2
No history of low back
pain
Not employed in
occupation requiring
static standing
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Instrumentation
EMG 16 Channels 46 Motion
Tracking Markers
(8 segments)
Two In-Floor Force Platforms
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RR
ExerciseExercise
InterventionInterventionControl/usuControl/usu
al activityal activity
4 Weeks
QuestionnairesQuestionnaires
ClinicalClinical
AssessmentAssessmentClassification into PD/NPDClassification into PD/NPD
based on VAS scoresbased on VAS scoresDataData
Analysis ByAnalysis By
GroupGroup
Experimental Protocol
EMG PrepEMG Prep
MVCsMVCs
Beiring-Beiring-
SorensenSorensen
Endurance TestEndurance Test
StandingStanding
FlexionFlexion
MarkerMarkerset-upset-up
2-hour2-hour
StandingStandingFunctionalFunctional
MovementsMovementsFunctionalFunctional
MovementsMovements
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Successful at Inducing LBP During Standing
40% developed LBP (17/43)
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Predisposing Factors Identified on pre-Test
(+) Active Hip Abduction Test (Nelson-Wong et al., JOSPT, 2009)
Increased co-contraction of bilateral gluteus mediusmuscles
Shorter muscle rest times (Gaps) in gluteal muscles
Nelson-Wong and Callaghan, J Electromyography Kinesiol2009
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Response to Exercise Intervention
Large Effect SizeCohens d = -3.78
Nelson-Wong and Callaghan, J Electromyography Kinesiol, Accepted in revision, 2010
Decrease from 24.2 ( 4) to 8.93 ( 3.7) mm
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Response to Exercise Intervention Non-Significant Trend
(z=1.73,p = 0.08) for PD
exercisers to improve on theAHAbd Test
Large Effect SizeCohens d = 0.95
Nelson-Wong, et al.JOSPT, 2009
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Male PDEX had decreased
co-contraction of
bilateral gluteus medius
muscles
Large Effect SizeCohens d = 1.88
p < 0.001
Response to Exercise Intervention
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Increase in right gluteus
medius muscle rest timefor Male PDEX
Response to Exercise Intervention
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Conclusions
Large impact of exercise intervention on subjective pain reporting
Muscle co-activation profiles can be impacted through exerciseintervention (gender specific?)
Mechanisms for LBP during standing yet to be identified, may be
related to low level muscle fatigue
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Clinical Relevance
Identify individuals who are pre-disposed tostanding-related LBPBEFOREthey become patients
Targeted interventions aimed at specific predisposingfactors
More work needed to characterize mechanisms andinvestigate gender-specific responses
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Mary McMillan, PODS I,
PODS II Scholarships
Thank You!
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