Restricted accessResearch articleFirst published online 2025-5
Associations among lumbopelvic muscle activation,functional capacity,and self-reported clinical outcomes in individuals with chronic low back pain: A cross-sectional study
Lumbar multifidus (LM) and transverse abdominis (TrA) muscle activation deficits have been reported in patients with chronic low back pain (CLBP). These activation deficits could be related to poor functional capacity and self-reported clinical outcomes.
Objective
To determine the associations between lumbopelvic muscle activation and functional capacity, as well as self-reported clinical outcomes in individuals with CLBP.
Methods
Thirty individuals with CLBP were recruited. Ultrasound imaging was used to measure muscle activation. Participants performed a functional reach test (FRT), 5-time sit-to-stand test (5STS), 2-min step test (2MST), prone trunk extension test (PTET), and abdominal curl test (ACT). Self-reported clinical outcomes including visual analog scale (VAS), duration of low back pain (DLBP), modified Oswestry disability questionnaire (MODQ), and short-form health survey (SF-36) were also collected.
Results
LM activation was significant associated (P < 0.05) with functional capacity (5STS and PTET) and self-reported clinical outcome (SF-36) were observed. Results also demonstrated TrA activation was significant associated (P < 0.05) with ACT, VAS, and DLBP.
Conclusion
Our findings suggest that clinicians should focus on LM activation to potentially improve functional capacity and quality of life, as well as minimize the chronicity. In addition, pain duration can influence TrA activation, while TrA activation training may be able to modulate pain.
KnezevicNNCandidoKDVlaeyenJWS, et al.Low back pain. Lancet2021; 398: 78–92.
2.
Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet2020; 396: 1204–1222.
3.
HodgesPWDanneelsL. Changes in structure and function of the back muscles in low back pain: different time points, observations, and mechanisms. J Orthop Sports Phys Ther2019; 49: 464–476.
4.
MacDonaldDMoseleyLGHodgesPW. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain2009; 142: 183–188.
5.
SungnakPSongjaroenSKrityakiaranaW, et al.Individuals with impaired lumbopelvic control demonstrate lumbar multifidus muscle activation deficit using ultrasound imaging in conjunction with electrical stimulation: a cross-sectional study. Arch Phys Med Rehabil2022; 103: 1951–1957.
6.
WattananonPSungnakPSongjaroenS, et al.Using neuromuscular electrical stimulation in conjunction with ultrasound imaging technique to investigate lumbar multifidus muscle activation deficit. Musculoskelet Sci Pract2020; 50: 102215.
7.
de JesusSFCBassi-DibaiDPontes-SilvaA, et al.Construct validity and reliability of the 2-Minute step test (2MST) in individuals with low back pain. BMC Musculoskelet Disord2022; 23: 1062.
8.
DenteneerLvan DaeleUTruijenS, et al.Convergent validity of clinical tests which are hypothesized to be associated with physical functioning in patients with nonspecific chronic low back pain. J Back Musculoskelet Rehabil2020; 33: 313–322.
9.
DenteneerLVan DaeleUTruijenS, et al.Reliability of physical functioning tests in patients with low back pain: a systematic review. Spine J2018; 18: 190–207.
10.
SakulsriprasertPVachalathitiRKingchaP. Association among pain, disability, and functional capacity in patients with chronic non-specific low back pain: a cross-sectional study. J Back Musculoskelet Rehabil2021; 34: 149–157.
11.
VachalathitiRSakulsriprasertPKingchaP. Decreased functional capacity in individuals with chronic non-specific low back pain: a cross-sectional comparative study. J Pain Res2020; 13: 1979–1986.
12.
VillafañeJHGobboMPeranzoniM, et al.Validity and everyday clinical applicability of lumbar muscle fatigue assessment methods in patients with chronic non-specific low back pain: a systematic review. Disabil Rehabil2016; 38: 1859–1871.
13.
BoonstraAMSchiphorst PreuperHRRenemanMF, et al.Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res2008; 31: 165–169.
14.
GargAPathakHChuryukanovMV, et al.Low back pain: critical assessment of various scales. Eur Spine J2020; 29: 503–518.
15.
SloverJAbduWAHanscomB, et al.Can condition-specific health surveys be specific to spine disease? An analysis of the effect of comorbidities on baseline condition-specific and general health survey scores. Spine (Phila Pa 1976)2006; 31: 1265–1271.
16.
WareJEJr. SF-36 health survey update. Spine (Phila Pa 1976)2000; 25: 3130–3139.
17.
AkogluH. User's guide to correlation coefficients. Turk J Emerg Med2018; 18: 91–93.
18.
HebertJJKoppenhaverSLParentEC, et al.A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine (Phila Pa 1976)2009; 34: E848–E856.
19.
Kian-BostanabadSAzghaniMR. The relationship between RMS electromyography and thickness change in the skeletal muscles. Med Eng Phys2017; 43: 92–96.
20.
ShahAliSShanbehzadehSShahAliS, et al.Application of ultrasonography in the assessment of abdominal and lumbar trunk muscle activity in participants with and without low back pain: a systematic review. J Manipulative Physiol Ther2019; 42: 541–550.
21.
BohannonRShoveMBarrecaS, et al.Five-repetition sit-to-stand test performance by community-dwelling adults: a preliminary investigation of times, determinants, and relationship with self-reported physical performance. Isokinetics and Exercise Science2007; 15: 77–81.
22.
KlukowskaAMStaartjesVEVandertopWP, et al.Five-repetition sit-to-stand test performance in healthy individuals: reference values and predictors from 2 prospective cohorts. Neurospine2021; 18: 760–769.
23.
WardSRTomiyaARegevGJ, et al.Passive mechanical properties of the lumbar multifidus muscle support its role as a stabilizer. J Biomech2009; 42: 1384–1389.
24.
FortinMMacedoLG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Phys Ther2013; 93: 873–888.
25.
TangYYangSChenC, et al.Assessment of the association between paraspinal muscle degeneration and quality of life in patients with degenerative lumbar scoliosis. Exp Ther Med2020; 20: 505–511.
26.
AlshehriMAAlzahraniHvan den HoornW, et al.Trunk postural control during unstable sitting among individuals with and without low back pain: a systematic review with an individual participant data meta-analysis. PLoS One2024; 19: e0296968.
27.
ParkJNguyenVQHoRLM, et al.The effect of chronic low back pain on postural control during quiet standing: a meta-analysis. Sci Rep2023; 13: 7928.
28.
HuysamenCOlivierBNaidooV, et al.Ability of physiotherapists and physiotherapy students to evaluate and classify lumbar movement control using lumbopelvic movement control tests. Physiother Can2021; 73: 257–267.
29.
JensenMPChenCBruggerAM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain2003; 4: 407–414.
30.
HsuSLOdaHShirahataS, et al.Effects of core strength training on core stability. J Phys Ther Sci2018; 30: 1014–1018.
31.
KiblerWBPressJSciasciaA. The role of core stability in athletic function. Sports Med2006; 36: 189–198.
32.
FerreiraPHFerreiraMLHodgesPW. Changes in recruitment of the abdominal muscles in people with low back pain: ultrasound measurement of muscle activity. Spine (Phila Pa 1976)2004; 29: 2560–2566.
33.
HodgesPWMoseleyGL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol2003; 13: 361–370.
34.
ChiarottoAMaxwellLJTerweeCB, et al.Roland-Morris disability questionnaire and oswestry disability index: which has better measurement properties for measuring physical functioning in nonspecific low back pain? Systematic review and meta-analysis. Phys Ther2016; 96: 1620–1637.
