The effect of surface instability on the differential activation of muscle activity in low back pain patients as compared to healthy individuals: A systematic review of the literature and meta-analysis
Restricted accessResearch articleFirst published online July, 2017
The effect of surface instability on the differential activation of muscle activity in low back pain patients as compared to healthy individuals: A systematic review of the literature and meta-analysis
Dynamic tasks over unstable surfaces are commonly done in daily activities.
OBJECTIVE:
A number of studies indicated positive effect of doing postural tasks over unstable surface on trunk muscle activities in patients with low back pain (LBP), while the others reported opposite effects. Due to lack of consensus in the findings in this area of research, we aimed to systematically review studies, which investigated the effect of surface instability on trunk muscle activity in patients with LBP as compared to healthy individuals.
METHIDS:
A literature search was performed using the PubMed, Science Direct, OVID, CINAHL, PEDro, Cochrane, Scopus and MEDLINE databases. Low back pain, unstable surface, posture or stability and trunk muscle activity were applied as keywords. The methodological quality was examined using valid assessment tools.
RESULTS:
The activity of superficial trunk muscles is impaired in patients with LBP during dynamic tasks over unstable surfaces. Differences in the methodology of included studies could be considered as reasons behind the inconsistencies in the findings in included studies. These studies included investigation of superficial or deep muscles, the timing of recorded muscle activity, the level of surface instability and the length of time over unstable surfaces.
CONCLUSION:
Dynamic tasks over unstable surfaces could decrease pre-program reaction (PPR) and increase voluntary reaction (VR) of superficial trunk muscles in patients with LBP, which may reduce the ratio of deep versus superficial muscles, compared to healthy individuals.
GourmelenJChastangJ-FOzgulerALanoëJ-LRavaudJ-FLeclercA. Frequency of low back pain among men and women aged 30 to 64 years in France, Results of two national surveys. Ann de Readapt Med Phys2007; 50(8): 640-4.
2.
BandpeiMAMEhsaniFBehtashHGhanipourM. Occupational low back pain in primary and high school teachers: Prevalence and associated factors. J Manipulative Physiol Ther2014; 37(9): 702-8.
3.
EhrlichGE. Low back pain. Bull World Health Organ2003; 81(9): 671-2.
4.
AnderssonGB. Epidemiological features of chronic low-back pain. The Lancet1999; 354(9178): 581-5.
5.
HestbaekLLeboeuf-YdeCEngbergMLauritzenTBruunNHMannicheC. The course of low back pain in a general population, Results from a 5-year prospective study. J Manipulative Physiol Ther2003; 26(4): 213-9.
6.
WeinerBK. Spine update: The biopsychosocial model and spine care. Spine2008; 33(2): 219-23.
7.
Vibe FersumKO’SullivanPSkouenJSmithAKvåleA. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: A randomized controlled trial. Eur J Pain2013; 17(6): 916-28.
8.
O’SullivanP. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Man Ther2005; 10(4): 242-55.
9.
van DeursenDLSnijdersCJPatijnJ. Influence of daily life activities on pain in patients with low back pain. Int Musculoskelet Med2002; 24: 74-6.
10.
MarshallPWMurphyBA. Evaluation of functional and neuromuscular changes after exercise rehabilitation for low back pain using a Swiss ball: A pilot study. J Manipulative Physiol Ther2006; 29(7): 550-60.
11.
Vera-GarciaFJGrenierSGMcGillSM. Abdominal muscle response during curl-ups on both stable and labile surfaces. Phys Ther2000; 80(6): 564-9.
12.
DesaiIMarshallPW. Acute effect of labile surfaces during core stability exercises in people with and without low back pain. J Electromyogr Kinesiol2010; 20(6): 1155-62.
13.
CurtisC. Get your bounce on: Use an exercise ball to enhance your upper-body workouts. Muscle Fitness2002; 63: 64.
14.
FerreiraPHFerreiraMLMaherCGHerbertRDRefshaugeK. Specific stabilisation exercise for spinal and pelvic pain: A systematic review. Aust J Physiother2006; 52(2): 79-88.
15.
ImaiAKaneokaKOkuboY, et al. Trunk muscle activity during lumbar stabilization exercises on both a stable and unstable surface. J Orthop Sports Phys Ther2010; 40(6): 369-75.
16.
KaderDRadhaSBanaszkiewiczPAStockerMDunbar-SmithLSmithFW. Gym ball exercise leads to recruitment and increased water content of the paraspinal muscles: An MRI pilot study. J Back Musculoskelet Rehabil2008; 21(2): 77-85.
17.
HodgesPWRichardsonCA. Inefficient muscular stabilization of the lumbar spine associated with low back pain: A motor control evaluation of transversus abdominis. Spine1996; 21(22): 2640-50.
18.
HodgesPWRichardsonCA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord1998; 11(1): 46-56.
19.
FerreiraPHFerreiraMLHodgesPW. Changes in recruitment of the abdominal muscles in people with low back pain: Ultrasound measurement of muscle activity. Spine2004; 29(22): 2560-6.
20.
HidesJABelavýDLCassarLWilliamsMWilsonSJRichardsonCA. Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain. Eur Spine J2009; 18(3): 410-8.
21.
TeyhenDSWilliamsonJNCarlsonNH, et al. Ultrasound characteristics of the deep abdominal muscles during the active straight leg raise test. Arch Phys Med Rehabil2009; 90(5): 761-7.
22.
TsaoHGaleaMHodgesP. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain2008; 131(8): 2161-71.
23.
RadeboldACholewickiJPolzhoferGKGreeneHS. Impaired postural control of the lumbar spine is associated with delayed muscle response times in patients with chronic idiopathic low back pain. Spine2001; 26(7): 724-30.
24.
LeinonenVKankaanpããMLuukkonenM, et al. Lumbar paraspinal muscle function, perception of lumbar position, and postural control in disc herniation-related back pain. Spine2003; 28(8): 842-8.
25.
JonesSLHittJRDeSarnoMJHenrySM. Individuals with non-specific low back pain in an active episode demonstrate temporally altered torque responses and direction-specific enhanced muscle activity following unexpected balance perturbations. Exp Brain Res2012; 221(4): 413-26.
26.
JacobsJVHenrySMJonesSLHittJRBunnJY. A history of low back pain associates with altered electromyographic activation patterns in response to perturbations of standing balance. J Neurophysiol2011; 106(5): 2506-14.
27.
BoudreauSFarinaDKongstadL, et al. The relative timing of trunk muscle activation is retained in response to unanticipated postural-perturbations during acute low back pain. Exp Brain Res2011; 210(2): 259-67.
28.
NewcomerKJacobsonTGabrielDLarsonDBreyRAK. Muscle activation patterns in participants with and without low back pain. Arch Phys Med Rehabil2002; 83: 97-112.
29.
RasouliOArabAMAmiriMJaberzadehS. Ultrasound measurement of deep abdominal muscle activity in sitting positions with different stability levels in subjects with and without chronic low back pain. Man Ther2011; 16(4): 388-93.
30.
MoseleyAMHerbertRDSherringtonCMaherCG. Evidence for physiotherapy practice: A survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother2002; 48(1): 43-9.
31.
MaherCGSherringtonCHerbertRDMoseleyAMElkinsM. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther2003; 83(8): 713-21.
de MortonNA. The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. Aust J Physiother2009; 55(2): 129-33.
34.
HodgesPW. Changes in motor planning of feedforward postural responses of the trunk muscles in low back pain. Exp Brain Res2001; 141(2): 261-6.
35.
JonesSLHenrySMRaaschCCHittJRBunnJY. Individuals with non-specific low back pain use a trunk stiffening strategy to maintain upright posture. J Electromyogr Kinesiol2012; 22(1): 13-20.
36.
RamprasadMShenoyDSSinghSJSankaraNJoseleyS. The magnitude of pre-programmed reaction dysfunction in back pain patients: Experimental pilot electromyography study. J Back Musculoskelet Rehabil2010; 23(2): 77-86.
37.
HigginsJPGreenS. Cochrane handbook for systematic reviews of interventions, Wiley Online Library, 2008.
38.
BaxLYuL-MIkedaNMoonsKG. A systematic comparison of software dedicated to meta-analysis of causal studies. BMC Med Res Methodol2007; 7(1): 40.
39.
DeeksJJHigginsJP. Statistical algorithms in review manager 5. Statistical Methods Group of The Cochrane Collaboration2010; 1-11.
40.
GuthrieRJGrindstaffTLCroyTIngersollCDSalibaSA. The effect of traditional bridging or suspension-exercise bridging on lateral abdominal thickness in individuals with low back pain. J Sport Rehabil2012; 21(2): 151-60.
41.
WilligenburgNWKingmaI, van DieënJH. Center of pressure trajectories, trunk kinematics and trunk muscle activation during unstable sitting in low back pain patients. Gait Posture2013; 38(4): 625-30.
42.
MarshallPMurphyB. Self-report measures best explain changes in disability compared with physical measures after exercise rehabilitation for chronic low back pain. Spine2008; 33(3): 326-38.
43.
MarshallPWMurphyBA. Muscle activation changes after exercise rehabilitation for chronic low back pain. Arch Phys Med Rehabil2008; 89(7): 1305-13.
44.
SalibaSACroyTGuthrieRGroomsDWeltmanAGrindstaffTL. Differences in transverse abdominis activation with stable and unstable bridging exercises in individuals with low back pain. N Am J Sports Phys Ther2010; 5(2): 63-73.
45.
KangHJungJYuJ. Comparison of trunk muscle activity during bridging exercises using a sling in patients with low back pain. J Sports Sci Med2012; 11(3): 510-5.
46.
HammondP. Involuntary activity in biceps following the sudden application of velocity to the abducted forearm. J Physiol1955; 127(2): 23-5.
47.
BergmarkA. Stability of the lumbar spine: A study in mechanical engineering. Acta Orthop Scand Suppl1989; 230: 1-54.
48.
RichardsonCJullGHodgesPHidesJPanjabiMM. Therapeutic exercise for spinal segmental stabilization in low back pain: Scientific basis and clinical approach: Churchill Livingstone Edinburgh; 1999.
49.
StokesIAFHenrySMSingleRM. Surface EMG electrodes do not accurately record from lumbar multifidus muscles. Clinical Biomechanics2003; 18(1): 9-13.
50.
CholewickiJSilfiesSPShahRA, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine2005; 30(23): 2614-20.
51.
RadeboldACholewickiJPanjabiMMPatelTC. Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine2000; 25(8): 947-54.
52.
StokesIAFoxJRHenrySM. Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain. Eur Spine J2006; 15(5): 658-67.
53.
AndersonKBehmDG. Trunk muscle activity increases with unstable squat movements. Can J Appl Physiol2005; 30(1): 33-45.
54.
AndersonKGBehmDG. Maintenance of EMG activity and loss of force output with instability. J Strength Cond Res2004; 18(3): 637-40.
55.
BehmDGAndersonKCurnewRS. Muscle force and activation under stable and unstable conditions. J Strength Cond Res2002; 16(3): 416-22.
56.
FeldwieserFSheeranLMeana-EstebanASparkesV. Electromyographic analysis of trunk-muscle activity during stable, unstable and unilateral bridging exercises in healthy individuals. Eur Spine J2012; 21(2): 171-86.
57.
MatreDASinkjærTSvenssonPArendt-NielsenL. Experimental muscle pain increases the human stretch reflex. Pain1998; 75(2): 331-9.
58.
HodgesPWMoseleyGLGabrielssonAGandeviaSC. Experimental muscle pain changes feedforward postural responses of the trunk muscles. Exp Brain Res2003; 151(2): 262-71.
