Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification.

摘要

STUDY DESIGN: A cross-sectional comparative study between healthy controls and two subgroups of nonspecific chronic low back pain (LBP) patients. OBJECTIVES: To determine differences in trunk muscle activation during usual unsupported sitting. SUMMARY OF BACKGROUND DATA: Patients with LBP commonly report exacerbation of pain on sitting. Little evidence exists to confirm that subgroups of patients with nonspecific chronic LBP patients use different motor patterns in sitting than pain-free controls. METHODS: A total of 34 pain-free and 33 nonspecific chronic LBP subjects were recruited. Two blinded clinicians classified nonspecific chronic LBP patients into two subgroups (active extension pattern and flexion pattern). Surface electromyography (sEMG) was recorded from five trunk muscles during subjects' unsupported "usual" and "slumped" sitting. RESULTS: No differences in trunk muscle activity were observed between healthy controls and nonspecific chronic LBP groups for usual sitting. When the classification system was applied, differences were identified. Compared with no-LBP controls, the active extension pattern group presented with higher levels of cocontraction of superficial fibers of lumbar multifidus (12%), iliocostalis lumborum pars thoracis (36%) and transverse fibers of internal oblique (43%). while the flexion pattern group showed a trend toward lower activation patterns (lumbar multifidus, -7%; iliocostalis lumborum pars thoracis, -6%, and transverse fibers of internal oblique, -5%). The flexion relaxation ratio of the back muscles was lower for nonspecific chronic LBP (superficial lumbar multifidus: t = 4.5; P < 0.001 and iliocostalis lumborum pars thoracis:t = 2.7; P < 0.001), suggesting a lack of flexion relaxation for the nonspecific chronic LBP. CONCLUSION: Subclassifying nonspecific chronic LBP patients revealed clear differences in sEMG activity during sitting between pain-free subjects and subgroups of nonspecific chronic LBP patients.