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Muscle activation during exercises to improve trunk stability in men with low back pain
Hubley-Kozey CL, Vezina MJ
Archives of Physical Medicine and Rehabilitation 2002 Aug;83(8):1100-1108
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To evaluate the relative activation amplitudes from 3 abdominal and 2 trunk extensor muscle sites of persons with low back pain (LBP) performing the pelvic-tilt, the abdominal-hollowing, and level 1 of the trunk stability test (TST) exercises and to compare the activation amplitudes among muscle sites and exercises. DESIGN: A prospective, comparative, repeated-measures design. SETTING: Motion analysis research laboratory. PARTICIPANTS: Fourteen men with LBP (mean duration 8 y; mean age +/- standard deviation 39 +/- 5 y). INTERVENTIONS: Subjects performed 3 exercises in random order while surface electromyograms were recorded from 5 muscle sites: lower and upper rectus abdominus, external oblique, erector spinae, and multifidus. The exercises were divided into 2 phases: a movement phase and a stabilization phase. The root-mean-square (RMS) electromyographic amplitude for each phase was calculated and normalized to the highest RMS amplitude from a series of 4 exercises, which attempted to elicit maximal voluntary isometric contractions (MVICs) for each muscle. A 2-factor, repeated-measures analysis of variance (ANOVA) tested the muscle by exercise interaction and the 2 main effects for each phase separately. MAIN OUTCOME MEASURES: Normalized RMS amplitude was the main dependent variable. The ensemble-average profiles for each muscle were calculated to examine the phasing of activation throughout the exercises. RESULTS: The ANOVA revealed a statistically significant muscle-by-exercise interaction (p < 0.05) for both phases, which showed that the 3 exercises; recruited the 5 muscle sites using different patterns of relative amplitudes. The external oblique muscle site was activated to higher amplitudes than the other 4 muscle sites for all 3 exercises; the highest normalized RMS activity occurred at the external oblique during the pelvic tilt (32% MVIC). The phasic patterns among the 5 muscle sites were not consistent for the TST but were consistent among the 5 sites for the other 2 exercises. CONCLUSIONS: None of the exercises recruited the abdominal muscles to intensities deemed adequate for strengthening. The TST challenges the coordination of muscle activity during the leg-loading task (stabilization phase) as evidenced by changes in amplitudes over the total exercise time for the external oblique site, but not the other 4 sites. All 3 exercises could be used as initial exercises in a dynamic stability progression when low-recruitment amplitudes of specific muscles were the objective but not for strengthening.

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