Canadian Journal of Basic and Applied Sciences

PEARL publication, 2014

ISSN 2292-3381

CJBAS Vol. 02(01), 1-8, 2014

EMG Activity of Trunk Muscles in Patients with Chronic Low Back Pain after Fatigue
T. Seyed Hoseinpoor1,, S. Kahrizi1, B. Mobini2
1

Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran,

Iran

Department of Orthopedics, Tehran University of Medical Sciences, Tehran, Iran

Keywords:

Fatigue;
Abdominal muscle;
EMG;
co-contraction;
loading

Abstract
Background:
Low back pain (LBP) is one of the most prevalent musculoskeletal disorders. Altered
movement patterns in LBP patients can reflect changes in neuromuscular control.
Objective:
This study aimed to assess trunk muscle electromyographic (EMG) response after
trunk extensor muscle fatigue in LBP subjects.
Methods:
Sixteen patients with chronic non-specific LBP and twenty healthy matched subjects
volunteered to participate in this interventional study. EMG activity of trunk muscles
was assessed before and after lifting fatigue task in two groups. Multivariate Analysis
of variance (MANOVA) was used for statistical analysis.
Results:
The results were significant for the main effects of fatigue (F=6.64, P <0.05) and
interaction of group by fatigue (F=5.34, P <0.05) in lower erector spine muscle activity.
Conclusions: Muscular fatigue is not unusual in daily activity and work place.
According to the results of the current study, trunk extensor muscles fatigue altered
trunk muscles activation in both healthy and CLBP but the alteration was greater in
CLBP patients.

1. Introduction
Low back pain (LBP) is one of the most prevalent musculoskeletal disorders [1]. Altered movement
patterns which have been demonstrated in LBP patients can reflect changes in neuromuscular
control [2]. Evidence illustrates impaired neuromuscular control over maintaining trunk posture and
movement in these patients [3].
Spinal Stability is mainly controlled by muscular activation, active muscle stiffness, and reflex
response [4]. Each of these neuromuscular parameters and therefore spinal stability can be affected
by fatigue [4]. Mechanical stiffness of the musculoskeletal system is one of the primary components
of trunk stability [4]. Antagonistic co-contraction can be utilized to modulate stiffness and enhance
spinal stability [5]. Muscle fatigue reduces muscle force generating capacity, and also it has a
detrimental effect on proprioception [6, 7]. Therefore, in response to reduced muscle stiffness in
muscular fatigue condition, modifications in co-contraction patterns may be necessary to maintain
spinal stability. Modified trunk muscle recruitment pattern has been reported with trunk fatigue [8].

Corresponding Author (Email: Tahere.hoseinpoor.65@gmail.com Tel. (+98 21 8288 4511 ext: 3824 lab))

Seyed Hoseinpoor T. et al. CJBAS Vol. (02)-January Issue 01 (2014) 1-8

While sustained neutral standing is one of the
common body postures in workplace and
daily activities. Studying the stability of the
spine in this position has been the topic of
many researches. Previous data represented
that low level of trunk flexor and extensor cocontraction was necessary to maintain the
spinal stability in the upright neutral posture.
And this co-contraction has been shown to
increase during vertical loading [9]. It seems
reasonable that segmental instability and
buckling of the spine can occur under submaximal conditions, to be expected as a result
of faulty motor control which is probable in
muscular fatigue [10]. According to the
impaired neuromuscular control in LBP
patients, the purpose of this study was to
assess trunk muscle electromyographic
response in axial loading task after trunk
extensor muscle fatigue in LBP subjects.

professional sports activities and neurologic,

systemic or heart diseases were not entered.
Exclusion criteria for the subjects(LBP &
healthy) was included not intended to
continue the experimentation in the middle of
test and having pain more than 3 through the
experimental test according to visual analog
scale (VAS).
2.2. Apparatus
Electromyography (EMG) activity was
collected using eight channels EMG surface
recording (Biometrics LS900) through the use
of bipolar silversilver chloride disposable
surface electrodes with a diameter of 10mm
and inter-electrode distance of 20mm.
Electrodes recorded the trunk muscle activity
of the thorasic erector spinae (TES), lumbar
erector spinae (LES), transverse abdominis/
internal oblique (TrA/IO), rectus abdominus
(RA), external oblique (EO) unilaterally from
the dominant side of the participants.
Electrodes were placed over these muscles
according to Hodges (1996) [11] methods.
EMG sampling frequency was 1000 HZ with
20-450 HZ band width and 50 HZ notch filter
and the sensitivity was 500 s. Total root
mean square (RMS) of the recorded signals
was obtained by Data link software.
The collected data were normalized to their
maximum voluntary contractions (MVCs)
that were obtained from the trunk extensor
and abdominal muscles. For the TES, LES
and LMF, subjects laid in prone position on a
padded table with the leg extended over the
table and hands beside their body. For the
right TrA/IO, EO and RA muscle MVCs,
subjects laid supine on the padded table, with
their knees extended.

2. Materials and Methods

2.1. Subject
Sixteen patients with chronic non-specific
LBP who reported episodes of LBP with no
specific etiology volunteered to participate in
this interventional study. Twenty healthy
women without any history of back pain were
matched according to sex, age and body mass
index (BMI) with LBP patients were also
participated in this investigation (Table 1).
The procedures were performed in accordance
with the Declaration of Helsinki and approved
by the research Ethics Committee at the
Department of Physical therapy at Tarbiat
Modares University. All subjects provided
signed informed consent prior to inclusion.
Subjects with dysfunction of upper or lower
extremity joint or muscle pain, lower
extremity, trunk surgery, lifting jobs,

Seyed Hoseinpoor T. et al. CJBAS Vol. (02)-January Issue 01 (2014) 1-8

Table1. Demographic data of the subjects in each group (mean SD).
Variables

Healthy (N=20)

CLBP (N=16)

Age(years)

26.26 1.88

27.56 1.71

Weight(kg)

58.46 7.68

60.12 8.71

Height(m)

1.61 6.18

1.61 6.11

22.4 2.75

22.9 2.88

BMI(kg/m )

Subjects were then asked to flex their

abdominal muscles and bend at the waist to
elevate their upper torso (to about 45 degree
with the table). Isometric MVC trials were
performed in symmetrical flexion without
twisting and with twisting to the right and
left. For each direction, two straps were used
to fix the subjects legs and the researcher
provided as much resistance at the shoulder(s)
as was necessary to keep the efforts isometric.
Each MVC was performed two times and the
subjects were asked to gradually ramp up the
force to reach an absolute maximum force,
and then to hold for 8-10 s. Approximately 30
s of rest was given between MVC
contractions.

and after performing fatigue task. One of the

conditions was when the participants stand
and just put on a vest (with 4 symmetric
pockets in back and front) and another was
when loads equal to 25% of subjects body
weight were put in the vests pocket
symmetrically (Figure 1). EMG signals were
recorded for 10 seconds in every condition.

2.3. Procedure
EMG activities of the trunk extensor and
abdominal muscles were recorded in two
conditions in relax standing position before

2.4. Fatiguing task

A dead-lift task (Figure 2) was used to induce
fatigue on trunk extensor muscles based on
Strange et al [12] method. Dead-lift repetition
was performed with 50% of their maximum
voluntary efforts by all subjects to exhaustion
(according to every participant report through
the fatigue task based on Borg scale).The
maximum isometric force exerted by the leg
and back musculature in dead-lift task was
measured using an isometric leg and back
dynamometer prior to start the fatigue task.

Figure 1. Comfortable upright standing

with a vest with four symmetric pockets.

Figure 2. Dead-lift exercise used to

induce fatigue

2.5. Data analysis

3

Seyed Hoseinpoor T. et al. CJBAS Vol. (02)-January Issue 01 (2014) 1-8

Normalized total root mean square (RMS) of
the EMG signals to their muscle MVC was
used for statistical analysis. The main effects
of group (healthy or CLBP subjects), fatigue
(with or without back extensor muscle
fatigue) and weight (0% or 25% body weight)
3. Result
There were no significant differences between
healthy and CLBP subjects in age (P =0.71),
height (P =0.99), weight (P =0.86) and BMI
(P =0.78). Table 1 summarized the
demographic data of two groups.
The results of MANOVA revealed a
significant difference for the main effects of

was assessed by Multivariate Analysis of

variance (MANOVA). SPSS statistical
package (version 16) was used for statistical
analysis and the statistical significance set at
P < 0.05.
fatigue (F=6.64, P <0.05) on the RMS of LES
muscle. This difference was also significant
for interaction of groups by fatigue (F=5.34, P
<0.05) in LES activity (Figure 3). Although
other muscles represented differences
between two groups but the amount was not
significant (Figure4).

Figure 3. Interaction of groups by fatigue on the RMS of LES muscle (nFatigue = before
fatigue task, Fatigue = after fatigue task, nLBP = healthy group, LBP = CLBP group).
Well-coordinated neuromuscular control is
stability [15].It has been proposed that
patients
with CLBP have an underlying instability of
the spine ,and this instability was the result of
osteoligamentous
laxity
or
damage,
dysfunction of the trunk muscles or
diminished neuromuscular control [16] that
may cause changes in muscle activation
patterns.

4. Discussion
The current study compared trunk extensor
and abdominal muscles activation patterns
between CLBP patients and healthy control
subjects before and after performing lifting
fatigue task (dead-lift task). While numerous
authors have reported differences in muscle
activation pattern in patients with CLBP and
healthy control [13, 14], trunk muscle
response has not been investigated after
fatigue phenomenon in CLBP patients.
Findings of the current study demonstrate
differences in trunk activation patterns
between
two
groups
after
fatigue
phenomenon.
4

Seyed Hoseinpoor T. et al. CJBAS Vol. (02)-January Issue 01 (2014) 1-8

Figure 4.(a) Interaction of groups by fatigue Figure 4.(b) Interaction of groups by fatigue
on the RMS of TrA/IO
on the RMS of RA

Figure 4.(c) Interaction of groups by fatigue Figure 4.(d) Interaction of groups by fatigue
on the RMS of EO
on the RMS of LMF

Figure 4. (e) Interaction of groups by fatigue on the RMS of TES

(nFatigue = before fatigue task, Fatigue = after fatigue task, nLBP = healthy group, LBP = CLBP group).

Seyed Hoseinpoor T. et al. CJBAS Vol. (02)-January Issue 01 (2014) 1-8

It is well documented that trunk muscle
fatigue reduces neuromuscular control of
trunk movement by deteriorating muscle
coordination [17, 18] ,and so it can lead to
instability of the spine [18]. Modified trunk
muscle recruitment has been reported
previously by trunk muscle fatigue in normal
subjects [8, 18-20].
According to results of the present study, in
CLBP group, all the investigated muscles
both trunk extensors and abdominals
represented higher recruitment after becoming
fatigue in comparison with healthy group but
the amount of difference was only significant
for LES. The effect of fatigue on trunk
extensor and abdominals was investigated in
the prior work by the same authors [8]. It has
been shown that trunk extensor has a greater
role in axial loading after fatigue task to make
the spinal column stable [8]. Therefore,
significant increase in LES EMG activation in
CLBP group in comparison to healthy
individuals was logical.
Individuals with LBP behave in a guarded
manner to minimize forces applied to painful
structures [21] or in the anticipation and fear
of pain [22]. Regarding to the medium value
of fear of movement and injury measured by
Tampa Scale of Kinesiophobia questioner in
CLBP patients in this study (32.81 4.13 in
the CLBP patients), it appears that these
subjects increased their trunk muscle activity
to stiffen the spinal column due to their fear
of movement and to reduce the risk of reinjury.
Higher activation of the trunk muscle in
CLBP subjects might be also related to higher
rate of neuromuscular noise in these patients
[23]. Authors have been reported that trunk
proprioception may impair by low back
trouble and this might be compensated for by
antagonistic co-activation to stiffen the
lumbar spine and make it stable [18, 24].
Some of the previous studies examining static
surface EMG reported higher levels in

patients with CLBP compared to healthy

subjects, whereas others reported no
difference [25]. Results of the present study
represented no between-group differences in
trunk muscle EMG activities with and without
axial loading before performing dead-lift
fatiguing task. While, after fatigue task
between-group differences was appeared.
Indeed, CLBP patients use co-contraction
strategy in more demanding situations to
encounter the underlying loss of stability but
greater amount of compressive load may be
induced on musculoskeletal system which
may be hazardous in longtime [26].
5. Conclusion
According to the results of the current study
trunk extensor and abdominal muscles
activation changed after becoming fatigue in
both LBP and healthy subjects. Although
these changes in muscle activation were in the
same direction in both groups, LBP patients
revealed more guarded and protected
behavior. Therefore, more spinal loading in
LBP subjects in muscular fatigue situations
may contribute to other episodes of acute
back pain and more care should be devoted to
these patients in long duration daily activities
and work places.
Acknowledgement
The authors would like to thank Department
of Physiotherapy at Tarbiat Modares
University for financial support. Thanks are
also extended to all subjects who participated
in this study.
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