Changes in Muscle Activation Patterns and

Subjective Low Back Pain Ratings

During Standing in Response to an Exercise
Intervention

Erika Nelson-Wong and Jack Callaghan

Presented at the Combined Sections Meeting of the APTA - February 19, 2010
Background and Rationale
Background and Rationale
Background and Rationale
Purpose
• Investigate the impact of a commonly used PT
exercise intervention on LBP development,
clinical and biomechanical risk factors during
a prolonged standing task.
Prolonged Testing Methods

Start of Session: End of Session:

Continuous EMG,
Motion Analysis &
Kinetic Data Collection

2 Hour Prolonged Exposure

15 min

VAS VAS VAS VAS VAS VAS VAS VAS VAS

Participants
• 43 volunteers
– 22 male, 21 female
– Age: 22.7 ± 3.4 years
– BMI: 23.8 ± 3.2 kg/m2
• No history of low back
pain
• Not employed in
occupation requiring
static standing
 Instrumentation
• EMG – 16 Channels
• 46 Motion
Tracking Markers
(8 segments)

• Two In-Floor Force Platforms

Experimental Protocol
Functional 2-hour Functional
Questionnaires Movements Standing Movements

Clinical
Assessment Classification into PD/NPD
based on VAS scores
Data
EMG Prep Analysis By
MVC’s Marker Group
set-up R
Beiring-
Sorensen
Endurance Test Exercise Control/usu
Intervention al activity
Standing
Flexion
4 Weeks
Successful at Inducing LBP During Standing

40% developed LBP (17/43)

 Predisposing Factors Identified on pre-Test
• (+) Active Hip Abduction Test
• (Nelson-Wong et al., JOSPT, 2009)

• Increased co-contraction of bilateral gluteus medius

muscles
• Shorter muscle rest times (Gaps) in gluteal muscles

Nelson-Wong and Callaghan, J Electromyography Kinesiol 2009

 Response to Exercise Intervention

Decrease from 24.2 (± 4) to 8.93 (± 3.7) mm

Large Effect Size

Cohen’s d = -3.78

Nelson-Wong and Callaghan, J Electromyography Kinesiol, Accepted in revision, 2010

Response to Exercise Intervention
• Non-Significant Trend
(z =1.73, p = 0.08) for PD–
exercisers to improve on the
AHAbd Test

• Large Effect Size

Cohen’s d = 0.95

Nelson-Wong, et al. JOSPT, 2009

Response to Exercise Intervention

p < 0.001
Male PDEX had decreased
co-contraction of
bilateral gluteus medius
muscles

Large Effect Size

Cohen’s d = 1.88
Response to Exercise Intervention

Increase in right gluteus

medius muscle rest time
for Male PDEX
Conclusions
• Large impact of exercise intervention on subjective pain reporting

• Muscle co-activation profiles can be impacted through exercise

intervention (gender specific?)

• Mechanisms for LBP during standing yet to be identified, may be

related to low level muscle fatigue
Clinical Relevance
• Identify individuals who are pre-disposed to
standing-related LBP BEFORE they become patients

• Targeted interventions aimed at specific predisposing

factors

• More work needed to characterize mechanisms and

investigate gender-specific responses
 Thank You!

Mary McMillan, PODS I,

PODS II Scholarships