MOVEMENT CONTROL EXERCISES VERSUS LUMBAR STABILIZATION EXERCISES ON FEEDFORWARD ACTIVATION IN PATIENTS WITH MECHANICAL LOW BACK PAIN

R. Desai¹, M. Rathi², T. Palekar¹

¹Dr. D. Y. Patil College of Physiotherapy, Musculoskeletal Sciences, Pune, India, ²Dr. D. Y. Patil College of Physiotherapy, Community Based Rehabilitation Department, Pune, India

Background: Experimental studies based on feedforward activation (FFA) of trunk muscles during rapid arm movements, demonstrated that deep trunk muscles contribute to the stability of spine. Lack of FFA of trunk musculature during unexpected perturbation in chronic mechanical low back pain (CMLBP) may result in inefficient muscular stabilization. Studies have been conducted to investigate timing of Transversus Abdominis (TA) muscle activation in response to rapid shoulder flexion after 8 weeks of Core Stabilization Exercises (CSE). Immediate changes in feedforward postural adjustments were studied following voluntary motor training by others. Research support to assess the differences in FFA and Recruitment Pattern (RP) of core muscles after implementing Movement Control Exercises (MCE) and CSE on subjects with CMLBP are lacking. This study explored whether timing of muscle onset and RP changed in TA, Superficial Lumbar Multifidus (SLM) and External Oblique (EO) muscles for advocating MCE and CSE.

Purpose: To compare the effects of MCE and CSE on muscle onset latency (MOL) and RP of core muscles by surface EMG in patients with CMLBP.

Methods: Thirty participants with CMLBP aged 20 to 40 years, were allocated into 2 groups by Computer generated random allocation method. Group A (n=15) received MCE and Group B (n=15) received CSE for 8 weeks, thrice a week on alternate days. Participants were evaluated at baseline, post 4 and 8 weeks. Outcome measures were MOL in milliseconds (ms), relative to anterior deltoid (AD) and RP in microvolt (µV) of TA, SLM, and EO muscles by surface EMG, with Quantitative Motor Unit Action Potential (QMUP). Feed forward window was defined as the onset of trunk muscle activity within 50 ms after the onset of AD. Data was analyzed using Medcalc software (version 18.2.1). Repeated Measures Analysis of Variances (ANOVA) test was used with time as factor and MCE and CSE as grouping variables. The significance level was set at p<0.05.

Results: There was no statistically significant difference between MCE and CSE in changing MOL and RP among participants with CMLBP. Mean MOL affected by MCE and CSE,F(1,28) = 0.04, p = .846 for Right TA, F(1,28) = 0.03, p = .871 for Left TA, F(1,28)=0.07,p = .788 for Right SLM, F(1,28) = 0.23, p = .637 for Left SLM, F(1,28) = 0.27,p = .610 for Right EO and F(1,28) = 0.19,p = .664 for Left EO. Mean RP showed, F(1,28) = 2.47,p = .127 for Right TA, F(1,28) = 1.01,p = .324 for Left TA, F(1,28) = 2.32,p = .139 for Right SLM, F(1,28) = 1.64,p = .211 for Left SLM, F(1,28) = 0.023,p = .881 for Right EO and F(1,28) = 0.037,p = .849.

Conclusions: Movement Control Exercises and Core Stabilization Exercises are equally effective in improving FFA and RP of core muscles. Further studies can be done to compare FFA of core muscles bilaterally.

Implications: Movement Control Exercises and Core Stabilization Exercises should be regularly practiced in patients with CMLBP as they improve FFA and RP of core muscles that is generally affected in such patients.

Funding acknowledgements:Funding, Acknowledgements: None

Keywords:
Muscle onset latency
Recruitment pattern
Surface Electromyography

Topics:
Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Dr. D. Y. Patil College of Physiotherapy, Pune, India.

Committee: The Ethics Committee, Dr. D. Y. Patil Vidyapeeth, Pune.

Ethics number: DYPV/EC/450/2020