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1.  Posterior muscle chain activity during various extension exercises: an observational study 
Background
Back extension exercises are often used in the rehabilitation of low back pain. However, at present it is not clear how the posterior muscles are recruited during different types of extension exercises. Therefore, the present study will evaluate the myoelectric activity of thoracic, lumbar and hip extensor muscles during different extension exercises in healthy persons. Based on these physiological observations we will make recommendations regarding the use of extensions exercises in clinical practice.
Methods
Fourteen healthy subjects performed four standardized extension exercises (dynamic trunk extension, dynamic-static trunk extension, dynamic leg extension, dynamic-static leg extension) in randomized order at an intensity of 60% of 1-RM (one repetition maximum). Surface EMG signals of Latissimus dorsi (LD), Longissimus thoracis pars thoracic (LTT) and lumborum (LTL), Iliocostalis lumborum pars thoracic (ILT) and lumborum (ILL), lumbar Multifidus (LM) and Gluteus Maximus (GM) were measured during the various exercises. Subsequently, EMG root mean square values were calculated and compared between trunk and leg extension exercises, as well as between a dynamic and dynamic-static performance using mixed model analysis. During the dynamic exercises a 2 second concentric contraction was followed by a 2 second eccentric contraction, whereas in the dynamic-static performance, a 5 second isometric interval was added in between the concentric and eccentric contraction phase.
Results
In general, the muscles of the posterior chain were recruited on a higher level during trunk extension (mean ± SD, 56.6 ± 30.8%MVC) compared to leg extension (47.4 ± 30.3%MVC) (p ≤ 0.001). No significant differences were found in mean muscle activity between dynamic and dynamic-static performances (p = 0.053). The thoracic muscles (LTT and ILT) were recruited more during trunk extension (64.9 ± 27.1%MVC) than during leg extension (54.2 ± 22.1%MVC) (p = 0.045) without significant differences in activity between both muscles (p = 0.138). There was no significant differences in thoracic muscle usage between the dynamic or dynamic-static performance of the extension exercises (p = 0.574).
Lumbar muscle activity (LTT, ILL, LM) was higher during trunk extension (70.6 ± 22.2%MVC) compared to leg extension (61.7 ± 27.0%MVC) (p = 0.047). No differences in myoelectric activity between the lumbar muscles could be demonstrated during the extension exercises (p = 0.574). During each exercise the LD (19.2 ± 13.9%MVC) and GM (28.2 ± 14.6%MVC) were recruited significantly less than the thoracic and lumbar muscles.
Conclusion
The recruitment of the posterior muscle chain during different types of extension exercises was influenced by the moving body part, but not by the type of contraction. All muscle groups were activated at a higher degree during trunk extension compared to leg extension. Based on the recruitment level of the different muscles, all exercises can be used to improve the endurance capacity of thoracic muscles, however for improvement of lumbar muscle endurance leg extension exercises seem to be more appropriate. To train the endurance capacity of the LD and GM extension exercises are not appropriate.
doi:10.1186/1471-2474-14-204
PMCID: PMC3716991  PMID: 23834759
Trunk extensor muscles; Multifidus; Posterior muscle chain; Extension exercise; Electromyography; Spine
2.  Electromyographic activity of trunk and hip muscles during stabilization exercises in four-point kneeling in healthy volunteers 
European Spine Journal  2006;16(5):711-718.
Stabilization exercises are intended to optimize function of the muscles that are believed to govern trunk stability. Debate exists whether certain muscles are more important than others in optimally performing these exercises. Thirty healthy volunteers were asked to perform three frequently prescribed stabilization exercises in four-point kneeling. The electromyographic activity of different trunk and hip muscles was evaluated. Average amplitudes obtained during the exercises were normalized to the amplitude in maximal voluntary contraction (% MVIC). During all three exercises, the highest relative muscle activity levels (> 20% MVIC) were consistently found in the ipsilateral lumbar multifidus and gluteus maximus. During both the single leg extension (exercise 1) and the leg and arm extension exercise (exercise 2) the contralateral internal oblique and ipsilateral external oblique reached high levels (> 20%MVIC). During exercise 2 there were also high relative activity levels of the ipsilateral lumbar part and the contralateral thoracic part of the iliocostalis lumborum and the contralateral lumbar multifidus. During the leg and arm extension exercise with contralateral hip flexion (exercise 3) there were high relative muscle activity levels of all back muscles, except for the latissimus dorsi muscle. The lowest relative muscle activity levels (< 10% MVIC) were found in the rectus abdominis and the ipsilateral internal oblique during all exercises, and in the contralateral gluteus maximus during exercises 1 and 2. The results of this study show that in exercises in four-point kneeling performed by healthy subjects, hip and trunk muscles seem to work together in a harmonious way. This shows that when relative activity of muscles is measured, both “global and local” muscles function together in order to stabilize the spine.
doi:10.1007/s00586-006-0181-1
PMCID: PMC2213547  PMID: 16896840
Stabilization exercise; Trunk and hip muscles; Electromyography
3.  Trunk muscle activity in healthy subjects during bridging stabilization exercises 
Background
Trunk bridging exercises are often used as therapeutic exercises for lumbopelvic stabilization. These exercises focus on the retraining of muscle coordination patterns in which optimal ratios between local segmental stabilizing and global torque producing muscle activity are assumed to be essential. However, a description of such ratios is lacking. The purpose of this study was to investigate both relative (as a percentage of maximal voluntary isometric contraction) muscle activity levels and ratios of local to global muscle activity, during bridging stabilization exercises.
Methods
Thirty healthy university students (15 men, 15 women) with a mean age of 19.6 year volunteered to perform 3 bridging exercises (single bridging, ball bridge and unilateral bridging). The surface electromyographic activity of different trunk muscles was evaluated on both sides.
Results
During all bridging exercises, the ratio of the internal oblique to the rectus abdominis was very high due to minimal relative activity of the rectus abdominis. In general, the ratio of the internal/external abdominal oblique activity was about 1. However, during the unilateral bridging exercise, the ipsilateral internal/external abdominal oblique activity ratio was 2.79 as a consequence of the significant higher relative activity of the internal oblique compared to the external oblique. The relative muscle activity and the ratios of the back muscles demonstrated similar activity levels for all back muscles, resulting in ratios about 1.
Conclusion
Both the minimal relative activity of the rectus abdominis and the high internal oblique to the rectus abdominis activity ratio reported in the present study are in accordance with results of other trunk stabilization exercises. The relative muscle activity and the ratio of the abdominal obliques seem to alter depending on the task and the presumable need for stability. The findings concerning the relative muscle activity and the ratios of the back muscles support the assumption that during these bridging exercises, all back muscles contribute in a similar way to control spine positions and movements in a healthy population.
doi:10.1186/1471-2474-7-75
PMCID: PMC1599724  PMID: 16987410
4.  Computed tomographic analysis of the quality of trunk muscles in asymptomatic and symptomatic lumbar discectomy patients 
Background
No consensus exists on how rehabilitation programs for lumbar discectomy patients with persistent complaints after surgery should be composed. A better understanding of normal and abnormal postoperative trunk muscle condition might help direct the treatment goals.
Methods
A three-dimensional CT scan of the lumbar spine was obtained in 18 symptomatic and 18 asymptomatic patients who had undergone a lumbar discectomy 42 months to 83 months (median 63 months) previously. The psoas muscle (PS), the paraspinal muscle mass (PA) and the multifidus muscle (MF) were outlined at the L3, L4 and L5 level. Of these muscles, fat free Cross Sectional Area (CSA) and fat CSA were determined. CSA of the lumbar erector spinae (LES = longissimus thoracis + iliocostalis lumborum) was calculated by subtracting MF CSA from PA CSA. Mean muscle CSA of the left and right sides was calculated at each level. To normalize the data for interpersonal comparison, the mean CSA was divided by the CSA of the L3 vertebral body (mCSA = normalized fat-free muscle CSA; fCSA = normalized fat CSA). Differences in CSA between the pain group and the pain free group were examined using a General Linear Model (GLM). Three levels were examined to investigate the possible role of the level of operation.
Results
In lumbar discectomy patients with pain, the mCSA of the MF was significantly smaller than in pain-free subjects (p = 0.009) independently of the level. The mCSA of the LES was significantly smaller in pain patients, but only on the L3 slice (p = 0.018). No significant difference in mCSA of the PS was found between pain patients and pain-free patients (p = 0.462). The fCSA of the MF (p = 0.186) and of the LES (p = 0.256) were not significantly different between both populations. However, the fCSA of the PS was significantly larger in pain patients than in pain-free patients. (p = 0.012).
The level of operation was never a significant factor.
Conclusions
CT comparison of MF, LES and PS muscle condition between lumbar discectomy patients without pain and patients with protracted postoperative pain showed a smaller fat-free muscle CSA of the MF at all levels examined, a smaller fat- free muscle CSA of the LES at the L3 level, and more fat in the PS in patients with pain. The level of operation was not found to be of importance. The present results suggest a general lumbar muscle dysfunction in the pain group, in particular of the deep stabilizing muscle system.
doi:10.1186/1471-2474-12-65
PMCID: PMC3079706  PMID: 21453531

Results 1-4 (4)