Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Department of Health Sciences, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, United Kingdom.
PLoS One. 2021 Apr 1;16(4):e0249308. doi: 10.1371/journal.pone.0249308. eCollection 2021.
People with chronic low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. The aim and objective of this study was to determine differences in postural control strategies (peak amplitude, APAs and CPAs) between symptomatic and asymptomatic adults with and without Lumbar Disc Degeneration (LDD) using surface electromyography during forward postural perturbation. Ninety-seven subjects participated in the study (mean age 50 years (SD 12)). 3T MRI was used to acquire T2 weighted images (L1-S1). LDD was determined using Pfirrmann grading. A bespoke translational platform was designed to deliver horizontal perturbations in sagittal and frontal planes. Electromyographic activity was analysed bilaterally from 8 trunk and lower limb muscles during four established APA and CPA epochs. A Kruskal-Wallis H test with Bonferroni correction for multiple comparisons was conducted. Four groups were identified: no LDD no pain (n = 19), LDD no pain (n = 38), LDD pain (n = 35) and no LDD pain (n = 5). There were no significant differences in age or gender between groups. The most significant difference between groups was observed during forward perturbation. In the APA and CPA phases of predictable forward perturbation there were significant differences ankle strategy between groups (p = 0.007-0.008); lateral gastrocnemius and tibialis anterior activity was higher in the LDD pain than the LDD no pain group. There were no significant differences in the unpredictable condition (p>0.05). These findings were different from the remaining groups, where significant differences in hip strategy were observed during both perturbation conditions (p = 0.004-0.006). Symptomatic LDD patients exhibit different electromyographic strategies to asymptomatic LDD controls. Future LBP electromyographic research should benefit from considering assessment of both lower limbs in addition to the spine. This approach could prevent underestimation of postural control deficits and guide targeted rehabilitation.
患有慢性下腰痛 (LBP) 的人表现出姿势控制的变化。由于外部干扰引起的典型肌肉激活包括预期性 (APAs) 和代偿性 (CPAs) 姿势调整。本研究的目的是确定使用表面肌电图在向前姿势扰动时，有和没有腰椎间盘退变 (LDD) 的症状性和无症状成年人之间的姿势控制策略（峰值幅度、APAs 和 CPAs）差异。97 名受试者参与了这项研究（平均年龄 50 岁（SD 12））。3T MRI 用于获取 T2 加权图像（L1-S1）。使用 Pfirrmann 分级确定 LDD。设计了一个定制的平移平台，用于在矢状面和额状面提供水平扰动。在四个既定的 APA 和 CPA 时期，从 8 个躯干和下肢肌肉双侧分析肌电图活动。使用 Kruskal-Wallis H 检验和 Bonferroni 多重比较校正进行检验。确定了四个组：无 LDD 无疼痛（n = 19）、LDD 无疼痛（n = 38）、LDD 疼痛（n = 35）和无 LDD 疼痛（n = 5）。组间年龄和性别无显著差异。组间差异最显著的是在向前扰动期间。在可预测的向前扰动的 APA 和 CPA 阶段，组间踝关节策略有显著差异（p = 0.007-0.008）；LDD 疼痛组比 LDD 无疼痛组的外侧腓肠肌和胫骨前肌活动更高。不可预测条件下无显著差异（p>0.05）。这些发现与其余组不同，在两种扰动条件下均观察到髋关节策略存在显著差异（p = 0.004-0.006）。有症状的 LDD 患者表现出与无症状的 LDD 对照组不同的肌电图策略。未来的 LBP 肌电图研究应该受益于考虑评估脊柱以外的两条腿。这种方法可以防止低估姿势控制缺陷，并指导有针对性的康复。
