Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients
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RESEARCH
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Age and gender related neuromuscular pattern during trunk flexion-extension in chronic low back pain patients Thomas Kienbacher1*, Elisabeth Fehrmann1, Richard Habenicht1, Daniela Koller1,4, Christian Oeffel1,4, Josef Kollmitzer1,3,4, Patrick Mair1,5 and Gerold Ebenbichler1,2
Abstract Background: The root mean square surface electromyographic activity of lumbar extensor muscles during dynamic trunk flexion and extension from standing has repeatedly been recommended to objectively assess muscle function in chronic low back pain patients. However, literature addressing older patients is sparse. This cross sectional study sought to examine differences in neuromuscular activation between age groups (>60 versus 40-60 versus 60 years), and between both sexes. In order to appropriately interpret the EMG signal, task specific landmark position angles and their respective changes related to the hip, lumbothoracic, and gross trunk regions were monitored to control for possible bias that may be caused by age and sex specific postural differences when performing the task.
Methods Patients
All back pain patients who were referred from various settings to the referral ambulatory rehabilitation center for diagnostic evaluation and treatment were asked to participate in this cross sectional study and were informed that they would be provided with six months of cost-free training after the testing. Those interested in participating completed a short screening questionnaire that assessed the location, duration, and intensity of their pain as well as some functional limitations and comorbidities. Thereafter, eligible patients were scheduled for an examination performed by a PM&R specialist. Between January 2012 and November 2014 a total of 294 cLBP patients volunteered to participate in this study by filling out the questionnaire. Of these a total of 216 male and female patients between 18 and 90 years of age were included in this study. Sixty-two patients were between 60 and 90 years old (33 females), 84 were between 40 and 59 years old (44 females), and 70 were between 18 and 39 years old (34 females). The included patients were generally healthy and suffered from low back pain with a minimum of 30 mm and neck pain less than 30 mm on a visual analogue scale (0 – 100 mm) during the 12 weeks prior to screening. The exclusion criteria were as follows: receipt of health care advice for headaches within the past year and more than five headache episodes (one or more lasting more than two days); headache within the last six
Kienbacher et al. Journal of NeuroEngineering and Rehabilitation (2016) 13:16
weeks [21]; peripheral neurological deficit; spinal fracture, infection, or cancer; previous surgery involving the back region; previous experience with trunk muscle strength testing; performance of exercise more than two times per week or at a competitive level [22]; inability to follow German verbal instructions, and a BMI exceeding 35 kg/ m2. Patients were asked not to take analgesic drugs, muscle relaxants, o
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