Diagnostic methods: Original ResearchEffects of tactile feedback on lumbar multifidus muscle activity in asymptomatic healthy adults and patients with low back pain
Introduction
The function of the lumbar multifidus muscle for spinal stabilization has been well-recognized due to its anatomic proximity to the spine, particularly for the lumbar segments (Bogduk, 2005, MacDonald et al., 2006). In an ultrasonographic imaging study of patients with acute unilateral low back pain (LBP), the size of the lumbar multifidus muscle was significantly smaller on the painful side than on the un-involved side, even though the patients had significant pain reduction at the 10-week follow-up (Hides et al., 1996). Decreased lumbar multifidus muscle size at the painful segments also was found in patients in subacute and chronic stages of LBP (Hides et al., 1994, Hides et al., 2008, Wallwork et al., 2009). In addition, a higher amount of fatty infiltration (i.e. muscle atrophy) in the lumbar multifidus muscle is positively correlated to a lower level of physical activity in patients with LBP (Le Cara et al., 2014). Therefore, improving this muscle's function is considered to be crucial to restoring physical function in rehabilitation of LBP. Moreover, the ability to activate the lumbar multifidus muscle was identified as a predictor for clinical success with a spinal stabilization exercise program (Hebert et al., 2010). Consequently, clinicians routinely include muscle activation training specific to the lumbar multifidus muscle in spinal stabilization exercise programs for treating patients with LBP (Hicks et al., 2005, O'Sullivan et al., 1997).
Many strategies have been employed clinically to facilitate activation of the lumbar multifidus muscle. A pressure biofeedback unit has been advocated to encourage lumbar stabilization or co-contraction of the lumbar multifidus and deep abdominal muscles during spinal stabilization exercise (Richardson et al., 2004, Cynn et al., 2006). However, a pressure biofeedback unit has been shown to be a more useful tool for identifying lumbopelvic stability impairments than for improving treatment effectiveness (Cairns et al., 2000, Mills et al., 2005). The evidence suggests ultrasound imaging to be a useful visual feedback tool for recruiting the lumbar multifidus and deep abdominal muscles in patients with LBP (Henry and Westervelt, 2005, Lee et al., 2016, Van et al., 2006). However, this mode of feedback is rarely used in clinical settings because of the high cost of ultrasound imaging machines. In contrast, verbal instructions are quick and easy to implement in clinics, and several verbal instructions have been found to be useful to activate the lumbar multifidus muscle (Van et al., 2006, Wallwork et al., 2009, Wang-Price et al., 2017). However, verbal instructions require patients to be able to understand the meaning of the instruction to perform the exercise properly.
Because the depth of the lumbar multifidus muscle limits the clinician's ability to observe muscle activation, tactile feedback often is added to verbal instruction in order to confirm or further facilitate contraction of this muscle (Van et al., 2006, Wallwork et al., 2009). Tactile feedback using taping was shown to improve posture sway when adhesive tape was applied to the ankle and heel (Matsusaka et al., 2001) and to improve muscle activity when a piece of kinesiotape was applied over the pectoral muscle (Gusella et al., 2014). Although taping has positive effects on muscle recruitment, the most common form of tactile feedback technique used by clinicians is direct hand contact (i.e. palpation) over the target muscle (Henry and Westervelt, 2005, Wallwork et al., 2009, Vega Toro et al., 2016). Despite the routine practice of tactile feedback by clinicians using direct hand contact for muscle recruitment, the effect of hand contact on lumbar multifidus muscle activation has not been studied previously. Therefore, the purposes of this study were (1) to examine the effect of tactile feedback on lumbar multifidus muscle activity at rest, and (2) to compare the added effect of tactile feedback to verbal instruction during a contralateral arm lift, in adults with and without LBP.
Section snippets
Participants
This study was approved by the investigator's affiliated Institutional Review Board and registered with ClinicalTrials.gov (NCT02836860). Before data collection began, a power analysis was performed using G*Power 3.1.3 to estimate an adequate sample size (Faul et al., 2007). Using a medium effect size of 0.25 and an alpha level of 0.025, a total of 42 participants, 21 in each group, were required to reach a power of 0.80. Forty-four eligible participants, 20 asymptomatic adults and 24 patients
Results
Forty-two participants were enrolled in the study and 40 participants completed the study. One participant had to leave for another medical appointment and was not able to complete the study. EMG recording from one participant was incomplete because an unexpected software problem occurred. Both drop outs were in the LBP group. Table 1 illustrates the characteristics of participants, including age, gender, height, weight and, the OSW scores of both groups, and the NPRS score and duration of pain
Discussion
All of the participants with or without LBP demonstrated decreased lumbar multifidus muscle activity by 2–3% of MVIC with tactile feedback at rest and during the contralateral arm lift. The results suggest that when tactile feedback is applied via continuous hand contact over the lumbar multifidus muscle, the hand contact appeared to produce an inhibitory or relaxing effect, rather than a facilitating effect, on lumbar multifidus muscle activity in both asymptomatic healthy adults and patients
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgement
We would like to show our gratitude to Zak Mitchell, Yousef Alshehre, and Khalid Alkhathami for their assistance in data collection and Jim Price for his comments and edits on this manuscript.
References (40)
- et al.
Pressure Biofeedback: a useful tool in the quantification of abdominal muscular dysfunction?
Physiotherapy
(2000) - et al.
Effects of lumbar stabilization using a pressure biofeedback unit on muscle activity and lateral pelvic tilt during hip abduction in sidelying
Arch. Phys. Med. Rehabil.
(2006) - et al.
Surface myoelectric signal cross-talk among muscles of the leg
Electroencephalogr. Clin. Neurophysiol.
(1988) - et al.
Kinesiologic taping and muscular activity: a myofascial hypothesis and a randomised, blinded trial on healthy individuals
J. Bodyw. Mov. Ther.
(2014) - et al.
The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: a cross-sectional study
Arch. Phys. Med. Rehabil.
(2010) - et al.
Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program
Arch. Phys. Med. Rehabil.
(2005) - et al.
Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects
Man. Ther.
(2008) - et al.
Correlation between the MRI changes in the lumbar multifidus muscles and leg pain
Clin. Radiol.
(2000) - et al.
Rehabilitative ultrasound measurement of select trunk muscle activation during induced pain
Man. Ther.
(2008) - et al.
Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging
Man. Ther.
(2007)
Patients with low back pain demonstrate increased activity of the posterior oblique sling muscle during prone hip extension
PM R
Tactile stimulation with kinesiology tape alleviates muscle weakness attributable to attenuation of Ia afferents
J. Sci. Med. Sport
Morphology versus function: the relationship between lumbar multifidus intramuscular adipose tissue and muscle function among patients with low back pain
Arch. Phys. Med. Rehabil.
The lumbar multifidus: does the evidence support clinical beliefs?
Man. Ther.
Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects
J. Clin. Epidemiol.
Repeatability of skin displacement and pressure during “inhibitory” vastus lateralis muscle taping
Man. Ther.
The effect of a 10-week training regimen on lumbo-pelvic stability and athletic performance in female athletes: a randomized-controlled trial
Phys. Ther. Sport
I can't find it! Distorted body image and tactile dysfunction in patients with chronic back pain
Pain
EMG activity of trunk muscles and torque output during isometric axial rotation exertion: a comparison between back pain patients and matched controls
J. Orthop. Res.
A comparison of surface and fine wire EMG recordings of gluteus medius during selected maximum isometric voluntary contractions of the hip
J. Electromyogr. Kinesiol.
Cited by (3)
Influence of upright exercise with external thoracic and pelvic compression on thoracic expansion and respiratory function in healthy young adults: A pilot study
2023, Journal of Bodywork and Movement Therapies