Comparison of the Effects of Static Stretching and Strengthening on Electromyographic ‎Activity of Paravertebral Muscles in Patients with Chronic Non-specific LBP with ‎Tightened Hamstring Muscles: A Randomized Controlled Clinical Trial ‎

Document Type : Original Article

Authors

1 Department of Physical Therapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran

2 Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract

Purpose:
This randomized clinical trial study was performed to compare the effect of static stretching exercises and strengthening exercises in lengthened position of shortened hamstring muscles on changes in electrical activity (EMG) of the paravertebral muscles in the back of patients with chronic low back pain.
Methods:
Forty-five patients with chronic low back pain were selected for this clinical trial through sampling available in the outpatient clinic of Kermanshah University of Medical Sciences. In addition to receiving conventional physiotherapy treatment for low back pain, all samples were randomly allocated into 3 groups: stretching exercises (n=15), strengthening exercises in muscle lengthened position (n=15) and the control group without additional intervention (n=15). Therapeutic interventions were performed for 4 weeks, 3 days a week and for a total of 12 sessions. Hamstring muscle length was measured by Norris test (thigh in vertical position and the patient tried to straighten the knee joint) with a goniometer. Electromyography information was recorded from the lumbar muscles of the patients during knee flexion against an elastic band.
Results:
Analysis of repeated measures showed that there was a non-significant difference between time, group, and time and group in the EMG activity of the back muscles (langismus and iliocostalis) (p>0.05) and only the time factor had a significant effect on pain and disability.
Conclusion:
None of the static stretching exercise and hamstring muscle strengthening exercises in lengthened position did not cause a significant change in the electromyographic activity of the paravertebral muscles of the patients.

Keywords


  1. Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Rev Saude Publica  2015; 49: 73-83.
  2.  Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet  2012; 379(9814): 482-491.
  3. Van Damme B, Stevens V, Perneel C, Van Tiggelen D, et al. A surface electromyography based objective method to identify patients with nonspecific chronic low back pain, presenting a flexion related movement control impairment. J Electromyogr Kinesiol  2014; 24(6): 954-964.
  4. D’hooge R, Hodges P, Tsao H, Hall L, et al. Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J Electromyogr Kinesiol  2013; 23(1): 173-181.
  5. Suehiro T, Mizutani M, Ishida H, Kobara K, et al. Individuals with chronic low back pain demonstrate delayed onset of the back muscle activity during prone hip extension. Journal Electromyogr Kinesiol  2015; 25(4): 675-680.
  6. Oh J-S, Cynn H-S, Won J-H, Kwon O-Y, Yi C-H. Effects of performing an abdominal drawing-in maneuver during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt. J Orthop Sports Phys Ther  2007; 37(6): 320-324.
  7. Van Wingerden J, Vleeming A, Snijders C, Stoeckart R. A functional-anatomical approach to the spine-pelvis mechanism: interaction between the biceps femoris muscle and the sacrotuberous ligament. Eur Spine J 1993; 2(3): 140-144.
  8. Li Y, McClure PW, Pratt N. The effect of hamstring muscle stretching on standing posture and on lumbar and hip motions during forward bending. Phys Ther  1996; 76(8): 836-849.
  9. Jandre RF, Macedo AR. Influence of hamstring tightness in pelvic, lumbar and trunk range of motion in low back pain and asymptomatic volunteers during forward bending. Asian Spine J 2015; 9(4): 535-540.
  10. Shamsi M, Mirzaei M, Samadzadeh S, Schuermans J. Comparing the effects of static stretching and strengthening in lengthened position on EMG activity of hamstring muscle in patients with chronic non-specific LBP having shortened muscle: a randomised controlled clinical trial. Eur J Phys  2020; 22(4): 184-190.
  11. Levangie P. The Hip complex. In: Levangie PNorkin C. Joint Structure and Function: A Comprehensive Analysis, 4th ed. Philadelphia, PA: F.A. Davis Company; 2005: 368–370.
  12. Frey M, Poynter A, Younge K, De Carvalho D. The relationship between lumbopelvic flexibility and sitting posture in adult women. J Biomech  2019; 84: 204-210.
  13. Ramesh M, Sivasankar P. Comparison of three different physiotherapeutic interventions in improving hamstring flexibility in individuals with hamstring tightness. Int J Health Sci Res 2014; 4(6): 129-134.
  14. Aquino CF, Fonseca ST, Gonçalves GG, Silva PL, et al. Stretching versus strength training in lengthened position in subjects with tight hamstring muscles: a randomized controlled trial. Man Ther  2010; 15(1): 26-31.
  15. Jalovaara P, Niinimäki T, Vanharanta H. Pocket-size, portable surface EMG device in the differentiation of low back pain patients. Eur Spine J 1995; 4(4): 210-212.
  16. Ahern DK, Follick MJ, Council JR, Laser-Wolston N, Litchman H. Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls. Pain 1988; 34(2): 153-160.
  17. McGorry RW, Hsiang SM, Fathallah FA, Clancy EA. Timing of activation of the erector spinae and hamstrings during a trunk flexion and extension task. Spine 2001; 26(4): 418-425.
  18. Hashemirad F, Talebian S, Hatef B, Kahlaee AH. The relationship between flexibility and EMG activity pattern of the erector spinae muscles during trunk flexion–extension. Journal of Electromyography and Kinesiology 2009; 19(5): 746-753.
  19. Meroni R, Cerri CG, Lanzarini C, Barindelli G, et al. Comparison of active stretching technique and static stretching technique on hamstring flexibility. Clin J Sport Med 2010; 20(1): 8-14.
  20. Mousavi SJ, Parnianpour M, Mehdian H, Montazeri A, Mobini B. The Oswestry disability index, the Roland-Morris disability questionnaire, and the Quebec back pain disability scale: translation and validation studies of the Iranian versions. Spine  2006; 3(1914): E454-E459.
  21. Bohannon RW. Cinematographic analysis of the passive straight-leg-raising test for hamstring muscle length. Phys Ther 1982; 62(9): 1269-1274.
  22. Norris C, Matthews M. Inter-tester reliability of a self-monitored active knee extension test. J Bodywork Mov Ther 2005; 9(4): 256-259.
  23. Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141(1): 2-18.
  24. Kim S-h, Kwon O-y, Park K-n, Kim M-H. Comparison of erector spinae and hamstring muscle activities and lumbar motion during standing knee flexion in subjects with and without lumbar extension rotation syndrome. J Electromyogr Kinesiol 2013; 23(6): 1311-1316.
  25. Cholewicki J, Silfies SP, Shah RA, Greene HS, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine 2005; 30(23): 2614-2620.
  26. Renkawitz T, Boluki D, Grifka J. The association of low back pain, neuromuscular imbalance, and trunk extension strength in athletes. Spine J 2006; 6(6): 673-683.
  27. van Dieën JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol 2003; 13(4): 333-351.
  28. Cassisi JE, Robinson ME, O'Conner P, MacMillan M. Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic low-back pain patients and controls. Spine 1993; 18(2): 245-251.
  29. Kamaz M, Kiresi D, Oguz H, Emlik D, et al. CT measurement of trunk muscle areas in patients with chronic low back pain. Diagn Interv Radiol 2007; 13(3): 144-148.
  30. Mayer TG, Kondraske G, Mooney V, Carmichael TW, Butsch R. Lumbar myoelectric spectral analysis for endurance assessment: a comparison of normals with deconditioned patients. Spine 1989; 14(9): 986-991.
  31. Liu X, Hanney WJ, Masaracchio M, Kolber MJ. Utilization and payments of office-based physical rehabilitation services among individuals with commercial insurance in New York state. Phys Ther 2016; 96(2): 202-211.
  32. Arab AM, Ghamkhar L, Emami M, Nourbakhsh MR. Altered muscular activation during prone hip extension in women with and without low back pain. Chiropr Man Therap  2011; 19: 1-6.
  33. Choi Y-D, Lee K-S, Yoon C-S. The effect of the Mckenzie exercise and the williams exercise on the reduction of low back pain and on the changes of EMG. J Kor Phys Ther Sci 2000; 7(2): 663-682.
  34. Lee C-W, Hwangbo K, Lee I-S. The effects of combination patterns of proprioceptive neuromuscular facilitation and ball exercise on pain and muscle activity of chronic low back pain patients. J Phys Ther Sci 2014; 26(1): 93-96.
  35. Ingerson E, Renfrow C, Aragon E, Ferger N, et al. Individuals with low back pain improve in standing tolerance and sagittal plane muscle activation following exercise intervention. J Back Musculoskelet Rehabil 2019; 32(6): 885-895.
  36. Arokoski JP, Valta T, Kankaanpää M, Airaksinen O. Activation of lumbar paraspinal and abdominal muscles during therapeutic exercises in chronic low back pain patients. Arch Phys Med Rehabil 2004; 85(5): 823-83.