Advertisement
Original Article| Volume 37, ISSUE 7, P494-501, September 2014

Download started.

Ok

Quantification of the Lumbar Flexion-Relaxation Phenomenon: Comparing Outcomes of Lumbar Erector Spinae and Superficial Lumbar Multifidus in Standing Full Trunk Flexion and Slumped Sitting Postures

Published:August 07, 2014DOI:https://doi.org/10.1016/j.jmpt.2014.07.003

      Abstract

      Objective

      The purpose of this study was to identify differences in flexion-relaxation outcomes in asymptomatic participants, with respect to both flexion-relaxation phenomenon (FRP) occurrence and spinal onset angles, as a function of posture and choice of muscle being examined.

      Methods

      This was a cross-sectional study in a laboratory setting. Thirty asymptomatic participants performed standing full trunk flexion and slumped sitting postures while activation levels of the lumbar erector spinae and superficial lumbar multifidus were monitored. Two thresholds were used to define whether FRP was present in each muscle and, if present, at what trunk flexion angle it occurred. These outcomes were compared descriptively between muscles and between postures.

      Results

      Most participants displayed FRP in both muscles during standing full flexion; occurrences were more variable in slumped sitting. On average, FRP during standing full flexion and slumped sitting occurred at approximately 80% and 52% of participants' maximum flexion value, respectively. Variability in the slumped sitting onset angles was greater than that in standing full flexion.

      Conclusion

      Outcomes for FRP during standing full flexion in asymptomatic participants appeared to be more robust and were not affected by the choice of either lumbar erector spinae or superficial lumbar multifidus. Conversely, during slumped sitting, FRP occurrence varied substantially depending on choice of muscle, although onset angles were relatively consistent between muscles. Although the choice of one muscle over the other may be warranted, it may be prudent to examine both muscles during FRP investigations in sitting postures, in order to fully characterize the behavior and activation patterns of the lumbar musculature.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Floyd WF
        • Silver PHS
        The function of erector spinae muscles in certain movements and postures in man.
        J Physiol. 1955; 129: 184-203
        • Dankaerts W
        • O'Sullivan P
        • Burnett A
        • Straker L
        Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients.
        Spine. 2006; 31: 2017-2023
        • Geisser ME
        • Ranavaya M
        • Haig AJ
        • et al.
        A meta-analytic review of surface electromyography among persons with low back pain and normal, healthy controls.
        J Pain. 2005; 6: 711-726
        • Watson PJ
        • Booker CK
        • Main CJ
        • Chen CAN
        Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio.
        Clin Biomech. 1997; 12: 165-171
        • Colloca CJ
        • Hinrichs RN
        The biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: a review of literature.
        J Manipulative Physiol Ther. 2005; 28: 623-631
        • Schinkel-Ivy A
        • Nairn BC
        • Drake JDM
        Evaluation of methods for the quantification of the flexion-relaxation phenomenon in the lumbar erector spinae muscles.
        J Manipulative Physiol Ther. 2013; 36: 349-358
        • Kippers V
        • Parker AW
        Posture related to myoelectric silence of erectors spinae during trunk flexion.
        Spine. 1984; 9: 740-745
        • Schultz AB
        • Haderspeck-Grib K
        • Sinkora G
        • Warwick DN
        Quantitative studies of the flexion-relaxation phenomenon in the back muscles.
        J Orthop Res. 1985; 3: 189-197
        • Gupta A
        Analyses of myo-electrical silence of erectors spinae.
        J Biomech. 2001; 34: 491-496
        • Shirado O
        • Ito T
        • Kaneda K
        • Strax TE
        Flexion-relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain.
        Am J Phys Med Rehabil. 1995; 74: 139-144
        • Neblett R
        • Mayer TG
        • Gatchel RJ
        • Keeley J
        • Proctor T
        • Anagnostis C
        Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications.
        Spine. 2003; 28: 1435-1446
        • 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: 153-160
        • Alschuler KN
        • Neblett R
        • Wiggert E
        • Haig AJ
        • Geisser ME
        Flexion-relaxation and clinical features associated with chronic low back pain: a comparison of different methods of quantifying flexion-relaxation.
        Clin J Pain. 2009; 25: 760-766
        • Callaghan JP
        • Dunk NM
        Examination of the flexion relaxation phenomenon in erector spinae muscles during short duration slumped sitting.
        Clin Biomech. 2002; 17: 353-360
        • Mak JNF
        • Hu Y
        • Cheng ACS
        • Kwok HY
        • Chen YH
        • Luk KDK
        Flexion-relaxation ratio in sitting: application in low back pain rehabilitation.
        Spine. 2010; 35: 1532-1538
        • Owens EF
        • Ram Gudavalli M
        • Wilder DG
        Paraspinal muscle function assessed with the flexion-relaxation ratio at baseline in a population of patients with back-related leg pain.
        J Manipulative Physiol Ther. 2011; 34: 594-601
        • Lalanne K
        • Lafond D
        • Descarreaux M
        Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study.
        J Manipulative Physiol Ther. 2009; 32: 203-209
        • Astfalck RG
        • O'Sullivan PB
        • Straker LM
        • et al.
        Sitting postures and trunk muscle activity in adolescents with and without nonspecific chronic low back pain.
        Spine. 2010; 35: 1387-1395
        • O'Sullivan PB
        • Grahamslaw KM
        • Kendell M
        • Lapendskie SC
        • Moller NE
        • Richards KV
        The effect of different standing and sitting postures on trunk muscle activity in a pain-free population.
        Spine. 2002; 27: 1238-1244
        • O'Sullivan P
        • Dankaerts W
        • Burnett A
        • et al.
        Evaluation of the flexion relaxation phenomenon of the trunk muscles in sitting.
        Spine. 2006; 31: 2009-2016
        • Nairn BC
        • Chisholm SR
        • Drake JDM
        What is slumped sitting? A kinematic and electromyographical evaluation.
        Man Ther. 2013; 18: 498-505
        • O'Sullivan PB
        • Dankaerts W
        • Burnett AF
        • et al.
        Effect of different upright sitting postures on spinal-pelvic curvature and trunk muscle activation in a pain-free population.
        Spine. 2006; 31: E707-E712
        • McGill SM
        A myoelectrically based dynamic three-dimensional model to predict loads on lumbar spine tissues during lateral bending.
        J Biomech. 1992; 25: 395-414
        • Dickey JP
        • McNorton S
        • Potvin JR
        Repeated spinal flexion modulates the flexion-relaxation phenomenon.
        Clin Biomech. 2003; 18: 783-789
        • Drake JDM
        • Callaghan JP
        Elimination of electrocardiogram contamination from electromyogram signals: an evaluation of currently used removal techniques.
        J Electromyogr Kinesiol. 2006; 16: 175-187
        • Brereton LC
        • McGill SM
        Frequency response of spine extensors during rapid isometric contractions: effects of muscle length and tension.
        J Electromyogr Kinesiol. 1998; 8: 227-232
        • Winter DA
        Biomechanics and motor control of human movement.
        4th ed. John Wiley & Sons Inc., Hoboken2009