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Understanding the impact of lumbar disc degeneration and chronic low back pain: a cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations

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Title: Understanding the impact of lumbar disc degeneration and chronic low back pain: a cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations
Authors: Deane, JA
Lim, AKP
McGregor, AH
Strutton, PH
Item Type: Journal Article
Abstract: 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.
Issue Date: 1-Apr-2021
Date of Acceptance: 24-Mar-2021
URI: http://hdl.handle.net/10044/1/89100
DOI: 10.1371/journal.pone.0249308
ISSN: 1932-6203
Publisher: Public Library of Science (PLoS)
Journal / Book Title: PLoS One
Volume: 16
Issue: 4
Copyright Statement: © 2021 Deane et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: Arthritis Research UK
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
General Science & Technology
Publication Status: Published
Article Number: ARTN e0249308
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Department of Surgery and Cancer



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