Differentiation of the Strength of Back Muscle Contraction Under Fatigue: Does Force Feedback Play a Role?

Quantitative assessments of paraspinal muscles and their relationship with lumbar extensor muscle function based on Dixon magnetic resonance imaging techniques

BackgroundThe dysfunction of paraspinal muscles is closely associated with degenerative spine disorders and the development of low-back pain. Currently, methods for evaluating paraspinal muscle function mainly focus on anatomical imaging and functional assessment.ObjectiveThis study aimed to explore the quantitative assessments of paraspinal muscles and their relationship with the strength and endurance of lumbar extensor muscles based on magnetic resonance imaging with Dixon techniques.MethodsFifty-four volunteers aged 45 years and older were recruited from our outpatient clinic. The participants underwent 3.0-T Dixon magnetic resonance imaging of the lumbar region. The Dixon sequence was used for measuring the cross-sectional area (CSA) and fat infiltration (FI) of paraspinal muscles (multifidus, erector spinae, and psoas major) at the L1-S1 level. The strength and endurance of lumbar extensor muscles were assessed using a standing external fixation testing bracket. Pearson or Spearman coefficients were used to evaluate the relationship between the quantitative assessment indicators of paraspinal muscle degeneration and the strength and endurance of lumbar extensor muscles (corrected for body height [BH] and weight [BW]).ResultsAt the L1-2 level, multifidus FI negatively correlated with extensor strength (ES), ES/BH, extensor endurance (EE), EE/BH, and EE/BW (r = -0.286, -0.269, -0.317, -0.306, -0.281; P < 0.05), and erector spinae FI negatively correlated with EE, EE/BH, and EE/BW (r = -0.315, -0.293, -0.268; P < 0.05). At the L2-3 level, multifidus FI negatively correlated with EE, EE/BH, and EE/BW (r = -0.358, -0.347, -0.327; P < 0.05), and erector spinae FI negatively correlated with EE, EE/BH, and EE/BW (r = -0.334, -0.310, -0.283; P < 0.05). At the L3-4 level, multifidus FI negatively correlated with EE (r = -0.271, P < 0.05), and psoas major CSA negatively correlated with ES/BW (r = -0.299, P < 0.05). At the L4-5 level, multifidus FI negatively correlated with EE and EE/BH (r = -0.286, -0.268; P < 0.05). At the L5-S1 level, multifidus FI negatively correlated with EE, EE/BH, and EE/BW (r = -0.418, -0.404, -0.377; P < 0.05).ConclusionThe FI of multifidus at the L5-S1 level may reflect the endurance level of extensor muscles to some extent. The FI of paraspinal muscles is relatively better than CSA in predicting the strength and endurance of lumbar extensor muscles. Proper extensor muscle functional exercises may slow down the process of paraspinal muscle FI to some extent.

Strength and Power-Related Measures in Assessing Core Muscle Performance in Sport and Rehabilitation

While force-velocity-power characteristics of resistance exercises, such as bench presses and squats, have been well documented, little attention has been paid to load, force, and power-velocity relationships in exercises engaging core muscles. Given that power produced during lifting tasks or trunk rotations plays an important role in most sport-specific and daily life activities, its measurement should represent an important part of the test battery in both athletes and the general population. The aim of this scoping review was 1) to map the literature related to testing methods assessing core muscle strength and stability in sport and rehabilitation, chiefly studies with particular focus on force-velocity-power characteristics of exercises involving the use of core muscles, 2) and to identify gaps in existing studies and suggest further research in this field. The literature search was conducted on Cochrane Library databases, Scopus, Web of Science, PubMed and MEDLINE, which was completed by SpringerLink, Google Scholar and Elsevier. The inclusion criteria were met in 37 articles. Results revealed that among a variety of studies investigating the core stability and core strength in sport and rehabilitation, only few of them analyzed force-velocity-power characteristics of exercises involving the use of core muscles. Most of them evaluated maximal isometric strength of the core and its endurance. However, there are some studies that assessed muscle power during lifting tasks at different loads performed either with free weights or using the Smith machine. Similarly, power and velocity were assessed during trunk rotations performed with different weights when standing or sitting. Nevertheless, there is still scant research investigating the power-velocity and force-velocity relationship during exercises engaging core muscles in able-bodied and para athletes with different demands on stability and strength of the core. Therefore, more research is needed to address this gap in the literature and aim research at assessing strength and power-related measures within cross-sectional and intervention studies. A better understanding of the power-force-velocity profiles during exercises with high demands on the core musculature has implications for designing sport training and rehabilitation programs for enhancement of athletes' performance and/or decrease their risk of back pain.

The association of reactive balance control and spinal curvature under lumbar muscle fatigue

Background

Although low back fatigue is an important intervening factor for physical functioning among sedentary people, little is known about its possible significance in relation to the spinal posture and compensatory postural responses to unpredictable stimuli. This study investigates the effect of lumbar muscle fatigue on spinal curvature and reactive balance control in response to externally induced perturbations.

Methods

A group of 38 young sedentary individuals underwent a perturbation-based balance test by applying a 2 kg load release. Sagittal spinal curvature and pelvic tilt was measured in both a normal and Matthiass standing posture both with and without a hand-held 2 kg load, and before and after the Sørensen fatigue test.

Results

Both the peak anterior and peak posterior center of pressure (CoP) displacements and the corresponding time to peak anterior and peak posterior CoP displacements significantly increased after the Sørensen fatigue test (all at p < 0.001). A lumbar muscle fatigue led to a decrease of the lumbar lordosis in the Matthiass posture while holding a 2 kg load in front of the body when compared to pre-fatigue conditions both without a load (p = 0.011, d = 0.35) and with a 2 kg load (p = 0.000, d = 0.51). Also the sacral inclination in the Matthiass posture with a 2 kg additional load significantly decreased under fatigue when compared to all postures in pre-fatigue conditions (p = 0.01, d = 0.48). Contrary to pre-fatigue conditions, variables of the perturbation-based balance test were closely associated with those of lumbar curvature while standing in the Matthiass posture with a 2 kg additional load after the Sørensen fatigue test (r values in range from −0.520 to −0.631, all at p < 0.05).

Conclusion

These findings indicate that lumbar muscle fatigue causes changes in the lumbar spinal curvature and this is functionally relevant in explaining the impaired ability to maintain balance after externally induced perturbations. This emphasizes the importance for assessing both spinal posture and reactive balance control under fatigue in order to reveal their interrelations in young sedentary adults and predict any significant deterioration in later years.

Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes?

The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.