(Verbatim from application) Revised Application: Because the specific causes underlying low back pain LBP have not yet been identified, it continues to be a significant public health problem. Many of the factors associated with low-back pain are mechanical in nature. Epidemiological and biomechanical studies have suggested that there is a link between sudden and unexpected loading, such as slips and falls, and low-back injuries. Under these circumstances, motor control of the mechanical stability of the lumbar spine is crucial in determining trunk kinematic response to sudden loading and the subsequent likelihood of injury. Compared to healthy controls, however, LBP patients exhibit deficits in motor control such as delayed trunk muscle reflex response, poor trunk positioning sense, and impaired postural control. These deficits may constitute predisposing risk factors for sustaining an injury, a compensation/pain avoidance mechanism, or they may be the consequence of damage sustained by the lumbar spine tissues. The objective of the proposed research is to improve our understanding of the relationship between the measured motor control deficit and LBP. Two experimental studies and a post-hoc analysis of the entire data set form the 3 specific aims. The first prospective design study will consist of the initial testing and a 2-year follow-up of varsity athletes. The goal is to determine whether poor motor control of the lumbar spine increases the risk for sustaining a low-back injury. The second randomized prospective study will be conducted to document the changes in motor control of the lumbar spine in LBP patients before and after standard and modified rehabilitation programs that emphasize motor control training. Several tests, developed in preliminary studies, will quantify the deficit in the motor control in LBP individuals: response of trunk muscles to a sudden, multi-directional load release and the stability of the lumbar spine, and postural control of the trunk in unstable sitting. Correlations between the above measures of motor control and other variables in the LBP population will be determined in the third specific aim. These additional variables will include: trunk position and motion proprioception, objective and subjective measures of physical function, diagnosis and duration of symptoms, and personal characteristics such as age and gender. The results of the proposed research will have a significant clinical relevance for designing more effective prevention, diagnosis, and rehabilitation strategies for LBP.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Geriatrics and Rehabilitation Medicine (GRM)
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Panagis, James S
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Yale University
Schools of Medicine
New Haven
United States
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Zazulak, Bohdanna; Cholewicki, Jacek; Reeves, N Peter (2008) Neuromuscular control of trunk stability: clinical implications for sports injury prevention. J Am Acad Orthop Surg 16:497-505
Lee, Angela S; Cholewicki, Jacek; Reeves, N Peter (2007) The effect of background muscle activity on computerized detection of sEMG onset and offset. J Biomech 40:3521-6
Silfies, Sheri P; Cholewicki, Jacek; Reeves, N Peter et al. (2007) Lumbar position sense and the risk of low back injuries in college athletes: a prospective cohort study. BMC Musculoskelet Disord 8:129
Zazulak, Bohdanna T; Hewett, Timothy E; Reeves, N Peter et al. (2007) Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med 35:1123-30
Reeves, N Peter; Cholewicki, Jacek; Silfies, Sheri P (2006) Muscle activation imbalance and low-back injury in varsity athletes. J Electromyogr Kinesiol 16:264-72
Reeves, N P; Cholewicki, J; Milner, T E (2005) Muscle reflex classification of low-back pain. J Electromyogr Kinesiol 15:53-60
Cholewicki, Jacek; Silfies, Sheri P; Shah, Riaz A et al. (2005) Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine (Phila Pa 1976) 30:2614-20
Silfies, Sheri P; Cholewicki, Jacek; Radebold, Andrea (2003) The effects of visual input on postural control of the lumbar spine in unstable sitting. Hum Mov Sci 22:237-52
Masi, A T; Dorsch, J L; Cholewicki, J (2003) Are adolescent idiopathic scoliosis and ankylosing spondylitis counter-opposing conditions? A hypothesis on biomechanical contributions predisposing to these spinal disorders. Clin Exp Rheumatol 21:573-80
Reeves, N Peter; Cholewicki, Jacek (2003) Modeling the human lumbar spine for assessing spinal loads, stability, and risk of injury. Crit Rev Biomed Eng 31:73-139

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