Poor neuromuscular control, such as delayed muscle recruitment or alterations in levels of muscle activation, can lead to abnormal loads on joints and ligaments of the spine, leading to spinal instability and lower back pain (LBP). Active contraction of trunk muscles helps to control inter-segmental movement and stability in the lumbar spine by adding stiffness to the trunk. Muscle dysfunction associated with LBP has been thought to involve deep, local trunk muscles - the transversus abdominis (TA) and multifidus muscles. These muscles are hypothesized to provide stability to the lumbar spine. Treatments which focus on retraining TA and multifidus by using low level isometric contractions of these specific deep trunk muscles during particular tasks and functional activities have been effective at reducing LBP and improving function for selected subgroups of LBP subjects. The precise muscle dysfunction associated with LBP has not been satisfactorily characterized, in part because muscles such as TA and multifidus are difficult to characterize directly given their anatomical location. However, analytical modeling can assist in characterizing these deeper muscles. A more complete characterization of the function of these muscles can lead to more precise treatments of LBP. ? ? The three major aims of this project are: 1) to characterize the pre-treatment motor control alterations (alterations in muscle latencies or in modulation of muscle activity level) in subjects with spondylolisthesis and mechanical LBP compared to healthy control subjects, and to determine whether specific deep trunk-muscle exercises (low level isometric contractions of TA and multifidus) improve these alterations compared to a general exercise protocol. We hypothesize that prior to treatment, muscle latencies will be earlier in LBP groups compared to the control group and that the latencies will improve (increase) in LBP subjects receiving specific trunk exercise protocol but not in subjects receiving a general exercise protocol at all time points post-treatment; 2) to employ biomechanical modeling to study mechanisms underlying these specific deep trunk muscle exercises. We hypothesize that increased activation of TA and multifidus muscles increases stability of the trunk by reducing intervetebral motion; and 3) to determine the effects of specific trunk exercises compared to more general strengthening and endurance exercises on pain and function during activities of daily living in the LBP subjects. We hypothesize that subjects in a specific exercise protocol will have decreased pain and increased functional ability compared to subjects in a general exercise protocol, at all time points post-treatment.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD040909-02
Application #
6726791
Study Section
Special Emphasis Panel (ZRG1-GRM (01))
Program Officer
Shinowara, Nancy
Project Start
2003-03-24
Project End
2008-02-29
Budget Start
2004-03-01
Budget End
2005-02-28
Support Year
2
Fiscal Year
2004
Total Cost
$337,399
Indirect Cost
Name
University of Vermont & St Agric College
Department
Other Health Professions
Type
Schools of Allied Health Profes
DUNS #
066811191
City
Burlington
State
VT
Country
United States
Zip Code
05405
Mehta, Rupal; Cannella, Marco; Henry, Sharon M et al. (2017) Trunk Postural Muscle Timing Is Not Compromised In Low Back Pain Patients Clinically Diagnosed With Movement Coordination Impairments. Motor Control 21:133-157
Jacobs, Jesse V; Lomond, Karen V; Hitt, Juvena R et al. (2016) Effects of low back pain and of stabilization or movement-system-impairment treatments on induced postural responses: A planned secondary analysis of a randomised controlled trial. Man Ther 21:210-9
Lomond, Karen V; Jacobs, Jesse V; Hitt, Juvena R et al. (2015) Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial. Spine J 15:596-606
Henry, Sharon M; Van Dillen, Linda R; Ouellette-Morton, Rebecca H et al. (2014) Outcomes are not different for patient-matched versus nonmatched treatment in subjects with chronic recurrent low back pain: a randomized clinical trial. Spine J 14:2799-810
Lomond, Karen V; Henry, Sharon M; Hitt, Juvena R et al. (2014) Altered postural responses persist following physical therapy of general versus specific trunk exercises in people with low back pain. Man Ther 19:425-32
Lomond, Karen V; Henry, Sharon M; Jacobs, Jesse V et al. (2013) Protocol to assess the neurophysiology associated with multi-segmental postural coordination. Physiol Meas 34:N97-105
Zielinski, Kristen A; Henry, Sharon M; Ouellette-Morton, Rebecca H et al. (2013) Lumbar multifidus muscle thickness does not predict patients with low back pain who improve with trunk stabilization exercises. Arch Phys Med Rehabil 94:1132-8
Jones, Stephanie L; Henry, Sharon M; Raasch, Christine C et al. (2012) Individuals with non-specific low back pain use a trunk stiffening strategy to maintain upright posture. J Electromyogr Kinesiol 22:13-20
Jones, Stephanie L; Hitt, Juvena R; DeSarno, Michael J et al. (2012) Individuals with non-specific low back pain in an active episode demonstrate temporally altered torque responses and direction-specific enhanced muscle activity following unexpected balance perturbations. Exp Brain Res 221:413-26
Stokes, Ian A F; Gardner-Morse, Mack G; Henry, Sharon M (2011) Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clin Biomech (Bristol, Avon) 26:797-803

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