A new concept for evaluating muscle function in the lower extremities in cases of low back pain syndrome in anamnesis
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Department of Rheumatology and Rehabilitation, University of Medical Sciences, Poznań, Poland
Department of Pathophysiology of Locomotor Organs, University of Medical Sciences in Poznań, Poland
Department of Rheumatology and Rehabilitation, University of Medical Sciences in Poznań, Poland
Department of Allergology and Environmental Hazards, Institute of Rural Health, Lublin, Poland
Department of Clinical Psychology, University of Medical Sciences in Poznań, Poland
Ann Agric Environ Med. 2014;21(2):375-381
There are difficulties in objective evaluation of activity of the muscles in the lower extremities of patients after successful treatment of sciatica and pseudosciatica, when no clear clinical symptoms are detected. However, the existence of some muscle dysfunction can be hypothesised and its detection was the aim of the study.

Recordings from chosen lower extremity muscles during standing were performed as supplementary differential diagnosis in evaluation of these patients. EMG in standing positions constitutes a new methodological approach not described in detail.

Twenty patients (11 after sciatica and 9 after sciatica-like episodes) were enrolled into the study. On the day of examination, clinical and electroneurographical (ENG; M and F waves tests) studies showed no pathology. The percentage of maximal voluntary contraction (MVC) defined muscle activity during standing. Mean amplitude and number of changes in muscle activity (fluctuations) were measured in surface electromyography recordings (sEMG) during normal standing and tandem positions.

Results and conclusions:
Activity of proximal lower extremity muscles expressed as percentage of MVC was bilaterally increased in patients after sciatica in normal standing position, compared with results from the group of healthy volunteers (N=9). Patients after sciatica were also characterized with a significant increase of mean sEMG amplitude, recorded especially in distal muscles on the affected side during tandem position. This pathological change was related to decrease in ‘fluctuations’ frequency in patients after sciatica (P<0.001) more than after pseudosciatica (P<0.01) groups in both standing positions, compared to parameters of healthy volunteers. Sciatica and pseudosciatica in anamnesis cause different abnormal patterns of lower extremity muscle activity during standing positions when recorded with surface EMG.

Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis and the role of epidural steroid injection in management. Br J Anaesth. 2007; 99: 461–473.
Freynhagen R, Rolke R, Baron R, Tolle TR, Rutjes AK, Schu S, Treede R-D. Pseudoradicular and radicular low-back pain – A disease continuum rather than different entities? Answers from quantitative sensory testing. Pain 2008; 135: 65–74.
Vroomen PCAJ, de Krom MCTFM, Wilmink JT, Kester ADM, Knottnerus JA. Diagnostic value of history and physical examination in patients suspected of lumbosacral nerve root compression. J Neurol Neurosurg Psychiatry. 2002; 72: 630–634.
Wolff AP, Groen GJ, Wilder-Smith OHG. Diagnosis of chronic radiating lower back pain without overt focal neurologic deficits: what is the value of segmental nerve blocks? Therapy 2005; 2: 577–585.
Margules KR, Gall EP. Sciatica-like pain arising in the sacroiliac joint. J Clin Rheumatol. 1997; 3: 9–15.
Rankine JJ. Further doubt is cast on the significance of the high intensity zone. Clin Radiol. 2004; 59: 1000–1001.
Sheehan NJ. Magnetic resonance imaging for low back pain: indications and limitations. Ann Rheum Dis. 2010;69:7–11.
Fisher MA, Bajwa R, Somashekar KN. Routine electrodiagnosis and a multiparameter technique in lumbosacral radiculopathies. Acta Neurol Scand. 2008; 118: 99–105.
Pastore-Olmedo C, Gonzalez O, Geijo-Barrientos E. A study of F-waves in patients with unilateral lumbosacral radiculopathy. Eur J Neurol. 2009; 16: 1233–1239.
Kendall R, Werner RA. Interrater reliability of the needle examination in lumbosacral radiculopathy. Muscle Nerve. 2006; 34: 238–241.
Lafond D, Champagne A, Descarreaux M, Dubois JD, Prado JM, Duarte M. Postural control during prolonged standing in persons with chronic low back pain. Gait Posture. 2009; 29: 421–427.
Marshall PW, Patel H, Callaghan JP. Gluteus medius strength, endurance, and co-activation in the development of low back pain during prolonged standing. Hum Mov Sci. 2011; 30: 63–73.
Heydari A, Nargol AVF, Jones APC, Humphrey AR, Greenough ChG. EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain. Eur Spine J. 2010; 19: 1145–1152.
Pullman SL, Goodin DS, Marquinez AI, Tabbal S, Rubin M. Clinical utility of surface EMG. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2000; 55: 171–177.
Huber J, Lisiński P, Samborski W, Wytrążek M. The effect of early isometric exercises on clinical and neurophysiological parameters in patients with sciatica: an interventional randomized one-blinded study. Isokinet Exerc Sci. 2011; 19: 207–214.
Wytrążek M, Huber J, Lisiński P. Changes in muscle activity determine progression of clinical symptoms in patients with chronic spine-related muscle pain. A complex clinical and neurophysiological approach. Funct Neurol. 2011; 26: 141–149.
Veiersted KB, Westgaard RH, Andersen P. Pattern of muscle activity during stereotyped work and its relation to muscle pain. Int Arch Occup Environ Health. 1990; 62: 31–41.
Jensen C, Nielsen K, Hansen K, Westgaard RH. Trapezius muscle load as a risk indicator for occupational shoulder-neck complaints. Int Arch Occup Environ Health. 1993; 64: 415–423.
Suri P, Rainville J, Katz JN, Jouve C, Hartigan C, Limke J, Pena E, Li L, Swaim B, Hunter DJ. The accuracy of the physical examination for the diagnosis of midlumbar and low lumbar nerve root impingement. Spine. 2011; 36: 63–73.
Rainoldi A, Melchiorri G, Caruso I. A method for positioning electrodes during surface EMG recordings in lower limb muscles. J Neurosci Meth. 2004; 134: 37–43.
Lisiński P, Huber J, Samborski W, Witkowska A. Neurophysiological assessment of the electrostimulation procedures used in stroke patients during rehabilitation. Int J Artif Organs. 2008; 31: 76–86.
Nardin RA, Patel MR, Gudas TF, et al. Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve. 1999; 22: 151–155.
Nardin RA, Patel MR, Gudas TF, Rutkove SB, Raynor EM. Alternate activity in the synergistic muscles during prolonged low-level contractions. J Appl Physiol. 1998; 84: 1943–1951.
Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P. The influence of low back pain on muscle activity and coordination during gait: A clinical and experimental study. Pain. 1996; 64: 231–240.
Van Dieën JH, Cholewicki J, Radebold A. Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine. 2003; 28: 834–841.
Hodges PW, Moseley GL. Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyograph Kinesiol. 2003; 13: 361–370.
Nordander C, Hansson GA, Rylander L, Asterland P, Byström JU, Ohlsson K, Balogh I, Skerfving S. Muscular rest and gap frequency as EMG measures of physical exposure: the impact of work tasks and individual related factors. Ergonomics. 2000; 43: 1904–1919.
Riley ZA, Terry ME, Mendes-Villanueva A, Litsey JC, Enoka RM. Motor units recruitment and bursts activity in the surface electromyography during a sustained contraction. Muscle Nerve. 2008; 37: 745–753.
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