Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain

AbstractMotor control exercise (MCE) is commonly prescribed for patients with low back pain. Although MCE can improve clinical outcomes, lumbar multifidus muscle (LM) activation remains unchanged. Neuromuscular electrical stimulation (NMES) can be used to re-activate motor units prior to MCE which should result in increased LM activation. Therefore, this study aimed to explore the immediate effects of NMES combined with MCE on LM activation and motor performance. Twenty-five participants without low back pain (NoLBP) and 35 participants with movement control impairment (MCI) were recruited. Participants with MCI were further randomized to combined NMES with MCE (COMB) or sham-NMES with MCE (MCE) group. Ultrasound imaging was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and NMES with MVIC. These data were used to calculate LM activation. Quadruped rocking backward was used to represent motor performance. LM activation and motor performance were measured at baseline and after one-session of intervention. Results showed that both COMB and MCE groups had significantly lower (P < 0.05) LM activation compared with NoLBP group at baseline. Additionally, both COMB and MCE groups demonstrated significant improvement (P < 0.05) in motor performance while COMB group demonstrated significantly greater improvement (P < 0.05) in LM activation compared with MCE group. Individuals with MCI still have persisting LM activation deficit. Our key findings suggest that combined NMES and MCE may have better ability to improve LM activation in individuals with MCI. These findings would support the utility of NMES to induce a priming effect before MCE.

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Does Motor Control Exercise Restore Normal Morphology of Lumbar Multifidus Muscle in People with Low Back Pain? – A Systematic Review

Journal of Pain Research ◽

10.2147/jpr.s314971 ◽

2021 ◽

Vol Volume 14 ◽

pp. 2543-2562

Author(s):

Sabina M Pinto ◽

Sweta B Boghra ◽

Luciana G Macedo ◽

Yong-Ping Zheng ◽

Marco YC Pang ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Low Back ◽

Multifidus Muscle ◽

Lumbar Multifidus ◽

Normal Morphology ◽

Control Exercise ◽

Lumbar Multifidus Muscle

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Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial

Physical Therapy ◽

10.2522/ptj.20090218 ◽

2009 ◽

Vol 89 (12) ◽

pp. 1275-1286 ◽

Cited By ~ 155

Author(s):

Leonardo O.P. Costa ◽

Christopher G. Maher ◽

Jane Latimer ◽

Paul W. Hodges ◽

Robert D. Herbert ◽

...

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Chronic Low Back Pain ◽

Exercise Intervention ◽

Patient Specific ◽

Low Back ◽

Functional Scale ◽

The Mean ◽

Control Exercise

BackgroundThe evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled.ObjectiveThe purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain.DesignThis was a randomized, placebo-controlled trial.SettingThe study was conducted in an outpatient physical therapy department in Australia.PatientsThe participants were 154 patients with chronic low back pain of more than 12 weeks’ duration.InterventionTwelve sessions of motor control exercise (ie, exercises designed to improve function of specific muscles of the low back region and the control of posture and movement) or placebo (ie, detuned ultrasound therapy and detuned short-wave therapy) were conducted over 8 weeks.MeasurementsPrimary outcomes were pain intensity, activity (measured by the Patient-Specific Functional Scale), and patient's global impression of recovery measured at 2 months. Secondary outcomes were pain; activity (measured by the Patient-Specific Functional Scale); patient's global impression of recovery measured at 6 and 12 months; activity limitation (measured by the Roland-Morris Disability Questionnaire) at 2, 6, and 12 months; and risk of persistent or recurrent pain at 12 months.ResultsThe exercise intervention improved activity and patient's global impression of recovery but did not clearly reduce pain at 2 months. The mean effect of exercise on activity (measured by the Patient-Specific Functional Scale) was 1.1 points (95% confidence interval [CI]=0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95% CI=0.4 to 2.5), and the mean effect on pain was 0.9 points (95% CI=−0.01 to 1.8), all measured on 11-point scales. Secondary outcomes also favored motor control exercise.LimitationClinicians could not be blinded to the intervention they provided.ConclusionsMotor control exercise produced short-term improvements in global impression of recovery and activity, but not pain, for people with chronic low back pain. Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups.

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Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: a randomized controlled trial

Brazilian Journal of Physical Therapy ◽

10.1016/j.bjpt.2018.10.003 ◽

2019 ◽

Vol 23 (6) ◽

pp. 506-515 ◽

Cited By ~ 2

Author(s):

Muhammad Alrwaily ◽

Michael Schneider ◽

Gwendolyn Sowa ◽

Michael Timko ◽

Susan L. Whitney ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Electrical Stimulation ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Controlled Trial ◽

Neuromuscular Electrical Stimulation ◽

Low Back ◽

Randomized Controlled

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Motor control exercise for chronic non-specific low-back pain (PEDro synthesis)

British Journal of Sports Medicine ◽

10.1136/bjsports-2016-097266 ◽

2017 ◽

Vol 51 (13) ◽

pp. 1037-1038 ◽

Cited By ~ 3

Author(s):

Cameron C New ◽

Jasan Dannaway ◽

Heather New ◽

Charles H New

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Low Back ◽

Control Exercise

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Does Neuromuscular Electrical Stimulation Have an Additive Effect on Disability, Pain and Abdominal and Lumbar Muscle Thickness in Chronic Low Back Pain? – A Randomized Controlled Double-Blind Study

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin ◽

10.1055/a-1577-9849 ◽

2021 ◽

Author(s):

Ecenur Atli ◽

Dilber Karagozoglu Coskunsu ◽

Zeynep Turan ◽

Ozden Ozyemisci Taskiran

Keyword(s):

Electrical Stimulation ◽

Low Back Pain ◽

Back Pain ◽

Outcome Measures ◽

Chronic Low Back Pain ◽

Neuromuscular Electrical Stimulation ◽

Muscle Thickness ◽

Transversus Abdominis ◽

Control Group ◽

Low Back

Abstract Objective To examine the effect of neuromuscular electrical stimulation (NMES) combined with core stabilization exercises (CSE) in patients with chronic low back pain (CLBP). Methods Thirty-six patients (mean age 33.6±12.6 years) with CLBP were randomly assigned to 4 weeks (12 sessions) of NMES group (NMES combined with CSE) (n=18) vs. Control group (sham NMES and CSE) (n=18). After the 4 weeks, same exercises were given as home exercise program without NMES. The outcome measures were Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Nottingham Health Profile (NHP) and ultrasonography. Ultrasonography was used for measuring transversus abdominis (TrA), internal oblique (IO), external oblique (EO) muscles thickness and lumbar multifidus muscle thickness and area. Assessments were performed at baseline and 4th week and eighth week follow-up. Results In both groups, the change of ODI, VAS and NHP values of the first measurement according to the values of the 4th week and the eighth week were found statistically significant (p=0.001; p<0.01). There were no statistically significant differences in ODI, VAS and NHP scores between the 4th week and the eighth week in both groups (p>0.05). None of NMES and control group measurements with US showed a statistically significant increase in the TrA, IO, EO thickness and multifidus thickness and area (p>0.05). Conclusions It was shown that NMES can be tolerated by patients with CLBP, but the addition of simultaneus NMES to CSE had no contribution to the clinical outcome measures.

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Effectiveness of motor control exercise on non-specific chronic low back pain, disability and core muscle morphological characteristics: a meta-analysis of randomized controlled trials

European Journal of Physical and Rehabilitation Medicine ◽

10.23736/s1973-9087.21.06555-2 ◽

2021 ◽

Vol 57 (5) ◽

Author(s):

Chanjuan ZHANG ◽

Yuelong LI ◽

Yuhua ZHONG ◽

Chenyang FENG ◽

Zhou ZHANG ◽

...

Keyword(s):

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Meta Analysis ◽

Morphological Characteristics ◽

Controlled Trials ◽

Low Back ◽

Randomized Controlled ◽

Pain Disability ◽

Control Exercise

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Exploring Neuromuscular Electrical Stimulation Intensity Effects on Multifidus Muscle Activity in Adults With Chronic Low Back Pain: An Ultrasound Imaging–Informed Investigation

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119849570 ◽

2019 ◽

Vol 12 ◽

pp. 117954411984957 ◽

Cited By ~ 1

Author(s):

Jaclyn Megan Sions ◽

DeJ’a Chyanna Crippen ◽

Gregory Evan Hicks ◽

Abdulmohsen Meshari Alroumi ◽

Tara Jo Manal ◽

...

Keyword(s):

Electrical Stimulation ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Muscle Activity ◽

Neuromuscular Electrical Stimulation ◽

Low Back ◽

High Tolerance ◽

Multifidus Muscle ◽

Thickness Change

Study design: Cross-sectional study. Background: Neuromuscular electrical stimulation (NMES) is an effective tool for stimulating multifidus muscle contractions. Ultrasound imaging (USI) is valid and reliable for quantifying multifidus activity represented by percent thickness change from a resting to contracted state. Thus, USI may be used to help determine optimal NMES intensity. Objectives: To explore NMES intensity effects on multifidus thickening in adults with chronic low back pain (CLBP). Methods: Sixty patients with CLBP participated. L4/5 multifidus ultrasound images were obtained and percent thickness change from a resting to a contracted state was determined at baseline with a limb lift and during NMES application. During NMES, the examiner recorded the intensity, in milliampere, when the multifidus first started to thicken as observed with USI. The examiner also recorded the NMES intensity that resulted in no further multifidus thickening (ie, high-tolerance group) or, in cases where maximal thickening was not observed, the NMES intensity of the submaximal contraction (ie, low-tolerance group). Differences between participants with high versus low NMES tolerance were evaluated. Results: During NMES, the multifidus began thickening at a higher intensity for the high-tolerance group (n = 39), that is, 34 mA, compared with the low-tolerance group (n = 21), that is, 32 mA ( P = .001). A greater mean intensity in the high-tolerance group, that is, 62 mA, as compared to 45 mA in the low-tolerance group, resulted in a larger percent thickness change, that is, 30.89% compared to 20.60%, respectively ( P < .001). Conclusions: Results provide clinicians with NMES intensity targets to facilitate multifidus muscle thickening, which provides insight into muscle activity.

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