Low Back Pain
Conditions
Keywords
Gluteus Maximus, Gluteus Medius, TFL, EMG, Perceived Exertion, Thera-Band
Brief summary
The gluteus medius (Gmed) and gluteus maximus (Gmax) muscles are important components in the treatment of many lower limb injuries. Recent studies have evaluated a myriad of exercises which activate the Gmed and Gmax, but limited research remains on exercises involving resistance and the role of the TFL. The purpose of this study is to evaluate Gmed, Gmax, and TFL percent maximal voluntary isometric contraction (%MVIC) and perceived exertion in healthy and low back pain patients while performing exercises with and without resistance. Methods: A convenience sample of healthy subjects and patients diagnosed with non-radicular low back pain will be recruited. Exclusionary criteria will include: current low back or lower extremity injury (healthy group), pregnancy, history of hip surgery, and radicular symptoms. Surface electromyography will be used to quantify the activity level of the gluteal muscles and TFL while performing a series of 8 exercises with and without Thera-Band® Resistance Tubing and Stability Trainer. The maximal voluntary isometric contraction (MVIC) will be established for each muscle group and the order of exercises performed will be randomized to minimize the effect of fatigue. Following the completion of each exercise, the patient will rate their perceived exertion level on the Thera-Band® Resistance Intensity Scale for Exercise (RISE). The EMG signals will be smoothed and rectified and analyzed using a root-mean-square algorithm. Clinical Relevance: The results of this study will allow clinicians to better prescribe exercises, proven to activate the gluteal muscles and limit the TFL involvement, in the treatment of low back pain.
Interventions
DEVICELower Body Exercises with and without resistance
lower body exercises with and without resistance designed to activate the gluteal/hip musculature
Sponsors
Sport and Spine Rehab Clinical Research Foundation
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* healthy, physically active subjects * patients diagnosed with non-radicular low back pain * 18-65
Exclusion criteria
* current low back or lower extremity injury (healthy group) * pregnancy * history of hip surgery * radicular symptoms
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Maximal Voluntary Isometric Contraction (%MVIC) | One 40 minute session | Percent of Maximal Voluntary Isometric Contraction was measured by placing EMG leads on selected muscles. Data was collected and analyzed with the MyoResearch XP Masters Edition (Noraxam Inc., Scottsdale, AZ). The EMG signals were smoothed and rectified and analyzed using a root-mean-square algorithm. We used visual onset and offset of the EMG signal amplitude to select the middle 3 of 5 trials. The middle three repetitions were analyzed. Average activation and peak activation were determined and then compared to the maximum voluntary isometric contraction (MVIC), captured during a manual muscle test, for each muscle group, and expressed as a %MVIC. The %MVIC can be greater than 100% since the MVIC is captured in a stationary, isometric position using manual force and all other activities are performed in motion against elastic or gravity resistance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Exertion | 16 exercises during one 40 minute session | Thera-Band(R) RISE (Resistance Intensity Scale for Exercise) Scale to measure amount of perceived exertion during resistance band exercises. This is a scale 0 to 10, 0 being extremely easy and 10 being extremely hard. The subject rated the intensity or resistance felt on each exercise on this scale. The ideal range for an exercise is in the middle of the scale (4-7) where the subject is feeling resistance but is not maximally exerted. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Low Back Pain Lower Body Exercises with and without resistance
Lower Body Exercises with and without resistance: lower body exercises with and without resistance designed to activate the gluteal/hip musculature | 15 |
| Healthy Lower Body Exercises with and without resistance
Lower Body Exercises with and without resistance: lower body exercises with and without resistance designed to activate the gluteal/hip musculature | 15 |
| Total | 30 |
Baseline characteristics
| Characteristic | Low Back Pain | Healthy | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 1 Participants | 1 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 15 Participants | 14 Participants | 29 Participants |
| Age, Continuous | 36.2 years | 29 years | 32.6 years |
| Race/Ethnicity, Customized African American | 2 participants | 1 participants | 3 participants |
| Race/Ethnicity, Customized Asian | 1 participants | 0 participants | 1 participants |
| Race/Ethnicity, Customized Caucasian | 11 participants | 11 participants | 22 participants |
| Race/Ethnicity, Customized Hispanic/Latino | 1 participants | 3 participants | 4 participants |
| Sex: Female, Male Female | 6 Participants | 11 Participants | 17 Participants |
| Sex: Female, Male Male | 9 Participants | 4 Participants | 13 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 15 | 0 / 15 |
| serious Total, serious adverse events | 0 / 15 | 0 / 15 |
Outcome results
Primary
Percent of Maximal Voluntary Isometric Contraction (%MVIC)
Percent of Maximal Voluntary Isometric Contraction was measured by placing EMG leads on selected muscles. Data was collected and analyzed with the MyoResearch XP Masters Edition (Noraxam Inc., Scottsdale, AZ). The EMG signals were smoothed and rectified and analyzed using a root-mean-square algorithm. We used visual onset and offset of the EMG signal amplitude to select the middle 3 of 5 trials. The middle three repetitions were analyzed. Average activation and peak activation were determined and then compared to the maximum voluntary isometric contraction (MVIC), captured during a manual muscle test, for each muscle group, and expressed as a %MVIC. The %MVIC can be greater than 100% since the MVIC is captured in a stationary, isometric position using manual force and all other activities are performed in motion against elastic or gravity resistance.
Time frame: One 40 minute session
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | ClamsR | 73.5 percentage of MVIC of gmax | Standard Deviation 17.8 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | Clams | 62.7 percentage of MVIC of gmax | Standard Deviation 12.6 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | HipExt | 41.5 percentage of MVIC of gmax | Standard Deviation 8.6 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | STHipExtR | 44.1 percentage of MVIC of gmax | Standard Deviation 12.3 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | SLHipAB | 59.3 percentage of MVIC of gmax | Standard Deviation 12.9 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | STHipAB_R | 55.8 percentage of MVIC of gmax | Standard Deviation 11.9 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | QuadHipExt | 44.9 percentage of MVIC of gmax | Standard Deviation 8 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | QuadHipExtR | 54.1 percentage of MVIC of gmax | Standard Deviation 12.2 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | Bridge | 33.6 percentage of MVIC of gmax | Standard Deviation 7.7 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | BridgeR | 37.3 percentage of MVIC of gmax | Standard Deviation 6.9 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | FireHydrant | 86.4 percentage of MVIC of gmax | Standard Deviation 16 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | FireHydrantR | 93.9 percentage of MVIC of gmax | Standard Deviation 17.3 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | Lunge | 55.8 percentage of MVIC of gmax | Standard Deviation 12.8 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | LungeR | 50.9 percentage of MVIC of gmax | Standard Deviation 11.9 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | RunningMan | 102.5 percentage of MVIC of gmax | Standard Deviation 23.7 |
| Low Back Pain | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | RunningManR | 103.4 percentage of MVIC of gmax | Standard Deviation 21.5 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | RunningManR | 56 percentage of MVIC of gmax | Standard Deviation 21.5 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | ClamsR | 57.6 percentage of MVIC of gmax | Standard Deviation 17.8 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | Bridge | 16.9 percentage of MVIC of gmax | Standard Deviation 7.7 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | Clams | 37 percentage of MVIC of gmax | Standard Deviation 12.6 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | Lunge | 25.1 percentage of MVIC of gmax | Standard Deviation 12.8 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | HipExt | 28.6 percentage of MVIC of gmax | Standard Deviation 8.6 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | BridgeR | 20.8 percentage of MVIC of gmax | Standard Deviation 6.9 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | STHipExtR | 23.8 percentage of MVIC of gmax | Standard Deviation 12.3 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | RunningMan | 56.1 percentage of MVIC of gmax | Standard Deviation 23.7 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | SLHipAB | 37.2 percentage of MVIC of gmax | Standard Deviation 12.9 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | FireHydrant | 52.5 percentage of MVIC of gmax | Standard Deviation 16 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | STHipAB_R | 37 percentage of MVIC of gmax | Standard Deviation 11.9 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | LungeR | 24.2 percentage of MVIC of gmax | Standard Deviation 11.9 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | QuadHipExt | 23.5 percentage of MVIC of gmax | Standard Deviation 8 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | FireHydrantR | 57.3 percentage of MVIC of gmax | Standard Deviation 17.3 |
| Healthy | Percent of Maximal Voluntary Isometric Contraction (%MVIC) | QuadHipExtR | 26.5 percentage of MVIC of gmax | Standard Deviation 12.2 |
Secondary
Perceived Exertion
Thera-Band(R) RISE (Resistance Intensity Scale for Exercise) Scale to measure amount of perceived exertion during resistance band exercises. This is a scale 0 to 10, 0 being extremely easy and 10 being extremely hard. The subject rated the intensity or resistance felt on each exercise on this scale. The ideal range for an exercise is in the middle of the scale (4-7) where the subject is feeling resistance but is not maximally exerted.
Time frame: 16 exercises during one 40 minute session
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Low Back Pain | Perceived Exertion | QHipExtR | 3.3 units on a scale |
| Low Back Pain | Perceived Exertion | Bridge | 1.9 units on a scale |
| Low Back Pain | Perceived Exertion | BridgeR | 2.5 units on a scale |
| Low Back Pain | Perceived Exertion | Fire Hydrant | 2.4 units on a scale |
| Low Back Pain | Perceived Exertion | Fire HydrantR | 3.7 units on a scale |
| Low Back Pain | Perceived Exertion | Lunge | 2.9 units on a scale |
| Low Back Pain | Perceived Exertion | LungeR | 2.9 units on a scale |
| Low Back Pain | Perceived Exertion | QHipExt | 2.3 units on a scale |
| Low Back Pain | Perceived Exertion | Clams | 1.7 units on a scale |
| Low Back Pain | Perceived Exertion | ClamsR | 2.8 units on a scale |
| Low Back Pain | Perceived Exertion | PrHipExt | 2.5 units on a scale |
| Low Back Pain | Perceived Exertion | StHipExt | 3 units on a scale |
| Low Back Pain | Perceived Exertion | SLAB | 1.5 units on a scale |
| Low Back Pain | Perceived Exertion | StABR | 3.4 units on a scale |
| Low Back Pain | Perceived Exertion | Running Man | 3.4 units on a scale |
| Low Back Pain | Perceived Exertion | RunningManR | 4.4 units on a scale |
| Healthy | Perceived Exertion | RunningManR | 4.3 units on a scale |
| Healthy | Perceived Exertion | QHipExtR | 2.3 units on a scale |
| Healthy | Perceived Exertion | Clams | 2.1 units on a scale |
| Healthy | Perceived Exertion | Bridge | 1.5 units on a scale |
| Healthy | Perceived Exertion | SLAB | 1.8 units on a scale |
| Healthy | Perceived Exertion | BridgeR | 2.1 units on a scale |
| Healthy | Perceived Exertion | ClamsR | 2.9 units on a scale |
| Healthy | Perceived Exertion | Fire Hydrant | 2.3 units on a scale |
| Healthy | Perceived Exertion | Running Man | 3.2 units on a scale |
| Healthy | Perceived Exertion | Fire HydrantR | 3.2 units on a scale |
| Healthy | Perceived Exertion | PrHipExt | 2.3 units on a scale |
| Healthy | Perceived Exertion | Lunge | 2.2 units on a scale |
| Healthy | Perceived Exertion | LungeR | 2.7 units on a scale |
| Healthy | Perceived Exertion | StABR | 2.2 units on a scale |
| Healthy | Perceived Exertion | StHipExt | 2.7 units on a scale |
| Healthy | Perceived Exertion | QHipExt | 1.3 units on a scale |