Evidence of Splinting in Low Back Pain? A Systematic Review of Perturbation Studies

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2017 Sep 14

PMID 28900711

Citations 19

Authors

Maarten R Prins

Mariette Griffioen

Thom T J Veeger

Henri Kiers

Onno G Meijer

Peter van der Wurff

Sjoerd M Bruijn

Jaap H van Dieen

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this systematic review was to assess whether LBP patients demonstrate signs of splinting by evaluating the reactions to unexpected mechanical perturbations in terms of (1) trunk muscle activity, (2) kinetic and (3) kinematic trunk responses and (4) estimated mechanical properties of the trunk.

Methods: The literature was systematically reviewed to identify studies that compared responses to mechanical trunk perturbations between LBP patients and healthy controls in terms of muscle activation, kinematics, kinetics, and/or mechanical properties. If more than four studies reported an outcome, the results of these studies were pooled.

Results: Nineteen studies were included, of which sixteen reported muscle activation, five kinematic responses, two kinetic responses, and two estimated mechanical trunk properties. We found evidence of a longer response time of muscle activation, which would be in line with splinting behaviour in LBP. No signs of splinting behaviour were found in any of the other outcome measures.

Conclusions: We conclude that there is currently no convincing evidence for the presence of splinting behaviour in LBP patients, because we found no indications for splinting in terms of kinetic and kinematic responses to perturbation and derived mechanical properties of the trunk. Consistent evidence on delayed onsets of muscle activation in response to perturbations was found, but this may have other causes than splinting behaviour.

Citing Articles

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References

Jones S, Hitt J, DeSarno M, Henry S . 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. 2012; 221(4):413-26. PMC: 3472522. DOI: 10.1007/s00221-012-3183-8. View

Dideriksen J, Negro F, Farina D . The optimal neural strategy for a stable motor task requires a compromise between level of muscle cocontraction and synaptic gain of afferent feedback. J Neurophysiol. 2015; 114(3):1895-911. PMC: 4575976. DOI: 10.1152/jn.00247.2015. View

Keefe F, Hill R . An objective approach to quantifying pain behavior and gait patterns in low back pain patients. Pain. 1985; 21(2):153-161. DOI: 10.1016/0304-3959(85)90285-4. View

Reeves N, Cholewicki J, Milner T . Muscle reflex classification of low-back pain. J Electromyogr Kinesiol. 2005; 15(1):53-60. DOI: 10.1016/j.jelekin.2004.07.001. View

Gotze M, Ernst M, Koch M, Blickhan R . Influence of chronic back pain on kinematic reactions to unpredictable arm pulls. Clin Biomech (Bristol). 2015; 30(3):290-5. DOI: 10.1016/j.clinbiomech.2015.01.001. View

Pataky T, Robinson M, Vanrenterghem J . Vector field statistical analysis of kinematic and force trajectories. J Biomech. 2013; 46(14):2394-401. DOI: 10.1016/j.jbiomech.2013.07.031. View

Radebold A, Cholewicki J, Panjabi M, Patel T . Muscle response pattern to sudden trunk loading in healthy individuals and in patients with chronic low back pain. Spine (Phila Pa 1976). 2000; 25(8):947-54. DOI: 10.1097/00007632-200004150-00009. View

Notzel D, Puta C, Wagner H, Anders C, Petrovich A, Gabriel H . [Altered hip muscle activation in patients with chronic non-specific low back pain]. Schmerz. 2011; 25(2):199-204, 206. DOI: 10.1007/s00482-010-1010-3. View

Hodges P, Bui B . A comparison of computer-based methods for the determination of onset of muscle contraction using electromyography. Electroencephalogr Clin Neurophysiol. 1996; 101(6):511-9. DOI: 10.1016/s0013-4694(96)95190-5. View

10.

Ahern D, Follick M, Council J, Litchman H . Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls. Pain. 1988; 34(2):153-160. DOI: 10.1016/0304-3959(88)90160-1. View

11.

Mok N, Brauer S, Hodges P . Changes in lumbar movement in people with low back pain are related to compromised balance. Spine (Phila Pa 1976). 2010; 36(1):E45-52. DOI: 10.1097/BRS.0b013e3181dfce83. View

12.

Hodges P, Coppieters M, MacDonald D, Cholewicki J . New insight into motor adaptation to pain revealed by a combination of modelling and empirical approaches. Eur J Pain. 2013; 17(8):1138-46. DOI: 10.1002/j.1532-2149.2013.00286.x. View

13.

Pataky T, Vanrenterghem J, Robinson M . The probability of false positives in zero-dimensional analyses of one-dimensional kinematic, force and EMG trajectories. J Biomech. 2016; 49(9):1468-1476. DOI: 10.1016/j.jbiomech.2016.03.032. View

14.

Newcomer K, Jacobson T, Gabriel D, Larson D, Brey R, An K . Muscle activation patterns in subjects with and without low back pain. Arch Phys Med Rehabil. 2002; 83(6):816-21. DOI: 10.1053/apmr.2002.32826. View

15.

van den Hoorn W, Bruijn S, Meijer O, Hodges P, van Dieen J . Mechanical coupling between transverse plane pelvis and thorax rotations during gait is higher in people with low back pain. J Biomech. 2011; 45(2):342-7. DOI: 10.1016/j.jbiomech.2011.10.024. View

16.

Maaswinkel E, Griffioen M, Perez R, van Dieen J . Methods for assessment of trunk stabilization, a systematic review. J Electromyogr Kinesiol. 2016; 26:18-35. DOI: 10.1016/j.jelekin.2015.12.010. View

17.

Miller E, Bazrgari B, Nussbaum M, Madigan M . Effects of exercise-induced low back pain on intrinsic trunk stiffness and paraspinal muscle reflexes. J Biomech. 2012; 46(4):801-5. PMC: 3568223. DOI: 10.1016/j.jbiomech.2012.11.023. View

18.

Leinonen V, Kankaanpaa M, Luukkonen M, Hanninen O, Airaksinen O, Taimela S . Disc herniation-related back pain impairs feed-forward control of paraspinal muscles. Spine (Phila Pa 1976). 2001; 26(16):E367-72. DOI: 10.1097/00007632-200108150-00014. View

19.

Stokes I, Fox J, Henry S . Trunk muscular activation patterns and responses to transient force perturbation in persons with self-reported low back pain. Eur Spine J. 2005; 15(5):658-67. PMC: 3489343. DOI: 10.1007/s00586-005-0893-7. View

20.

Navalgund A, Buford J, Briggs M, Givens D . Trunk muscle reflex amplitudes increased in patients with subacute, recurrent LBP treated with a 10-week stabilization exercise program. Motor Control. 2012; 17(1):1-17. PMC: 3881973. DOI: 10.1123/mcj.17.1.1. View