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Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 1: Normal endurance and trunk muscle strength in 101 women.

The lack of trunk muscle strength and endurance has frequently been cited as a suspected factor in the etiology of low-back pain. Several investigators have suggested that asymptomatic patients have stronger trunk muscles than patients with low-back pain. People who are physically fit appear to have a decreased incidence of low-back pain. Increased trunk muscle endurance also have been observed to decrease the incidence of low-back pain. The objective evaluation of the strength and endurance of trunk musculature may, therefore, be significant. Part 1 of this study was designed to develop a reproducible strength-endurance screening procedure and to establish normal isometric-isokinetic trunk muscle strength and endurance parameters for women. This study showed that isometric trunk flexion varied from 19-109 Nm and trunk extension from 38-168 Nm. Peak values for isokinetic trunk flexion at two speeds (30 degrees per second and 60 degrees per second) varied from 17-191 Nm and isokinetic trunk extension from 14-208 Nm. The average endurance time for trunk extensors tested with the Sorensen test was 196 seconds.

Adolescent

Normal trunk muscle strength and endurance in women and the effect of exercises and electrical stimulation. Part 2: Comparative analysis of electrical stimulation and exercises to increase trunk muscle strength and endurance.

Several studies have shown positive correlations between muscle strength, flexibility, and the frequency of low-back pain. Weak trunk musculature and decreased endurance have thereby come to be identified as significant risk factors in the development of occupational back problems. Because it is widely accepted that exercise plays an important role in the conservative treatment and prevention of low-back pain, the goals of most rehabilitative programs involves improving the strength and endurance of the low-back pain patient. Whereas electrical stimulation has been shown to increase the muscle strength of the lower extremities, this effect has not been demonstrated for the trunk muscles. Part 2 is a prospective controlled study designed to document and to compare objectively the effects of electrical stimulation and exercise on trunk muscle strength. A total of 117 healthy women were divided randomly into four groups. Two groups received electrical stimulation with different electrical parameters, one group received exercises, and one group acted as a control group. The results showed that low-frequency electrical stimulation and exercises significantly (P less than .05) increased isokinetic back-muscle strength compared to the control and medium-high-frequency electrical stimulation groups. Both types of electrical stimulation, however, significantly increased (P less than .05) the endurance in the back muscles compared with the control and the exercise groups. This study showed that electrical stimulation may be a valuable treatment in the early care of low-back pain patients in maintaining and increasing strength and endurance of back muscles when a more active exercise program is too painful to perform.

Adolescent

The activity of individual trunk muscles during heavy physical loading.

The myoelectric activity of ten trunk muscles were recorded, using intramuscular electrodes, when ten subjects made maximal and 50% of maximal static exertions in standing postures. Exertions were made in flexion, extension, and left and right lateral bending. Three heavy-lifting tasks also were studied. A biomechanical model was used to predict the forces in the trunk muscles, and the predictions then were compared to the measurements. The abdominal muscles were all active in attempted flexion, while the erector spinae muscles were inactive. In attempted extension, the erectors were maximally active, but considerable activity was present in the abdominal muscles as well. The highest activity levels recorded in the oblique abdominal muscles were in lateral bending. There were high degrees of correlation between the measured muscle activities and predicted muscle tensions for the erector spinae and rectus abdominus muscles, while the correlation coefficients for the oblique abdominal muscles were lower (0.4-0.7). The study indicates that inclusion of antagonistic activity is an important consideration to improve model predictions. The oblique abdominal muscles appear to be more active, in general, than predicted. For the longitudinal trunk muscles, the predictions are excellent throughout.

Abdominal Muscles

Exploration of mechanical and electromyographic responses of trunk muscles to high-intensity resistive exercise.

The purposes of this study were to determine the effects of high intensity exercise on fatigue of the trunk muscles within a test session, and on multiple kinetic and electromyographic (EMG) variables over a 6-week training period. Fourty-five normal men and women (20-40 years of age) completed the study. The KIN/COM trunk testing unit (Chattecx Corporation, Chattanooga, Tennessee) was used for both testing and training. The results of the study follow: 1) The KIN/COM trunk testing system was very accurate, and the method used was highly reproducible for the kinetic variables. Reproducibility for the endurance variables was mixed, and isolated EMG variables were poor. 2) Kinetic and EMG decrements associated with fatigue did occur in the trunk muscles with ten continuous cycles of maximal concentric and eccentric contractions. 3) Trunk muscle strength gains were highest for the same mode of exercise used in training (specificity), but significant strength gains also were seen in different modes of muscle contraction (transfer of training). For the trunk extensors, the eccentric form of exercise was superior. 4) The rate of isometric torque development and decay was increased by exercise in men. 5) Trunk muscle endurance was retained when gains in strength occurred. 6) The majority of variables reflecting strength and endurance were retained. The methods and results can serve as guidelines for the evaluation of trunk muscle function and resistive exercise in the clinic.

Abdominal Muscles

Response of the trunk muscles to training assessed by magnetic resonance imaging and muscle strength.

A group of 12 sedentary medical students (1 man and 11 women aged 21-27 years) participated in a strength training programme for the trunk muscles lasting 18 weeks. The maximal isometric flexion and extension forces of the trunk muscles were measured before the training and at 18 weeks by dynamometer. The cross-sectional area of the back muscles, i.e. erector spinae, multifidus and psoas muscles, was measured from magnetic resonance images (spin echo sequence TR/TE 1500/80, slice thickness 10 mm) obtained at the L4-L5 disc level before the training, at 11 and 18 weeks. During training, no significant change in the body mass or body fat content was found. Muscle forces or muscle cross-sectional area were not related to body mass. There was a significant increase in both trunk muscle cross-sectional area (psoas muscle P < 0.001 and back muscles P < 0.01) and trunk muscle forces (flexion and extension forces P < 0.01) during the training but no direct association between the muscle cross-sectional area and strength of the flexors and extensors was detected before or after the training.

Adipose Tissue

Temporal patterns of trunk muscle activity throughout a dynamic, asymmetric lifting motion.

This study examined the effects of trunk speed and exertion level on temporal aspects of trunk muscle activity patterns during dynamic, asymmetric lifting. Electromyographic (EMG) data from eight trunk muscles were collected along with trunk torque output, position, and velocity data during several repetitions of four speed/loading combination conditions. During analysis, each muscle's EMG record was reduced to three key events: a start, a peak, and an end point. For each subject, temporally ordered event lists were constructed for each test condition. Networks of events that consistently occurred regardless of loading or speed levels were constructed for each subject. Two event pairs occurred consistently for all subjects under all conditions, whereas some pairs occurred in association with specific speed or resistance levels. Temporal information related to muscle activity could be used in biomechanical models in order to predict changes in spinal loading during the course of workplace tasks.

Adult

Reliability of isokinetic measurements of trunk muscle performance.

The purpose of this investigation was to assess the reliability of isokinetic trunk muscle performance. Sixty-one volunteers participated (29 men, 32 women; age range, 20-60 years). All subjects were without low-back symptoms at the time of testing. All testing was performed with the subject initially standing, using speeds of 60, 120, and 180 degrees per second. Ten repetitions of flexion and extension were performed reciprocally at each speed, with a 3-minute rest period between speeds. Test-retest intervals were 1 and 3 weeks from the initial test. Peak torque-to-body-weight ratios, extension-to-flexion ratios, and average work per repetition were calculated for each speed for flexion and extension. Data were analyzed with analysis of variance, intraclass correlation coefficients, and Pearson correlation coefficients. Intraclass correlation coefficient values ranged from .74 to .88 for measurements derived from peak torque, and from .88-.93 for measurements derived from work (with the exception of .69 for men at 180 degrees/sec). Standard error of measurements ranged from 8 to 32 ft-lb, with a tendency to increase with increasing speeds. It was concluded that, when using this protocol, isokinetic measurements of muscle function offer the clinician sensitive and reliable measurements of trunk muscle performance and that incorporating increased practice with women and longer rest periods with men may further decrease error associated with these isokinetic trunk strength measurements.

Adult

Trunk-muscle strength during concentric and eccentric contraction: a comparison between healthy subjects and patients with chronic low-back pain.

The physical evaluation and exercise program of trunk muscles in patients with chronic low-back pain (CLBP) is still controversial. Many studies have been performed in the isometric and/or concentric contraction mode. Few data, however, have been reported on trunk-muscle strength during eccentric contraction, which plays a significant role in functional activities. To evaluate whether trunk-muscle strength on eccentric contraction could be applicable to the assessment and exercise of the patients with CLBP, trunk strength was measured in 20 healthy men and 16 healthy women, as well as 15 male and 10 female patients with CLBP. Maximum voluntary concentric and eccentric strength was measured during attempted flexion and extension in a seated position. In the healthy subjects, the maximum torque of extensors was greater than that of the flexors during both concentric and eccentric contraction (p less than 0.05). In flexors and extensors, maximum torque exerted on the eccentric contraction was always greater than that on the concentric contraction (p less than 0.05). Although strength was likely to be weaker in the patients with CLBP than in the healthy subjects, there were no statistical differences between the two groups. In terms of the flexor/extensor ratio of maximum torque, there were also no statistical significances between the two groups in either contraction mode. In the flexors, correlation coefficient (r) between concentric and eccentric torque was 0.84 for the healthy subjects and 0.48 for the CLBP subjects (p less than 0.05). In the extensors, the coefficient was 0.90 for the healthy patients and 0.71 for the CLBP patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

[A study of trunk muscle in idiopathic scoliosis].

Isometric and isokinetic parameters related to trunk muscle function in patients with idiopathic scoliosis were measured by Cybex dynamometer with a trunk stabilization system. Activities of the paraspinal muscles were also determined by electromyographic observations. In scoliotic patients some parameters, especially endurance in lateral bending to the concave side of the trunk, were predominant. In electromyographic analysis, neurogenic changes were observed in 25.9% of patients with idiopathic scoliosis. In nonprogressive scoliosis, the mean amplitude of EMG did not differ between the convex and the concave. In progressive scoliosis, however, the mean amplitude of EMG was higher on the convex side than on the concave side. Thus, the compensatory reaction on the curvature of the spine caused higher amplitude of action potential of the back muscles on the convex side than in the concave side. These data suggest that the trunk muscle imbalance is one of the most important factors in the onset and progression of idiopathic scoliosis.

Adolescent

Trunk muscle function and low back disorders: a ten-year follow-up study.

Low back disorders and trunk muscle function were studied by questionnaire, interview, clinical examination, and performance tests in 902 employees in the metal industry. The survey was repeated after a 10-yr interval for 654 persons. For those who were allowed to participate in the muscle function tests, the prevalences of clinical findings in the low back and of chronic lumbosacral disease were inversely associated with muscle function in both cross-sectional studies. This association seems not to be explained by the interference of pain with muscle function tests. There was no association between muscle function at baseline and either the 10-yr incidence of chronic low back disease or the development of low back symptoms. Men with poor muscle function at baseline had a slightly elevated risk for the appearance of clinical findings at follow-up. There was an inverse association between the clinical findings at baseline and muscle function at follow-up. The association between low back disorder and trunk muscle function seems to result from an effect of the former on the latter, but poor muscle function may also contribute to the risk of disorder.

Back Pain

Comparison of clinical and objective methods of assessing trunk muscle strength--an experimental approach.

An objective method was used to evaluate the validity of the sit-up, prone trunk extension, and double leg lowering clinical tests. Normal men and women and patients with a history of backache served as subjects. The vast majority of the subjects were able to perform the Grade 1 level, which was the highest resistance imposed by the sit-up and prone extension tests. The double leg lower was superior to the other two clinical tests but was able to identify only broad differences in strength capability. In the main, the subjective clinical tests were poor discriminators and seemed to lack the range of resistance necessary to be definitively useful as methods of assessing trunk muscle strength and may not provide appropriate resistance for improving trunk muscle strength in most patients.

Adult

Trunk muscle strength in athletes.

Maximal voluntary strength of the trunk muscles was measured in 57 male elite athletes (soccer players, wrestlers, tennis players, and gymnasts), 14 female elite gymnasts, and in a normal group of 87 conscripts. Mean ages in the different groups ranged from 18-22 yr. An isokinetic (constant velocity) technique was used to record maximal torque produced by trunk and hip muscles during flexion, extension, and lateral flexion over the range of motion. The constant angular velocities used were 15 deg.s-1 and 30 deg.s-1, respectively. Isometric strength was measured in a straight body position (0 deg. of flexion). The measurements were made with the subjects in a horizontal position with the pivot point at the hip and at the lumbar (L2-L3) level. All male athlete groups showed higher peak torque values than the normals. The differences were largest in hip extension and trunk flexion. The male gymnasts also showed significantly higher peak values in hip flexion as compared to all other categories. There was no difference in strength per kg body weight between female gymnasts and untrained males, except in trunk extension. The position for peak torque occurred earlier in the movements for the athletes, especially for the gymnasts in extension movements and for the tennis players in flexion movements. In isometric contractions essentially the same strength differences were present as in the slow isokinetic contractions. In lateral flexion wrestlers and tennis players showed significantly higher strength in movements toward the nondominant side. Thus, differences were present between the athletes and the normals, some of which appeared to be sport specific and related to long-term systematic training.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Effects of lumbar belts on trunk muscle strength and endurance: a follow-up study of construction workers.

The effects on maximal isometric trunk muscle strength and endurance after wearing a soft heat-retaining lumbar belt or a weightlifter's belt were studied. The soft belt (SB) study group comprised 12 construction workers with healthy backs, and the weightlifter's belt (WB) group comprised 24 construction workers with current or previous low back pain. The strength and endurance measurements were performed before the start of belt use, and after 1 and 2 months. The SB group increased the trunk flexor strength by 13% (p less than or equal to 0.01) after 2 months. The WB group increased the trunk flexor strength and endurance by 12% and 29%, respectively (p less than or equal to 0.001). No significant decrease of trunk muscle strength and endurance was found at the end of the follow-up period.

Adult

A review of the literature related to trunk muscle performance.

In the past, there has been no comprehensive review of the literature pertaining to different methods of assessing trunk muscle strength. This review describes the different studies that have been performed, and determines the hierarchy of strength values and agonist/antagonist strength ratios for the trunk musculature. In general, the strength hierarchy consists of, from strongest to weakest: extension, flexion, side bending, and rotation. The agonist/antagonist ratio for extension/flexion is 1.30 and for rotation and side bending, motion to the right approximately equals motion to the left. Changes in the relative strengths of the different trunk muscle groups is affected by spinal pathology, and this is discussed. Possible clinical implications and direction for future research are delineated based on the findings of this review.

Back

Orientation and moment arms of some trunk muscles.

The orientations and moment arms of nine trunk muscles: latissimus dorsi, iliocostalis, longissimus dorsi, obliquii, rectus and transversalis abdominis, quadratus lumborum, and iliopsoas were obtained on embalmed specimens. Each muscle was considered as one or several, linear or curvilinear, lines of action. Origins, insertions, and points along the length of main bundles were digitized for each muscle using a three-dimensional digitizer. The results obtained from seven male specimens are presented and will permit more refined biomechanical models.

Abdominal Muscles

Dietary protein levels affect growth and protein metabolism in trunk muscle of cod, Gadus morhua.

Cod (Gadus morhua) of 50 g body weight were kept at 14 degrees C. The fish were fed ad libitum during 80 days a diet containing protein levels which in terms of total energy corresponded to 25%, 45% or 65%. Growth increased in accordance with protein-energy levels. The protein content per gram of wet weight of white trunk muscle was unchanged, as was the myofibrillar protein myosin heavy chain determined by the antigen-antibody reaction of the enzyme-linked immunosorbent assay. The amount of messenger ribonucleic acid (mRNA) coding for myosin heavy chain was lower at 25% than at 45% or 65% protein-energy intake, the differences being significant per gram of wet weight of muscle. Acid proteinase activity was highest at the lowest protein-energy intake. Glycogen content in muscle increased with the protein-energy levels. It is concluded that the metabolic response of white trunk muscle to graded protein-energy intake included a change in the capacity to synthesize myosin heavy chain as judged by its mRNA content. The protein content per gram of wet weight was unaffected by dietary protein-energy levels of 25%, 45% and 65%, but protein accretion and thus growth of the animals increased with the protein intake. Dietary protein-energy restriction caused a rise in acid proteinase activity and a decrease in content of mRNA for myosin heavy chain, resulting in a diminished growth rate at an unchanged protein content per gram of wet weight of muscle.

Animals

Spinal mobility and trunk muscle strength in 15-year-old schoolchildren with and without low-back pain.

From a population of 1,503 schoolchildren, 38 15-year-old children suffering from low-back pain and 38 asymptomatic controls were selected for testing of spinal mobility and trunk muscle strength. The asymptomatic controls were matched by age, sex, and school class. In the group with recurrent or continual low-back pain (17 boys and 21 girls), the boys were over 4 cm taller than those in the control group. In both sexes sagittal mobility was decreased in lumbar extension and straight leg raising, and increased in lumbar flexion. Endurance strength in the abdominal and back muscles was decreased compared to the control pupils, who reported no back pain at all in the questionnaire collected 1 year before the testing procedure. The pupils reporting sciatica (n = 7) at some time, in addition to recurrent low-back pain, had decreased lumbar flexion and side bending compared to those with recurrent low-back pain (n = 31) without sciatica. The results of the study indicated that in this growing-age population there was a subgroup with recurrent low-back pain having a different spinal mobility pattern as well as decreased trunk muscle strength.

Adolescent