Cursus methode 'de Goey', o.a. corrigeren houding

Deelnemer

Hier wat om rekening mee te houden en logische conclusies te verbinden aan het idee van houding versus pijnklachten. Het is nog maar zeer de vraag of de m.i. verouderde opvatting dat een “slechte houding cq postuur” de oorzaak is van pijn.

Clin J Pain. 2005 Jul-Aug;21(4):323-9. Related Articles, Books, LinkOut
Are the changes in postural control associated with low back pain caused by pain interference?

Moseley GL, Hodges PW.

The University of Queensland, Brisbane, Australia. – mailadres –

BACKGROUND: Voluntary limb movements are associated with involuntary and automatic postural adjustments of the trunk muscles. These postural adjustments occur prior to movement and prevent unwanted perturbation of the trunk. In low back pain, postural adjustments of the trunk muscles are altered such that the deep trunk muscles are consistently delayed and the superficial trunk muscles are sometimes augmented. This alteration of postural adjustments may reflect disruption of normal postural control imparted by reduced central nervous system resources available during pain, so-called “pain interference,” or reflect adoption of an alternate postural adjustment strategy. METHODS: We aimed to clarify this by recording electromyographic activity of the upper (obliquus externus) and lower (transversus abdominis/obliquus internus) abdominal muscles during voluntary arm movements that were coupled with painful cutaneous stimulation at the low back. If the effect of pain on postural adjustments is caused by pain interference, it should be greatest at the onset of the stimulus, should habituate with repeated exposure, and be absent immediately when the threat of pain is removed. Sixteen patients performed 30 forward movements of the right arm in response to a visual cue (control). Seventy trials were then conducted in which arm movement was coupled with pain (“pain trials”) and then a further 70 trials were conducted without the pain stimulus (“no pain trials”). RESULTS: There was a gradual and increasing delay of transversus abdominis/obliquus internus electromyograph and augmentation of obliquus externus during the pain trials, both of which gradually returned to control values during the no pain trials. CONCLUSION: The results suggest that altered postural adjustments of the trunk muscles during pain are not caused by pain interference but are likely to reflect development and adoption of an alternate postural adjustment strategy, which may serve to limit the amplitude and velocity of trunk excursion caused by arm movement.

PMID: 15951650 [PubMed – indexed for MEDLINE]

2: Aust J Physiother. 2005;51(1):49-52. Related Articles, Books, LinkOut
Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain.

Moseley GL.

Department of Physiotherapy, Royal Brisbane and Women’s Hospital & The University of Queensland, Brisbane, Australia. – mailadres –

The way people with chronic low back pain think about pain can affect the way they move. This case report concerns a patient with chronic disabling low back pain who underwent functional magnetic resonance imaging scans during performance of a voluntary trunk muscle task under three conditions: directly after training in the task and, after one week of practice, before and after a 2.5 hour pain physiology education session. Before education there was widespread brain activity during performance of the task, including activity in cortical regions known to be involved in pain, although the task was not painful. After education widespread activity was absent so that there was no brain activation outside of the primary somatosensory cortex. The results suggest that pain physiology education markedly altered brain activity during performance of the task. The data offer a possible mechanism for difficulty in acquisition of trunk muscle training in people with pain and suggest that the change in activity associated with education may reflect reduced threat value of the task.

Publication Types:

* Case Reports
* Evaluation Studies

PMID: 15748125 [PubMed – indexed for MEDLINE]

3: Pain. 2005 Mar;114(1-2):54-61. Epub 2005 Jan 26. Related Articles, Books, LinkOut
Is successful rehabilitation of complex regional pain syndrome due to sustained attention to the affected limb? A randomised clinical trial.

Moseley GL.

School of Physiotherapy, The University of Sydney, Lidcombe, Sydney, NSW 1825, Australia. – mailadres –

In complex regional pain syndrome (CRPS1) initiated by wrist fracture, a motor imagery program (MIP), consisting of hand laterality recognition followed by imagined movements and then mirror movements, reduces pain and disability, but the mechanism of effect is unclear. Possibilities include sustained attention to the affected limb, in which case the order of MIP components would not alter the effect, and sequential activation of cortical motor networks, in which case it would. Twenty subjects with chronic CRPS1 initiated by wrist fracture and who satisfied stringent inclusion criteria, were randomly allocated to one of three groups: hand laterality recognition, imagined movements, mirror movements (RecImMir, MIP); imagined movements, recognition, imagined movements (ImRecIm); recognition, mirror movements, recognition (RecMirRec). At 6 and 18 weeks, reduced pain and disability were greater for the RecImMir group than for the other groups (P<0.05). Hand laterality recognition imparted a consistent reduction in pain and disability across groups, however, this effect was limited in magnitude. Imagined movements imparted a further reduction in pain and disability, but only if they followed hand laterality recognition. Mirror movements also imparted a reduction in pain and disability, but only when they followed imagined movements. The effect of the MIP seems to be dependent on the order of components, which suggests that it is not due to sustained attention to the affected limb, but is consistent with sequential activation of cortical motor networks.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial

PMID: 15733631 [PubMed – indexed for MEDLINE]

4: Clin J Pain. 2004 Sep-Oct;20(5):324-30. Related Articles, Books, LinkOut
A randomized controlled trial of intensive neurophysiology education in chronic low back pain.

Moseley GL, Nicholas MK, Hodges PW.

University of Queensland, Brisbane, Australia. – mailadres –

OBJECTIVES: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. METHODS: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal “drawing-in” task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. RESULTS: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. DISCUSSION: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial

PMID: 15322439 [PubMed – indexed for MEDLINE]

5: Brain. 2004 Oct;127(Pt 10):2339-47. Epub 2004 Jul 28. Related Articles, Books, LinkOut
Does anticipation of back pain predispose to back trouble?

Moseley GL, Nicholas MK, Hodges PW.

Prince of Wales Medical Research Institute, Randwick, Sydney, Austalia. – mailadres –

Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term.

PMID: 15282214 [PubMed – indexed for MEDLINE]

6: Man Ther. 2004 Aug;9(3):157-63. Related Articles, Books, LinkOut
Impaired trunk muscle function in sub-acute neck pain: etiologic in the subsequent development of low back pain?

Moseley GL.

Division of Physiotherapy, The University of Queensland, Australia. – mailadres –

Low back pain (LBP) and neck pain are associated with dysfunction of the trunk and neck muscles, respectively, and may involve common or similar mechanisms. In both cases, dysfunction may compromise spinal control. Anecdotally, neck pain patients commonly develop LBP. This study investigated the possibility that trunk muscle function is compromised in neck pain patients and that compromised trunk muscle function is associated with increased risk of LBP. Fifty-four neck pain patients and 52 controls were assessed on an abdominal drawing-in task (ADIT) and on self-report tests. Performance on the ADIT was able to detect neck pain patients with 85% sensitivity and 73% specificity. Catastrophizing and McGill pain questionnaire (affective) scores were higher in patients with an abnormal task response than in patients with an uncertain or normal response, although the self-report data did not predict task performance. Fifty subjects from each group were contactable by telephone at 2 years. They were asked whether they had experienced persistent or recurrent LBP since the assessment. Subjects (patients and controls) who obtained an abnormal response on the ADIT were 3 to 6 times more likely to develop persistent or recurrent LBP than those who obtained an uncertain or normal response. ADIT performance was the main predictor of development of LBP in patients. The results suggest that reduced voluntary trunk muscle control in neck pain patients is associated with an increased risk of developing LBP.

PMID: 15245710 [PubMed – indexed for MEDLINE]

7: Neurology. 2004 Jun 22;62(12):2182-6. Related Articles, Books, LinkOut
Why do people with complex regional pain syndrome take longer to recognize their affected hand?

Moseley GL.

Department of Physiotherapy, The University of Queensland, and Royal Brisbane & Women’s Hospital, Brisbane, Australia. – mailadres –

BACKGROUND: People with complex regional pain syndrome (CRPS) take longer to recognize the laterality of a pictured hand when it coincides with their affected hand. The author explored two aspects of this phenomenon: whether the duration of symptoms relates to the extent of the delay and whether guarding-type mechanisms are involved. METHODS: Eighteen patients with CRPS type 1 of the wrist and 18 matched control subjects performed a hand laterality recognition task. McGill pain questionnaire, Neuropathic Pain Scale, and response time (RT) to recognize hand laterality were analyzed. Regressions related 1) mean RT for patients to the duration of symptoms and to pain intensity; and 2) mean RT for each picture to the predicted pain on executing that movement as judged by the patient, and to the awkwardness of the movement that would be required. RESULTS: For patients, the duration of symptoms correlated with mean RT (Spearman rho = 0.44; p = 0.02). Predicted pain rating explained 45% of the variance in RT for each picture for each patient (p < 0.01). CONCLUSIONS: The results suggest that in patients with complex regional pain syndrome type 1, delayed recognition of hand laterality is related to the duration of symptoms and to the pain that would be evoked by executing the movement. The former is consistent with chronic pain and disuse and may involve reorganization of the cortical correlate of body schema. The latter is consistent with a guarding-type response that probably occurs upstream of the motor cortex at a motor planning level.

PMID: 15210879 [PubMed – indexed for MEDLINE]

8: Neurology. 2004 May 11;62(9):1644. Related Articles, Books, LinkOut
Imagined movements cause pain and swelling in a patient with complex regional pain syndrome.

Moseley GL.

University of Queensland and Royal Brisbane & Women’s Hospital, Brisbane, Australia. – mailadres –

Publication Types:

* Case Reports

PMID: 15136704 [PubMed – indexed for MEDLINE]

9: Eur J Pain. 2004 Feb;8(1):39-45. Related Articles, Cited in PMC, Books, LinkOut
Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain.

Mosel ey GL.

Departments of Physiotherapy, Royal Brisbane Hospital and The University of Queensland, Herston, 4029, Australia. – mailadres –

BACKGROUND: Unhelpful pain cognitions of patients with chronic low back pain (LBP) may limit physical performance and undermine physical assessment. It is not known whether a direct relationship exists between pain cognitions and physical performance. AIMS: To determine if a relationship exists between change in pain cognitions and change in physical performance when chronic LBP patients participate in a single one-to-one education intervention during which they have no opportunity to be active. METHODS: In a quasi-experiment using a convenience sample, moderately disabled chronic LBP patients (n=121) participated in a one-to-one education session about either lumbar spine physiology or pain physiology. Multiple regression analysis evaluated the relationship between change in pain cognitions measured by the survey of pain attitudes (SOPA) and the pain catastrophising scale (PCS) and change in physical performance, measured by the straight leg raise (SLR) and standing forward bending range. RESULTS: There was a strong relationship between cognitive change and change in straight leg raise (SLR) and forward bending (r=0.88 and 0.79, respectively, P<0.01), mostly explained by change in the conviction that pain means tissue damage and catastrophising. CONCLUSIONS: Change in pain cognitions is associated with change in physical performance, even when there is no opportunity to be physically active. Unhelpful pain cognitions should be considered when interpreting physical assessments.

PMID: 14690673 [PubMed – indexed for MEDLINE]

10: Exp Brain Res. 2004 May;156(1):64-71. Epub 2003 Dec 19. Related Articles, Books, LinkOut
Pain differs from non-painful attention-demanding or stressful tasks in its effect on postural control patterns of trunk muscles.

Moseley GL, Nicholas MK, Hodges PW.

Department of Physiotherapy, Royal Brisbane Hospital, 4029, Herston, Queensland, Australia. – mailadres –

Pain changes postural activation of the trunk muscles. The cause of these changes is not known but one possibility relates to the information processing requirements and the stressful nature of pain. This study investigated this possibility by evaluating electromyographic activity (EMG) of the deep and superficial trunk muscles associated with voluntary rapid arm movement. Data were collected from control trials, trials during low back pain (LBP) elicited by injection of hypertonic saline into the back muscles, trials during a non-painful attention-demanding task, and during the same task that was also stressful. Pain did not change the reaction time (RT) of the movement, had variable effects on RT of the superficial trunk muscles, but consistently increased RT of the deepest abdominal muscle. The effect of the attention-demanding task was opposite: increased RT of the movement and the superficial trunk muscles but no effect on RT of the deep trunk muscles. Thus, activation of the deep trunk muscles occurred earlier relative to the movement. When the attention-demanding task was made stressful, the RT of the movement and superficial trunk muscles was unchanged but the RT of the deep trunk muscles was increased. Thus, the temporal relationship between deep trunk muscle activation and arm movement was restored. This means that although postural activation of the deep trunk muscles is not affected when central nervous system resources are limited, it is delayed when the individual is also under stress. However, a non-painful attention-demanding task does not replicate the effect of pain on postural control of the trunk muscles even when the task is stressful.

PMID: 14689133 [PubMed – indexed for MEDLINE]

11: Aust J Physiother. 2003;49(4):263-7. Related Articles, Books, LinkOut
The threat of predictable and unpredictable pain: differential effects on central nervous system processing?

Moseley GL, Brhyn L, Ilowiecki M, Solstad K, Hodges PW.

Department of Physiotherapy, Royal Brisbane Hospital, Brisbane, Australia. – mailadres –

Central nervous system performance is disrupted by pain and by the threat of pain. It is not known whether disruption caused by the threat of pain is dependent on the likelihood of pain occurring. We hypothesised that when a painful stimulus is possible but unpredictable central nervous system performance is reduced, but when the pain is predictable and unavoidable it is not. Sixteen healthy subjects performed a reaction time task during predictable and unpredictable conditions (100% and 50% probability of pain, respectively). Group data showed increased reaction time with the threat of pain by 50 ms (95% CI 16 to 83 ms) for the predictable condition and 46 ms (95% CI 12 to 80 ms) for the unpredictable condition (p lt 0.01 for both), but there was no difference between predictable and unpredictable conditions (p = 0.41). However, individual data showed that there was a differential effect in 75% of subjects (p lt 0.05 for all) and that there was a greater effect of predictable pain for some subjects and a greater effect of unpredictable pain for others. Reaction time was related to reported anxiety (r = 0.49, p = 0.02 for both conditions). The predictability of a painful stimulus may have a differential effect on central nervous system performance within individuals, but anxiety about the impending pain appears to be important in determining this effect.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial

PMID: 14632625 [PubMed – indexed for MEDLINE]

12: J Pain. 2003 May;4(4):184-9. Related Articles, Books, LinkOut
Unraveling the barriers to reconceptualization of the problem in chronic pain: the actual and perceived ability of patients and health professionals to understand the neurophysiology.

Moseley L.

Department of Physiotherapy, The University of Queensland and Royal Brisbane Hospital, Herston, Australia. – mailadres –

To identify why reconceptualization of the problem is difficult in chronic pain, this study aimed to evaluate whether (1) health professionals and patients can understand currently accurate information about the neurophysiology of pain and (2) health professionals accurately estimate the ability of patients to understand the neurophysiology of pain. Knowledge tests were completed by 276 patients with chronic pain and 288 professionals either before (untrained) or after (trained) education about the neurophysiology of pain. Professionals estimated typical patient performance on the test. Untrained participants performed poorly (mean +/- standard deviation, 55% +/- 19% and 29% +/- 12% for professionals and patients, respectively), compared to their trained counterparts (78% +/- 21% and 61% +/- 19%, respectively). The estimated patient score (46% +/- 18%) was less than the actual patient score (P <.005). The results suggest that professionals and patients can understand the neurophysiology of pain but professionals underestimate patients’ ability to understand. The implications are that (1) a poor knowledge of currently accurate information about pain and (2) the underestimation of patients’ ability to understand currently accurate information about pain represent barriers to reconceptualization of the problem in chronic pain within the clinical and lay arenas.

PMID: 14622702 [PubMed – indexed for MEDLINE]

13: J Electromyogr Kinesiol. 2003 Aug;13(4):361-70. Related Articles, Books, LinkOut
Pain and motor control of the lumbopelvic region: effect and possible mechanisms.

Hodges PW, Moseley GL.

Department of Physiotherapy, The University of Queensland, Brisbane, Qld 4072, Australia. – mailadres –

Many authors report changes in the control of the trunk muscles in people with low back pain (LBP). Although there is considerable disagreement regarding the nature of these changes, we have consistently found differential effects on the deep intrinsic and superficial muscles of the lumbopelvic region. Two issues require consideration; first, the potential mechanisms for these changes in control, and secondly, the effect or outcome of changes in control for lumbopelvic function. Recent data indicate that experimentally induced pain may replicate some of the changes identified in people with LBP. While this does not exclude the possibility that changes in control of the trunk muscles may lead to pain, it does argue that, at least in some cases, pain may cause the changes in control. There are many possible mechanisms, including changes in excitability in the motor pathway, changes in the sensory system, and factors associated with the attention demanding, stressful and fearful aspects of pain. A new hypothesis is presented regarding the outcome from differential effects of pain on the elements of the motor system. Taken together these data argue for strategies of prevention and rehabilitation of LBP.

PMID: 12832166 [PubMed – indexed for MEDLINE]

14: Exp Brain Res. 2003 Jul;151(2):262-71. Epub 2003 Jun 3. Related Articles, Cited in PMC, Books, LinkOut
Experimental muscle pain changes feedforward postural responses of the trunk muscles.

Hodges PW, Moseley GL, Gabrielsson A, Gandevia SC.

Department of Physiotherapy, The University of Queensland, Brisbane, QLD 4072, Australia. – mailadres –

Many studies have identified changes in trunk muscle recruitment in clinical low back pain (LBP). However, due to the heterogeneity of the LBP population these changes have been variable and it has been impossible to identify a cause-effect relationship. Several studies have identified a consistent change in the feedforward postural response of transversus abdominis (TrA), the deepest abdominal muscle, in association with arm movements in chronic LBP. This study aimed to determine whether the feedforward recruitment of the trunk muscles in a postural task could be altered by acute experimentally induced LBP. Electromyographic (EMG) recordings of the abdominal and paraspinal muscles were made during arm movements in a control trial, following the injection of isotonic (non-painful) and hypertonic (painful) saline into the longissimus muscle at L4, and during a 1-h follow-up. Movements included rapid arm flexion in response to a light and repetitive arm flexion-extension. Temporal and spatial EMG parameters were measured. The onset and amplitude of EMG of most muscles was changed in a variable manner during the period of experimentally induced pain. However, across movement trials and subjects the activation of TrA was consistently reduced in amplitude or delayed. Analyses in the time and frequency domain were used to confirm these findings. The results suggest that acute experimentally induced pain may affect feedforward postural activity of the trunk muscles. Although the response was variable, pain produced differential changes in the motor control of the trunk muscles, with consistent impairment of TrA activity.

Publication Types:

* Clinical Trial

PMID: 12783146 [PubMed – indexed for MEDLINE]

15: J Physiol. 2003 Mar 1;547(Pt 2):581-7. Epub 2002 Dec 20. Related Articles, Books, LinkOut
External perturbation of the trunk in standing humans differentially activates components of the medial back muscles.

Mosel ey GL, Hodges PW, Gandevia SC.

Prince of Wales Medical Research Institute, Sydney, Australia.

During voluntary arm movements, the medial back muscles are differentially active. It is not known whether differential activity also occurs when the trunk is perturbed unpredictably, when the earliest responses are initiated by short-latency spinal mechanisms rather than voluntary commands. To assess this, in unpredictable and self-initiated conditions, a weight was dropped into a bucket that was held by the standing subject (n = 7). EMG activity was recorded from the deep (Deep MF), superficial (Sup MF) and lateral (Lat MF) lumbar multifidus, the thoracic erector spinae (ES) and the biceps brachii. With unpredictable perturbations, EMG activity was first noted in the biceps brachii, then the thoracic ES, followed synchronously in the components of the multifidus. During self-initiated perturbations, background EMG in the Deep MF increased two- to threefold, and the latency of the loading response decreased in six out of the seven subjects. In Sup MF and Lat MF, this increase in background EMG was not observed, and the latency of the loading response was increased. Short-latency reflex mechanisms do not cause differential action of the medial back muscles when the trunk is loaded. However, during voluntary tasks the central nervous system exerts a ‘tuned response’, which involves discrete activity in the deep and superficial components of the medial lumbar muscles in a way that varies according to the biomechanical action of the muscle component.

PMID: 12562944 [PubMed – indexed for MEDLINE]

16: Aust J Physiother. 2002;48(4):313-4. Related Articles, Books, LinkOut
Comment on:

* Aust J Physiother. 2002;48(3):171-9; discussion 180-5.

Promotion of knowledge leads to better patient outcomes. (Comment on Refshauge et al, Australian Journal of Physiotherapy 48: 171-179).

Moseley L.

Publication Types:

* Comment
* Letter

PMID: 12443527 [PubMed – indexed for MEDLINE]

17: Aust J Physiother. 2002;48(4):297-302. Related Articles, Books, LinkOut
Combined physiotherapy and education is efficacious for chronic low back pain.

Moseley L.

The University of Queensland and Royal Brisbane Hospital, Australia. – mailadres –

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial

PMID: 12443524 [PubMed – indexed for MEDLINE]

18: Spine. 2002 Jan 15;27(2):E29-36. Related Articles, Cited in PMC, Books, LinkOut
Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements.

Moseley GL, Hodges PW, Gandevia SC.

Prince of Wales Medical Research Institute and the University of New South Wales, Sydney, Australia.

STUDY DESIGN: A cross-sectional study was conducted. OBJECTIVE: To determine the activity of the deep and superficial fibers of the lumbar multifidus during voluntary movement of the arm. SUMMARY OF BACKGROUND DATA: The multifidus contributes to stability of the lumbar spine. Because the deep and superficial parts of the multifidus are near the center of lumbar joint rotation, the superficial fibers are well suited to control spine orientation, and the deep fibers to control intervertebral movement. However, there currently are limited in vivo data to support this distinction. METHODS: Electromyographic activity was recorded in both the deep and superficial multifidus, transversus abdominis, erector spinae, and deltoid using selective intramuscular electrodes and surface electrodes during single and repetitive arm movements. The latency of electromyographic onset in each muscle during single movements and the pattern of electromyographic activity during repetitive movements were compared between muscles. RESULTS: With single arm movements, the onset of electromyography in the erector spinae and superficial multifidus relative to the deltoid was dependent on the direction of movement, but the onset in the deep multifidus and transversus abdominis was not. With repetitive arm movements, peaks in superficial multifidus and erector spinae electromyography occurred only during flexion for most subjects, whereas peaks in deep multifidus electromyography occurred during movement in both directions. CONCLUSIONS: The deep and superficial fibers of the multifidus are differentially active during single and repetitive movements of the arm. The data from this study support the hypothesis that the superficial multifidus contributes to the control of spine orientation, and that the deep multifidus has a role in controlling intersegmental motion.

PMID: 11805677 [PubMed – indexed for MEDLINE]

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Cursus methode ‘de Goey’, o.a. corrigeren houding

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