Spine Stiffness Clinical Trial
Official title:
Evaluation of Neuro-Muscular Trunk Stabilization Functions and Development of Exercise Programs for Lower Back Pain Prevention
In this research project, effects of two sports specific types of fatiguing protocols on
trunk muscles and specific trunk stability indicators will be studied. In general, sports
activities involving gross motor activities activate higher percentage of muscle mass. In
addition, such activities usually demand increased ventilation and more demanding
inter-muscular activation. Such an example is running, with medium intensity until exhaustion
or with the goal to cover the longest distance possible in a given time. On the contrary,
sports practice often incorporates local strengthening exercises into a workout, especially
for the trunk muscles. These, if performed correctly, cause localized muscle fatigue and can
affect their function. Understanding the effects of these activities is of importance for
coaches as well as for health care providers, as other types of training usually follow such
activities that can more easily lead to trunk or spinal overload. We expect that localized
muscle strengthening protocol until exhaustion will have more detrimental effects on trunk
stability indicators as fatiguing with exhaustive running.
In these study 100 subjects will be studied, divided into two groups. First group will
perform an exhaustive running protocol and the second group a localized trunk muscle
strengthening protocol until exhaustion. The effect of intervention will be studied by
observing the changes in trunk muscle reflex responses following sudden arm loading and
changes in anticipated trunk muscle activation during a quick arm raising task. Activation
latencies and electromyographic (EMG) amplitude, and center of foot pressure excursion will
be used to quantify trunk stability. In addition, center of pressure movement during a
sitting balance task will be studied as to gather information of local trunk stabilization
functions. Finally, changes in joint position sense will be assessed in order to account for
the possible changes in kinesthesia.
It has been shown, that fatiguing a muscles in a kinetic chain leads to changes in activities
of other non-fatigued muscles during postural tasks. This indicates that central changes take
place to adapt the muscle responses according to the new state of the kinetic chain. However,
these studies have mainly been focused on studying the effects of localized isometrically
induced muscular fatigue that is less relevant to the sport community. In sports training,
trunk muscle fatigue is often induced by performing dynamic strength training during a
workout session, followed by other training interventions that pose high demands on trunk
stability. On the other hand, more complex and gross motor tasks are used such as running,
that also have the potential to influence trunk stability. Their effect on trunk stability
comes from changes in muscle function as well as form increased ventilation. In both cases,
trunk stability can be affected, leading to increased risk of injury. Especially the
localized fatigue of the trunk muscles can have a direct effect on trunk stabilizing
activities. One might speculate, that the intramuscular coordination can change as to
compensate for the decreased ability of the trunk muscles to produce trunk and spinal
stabilization impulses. After exhaustive running, especially trunk extensors might be
affected, because of the increased trunk forward lean. In addition, trunk muscles are
important contributors to increased ventilation in such tasks. As opposed to isolated
fatiguing, running might have more complex effects on the trunk stabilization.
It is of most relevance for sports trainers and health care community dealing with athletes
to be familiar with the effects of exhaustive running and localized trunk muscle fatigue on
trunk and spinal stability in order to be better suited in preventing low back pain. This
understanding will enable preparation of more suited training plans, periodization and
individualization approaches.
This study will recruit volunteers form local university. Each participant will receive his
own identification code that will be known only to the principal investigator. In order to
account for the possible bias of the investigators, these will not be allowed to participate
in assessing subject, which they are familiar with. Six investigators will participate, all
trained in performing the measurement and fatiguing protocols.
All participants will be familiarized with the measurement tasks to overcome possible
misunderstandings during the study and to ensure most fluent execution of the measurement
protocol. The familiarization will account for as much time as needed for the participants to
become proficient in each assessment task. Each participant will sigh an informed consent
form that will be prepared in accordance with declaration of Helsinki.
Prior to starting the measurements, each subject will perform a worm-up. The measurement will
follow in a predefined order, starting with the EMG electrode placement. First subjects will
(ii) perform measurements of trunk muscles reflex responses during a sudden hand loading,
followed by (iii) measurements of anticipatory postural adjustments during a quick arm rising
test, (iv) body sway during a sitting balance tasks, (v) joint position test and (vi)
measurements of maximal voluntary contraction for trunk extension and flexion in a neutral
upright stance. Next, subjects will perform a fatiguing protocol. One group of subjects will
perform a twelve-minute running test (Coopers test) with the goal to cower as much distance
as possible. Subjects in the second group will perform dynamic strengthening exercises
(curl-up, right lateral trunk flexion, trunk extension and left lateral trunk flexion), each
session performed until exhaustion. All together subjects in a dynamic strengthening group
will perform three sets with minimal rest in between. Immediately after finishing the
fatiguing protocol, the above measurement protocol will be repeated in the same order.
The measurement data will be saved to a personal computers encoded with the subject's
identification code. During data acquisition, processing, statistical analysis and data
presentation only identification codes will be used. No individual data will be presented.
All data will be gathered in a common data sheet for further statistical analysis.
Prior to performing the study, the sample size will be calculated based on the effect size of
data gathered during a pilot study using 10 subjects. For main results, fallowing statistics
will be calculated:
- Descriptive statistics.
- For parameters not normally distributed, appropriate corrections will be made.
- Intra-group differences prior to fatiguing protocol will be identified using the T-test
for independent samples.
- For parameters, where no baseline differences between the two groups were observed, a
Two-way repeated measures ANOVA model will be used to observe the possible changes after
fatiguing protocols and possible interaction effects for the two groups. Observed
differences will be additionally studied with post-hock tests.
- In cases where the baseline status between the two groups will be different, ANCOVA
model will be used.
- Correlations between the parameters will be studied using Pearson correlation
coefficient.
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