Quadriceps activation following aerobic exercise in persons with low back pain and healthy controls

BackgroundA relationship between the muscles that stabilize the lumbar spine and the lower extremity exists that may result in neuromuscular and biomechanical changes during prolonged aerobic exercise in those with low back pain.MethodsTwenty recreationally active adults with healthy lower extremity joints, 7 with recurring episodes of low back pain performed a standard 15-minute aerobic exercise protocol on a treadmill. Quadriceps torque during a maximal isometric voluntary contraction, quadriceps central activation ratio and superimposed burst torque as measured with the superimposed burst technique, and vastus lateralis median frequency were recorded before and after treadmill exercise. A burst of electrical stimuli was superimposed during maximal knee extension causing a transient increase in torque. Quadriceps central activation was calculated as the ratio between maximal volitional and superimposed burst torques. We recorded vastus lateralis surface Electromyography (EMG) during knee extension contractions and calculated the median frequency.FindingsWe observed a 12.4% reduction in the quadriceps central activation ratio after aerobic exercise in participants with recurrent low back pain; healthy controls only experienced a 1.7% reduction. There was no change in quadriceps median frequency following aerobic exercise.InterpretationDeteriorated quadriceps function following aerobic exercise was observed in patients with recurrent episodes of low back pain who had healthy knee joints. This reduction is mediated by a central process that may arise from poor strength and endurance in the muscles surrounding the spine, which is common in persons with recurrent low back pain.