Analysis Of Neuromuscular Control In Patients With Chronic Nonspecific Low Back Pain With Motor Control Disorder

Objective: Chronic non-specific low back pain(CNLBP)is characterized by high recurrence,rejuvenation and increasing year by year,which brings heavy burden to individuals,families and society.There are differences in neuromuscular control among CNLBP people with Motor Control Impairment(MCI).This experiment analyzes the characteristics of neuromuscular control in MCI CNLBP,and provides guidance for rehabilitation treatment of MCI CNLBP for the future.Methods: Low back pain and healthy subjects were recruited in Chengdu Institute of Physical Education and screened by inclusion,exclusion criteria.At last,32 MCI of CNLBP(MCI-CNLBP,MCI group)and 32 healthy college students(Control,Con group)completed the experiment.Y-balance text(YBT)and pressure feedback test were used to reflect the core stability;surface electromyography test in different stages of Sit to Stand to Sit(STSTS)was used evaluated the muscle activation pattern.Test indicators:anterior,A,Post-medial,PM,Posterolateral,PL extension distance,pressure value,Root Mean Square(RMS),Integrated Electromyograph(IEMG),muscle activation time and sustained muscle activation of YBT.SPSS21.0 was used for data analysis.Independent sample T test was used between groups,and paired sample T test was used for intra-group analysis.Results:(1)YBT test results: Compared with Con group,MCI group has significant differences in PL and PM direction(P < 0.05),has lower stability in the rear;In MCI group,the left and right sides were asymmetric in PL and PM directions(P <0.05).(2)Pressure feedback test: Compared with Con group,the intra-abdominal pressure and core stability of MCI group decreased(P < 0.05)in both static actions(supine static and prone static)and dynamic actions(supine hip flexion,knee flexion and prone shoulder flexion).In MCI group,both sides of supine hip flexion and knee flexion and prone shoulder flexion were asymmetric(P < 0.05),and the ability of maintaining intra-abdominal pressure on both sides was unbalanced.(3)Surface electromyography test results: 1.Sit to Stand stage:(1)RMS: Compared with Con group,there were significant differences in rectus abdominis and erector spinae in MCI group(P < 0.05),the average activation level of erector spinae decreased significantly and rectus abdominis increased significantly.Bilateral erector spinae and rectus abdominis showed asymmetry in MCI group(P < 0.05).(2)IEMG: compared with Con group,there were significant differences in erector spinae,medial femoral muscle and rectus abdominis in MCI group(P < 0.05),and the cumulative activation level of erector spinae,medial femoral muscle and rectus abdominis increased.In MCI group,the participation degree of rectus abdominis muscle and left and right muscles of erector spinae was asymmetric(P < 0.05).(3)Muscle activation time: Compared with Con group,rectus abdominis,erector spinae and rectus femoris in MCI group were all advanced(P < 0.05).In MCI group,the activation time of left and right sides of erector spinae was asymmetric(P < 0.05).(4)Duration of muscle activation: Compared with Con group,the duration of activation of anterior tibial muscle in MCI group increased(P < 0.05),and the stability from sitting to standing was maintained by continuous activation of anterior tibial muscle in sitting.The activation time of erector spinae in MCI group was asymmetric(P < 0.05).2.Stand to Sit stage:(1)RMS: Compared with Con group,there are significant differences in rectus abdominis and erector spinae in MCI group(P < 0.05).In the standing stage,the average activation of rectus abdominis increases and the average activation of erector spinae decreases.The activation of rectus abdominis and erector spinae in MCI group was unbalanced(P < 0.05).(2)IEMG:compared with Con group,MCI group had significant difference in erector spinae(P <0.05),and the cumulative activation level of erector spinae increased significantly.The rectus abdominis muscle and erector spinae were unbalanced in MCI group(P < 0.01).(3)Muscle activation time: Compared with Con group,there were significant differences in rectus abdominis,erector spinae and biceps femoris in MCI group(P <0.05).The activation time of erector spinae in MCI group was asymmetric(P < 0.05).(4)Duration of muscle activation: There was no significant difference between all muscle groups.Conclusion: Neuromuscular control ability of MCI of CNLBP population is decreased:(1)Lower limb stability and intra-abdominal pressure are decreased in MCI CNLBP population.Lower limb stability of MCI of CNLBP population is unstable on the back side and bilateral asymmetry exists in individuals.Core muscles cannot maintain the normal standard of intra-abdominal pressure,which leads to the decrease of core stability.(2)In the process of ‘sitting-standing-sitting task,the muscle activation pattern changes in both sitting and standing stages,and the activation of erector spinae and rectus abdominis is advanced.In the process of task,the activation of erector spinae decreases,while the activation of rectus abdominis increases,showing the overall change of intermuscular coordination.By increasing the participation of rectus abdominis to compensate,the core stability in dynamic task can be improved.Suggestions:(1)It is suggested that the rehabilitation process of MCI population in CNLBP can be improved by increasing lower limb stability training,especially in the rear.And stress biofeedback training to improve core stability.(2)It is suggested that in the rehabilitation process of MCI patients in CNLBP,the activation of deep abdominal muscles and the training of movement patterns should be adopted to correct the wrong muscle activation patterns.(3)It is suggested that future studies can combine brain function research techniques,such as EEG and near-infrared imaging,to further analyze the structural or functional changes of the center.To explore the mechanism of changes in neuromuscular control in MCI population in CNLBP.