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Determining the activation of gluteus medius and the validity of the single leg stance test in chronic, nonspecific low back pain.

Abstract：

OBJECTIVES:To determine the activation of the gluteus medius in persons with chronic, nonspecific low back pain compared with that in control subjects, and to determine the association of the clinical rating of the single leg stance (SLS) with chronic low back pain (CLBP) and gluteus medius weakness. DESIGN:Cohort-control comparison. SETTING:Academic research laboratory. PARTICIPANTS:Convenience sample of people (n=21) with CLBP (>12wk) recruited by local physiotherapists, and age- and sex-matched controls (n=22). Subjects who received specific pain diagnoses were excluded. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Back pain using the visual analog scale (mm); back-related disability using the Oswestry Back Disability Index (%); strength of gluteus medius measured using a hand dynamometer (N/kg); SLS test; gluteus medius onset and activation using electromyography during unipedal stance on a forceplate. RESULTS:Individuals in the CLBP group exhibited significant weakness in the gluteus medius compared with controls (right, P=.04; left, P=.002). They also had more pain (CLBP: mean, 20.50mm; 95% confidence interval [CI], 13.11-27.9mm; control subjects: mean, 1.77mm; 95% CI, -.21 to 3.75mm) and back-related disability (CLBP: mean, 18.52%; 95% CI, 14.46%-22.59%; control subjects: mean, .68%; 95% CI, -.41% to 1.77%), and reported being less physically active. Weakness was accompanied by increased gluteus medius activation during unipedal stance (R=.50, P=.001) but by no difference in muscle onset times. Although greater gluteus medius weakness was associated with greater pain and disability, there was no difference in muscle strength between those scoring positive and negative on the SLS test (right: F=.002, P=.96; left: F=.1.75, P=.19). CONCLUSIONS:Individuals with CLBP had weaker gluteus medius muscles than control subjects without back pain. Even though there was no significant difference in onset time of the gluteus medius when moving to unipedal stance between the groups, the CLBP group had greater gluteus medius activation. A key finding was that a positive SLS test did not distinguish the CLBP group from the control group, nor was it a sign of gluteus medius weakness.

journal_name

Arch Phys Med Rehabil

journal_title

Archives of physical medicine and rehabilitation

authors

Penney T,Ploughman M,Austin MW,Behm DG,Byrne JM

doi

10.1016/j.apmr.2014.06.009

subject

Has Abstract

pub_date

2014-10-01 00:00:00

pages

1969-76

issue

eissn

0003-9993

issn

1532-821X

pii

S0003-9993(14)00440-7

journal_volume

pub_type

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Determining the activation of gluteus medius and the validity of the single leg stance test in chronic, nonspecific low back pain.