Directed attention alters the temporal activation patterns of back extensors during trunk flexion-extension in individuals with chronic low back pain

Abstract

In chronic low back pain patients (CLBP), neuromuscular and pain intensity have been identified as contributing factors in the disability of the individual. However, it is unclear whether pain intensity influences neuromuscular activation and if directed attention mediates this relationship. Thus, the purpose of this study was to determine the effect of directed attention in individuals with different pain intensities on back extensor activation profiles. Fifty-four CLBP patients were separated into either high- or low-pain groups. Surface electromyograms were recorded from back muscles while the subjects performed a trunk flexion motion for four different attention conditions. Pattern recognition and repeated measures ANOVAs were used to examine the effect of sex, attention and pain intensity on temporal muscle activation patterns. The results showed that there was a significant sex x attention x pain interaction. The largest changes in muscle timing were observed in the low-pain group when their attention was focused on their pain, but the pattern of muscle activation differed between sexes. For males, a rapid decline in activation at mid-extension occurred, whereas females showed delayed activation at the beginning of extension. Overall, this study demonstrated that directed attention on pain had an effect on trunk muscle temporal recruitment, and that this relationship differed between sexes and pain groups. This suggests that sex-specific mechanisms may alter the neuromuscular control of the spine in CLBP patients for different pain levels.

Fig. 1

Mean waveforms for back muscles during trunk flexion–extension motion

Fig. 2

First three principal patterns

Fig. 3

Mean back waveforms with shaded portions of the waveform representing the neuromuscular feature for a PP1, b PP2 and c PP3. Mean PP_iscores and standard error of the mean for d PP1, e PP2 and g PP3. Different capital letters, where indicated, represent significant differences among pair-wise comparisons

Fig. 4

Significant pain × sex × condition interaction showing mean PP₂scores and standard error of the mean for PP2