Physically Active Adults with Low Back Pain do not Demonstrate Altered Deadlift Mechanics: A Novel Application of Myotonometry to Estimate Inter-Muscular Load Sharing

Abstract

Background: Rehabilitation clinicians that work with physically active populations are challenged with how to safely return patients back to performing deadlift movements following low back injury. Application of reliable and valid tests and measures to quantify impairments related to low back pain (LBP) enhances clinical decision making and may affect outcomes. Myotonometry is a non-invasive method to assess muscle stiffness which has demonstrated significant associations with physical performance and musculoskeletal injury.

Hypothesis/purpose: The purpose of this study was to compare the stiffness of trunk (lumbar multifidus [LM] and longissimus thoracis [LT]) and lower extremity (vastus lateralis [VL] and biceps femoris [BF]) muscles between individuals with and without LBP during the lying, standing, and deadlifting body positions.

Study design: Cross-sectional cohort comparison.

Methods: Muscle stiffness measures were collected in the VL, BF, LM, and LT muscles with participants in lying (supine and prone), standing, and the trap bar deadlift position. Separate analyses of covariance were conducted to compare absolute and relative muscle stiffness between the groups for each muscle and condition.

Results: Sixty-eight participants (41 female, 21.3 years, 34 LBP) volunteered for the study. Within the deadlift condition there was a significantly greater increase in the percent-muscle stiffness change in the VL (p = .029, 21.9%) and BF (p = .024, 11.2%) muscles in the control group than in the LBP group. There were no differences in percent-muscle stiffness changes for the standing condition nor were there any absolute muscle stiffness differences between the two groups for the three conditions.

Conclusion: No differences in muscle stiffness were identified in the lying, standing, or deadlifting conditions between participants with and without LBP. Differences in percent stiffness changes were noted between groups for the deadlift position, however the differences were modest and within measurement error. Future studies should investigate the utility of myotonometry as a method to identify LBP-related impairments that contribute to chronic and/or recurrent low back injury.

Level of evidence: Level 3.

Keywords: Muscle stiffness; clinical decision making; neuromuscular function; rehabilitation.

Figure 1.. Trap bar deadlift position.

Figure 2.. Obtaining stiffness measure of the lumbar multifidus muscle with the MyotonPRO.

Figure 3.. Trap bar deadlift set-up position. Cone dimensions represent height and width of trap bar handles.

Figure 4.. Graph depicting percent-muscle stiffness change per muscle for the trap bar deadlift in healthy controls and participants with low back pain (LBP).

*Statistically significant difference at p < or equal to 0.05.