Introduction

1. The Influence Of A Muscle Energy Treatment Session On Trunk Muscle Activity In Participants With Chronic Low Back Pain Brown, Lauren¹,Banks, Heather¹,Mahato, Niladri²,Clark, Brian²,³,Walkowski, Steven²,³ , Thomas, James¹,²,³ 1School of Rehabilitation and Communication Sciences, Division of Physical Therapy, Ohio University, 2Ohio Musculoskeletal and Neurological Institute,3Department of Biomedical Sciences College of Osteopathic Medicine, Ohio University, Athens, OH • Introduction • The most common type of pain reported by adults in the United States is low back pain, causing dysfunction, disability and a decline in daily activities. (Day, Nitz) • After the initial incident of acute low back pain, the likelihood of recurrent low back pain is 25% within the first year. (Stanton, Henschke) • There are many treatment approaches for low back pain including therapeutic exercise, modalities, mobilization, manipulation and muscle energy. • Muscle energy techniques are defined as a voluntary muscle contraction performed by the patient “in a precisely controlled direction, against a distinctly executed counter force applied by the operator.” (Day, Nitz) • Muscle energy techniques when combined with other treatment techniques such as supervised motor control and resistance exercises has been shown to be beneficial for decreasing disability and improving function in individuals suffering from acute low back pain. (Wilson, Payton, Donegan-Shoaf, Dec) • Muscle energy is commonly used in clinical practice for the treatment of low back pain, particularly when patients are unable to receive joint manipulations due to precautions or contraindications. (Day, Nitz) However, there is limited evidence regarding muscle energy as a treatment for chronic low back pain. In addition, changes in lumbar motion following a muscle energy technique have not been investigated. • In contrast, other techniques such as mobilization and manipulation have been highly researched regarding the treatment of low back pain and changes in lumbar mobility. • In the physical therapy discipline, one of the main impairments clinicians focus on during the episode of care is decreasing the patient’s pain. In contrast, osteopaths focus more on restoring normal kinematics and motion regardless of the source of the patient’s pain. We chose to focus on changes in lumbar kinematics to understand the effects of muscle energy treatment from a different perspective. • More specifically, the purpose of this study was to examine the influence of a muscle energy treatment session on lumbar flexion during reaching in female subjects with and without chronic low back pain. • Methods • This study consisted of reaching tasks and sudden trunk perturbations before and after a muscle energy treatment session was performed on subjects with and without chronic low back pain. This abstract will focus on the effects of the treatment on the amount of lumbar flexion used to reach to two targets located in the mid-sagittal plane. Thirteen subjects with chronic low back pain and twelve healthy subjects were recruited. The subjects were matched on age, height, and weight Prior to testing, subjects completed the Roland Morris Disability Questionnaire (RMDQ) and the McGill Pain Questionnaire-short form (MPQ-SF). • To track full body motion, reflective markers were placed on the subjects’ limbs and trunk segments. The trajectories were recorded using Nexus software and a 7-camera Vicon MX-13 system (SEE FIGURE 1. The 3-D Euler angles of the thoracic and lumbar spines were calculated in Motion Monitor. The first task consisted of a series of trunk perturbations where the timing and direction were unanticipated, followed by a forward reaching task to two targets (high and low) with both hands. CONSTRAINED and UNCONSTRAINED • The targets were normalized to the subject’s anthropometric measures. HOW SEE Figure 2The subjects completed 3 trials to each target location, and then they received a single muscle energy treatment on the low back. The reaching and perturbations tasks were then repeated in reverse order. Mixed model ANOVAs were used to test the effects of group (LBP and healthy) and treatment (pre and post muscle energy treatment) on the magnitude of lumbar spine and thoracic spine excursions used to complete the reaching tasks. Results Our healthy subjects had an average score of 0 on the MPQ-SF PPI, whereas the LBP subjects had an average score of 1.33. On the RMDQ, the healthy subjects had an average score of 0, and the LBP subjects had an average score of 5.67. There were no significant differences between the groups for age, height and weight (p>.05). Across the two target locations, the average lumbar excursion was 19.1° for the LBP subjects and 11.4° for the healthy matched controls (SD=2.59, F=4.36, p=.05) There was also a significant interaction of treatment (pre vs. post-manipulation) and group (LBP vs. healthy subjects) (F=6.78, p=.02). After treatment, females with LBP demonstrated increased lumbar flexion whereas healthy female subjects exhibited a slight decrease in lumbar flexion. Conclusions Female subjects with low back pain displayed increased lumbar flexion motion in a reaching task after receiving the muscle energy treatment. Healthy female subjects showed slightly less lumbar flexion following the same treatment. Females with chronic low back pain may benefit from muscle energy treatment to improve lumbar motion as well as their ability to perform tasks requiring large trunk excursions. Future Directions To be determined