Flexion-relaxation ratio in sitting: application in low back pain rehabilitation

Joseph N F Mak, Yong Hu, Aldous C S Cheng, H Y Kwok, Y H Chen, Keith D K Luk
Spine 2010 July 15, 35 (16): 1532-8

STUDY DESIGN: A multiple-comparative study between normal and low back pain (LBP) patients before and after rehabilitation.

OBJECTIVE: To examine whether there is a change in flexion-relaxation phenomenon in sitting in LBP patient following a rehabilitation treatment.

SUMMARY OF BACKGROUND DATA: There is an association between LBP and seated spine posture. Previous study has reported an absence of flexion-relaxation phenomenon in LBP patients during sitting. However, it is unknown whether there is a difference in flexion-relaxation phenomenon in sitting in LBP patients before and after rehabilitation treatment.

METHODS: A total of 20 normal subjects and 25 chronic LBP patients who underwent a 12 weeks rehabilitation program were recruited. Surface electromyography recordings during upright sitting and flexed sitting were taken from the paraspinal muscles (L3) bilaterally from the normal subjects, and in the LBP patients before and after the rehabilitation treatment. The main outcome measures for patients include the visual analogue scale, Oswestry disability index, subjective tolerance for sitting, standing and walking, trunk muscle endurance, lifting capacity, and range of trunk motion in the sagittal plane. Flexion-relaxation phenomenon in sitting, expressed as a ratio between the average surface electromyography activity during upright and flexed sitting, was compared between normal and patients; and in LBP patients before and after rehabilitation.

RESULTS: Flexion-relaxation ratio in sitting in normal subjects (Left: 6.83 +/- 3.79; Right: 3.45 +/- 2.2) presented a significantly higher (Left: P < 0.001; Right: P < 0.05) value than LBP patients (Left: 3.04 +/- 2.36; Right: 2.02 +/- 1.49). An increase in flexion-relaxation ratio in sitting was observed in LBP patients after rehabilitation (Left: 4.69 +/- 3.94, P < 0.05; Right: 3.58 +/- 2.97, P < 0.001), together with a significant improvement (P < 0.05) in subjective tolerance in sitting and standing, abdominal and back muscle endurance, lifting capacity, and range of motion. There were no significant changes in disability and pain scores, and subjective tolerance in walking.

CONCLUSION: Flexion-relaxation ratio in sitting has demonstrated its ability to discriminate LBP patients from normal subjects, and to identify changes in pattern of muscular activity during postural control after rehabilitation.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"