Ann Rehabil Med.  2014 Aug;38(4):506-513. 10.5535/arm.2014.38.4.506.

Activations of Deep Lumbar Stabilizing Muscles by Transcutaneous Neuromuscular Electrical Stimulation of Lumbar Paraspinal Regions

• Baek SO
• Ahn SH
• Jones R
• Cho HK
• Jung GS
• Cho YW
• Tak HJ

• KMID: 2165733
• DOI: http://doi.org/10.5535/arm.2014.38.4.506

Abstract

OBJECTIVE
To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI).
METHODS
Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency.
RESULTS
The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05).
CONCLUSION
The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles.

Keyword

Transcutaneous neuromuscular electrical stimulation; Lumbar stabilizing muscle; Real-time ultrasound imaging; Lumbar multifidus; Transverse abdominis

MeSH Terms

Abdominal Muscles
Electric Stimulation*
Humans
Male
Muscles*
Paraspinal Muscles
Ultrasonography
Volunteers

Figure

• 

  Fig. 1 (A) Sites of stimulation and recording: lumbar paraspinal region and abdominal region shown in blue; 4 hydrogel surface electrodes (5 cm×5 cm) placed bilaterally at the level of the L4 and L5 spinous processes shown in black. (B) Site of the ultrasound transducer: the abdominal ultrasound transducer position was adjusted to ensure that the medial edge of transversus abdominis muscle was approximately 2 cm from the medial edge of the ultrasound image when the participant was relaxed.

• 

  Fig. 2 (A) Comparison of the thicknesses of abdominal muscles during NMES: three vertical lines-one at image midline and 1 cm (calibrated to the image scale) to either side of the midline-were archived. At rest (B), NMES at 20 Hz (C), NMES at 50 Hz (D), NMES at 80 Hz (E). NMES, neuromuscular electrical stimulation; OE, obliquus externus; OI, obliquus internus; TrA, transverse abdominis.

• 

  Fig. 3 Comparison of the thicknesses of superficial and deep lumbar multifidus (LM) muscles during NMES. At rest (A), NMES at 20 Hz (B), NMES at 50 Hz (C), NMES at 80 Hz (D). LM thickness was measured between the posteriormost portion of the L4-5 facet joint ('F' in B) and the fascial plane between the muscle and subcutaneous tissue. SM and LM were separated along the edge of the hypoechoic region ('L' in B), which represents the locations of fascial separations between muscles. NMES, neuromuscular electrical stimulation; SM, superficial multifidus; DM, deep multifidus.

• 

  Fig. 4 Graphs of changes in thickness of individual muscles at different frequencies. Colored bars represent mean ratios and black vertical lines indicate standard deviations. Different frequencies elicited similar changes in thickness in all muscles. OE, obliquus externus; OI, obliquus internus; TrA, transverse abdominis; SLM, superficial lumbar multifidus; DLM, deep lumbar multifidus.

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