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Table 2 Characteristics of 8 Studies showing the prevalence of muscle dysfunction in patients with back pain (RCTs indicated by **)

From: On the reliability and validity of manual muscle testing: a literature review

Authors, date Subjects Design Findings and statistics
Hossain et al 90 (2005) Literature review Gait analysis studies reviewed show an orderly sequence of muscle activation – this contributes to efficient stabilization of the joint and effective weight transfer to the lower limb. Gluteus maximus fibres – lying almost perpendicular to the joint surfaces are oriented for this purpose. Biceps femoris is another important muscle that can also influence joint stability by its proximal attachment to sacrotuberous ligament. Altered pattern of muscle recruitment has been observed in patients with low back pain. Because of its position as a key linkage in transmission of weight from the upper limbs to the lower, poor joint stability could have major consequences on weight bearing. It is proposed that sacro-iliac joint dysfunction can result from malrecruitment of gluteus maximus motor units during weight bearing, resulting in compensatory biceps femoris over activation. The resulting soft tissue strain and joint instability may manifest itself in low back pain.
This thesis was also proposed by Janda (1964). 18
Falla et al 71 (2004) ** 10 patients with chronic neck pain; 10 controls To compare activity of deep and superficial cervical flexor muscles during a test of craniocervical flexion. Showed a strong linear relation between the electromyographic amplitude of the deep cervical flexor muscles and the incremental stages of the craniocervical flexion test for control and individuals with neck pain (P = 0.002). A reduced performance of the craniocervical flexion test is associated with dysfunction of the deep cervical flexor muscles.
Hodges et al 83 (1996) ** 15 patients with low back pain and 15 matched control subjects Subjects performed rapid shoulder flexion, abduction, and extension in response to a visual stimulus. Electromyographic activity of the abdominal, and lumbar multifidus muscles recorded by surface electrodes. Contraction of transversus abdominis was significantly delayed in patients with low back pain with all movements. The delayed onset of contraction of transversus abdominis indicated a deficit of motor control and is hypothesized to result in inefficient muscular stabilization of the spine.
Triano et al 91 (1987) ** 41 low-back pain patients; and 7 pain-free control subjects To examine relations among some objective and subjective measures of low-back-related disability Oswestry disability score related significantly (P less than 0.001) to presence or absence of relaxation in back muscles during flexion. Mean trunk strength ratios were inversely related to disability score (P less than .05). Findings imply that myoelectric signal levels, trunk strength ratios, and ranges of trunk motion may be used as objective indicators of low-back pain disability.
Biering-Sorensen 85(1984) 449 men and 479 women The examination consisted of anthropometric measurements, flexibility/elasticity measurements of the back and hamstrings, as well as tests for trunk muscle strength and endurance. The main findings were that good isometric endurance of the back muscles may prevent first-time occurrence of low back trouble (LBT) in men and that men with hypermobile backs are more liable to contract LBT. Weak trunk muscles and reduced flexibility/elasticity of the back and hamstrings were found as residual signs, in particular, among those with recurrence or persistence of LBT in the follow-up year.
McNeill T et al 92 (1980) ** 27 healthy males and 30 healthy females; and 25 male and 15 female patients with low-back pain and/or sciatica. Maximum voluntary isometric strengths were measured during attempted flexion, extension, and lateral bending from an upright standing position. The ratios showed that the patients with low back pain and/or sciatica had extension strengths that were significantly less than their strengths in the other types of movements tested. The strength ratios for attempted extension were particularly low for patients with sciatica. Both male and female with LBP and/or sciatica had approximately 60% of the absolute trunk strengths of the corresponding healthy subjects.
Karvonen et al 77 (1980) 183 male conscripts. A history of sciatica was reported by 8%, lumbago by 13%, back injury by 13% and low back insufficiency by 63%. To correlate muscle weaknesses in young men with complaints of LBP Weak trunk extensors were associated with a history of sciatica; weak trunk flexors with back injuries and with current backache at work/exercise. Weak leg extensors showed associations with a history of low back insufficiency and of sick leave due to the back and with current hip pain. Men with a history of lumbago and of hip and knee complaints performed poorly during 12 min of running. The questionnaire and strength measurements proved suitable for studying low back syndrome in its early stages.
Addison et al 76 (1980) 16 male and 17 female patients with chronic LBP Maximum voluntary trunk strengths in the standing position were measured during attempted flexion, extension, and lateral bending. The trunk strengths of these patients were then compared with those of healthy subjects and with those of patients with low-back disorders who sought treatment as outpatients of a general orthopaedic office practice. When compared with healthy subjects, the patients seeking hospitalization had significantly smaller strengths during attempted extension relative to their strengths during attempted flexion or lateral bending.