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The effects of rehabilitation on the muscles of the trunk following prolonged bed rest

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An Erratum to this article was published on 13 August 2010

Abstract

Microgravity and inactivity due to prolonged bed rest have been shown to result in atrophy of spinal extensor muscles such as the multifidus, and either no atrophy or hypertrophy of flexor muscles such as the abdominal group and psoas muscle. These effects are long-lasting after bed rest and the potential effects of rehabilitation are unknown. This two-group intervention study aimed to investigate the effects of two rehabilitation programs on the recovery of lumbo-pelvic musculature following prolonged bed rest. 24 subjects underwent 60 days of head down tilt bed rest as part of the 2nd Berlin BedRest Study (BBR2-2). After bed rest, they underwent one of two exercise programs, trunk flexor and general strength (TFS) training or specific motor control (SMC) training. Magnetic resonance imaging of the lumbo-pelvic region was conducted at the start and end of bed rest and during the recovery period (14 and 90 days after re-ambulation). Cross-sectional areas (CSAs) of the multifidus, psoas, lumbar erector spinae and quadratus lumborum muscles were measured from L1 to L5. Morphological changes including disc volume, spinal length, lordosis angle and disc height were also measured. Both exercise programs restored the multifidus muscle to pre-bed-rest size, but further increases in psoas muscle size were seen in the TFS group up to 14 days after bed rest. There was no significant difference in the number of low back pain reports for the two rehabilitation groups (p = .59). The TFS program resulted in greater decreases in disc volume and anterior disc height. The SMC training program may be preferable to TFS training after bed rest as it restored the CSA of the multifidus muscle without generating potentially harmful compressive forces through the spine.

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References

  1. Alon G, McCombe SA, Koutsantonis S, Stumphauzer LJ, Burgwin KC, Parent MM, Bosworth RA (1987) Comparison of the effects of electrical stimulation and exercise on abdominal musculature. J Orthop Sports Phys Ther 8:567–573

    PubMed  CAS  Google Scholar 

  2. Axler CT, McGill SM (1997) Low back loads over a variety of abdominal exercises: searching for the safest abdominal challenge. Med Sci Sports Exerc 29:804–811

    PubMed  CAS  Google Scholar 

  3. Baecke JA, Burema J, Frijters JE (1982) A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr 36:936–942

    PubMed  CAS  Google Scholar 

  4. Belavý DL, Armbrecht G, Richardson CA, Felsenberg D, Hides JA (2010) Muscle atrophy and changes in spinal morphology: is the lumbar spine vulnerable after prolonged bed-rest? Spine (in press)

  5. Belavý DL, Bock O, Börst H, Armbrecht G, Gast U, Degner C, Beller G, Heer M, de Haan A, Stegeman DF, Ceretteli P, Blottner D, Rittweger J, Gelfi C, Kornak U, Felsenberg D. (2010) The 2nd Berlin BedRest Study: protocol and implementation. J Musculoskel Neuronal Interact (in press)

  6. Belavý DL, Hides JA, Wilson SJ, Stanton W, Dimeo FC, Rittweger J, Felsenberg D, Richardson CA (2008) Resistive simulated weight bearing exercise with whole body vibration reduces lumbar spine deconditioning in bed-rest. Spine 33:E121–E131

    Article  PubMed  Google Scholar 

  7. Belavý DL, Ng JK, Wilson SJ, Armbrecht G, Stegeman DF, Rittweger J, Felsenberg D, Richardson CA (2009) Influence of prolonged bed-rest on spectral and temporal electromyographic motor control characteristics of the superficial lumbo-pelvic musculature. J Electromyogr Kinesiol. doi:10.1016/j.jelekin.2009.1003.1006

  8. Belavý DL, Richardson CA, Wilson SJ, Felsenberg D, Rittweger J (2007) Tonic to phasic shift of lumbo-pelvic muscle activity during 8-weeks of bed-rest and 6-months follow-up. J Appl Physiol 103:48–54

    Article  PubMed  Google Scholar 

  9. Belavý DL, Richardson CA, Wilson SJ, Rittweger J, Felsenberg D (2007) Superficial lumbo-pelvic muscle overactivity and decreased co-contraction after 8-weeks of bed-rest. Spine 32:E23–E29

    Article  PubMed  Google Scholar 

  10. Bogduk N (1997) Clinical anatomy of the lumbar spine and sacrum, 3rd edn. Churchill Livingstone, London

    Google Scholar 

  11. Bogduk N, Pearcy M, Hadfield G (1992) Anatomy and biomechanics of psoas major. Clin Biomech 7:109–119

    Article  Google Scholar 

  12. Cao P, Kimura S, Macias BR et al (2005) Exercise within lower body negative pressure partially counteracts lumbar spine deconditioning associated with 28-day bed rest. J Appl Physiol 99:39–44

    Article  PubMed  Google Scholar 

  13. Carman BJ, Blanton PL, Biggs NL (1972) Electromyographic study of the anterolateral abdominal musculature utilizing indwelling electrodes. Am J Phys Med 51:113–129

    PubMed  CAS  Google Scholar 

  14. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Cuyper HJ (2000) CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J 9:266–272

    Article  PubMed  CAS  Google Scholar 

  15. Demont RG, Lephart SM, Giraldo JL, Giannantonio FP, Yuktanandana P, Fu FH (1999) Comparison of two abdominal training devices with an abdominal crunch using strength and EMG measurements. J Sports Med Phys Fitness 39:253–258

    PubMed  CAS  Google Scholar 

  16. Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA (1978) Studies with pain rating scales. Ann Rheum Dis 37:378–381

    Article  PubMed  CAS  Google Scholar 

  17. Goldby LJ, Moore AP, Doust J, Trew ME (2006) A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine 31:1083–1093

    Article  PubMed  Google Scholar 

  18. Gutin B, Lipetz S (1972) An electromyographic investigation of the rectus abdominis in exercises. Res Q 42:256–263

    Google Scholar 

  19. Hauggaard A, Persson A (2007) Specific spinal stabilisation exercises in patients with low back pain—a systematic review. Phys Ther Rev 12:233–248

    Article  Google Scholar 

  20. Hicks GS, Duddleston DN, Russell LD et al (2002) Low back pain. Am J Med Sci 324:207–211

    Article  PubMed  Google Scholar 

  21. Hides JA, Belavý DL, Stanton W, Wilson SJ, Rittweger J, Felsenberg Richardson C (2007) MRI assessment of trunk muscles during prolonged bed rest. Spine 32:1687–1692

    Article  PubMed  Google Scholar 

  22. Hides JA, Jull GA, Richardson CA (2001) Long-term effects of specific stabilizing exercises for first episode low back pain. Spine 26:E243–E248

    Article  PubMed  CAS  Google Scholar 

  23. Hides JA, Richardson CA, Hodges PW (2004) Local segmental control. In: Richardson C, Hodges PW, Hides J (eds) Therapeutic exercise for lumbo-pelvic stabilization: a motor control approach for the treatment and prevention of low back pain, 2nd edn. Churchill Livingstone, Edinburgh, pp 185–220

    Google Scholar 

  24. Hides JA, Richardson CA, Jull GA (1996) Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 21:2763–2769

    Article  PubMed  CAS  Google Scholar 

  25. Hides JA, Richardson CA, Jull GA (1998) Use of real-time ultrasound imaging for feedback in rehabilitation. Man Ther 3:125–131

    Article  Google Scholar 

  26. Hides JA, Stanton W, McMahon S, Sims K, Richardson C (2008) The effect of stabilization training on multifidus muscle size among young elite cricketers. JOSPT 38:101–108

    PubMed  Google Scholar 

  27. Hodges PW, Moseley GL, Gabrielsson AH, Gandevia SC (2003) Acute experimental pain changes postural recruitment of the trunk muscles in pain-free humans. Exp Brain Res 151:262–271

    Article  PubMed  Google Scholar 

  28. Holguin N, Muir J, Rubin C, Judex S (2009) Short applications of very low-magnitude vibrations attenuate expansion of the intervertebral disc during extended bed rest. Spine J 9:470–477

    Article  PubMed  Google Scholar 

  29. Johnson C, Reid JG (1991) Lumbar compressive and shear forces during various trunk curl up exercises. Clin Biomech 6:97–104

    Article  Google Scholar 

  30. Johnston SL, Wear ML, Hamm PB (1998) Increased incidence of herniated nucleus pulposus among astronauts and other selected populations (abstract). Aviat Space Environ Med 69:220

    Google Scholar 

  31. Kader D, Wardlaw D, Smith F (2000) Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol 55:145–149

    Article  PubMed  CAS  Google Scholar 

  32. Kiesel KB, Uhl TL, Underwood FB, Nitz A (2007) Rehabilitative ultrasound measurement of select trunk muscle activation during induced pain. Man Ther (in press)

  33. Knudson D (1996) A review of exercise and fitness tests for abdominal muscle. Sports Med Update 11(4–5):25–30

    Google Scholar 

  34. Krølner B, Toft B (1983) Vertebral bone loss: an unheeded side effect of therapeutic bed rest. Clin Sci (Lond) 64:537–540

    Google Scholar 

  35. Le Blanc AD, Evans HJ, Schneider VS et al (1994) Changes in intervertebral disc cross-sectional area with bed rest and space flight. Spine 19:812–817

    Article  CAS  Google Scholar 

  36. Le Blanc A, Lin C, Shackelford L et al (2000) Muscle volume, MRI relaxation times (T2), and body composition after spaceflight. J Appl Physiol 89:2158–2164

    CAS  Google Scholar 

  37. Le Blanc A, Rowe R, Schneider V et al (1995) Regional muscle loss after short duration spaceflight. Aviat Space Environ Med 66:1151–1154

    CAS  Google Scholar 

  38. Le Blanc AD, Schneider VS, Evans HJ, Pientok C, Rowe R, Spector E (1992) Regional changes in muscle mass following 17 weeks of bed rest. J Appl Physiol 73:2172–2178

    CAS  Google Scholar 

  39. Lee SU, Hargens AR, Fredericson M, Lang PK (2003) Lumbar spine disc heights and curvature: upright posture vs. supine compression harness. Aviat Space Environ Med 74:512–516

    PubMed  Google Scholar 

  40. Lipetz S, Gutin B (1970) An electromyographic study of four abdominal exercises. Med Sci Sports 2:35–38

    PubMed  CAS  Google Scholar 

  41. McGill SM (1995) The mechanics of torso flexion: situps and standing dynamic flexion manoeuvres. Clin Biomech (Bristol, Avon) 10:184–192

    Article  Google Scholar 

  42. McGill SM, Norman RW (1986) Partitioning of the L4–L5 dynamic moment into disc, ligamentous, and muscular components during lifting. Spine 11:666–678

    Article  PubMed  CAS  Google Scholar 

  43. McGregor AH, Anderton L, Gedroyc WM (2002) The trunk muscles of elite oarsmen. Br J Sports Med 36:214–221

    Article  PubMed  CAS  Google Scholar 

  44. Mengiardi B, Schmid MR, Boos N et al (2006) Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology 240:786–792

    Article  PubMed  Google Scholar 

  45. Monfort-Pañego M, Vera-García FJ, Sánchez-Zuriaga D, Sarti-Martínez MA (2009) Electromyographic studies in abdominal exercises: a literature synthesis. J Manip Physiol Ther 32:232–244

    Article  Google Scholar 

  46. Nachemson A, Elfström G (1970) Intravital dynamic pressure measurements in lumbar discs. A study of common movements, maneuvers and exercises. Scand J Rehabil Med Suppl 1:1–40

    PubMed  CAS  Google Scholar 

  47. Natarajan RN, Andersson GB (1999) The influence of lumbar disc height and cross-sectional area on the mechanical response of the disc to physiologic loading. Spine 24:1873–1881

    Article  PubMed  CAS  Google Scholar 

  48. Neeves N, Barlow D (1975) Torque work and power differences in bent-knee and straight leg sit-ups in women. Med Sci Sports Exerc 7:77

    Google Scholar 

  49. Neumann P, Gill V (2002) Pelvic floor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. Int Urogynecol J 13:125–132

    Article  CAS  Google Scholar 

  50. Niemistö L, Lahtinen-Soupanki T, Rissanen P, Lindgren K-A, Sarna S, Hurri H (2003) A randomized trial of combined manipulation, stabilization exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine 28:2185–2191

    Article  PubMed  Google Scholar 

  51. O’Sullivan PB, Twomey LT, Allison GT (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22:1959–1967

    Google Scholar 

  52. Pinheiro JC, Bates DM (2000) Mixed-effects models in S and S-PLUS. Springer, Berlin

    Book  Google Scholar 

  53. Quint U, Wilke HJ, Shirazi-Adl A, Parnianpour M, Löer F, Claes LE (1998) Importance of the intersegmental trunk muscles for the stability of the lumbar spine. A biomechanical study in vitro. Spine 23:1937–1945

    Article  PubMed  CAS  Google Scholar 

  54. Richardson CA, Hides JA (2004) Closed chain segmental control. In: Richardson CA, Hodges PW, Hides JA (eds) Therapeutic exercise for lumbo-pelvic stabilisation: a motor control approach for the treatment and prevention of low back pain, 2nd edn. Churchill Livingstone, Edinburgh, pp 221–232

    Google Scholar 

  55. Shaughnessy M, Caulfield B (2004) A pilot study to investigate the effect of lumbar stabilization exercise training on functional ability and quality of life in patients with chronic low back pain. Int J Rehabil Res 27:297–301

    Article  PubMed  CAS  Google Scholar 

  56. Sinaki M, Mikkelson BA (1984) Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil 65:593–596

    PubMed  CAS  Google Scholar 

  57. Soderberg GL, Barr JO (1983) Muscular function in chronic low back dysfunction. Spine 8:79–85

    Article  PubMed  CAS  Google Scholar 

  58. Stewart S, Stanton WR, Wilson SJ, Hides JA (2009) Consistency in size and asymmetry of the psoas major muscle among footballers. BJSM. doi:10.1136/bjsm.2009.058909

  59. Stuge B, Laerum E, Kirkesola G, Vollestad N (2004) The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 29:351–359

    Article  PubMed  Google Scholar 

  60. Wallwork TL, Stanton W, Freke M, Hides JA (2009) The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther 14:496–500

    Article  PubMed  Google Scholar 

  61. Wing PC, Tsang IK, Susak L et al (1991) Back pain and spinal changes in microgravity. Orthop Clin N Am 22:255–262

    CAS  Google Scholar 

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Acknowledgments

The authors wish to thank the subjects who participated in the study, and the staff of ward 18A in the Charité Campus Benjamin Franklin Hospital, Berlin, Germany. We would also like to acknowledge Professor Chris Snijders and Christine Hamilton. Christine Hamilton contributed to the development of the rehabilitation program and assisted in delivering the program to the first group of subjects. The 2nd Berlin BedRest Study was supported by grant 14431/02/NL/SH2 from the European Space Agency and grant 50WB0720 from the German Aerospace Center (DLR). The 2nd Berlin BedRest Study was also sponsored by Novotec Medical, Charité Universitätsmedizin Berlin, Siemens, Osteomedical Group, Wyeth Pharma, Servier Deutschland, P&G, Kubivent, Seca, Astra-Zeneka and General Electric. The rehabilitation project was funded by the European Space Agency. Julie A Hides was supported by a travel grant from The University of Queensland, Australia. Gunda Lambrecht was supported by a grant from the European Space agency and Daniel L. Belavý was supported by a post-doctoral fellowship from the Alexander von Humboldt Foundation. The investigations in the current study were also supported by grant number FE 468/5-1 from the German Research Foundation (DFG).

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Authors and Affiliations

  1. School of Physiotherapy, Australian Catholic University, McCauley Campus, PO Box 456, Virginia, QLD, 4014, Australia

    Julie A. Hides & Warren R. Stanton

  2. Mater Health Services Brisbane Limited, South Brisbane, QLD, 4101, Australia

    Julie A. Hides & Warren R. Stanton

  3. Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia

    Julie A. Hides & Carolyn A. Richardson

  4. Krankengymnastikpraxis, Kaiserstraße 34, 53721, Siegburg, Germany

    Gunda Lambrecht

  5. Zentrum für Muskel- und Knochenforschung, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Gabriele Armbrecht, Dieter Felsenberg & Daniel L. Belavý

  6. Wyle Laboratories GmbH, Albin-Koebis Strasse 4, 51147, Cologne, Germany

    Casey Pruett

  7. European Astronaut Center, European Space Agency, Linder Hoehe, 51147, Cologne, Germany

    Volker Damann

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  1. Julie A. Hides
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Correspondence to Julie A. Hides.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00586-010-1551-2

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Hides, J.A., Lambrecht, G., Richardson, C.A. et al. The effects of rehabilitation on the muscles of the trunk following prolonged bed rest. Eur Spine J 20, 808–818 (2011). https://doi.org/10.1007/s00586-010-1491-x

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