The effects of transcutaneous neuromuscular electrical stimulation on the activation of deep lumbar stabilizing muscles of patients with lumbar degenerative kyphosis

So Yeon Kim, Jin Hyun Kim, Gil Su Jung, Seung Ok Baek, Rodney Jones, Sang Ho Ahn, So Yeon Kim, Jin Hyun Kim, Gil Su Jung, Seung Ok Baek, Rodney Jones, Sang Ho Ahn

Abstract

[Purpose] To investigate the effectiveness of three different neuromuscular electrical stimulation (NMES) protocols for the deep lumbar stabilizing muscles of patients with lumbar degenerative kyphosis (LDK). [Subjects and Methods] Twenty patients with LDK were recruited. Three stimulation protocols were investigated: stimulation of the abdominal muscles (protocol A); stimulation of the lumbar muscles (protocol B); and simultaneous stimulation of the abdominal and lumbar muscles (protocol A+B). Images of the obliquus externus (OE), obliquus internus (OI), transversus abdominis (TrA), and lumbar multifidus (LM) muscles were captured by real-time ultrasound imaging (RUSI). [Results] The thickness of LM was significantly greater during stimulation than at rest for all three protocols. Thicknesses of the abdominal muscles (TrA, OI, and OE) were significantly greater during stimulation than at rest for protocols A and A+B. Thickness increases in LM were significantly greater during protocols B and A+B, but not during protocol A. Thickness increases in the abdominal muscles (TrA, OI, and OE) were significantly greater during protocols A and A+B, but not during protocol B. [Conclusion] NMES can significantly activate the deep lumbar stabilizing muscles of patients with LDK. Protocol A+B of NMES is recommended to aid postural correction and low back pain (LBP) in patients with LDK.

Keywords: Deep lumbar stabilizing muscle; Lumbar degenerative kyphosis; Neuromuscular electrical stimulation.

Figures

Fig. 1.
Fig. 1.
Sites of stimulation used on the abdominal wall and lumbar paraspinal region (A) abdominal wall (frontal view), (B) abdominal wall (lateral view), (C) lumbar paraspinal region S: stimulation electrode, R: reference electrode
Fig. 2.
Fig. 2.
Thicknesses of abdominal muscles during NMES Three vertical lines were drawn: one at the midline of the image and two 1 cm (adjusted for scale) either side of the midline. OE: obliquus externus muscle, OI: obliquus internus muscle, TrA: transversus abdominis muscle
Fig. 3.
Fig. 3.
Thickness of the lumbar multifidus muscle during NMES The lumbar multifidus muscle thickness was measured at the distance between the posterior-most portion of the L4/L5 facet joint and the fascial plane between the muscle and subcutaneous tissue. SM: superficial lumbar multifidus muscle, DM: deep lumbar multifidus muscle
Fig. 4.
Fig. 4.
Comparison of the thicknesses of lumbar multifidus muscles (A) at rest, (B) during protocol B; stimulation of lumbar muscles, (C) during protocol A+B; concurrent stimulation of abdominal and lumbar muscles, and (D) during protocol A; stimulation of abdominal muscles SM: superficial lumbar multifidus muscle, DM: deep lumbar multifidus muscle
Fig. 5.
Fig. 5.
Comparison of the thicknesses of three abdominal muscles. (A) at rest, (B) protocol A; stimulation of abdominal muscles, (C) protocol A+B; concurrent stimulation of abdominal and lumbar muscles, (D) protocol B; stimulation of lumbar muscles. OE: obliquus externus muscle, OI: obliquus internus muscle, TrA: transversus abdominis muscle

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