Journal of Electromyography and Kinesiology 13 (2003) 303–304
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Editorial
Muscle function and dysfunction in the spine
Although there have been much data generated from
research conducted in the area of spine biomechanics
and muscle function, these results have not yet lead to
the emergence of credible unifying theories on the mech-
anisms of low back pain and its treatment. Neither have
the diagnostic techniques that provide more than partial
information, materialized. Instead, conflicting results and
their lax interpretations guide clinicians and therapists
in their choices of treatment. This special journal issue
comprises the collection of papers presented at two
scientific meetings that attempted to address the above
problems. The first meeting was the Seminar on Assess-
ment of Back Muscle Weakness and Fatigue held as part
of the XIVth congress of the International Society of
Electrophysiology and Kinesiology from June 22-25,
2002 in Vienna, Austria. A while later, a special empha-
sis symposium, entitled “Muscle Function and Dysfunc-
tion in the Spine”, was held in conjunction with the IVth
World Congress on Biomechanics, August 4-9, 2002 in
Calgary, Canada. The goal of these meetings was to
gather often-conflicting opinions of several of the lead-
ing scientists in the area of spine mechanics to reach
consensus on the following points:
1. To delineate the current state of knowledge on which
most researchers can agree.
2. To outline the areas where conflicting results are
present.
3. To prioritize the areas in most need of future research.
Because the conference format of 15-20 minutes per
presentation did not even begin to address the above
issues, we asked the invited panelists to contribute a full-
length paper summarizing their views on muscle func-
tion and dysfunction in the spine in relation to low back
pain and its treatment in the framework of their area of
expertise. Eight papers were contributed [1–8].
Although we encourage the readers to interpret this
collection of work themselves, we would like to point
out several remarkable themes that stood out when we
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doi:10.1016/S1050-6411(03)00038-5
listened to the presenters and later when we were
assembling this special issue. Our point of view, we
hope, may also motivate the readers to explore this col-
lection of papers in its entirety.
A variety of methods for studying spinal mechanics
are presented in this collection. From animal models, in
vitro and in vivo experiments, to mathematical and
theoretical hypotheses formulation, the problem of mus-
cle function and dysfunction has been approached from
many different directions. Despite such diversity in the
applied methods, many authors identified the motor con-
trol system as a key factor in the etiology of low back
pain. We believe that this reflects a shift in focus in the
literature on back function and dysfunction in general.
In the past the morphological and mechanical properties
of passive spinal tissues have received much interest.
Much of the literature has focused on muscle dysfunc-
tion and especially muscle fatigue in patients with low
back pain. In this issue, two independent research groups
provided compelling data to question the validity of the
traditional muscle fatigue assessment procedures based
on time and frequency domain analyses of surface EMG
signals [2,4]. Also in the current issue, Lariviere et al. [4]
and van Dieën et al. [1] showed that traditional outcome
measures on muscle function do not clearly set patients
with low back pain apart from healthy control subjects.
Although novel methods may provide more insight, as is
indicated by Farina et al. [2], it seems that motor control
aspects deserve increasing attention.
In the present issue consensus emerges on muscle acti-
vation patterns exhibited by patients with low back pain
being different from those in healthy subjects. However,
the interpretations of such findings are divergent. First,
there is no answer yet to the question of causality. In
other words, we don’t know whether poor motor control
leads to low back pain or low back injury and pain
results in altered motor control. Furthermore, the same
changes in motor control can be interpreted as functional
or dysfunctional depending on the point of view. For
example, van Dieen et al. [1] and Hodges and Moseley
[3] performed extensive literature reviews. Both groups
concluded that muscle activation patterns in low back
pain population are not consistent with either pain-
spasm-pain nor pain-adaptation models proposed in the
304 Editorial / Journal of Electromyography and Kinesiology 13 (2003) 303–304
past. However, while van Dieen et al. [1] emphasized
possible functional adaptations by pointing out positive
effects of altered muscle recruitment patterns, Hodges
and Moseley [3] emphasized dysfunction by outlining
deleterious effects of such changes. Importantly both
show that simple hard-wired control mechanisms trig-
gered by pain cannot account for the data and higher-
level control is implicated. This indicates that task con-
straints may have important effects on the motor control
changes and consequently these changes may be highly
context specific.
An emphasis on the effects of various muscle acti-
vation patterns on spinal stability resonated in several
papers. McGill et al. [5] focused on correct muscle
recruitment pattern and timing to assure spine stability
during all physical tasks. Panjabi [6] stressed the impor-
tance of interactions of spinal structures, trunk muscles,
and the nervous system. Collectively, the papers by Sol-
omonow et al. [7] and by Panjabi [6] emphasized the
sensory role played by spinal structures. However, the
work of Stokes et al. [8] suggests that the stability of
the spine may be more robust than we have previously
thought, because the osteoligamentous spine stiffens sig-
nificantly under the combined compressive action of the
trunk muscles, regardless of their relative activation pat-
terns.
The papers in this issue highlight that the mechanical
functioning of the spine is the outcome of a highly com-
plex system. Therefore, in theorizing about spine func-
tion, we need to develop a view that encompasses effects
of all relevant structures, such as muscles, intervertebral
discs, ligaments, the nervous system, and their interac-
tions, which become apparent in motor control. Even
when considering only mechanical low back pain, the
theory needs to account additionally for non-mechanical
e.g. cognitive influences such as fear of pain. Such a
theory will probably predict that findings in back pain
patients such as altered muscle recruitment are highly
context specific, and thus allow substantial between- and
within-subject variance. This variability poses a tremen-
dous challenge in translating the research findings into
the clinical context, but this task appears to be a pre-
requisite for further progress in this field.
We hope that this special issue of the Journal of Elec-
tromyography and Kinesiology will amplify the impact
of the objectives set out by the two symposia. We would
like to thank all of the panelists and contributors to this
issue for the privilege of guest-editing their work. A spe-
cial mention is due to the sponsors of the speakers at
the Vienna meeting: Institut Robert-Sauvé de recherche
en santé et sécurité du travail (IRSST) du Québec and
the Centre de recherche interdisciplinaire en réadaptation
(CRIR) de Montréal.
Jacek Cholewickia,
Jaap H. van Dieënb,
A. Bertrand Arsenaultc,
a
Yale University School of Medicine, Department of
Orthopaedics and Rehabilitation, Biomechanics
Research Laboratory, PO Box 208071, 333 Cedar
Street, New Haven, CT 06520-8071, USA
E-mail address: jacek.cholewicki@yale.edu
b
Institute for Fundamental and Clinical Human
Movement Sciences, Faculty of Human Movement
Sciences, Vrije Universiteit, Amsterdam, The Netherlands
c
School of Rehabilitation, Faculty of Medicine,
University of Montreal and CRIR/Montreal
Rehabilitation Institute, Montreal, QC, Canada
doi:10.1016/S1050-6411(03)00038-5
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