Measurement of fatigue in paraspinal muscles while performing a modified side plank in patients with Adolescent Idiopathic Scoliosis

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Measurement of fatigue in paraspinal muscles while performing a modified side plank in patients with Adolescent Idiopathic Scoliosis Richter, A., Parent E.

1 Measurement of fatigue in paraspinal muscles while performing a modified side plank in patients with Adolescent Idiopathic Scoliosis Richter, A., Parent E., Kawchuk G., Moreau, M. Department of Physical Therapy, University of Alberta, Edmonton, Canada Department of Surgery, University of Alberta, Edmonton, Canada

2 Background Scoliosis-specific exercises show promising effect in the treatment of Adolescent Idiopathic Scoliosis (AIS) (Monticone 2013, Negrini 2008) Studies show fibre type and EMG muscle activity imbalances between the concave and convex side of the curves in patients with scoliosis. (Mannion 1997, Cheung 2004) There is a lack of research into the fatigability of paraspinal muscles in AIS, even though exercise prescription parameters are consistent with targeting improvements in muscle endurance of postural muscles. EMG can be used to quantify muscular fatigue. The slope of the median frequency (MDF) over time has been recommended to quantify muscular fatigue 5,6

3 Objective To compare the fatigability of paraspinal muscles between three spinal levels (apex, upper and lower endpoint) and between sides (convex vs concave) in patients with AIS when performing a modified side plank to each side.

Subjects / Task Consecutive volunteers with AIS, 10-18yo, with curves between 10 and 50 o, and treated conservatively were recruited from the Scoliosis Clinic at the Stollery Children s Hospital.

4 Subjects / Task Consecutive volunteers with AIS, 10-18yo, with curves between 10 and 50 o, and treated conservatively were recruited from the Scoliosis Clinic at the Stollery Children s Hospital. Subjects were asked to perform 3 modified side planks on both the left and right sides for as long as they could. 1 min rest between planks and 5 min between sides Subjects maintained the plank for up to 3 minutes or until losing alignment

EMG Bipolar semg electrodes were placed at 2cm on either side of the spine at Upper End Vertebrae, Apex, Lower End Vertebrae, and on medial deltoids.

5 EMG Bipolar semg electrodes were placed at 2cm on either side of the spine at Upper End Vertebrae, Apex, Lower End Vertebrae, and on medial deltoids. Ultrasound imaging was used to locate levels matching curve apex and endpoints from PA X-rays. Raw EMG activity was recorded during each trial Bandpass filter 10Hz -2kHz, Sampling rate 2kHz, with a notch filter at 60Hz Raw EMG signals were processed in Matlab and the slope of the Median Frequency decline was calculated for each muscle

6 Slope of the median frequency Mean Median frequency slope of the closest 2 out of 3 trials was calculated EG. Left paraspinals at LEV on left side during left plank.

7 EMG Output EG. Left plank, left paraspinals at LEV on left side

8 ANALYSIS A repeated measures ANOVA comparing the convex-concave side and levels (UEV, LEV, Apex). A paired t-test was performed to calculate differences in trial duration between left and right planks

9 Results Subjects n=13 (10 females) Age: 13.6 ± 1.6 years Years BMI: ± 3.8 Kg/m Kg/m 2 Cobb Angle: 25 ± o 40 o

10 Differences in fatigability between sides and levels No significant interaction or main effects between sides and levels Mean slope of the median frequency over all sides and levels was: for the left plank 95%CI = to for right plank 95%CI = to Mean slope of the median frequency in the medial deltoid: (SD =0.176) in the left deltoid left plank (SD =0.815) in the right deltoid right plank No significant differences in plank durations between left at 55.5 (±17.98) sec and right at 58.3 (±17.46) sec. (p>0.05)

11 Median frequency slope differences between sides and levels

12 Conclusions The modified side planks tested did not generate sufficient paraspinal muscle fatigue to be measured by semg Future work will: Use the Sorensen to generate more paraspinal fatigue Recruit a control group to compare differences vs scoliosis. Patients with scoliosis maybe rely on muscles other than their paraspinals to maintain side planks or side plank times may be limited by fatigue occurring at the shoulders rather than the paraspinals.

13 Acknowledgment This study was funded by a student grant to Alan Richter from: and the Alun Morgan Memorial Award in Orthopaedic Physiotherapy Research from: Research Coordinator: Kathleen Shearer

14 References 1. Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J doi: /s y. 2. Fusco C, Zaina F, Atanasio S, Romano M, Negrini A, Negrini S. Physical exercises in the treatment of adolescent idiopathic scoliosis: An updated systematic review. Physiother Theory Pract. 2011;27(1): doi: / Mannion AF, Dumas GA, Cooper RG, Espinosa FJ, Faris MW, Stevenson JM. Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences. J Anat. 1997;190 ( Pt 4): Cheung J, Halbertsma JPK, Veldhuizen AG, et al. A preliminary study on electromyographic analysis of the paraspinal musculature in idiopathic scoliosis. Eur Spine J. 2004;14(2): doi: /s Cifrek M, Medved V, Tonkovic S. ScienceDirect.com - Clinical Biomechanics - Surface EMG based muscle fatigue evaluation in biomechanics. Clinical Biomechanics González-Izal M, Malanda A, Gorostiaga E, Izquierdo M. Electromyographic models to assess muscle fatigue. J Electromyogr Kinesiol doi: /j.jelekin

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