慢性腰痛患者静止站立时躯干肌的激活特征及足底压力分布

doi:10.3969/j.issn.1006-9771.2025.04.012

Abstract

Abstract:

Objective To compare trunk muscle activation, muscle co-contraction levels and plantar pressure distribution between patients with chronic low back pain (cLBP) and healthy subjects during static standing.
Methods From July, 2021 to July, 2022, 17 healthy subjects (healthy control group) and 18 cLBP patients (cLBP group) were recruited from the Department of Rehabilitation Medicine, the First Affiliated Hospital of Sun Yat-sen University. Demographic information was collected for both groups, as well as the pain intensity, functional disability, and center of pressure displacement parameters of the cLBP group in static standing. A plantar pressure plate was used to record plantar pressure distribution in static standing task. Simultaneously, a wireless surface electromyography (sEMG) system was used to record the activity of the transverse abdominis (TrA), erector spinae (ES) and lumbar multifidus (LM). The activation levels of each muscle and the co-contraction index (CCI) between trunk muscle pairs were analyzed.
Results Compared with the healthy control group, the cLBP group showed higher activation levels of the bilateral LM (∣t∣ > 2.479, P < 0.05) and higher lumbar-abdominal muscle CCI of left LM-left TrA (t = 2.212, P = 0.042), left LM-right TrA (t = 2.868, P = 0.008) and right LM-right TrA (U = 75.000, P = 0.009). In the cLBP group, pressure decreased in the right big toe region (t = 2.825, P = 0.009), and increased in the right medial and left lateral heel regions (U < 77.000, P < 0.05).
Conclusions During static standing, patients with cLBP require higher level of trunk muscle activation and co-contraction， with a posterior shift in plantar pressure distribution, which might be due to the adoption of different postural compensation strategies to maintain postural stability.

Key words: chronic low back pain, surface electromyography, co-contraction index, plantar pressure, static standing task

CLC Number:

R681.5

XU Zhaoqiang, LI Yan, PENG Jiahui, XIE Haoyu, CHEN Yu, WANG Chuhuai. Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 466-475.

Figures/Tables 5

Table 1

Table 2

Comparison of RMS values of lumboabdominal muscles between two groups 单位：μV"

靶肌肉	组别	n	$x - ± s$	t值	P值
左侧TrA	健康对照组	17	0.18±0.05	-1.254	0.218
	cLBP组	18	0.20±0.05
右侧TrA	健康对照组	17	0.18±0.06	-0.529	0.600
	cLBP组	18	0.19±0.04
左侧ES	健康对照组	17	0.15±0.06	-1.360	0.183
	cLBP组	18	0.17±0.04
右侧ES	健康对照组	17	0.15±0.04	-1.075	0.290
	cLBP组	18	0.17±0.03
左侧LM	健康对照组	17	0.18±0.09	-2.479	0.020
	cLBP组	18	0.21±0.05
右侧LM	健康对照组	17	0.16±0.06	-3.159	0.003
	cLBP组	18	0.22±0.05

Table 2

Table 3

Comparison of CCI for muscle-pairs between two groups 单位：μV"

肌肉对	组别	n	( $x - ± s$ )/M(Q_L,Q_U)	t/U值	P值
左ES-左TrA	健康对照组	17	10.21 $± 3.89$	0.796	0.432
	cLBP组	18	11.20 $± 3.52$
左ES-右TrA	健康对照组	17	9.18 $± 4.12$	1.617	0.115
	cLBP组	18	11.22 $± 3.33$
右ES-左TrA	健康对照组	17	10.92(8.31,12.91)	156.000	0.935
	cLBP组	18	10.88(9.52,12.58)
右ES-右TrA	健康对照组	17	10.30(6.44,13.11)	126.000	0.386
	cLBP组	18	11.15(9.66,12.50)
左LM-左TrA	健康对照组	17	9.50 $± 5.37$	2.212	0.042
	cLBP组	18	12.97 $± 4.28$
左LM-右TrA	健康对照组	17	8.31 $± 5.18$	2.868	0.008
	cLBP组	18	12.59 $± 3.42$
右LM-左TrA	健康对照组	17	10.53 $± 4.14$	1.961	0.058
	cLBP组	18	13.14 $± 3.72$
右LM-右TrA	健康对照组	17	10.87(6.69,12.62)	75.000	0.009
	cLBP组	18	12.69(11.15,16.13)

Table 3

Table 4

Comparison of time-integrated average pressure in eight plantar regions between two groups 单位：kPa"

足底区域	组别	n	( $x - ± s$ )/(M(Q_L,Q_U))	t/U值	P值
左侧T₁	健康对照组	17	12.85±6.37	0.580	0.566
	cLBP组	18	11.61±6.32
右侧T₁	健康对照组	17	13.88±5.90	2.825	0.009
	cLBP组	18	9.23±3.45
左侧T_2-5	健康对照组	17	5.60(4.89,7.62)	185.000	0.303
	cLBP组	18	5.47(3.80,6.13)
右侧T_2-5	健康对照组	17	6.67±2.94	0.785	0.438
	cLBP组	18	5.93±2.59
左侧M₁	健康对照组	17	22.47±6.79	1.066	0.294
	cLBP组	18	19.81±7.86
右侧M₁	健康对照组	17	22.28±8.75	2.013	0.052
	cLBP组	18	17.06±6.49
左侧M_2-4	健康对照组	17	38.5(32.9,39.8)	191.000	0.219
	cLBP组	18	35.47(31.22,38.40)
右侧M_2-4	健康对照组	17	34.81±7.69	1.105	0.277
	cLBP组	18	32.31±5.59
左侧M₅	健康对照组	17	20.84±5.32	1.771	0.086
	cLBP组	18	17.37±6.20
右侧M₅	健康对照组	17	21.36±5.14	1.744	0.091
	cLBP组	18	17.60±7.34
左侧MF	健康对照组	17	13.59±3.76	0.144	0.886
	cLBP组	18	13.36±5.54
右侧MF	健康对照组	17	14.03(12.25,15.84)	176.500	0.443
	cLBP组	18	10.06(9.34,18.45)
左侧MH	健康对照组	17	40.93(39.33,42.23)	102.000	0.096
	cLBP组	18	41.84(40.15,42.94)
右侧MH	健康对照组	17	39.17(36.6,41.47)	77.000	0.011
	cLBP组	18	41.99(40.48,42.65)
左侧LH	健康对照组	17	40.70(40.12,42.2)	60.500	0.002
	cLBP组	18	43.13(42.13,44.44)
右侧LH	健康对照组	17	39.90(37.15,43.72)	103.500	0.103
	cLBP组	18	42.80(40.88,44.54)

Table 4

Table 5

Comparison of center of gravity displacement parameters between two groups"

项目	组别	n	$x - ± s$	t值	P值
前-后位移速度/(mm⋅s^-1)	健康对照组	17	6.00±2.00	0.681	0.525
前-后位移速度/(mm⋅s^-1)	cLBP组	18	5.50±1.25	0.681	0.525
左-右位移速度/(mm⋅s^-1)	健康对照组	17	4.00±2.00	-1.188	0.258
左-右位移速度/(mm⋅s^-1)	cLBP组	18	4.50±3.25	-1.188	0.258
位移长度/mm	健康对照组	17	244.00±64.50	1.047	0.152
位移长度/mm	cLBP组	18	254.00±100.50	1.047	0.152
位移面积/mm²	健康对照组	17	200.00±138.00	0.140	0.890
位移面积/mm²	cLBP组	18	206.50±185.75	0.140	0.890

Table 5

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组别	n	性别(男/女)/n	年龄/岁	身高/m	体质量/kg	BMI/(kg⋅m^-2)	足姿指数
健康对照组	17	6/11	25.71±2.64	1.67±0.08	60.06±8.92	21.33±1.85	0.71±0.69
cLBP组	18	6/12	27.00±3.25	1.66±0.09	59.17±9.26	21.41±2.14	0.67±0.69
χ²/t/Z值		0.015	1.287	-0.491	-0.290	0.104	0.182
P值		0.903	0.207	0.627	0.774	0.918	0.883

Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing

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[3]	MA Yubao, HUANG Zhibin, LI Yige, FAN Zhijiao, ZHANG Lihua, SUN Fenglong. Effect of soft brace wearing on plantar dynamics in patients with chronic ankle instability [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(5): 613-620.
[4]	WU Qian, WEI Mengli, CAO Sijia, YU Tingting, ZHONG Yaping. Changes of muscle activation during landing impact of human lower limbs during accumulation of running fatigue [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(10): 1215-1223.
[5]	MA Shengnan, KE Jingyue, DONG Hongming, LI Jianping, ZHANG Honghao, LIU Chao, SHEN Shuang, LI Guqiang. Effect of core stability training on dynamic balance and surface electromyography after anterior cruciate ligament reconstruction [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(8): 882-889.
[6]	CUI Yao, CONG Fang, HUANG Fubiao, ZENG Ming, YAN Ruxiu. Brain and muscle activation under mirror neuron-based training strategies: a near-infrared spectroscopy and surface electromyography study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(7): 782-790.
[7]	LI Dan, WANG Jianxiong, HUANG Maomao, XU Fangyuan, ZENG Qiu, LI Jiyang, LI Yang, XIA Cuihong, ZHENG Yadan, XU Zhangyu, FANG Wenfeng, WAN Tenggang. Surface electromyography of lower limb muscles in healthy middle-aged and old women during stair ascent and descent [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(6): 731-737.
[8]	WANG Fang, YANG Tao, HE Yaoguang, CAO Zijun, LIU Guoqing, HU Jun, ZHANG Jianguo, FAN Yubo. Design of variable stiffness insole based on diabetics plantar pressure during gait period [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(4): 408-415.
[9]	ZHU Xu,LIU Jing,DONG Zeping,QIU Dawei. Gesture action intent recognition based on surface electromyography: a systematic review [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(9): 1032-1038.
[10]	TIAN Yaxing,HONG Yongfeng,KAN Xiuli,SHEN Xianshan,MAO Jing,JIANG Yan,HE Ziyan,WU Yu,HU Wei,SUN Xiaoning,HU Shunyin. Effects of manual digitorum sensory stimulation on spasticity of fingers for stroke patients: a surface electromyography study [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 515-519.
[11]	ZHOU Yue,LIU Xu,SUN Yuemei,HU Chunying,ZHU Yuetong,LI Bo. Effect of Flexi-bar training in different exercise patterns on trunk stability muscles [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(4): 384-388.
[12]	HUANG Zhaoxin,ZHANG Yi,CUI Chenxi,ZHU Xiaojing,XIAO Xiaofei. Biomechanical analysis of in-toeing gait in young females based on ICF [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1459-1465.
[13]	GUO Jingwei,GE Ruidong,BAI Shuo,WANG Jiaxi,WU Shuai,WANG Le. Characteristics of surface electromyography of muscles in stroke patients with lower limb spasticity under isokinetic passive movement [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1473-1477.
[14]	ZHI Wenqian,HUANG Qiang,LI Qiang,LI Yanchao,WANG Yuzhang,YANG Ming,LIU Xiaohua. Application of surface electromyography in motor function evaluation of patients after elbow fracture surgery [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(12): 1478-1483.
[15]	LI Jingyue,ZHANG Tong,WANG Ya'nan,WANG Chen. Application of three-dimensional dynamic capture system and surface electromyography in upper extremity motor evaluation for stroke patients with hemiplegia [J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(11): 1241-1246.