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PM R. 2015 May;7(5):519-26. doi: 10.1016/j.pmrj.2015.01.013. Epub 2015 Jan 26.

Trunk muscles activation pattern during walking in subjects with and without chronic low back pain: a systematic review.

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Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran(∗).
Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Koodakyar street, Daneshjoo Blvd., Evin., Postal Code: 1985713831, Tehran, Iran(†). Electronic address:



The purpose of this study was to identify how activity patterns of trunk muscles change in chronic LBP during walking. TYPE: This was a systematic review


ELSEVIER, Pro Quest, PubMed, Google scholar and MEDLINE electronic databases were explored for the period from the earliest researchable time to August 2014. Articles investigating patients with chronic LBP and analyzing trunk muscles with surface electromyography (EMG) during walking were included.


All studies had a case-control design. Characteristics of the LBP patients, sample size, studied muscles and EMG parameters, and gait condition and velocity were investigated. Studies were rated as "A" to "E" (5 grades defined) based on study design and performance.


Multifidus (MF), erector spinae (ES), external oblique (EO), and rectus abdominus (RA) muscle activity level were found to be increased in LBP subjects in comparison with controls. ES activity in subjects with LBP was found not to be as adaptive to walking velocity alterations as in healthy controls.


Individuals with chronic LBP exhibit higher global trunk muscle activity. However, the activation pattern appears to vary depending on subphases of gait. It seems that increased walking velocity challenges the stability of the spine and the control system increases muscular activation and variability level to cope with this problem. Further standardized studies with subtyped LBP cases are needed to clarify the controversial findings.

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