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Resting Electromyographic Activity of Deep Thoracic Transversospinalis Muscles Identified As Abnormal with Palpation

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Resting Electromyographic Activity of Deep Thoracic Transversospinalis Muscles Identified As Abnormal with Palpation ORIGINAL CONTRIBUTION Resting Electromyographic Activity of Deep Thoracic Transversospinalis Muscles Identified as Abnormal With Palpation Gary Fryer, BSc (Osteopathy), PhD; Michael Bird, PhD; Barry Robbins, DO; Christian Fossum, DO (Norway); and Jane C. Johnson, MA Context: In the 1940s, osteopathic researchers suggested that activity at each of the three intramuscular sites was evident paraspinal tissue abnormality was associated with sponta - (mean [SD] percent of MVIC: abnormal 7.83 [8.76]; normal 9.47 neous muscle activity, but few studies have since re-examined [8.45], 6.65 [7.39]). No statistically significant differences existed these reports. in the intramuscular EMG values between the two resting baseline periods ( P=.10). Objective: To determine whether abnormal motor activity plays a role in deep paraspinal tissues that appear abnormal Conclusion: The lack of statistically significant differences to palpation. between EMG activity at the abnormal and normal paraspinal sites suggests that factors other than muscle activity are respon - Methods: Using an observational study design, the PVG of sible for the apparent abnormality of these tissues to palpation. participants with thoracic pain were palpated by two exam - Investigation of these regions for increased tissue fluid and iners for consensus on the most marked level of tissue abnor - inflammatory mediators is recommended. mality. Dual fine-wire, intramuscular electrodes were inserted into the deep transversospinalis (multifidus, rotatores) mus - J Am Osteopath Assoc . 2010;110(2):61-68 cles at the abnormal level and at two normal sites (above and below the abnormal level). Surface electrodes were placed over the erector spinae muscles adjacent to each intramuscular esearchers in osteopathic medicine and other manual electrode site. Electromyography signals were recorded during Rmedicine disciplines have claimed that paraspinal tissue initial prone resting, three maximal voluntary isometric con - texture irregularity is an important clinical sign of functional tractions (MVIC), and a second prone resting. The area under disturbances to the spinal joints and tissues. 1-5 These functional the curve for a 2-second period was analyzed for each con - disturbances, termed somatic dysfunction in the osteopathic lit - dition, and values were normalized and reported as a per - erature, are identified primarily by the palpation of abnormal centage of MVIC. Data were analyzed using a 2-factor tissue texture, asymmetry, range-of-motion disturbance, and repeated-measures analysis of variance. tenderness. 2,3 Tissues in the paravertebral gutter (PVG) Results: Twenty-five participants with mean (SD) thoracic region—the longitudinal groove that lies between the verte - pain of 3.3 (1.9) on a 0 to 10 visual analog pain scale com - bral spinous processes and the bulk of the erector spinae pleted the study protocol. There were no statistically signifi - muscle group—are claimed to be of particular relevance to cant differences in normalized resting activity between the spinal assessment. 1-3,6 Irregularity of segmental tissue tex - three intramuscular sites ( P=.25) or between the three sur - ture in the PVG may include abnormal hardness, bogginess, face sites ( P=.33). Substantial variability in normalized resting or ropiness of the deep paraspinal tissues. 1-3,6 Increased motor activity of the deep paraspinal musculature, particularly the multifidus and rotatores muscles, has been cited as a possible etiologic process for paraspinal tissue irregularity associated From the A.T. Still Research Institute (Dr Fryer, Mr Fossum, and Ms Johnson) with somatic dysfunction. 1,2,6 and the Department of Neurobehavioral Sciences (Dr Robbins) at Kirksville Col - Although the clinical concept of somatic dysfunction has lege of Osteopathic Medicine-A.T. Still University in Missouri; and from the been central to osteopathic manipulative medicine for more Department of Exercise Science at Truman State University, also in Kirksville (Dr Bird). Dr Fryer is also affiliated with Osteopathic Medicine, School of than a century, objective evidence for the pathophysiology of Biomedical & Health Sciences at Victoria University in Melbourne, Australia. the proposed dysfunction and associated tissue texture abnor - This study was funded by the Strategic Research Fund (Grant # 501-281) mality is limited. Various models for the etiologic process of of the A.T. Still University of Health Sciences in Kirksville, Missouri. The authors have no conflicts of interest to declare. somatic dysfunction have attributed tissue texture abnormal - Address correspondence to Gary Fryer, BSc, PhD, Osteopathic Medicine ities to overactivity of segmental musculature, 7,8 tissue inflam - Unit, School of Biomedical & Health Sciences, Victoria University, PO Box mation, 8,9 segmental muscle atrophy, 9 or a combination of all 14428 MCMC, Melbourne, 8001, Australia. E-mail: [email protected] these factors. 9 As cited in the osteopathic medical literature, 10-12 many Submitted May 19, 2009; revision received October 6, 2009; accepted October researchers 13 -16 in the 1940s claimed evidence of increased 19, 2009. Fryer et al • Original Contribution JAOA • Vol 110 • No 2 • February 2010 • 61 ORIGINAL CONTRIBUTION segmental muscle activity and segmental sympathetic motor individuals during different activities indicates that this method output at spinal levels associated with palpable lesions (ie, should be examined for reliability. More importantly, sub - somatic dysfunction). Denslow and Clough 13 used needle stantial electromagnetic noise contaminated the EMG record - electrodes to examine the electromyographic (EMG) activity at ings and particularly affected the resting conditions, during “lesioned” and normal segments, as identified by palpation, of which activity was low. When resting conditions were excluded the thoracic paraspinal muscles in 16 healthy participants. from the analysis, a statistically significant difference between They reported that spontaneous electrical activity occurred at the normal and abnormal sites still existed, 25 but these limita - lesioned segments but was rare at normal segments. 13 These tions cast doubt on the veracity of the findings. findings were also reported in participants with postural The present study re-examined the hypothesis of Fryer et abnormalities. 14 A few years later, Denslow 15 and Denslow al 22 that increased paraspinal EMG activity at rest is associated et al 16 reported that when graded pressure was applied to the with abnormal sites as determined by palpation. Sites that thoracic and lumbar spinous processes, reflex paraspinal EMG appeared abnormal to palpation in the PVG were chosen for activity occurred at lower pressures in segments palpated as the present study because practitioners in the field have claimed abnormal than in adjacent, normal segments. Although these tissue abnormality in this region may be indicative of seg - studies 13 -16 are regarded as landmark research in the osteo - mental dysfunction. 1-3,6 In addition, increased activity of the pathic medical profession, they are more than 50 years old multifidus and rotatores muscles has been proposed as the and are, by today’s standards, poorly described with insuffi - cause of this tissue abnormality, 1,2,6 and these muscles, as well cient data and sometimes no statistical analysis. 17,18 as the zygapophysial joint, are located within the thoracic Few researchers have since investigated paraspinal tissue PVG region. 26 Compared to previous studies, 13,22 the current texture abnormality for empirical characteristics. In 2004, Fryer study examined a larger cohort of symptomatic participants et al 19 reported that sites abnormal to palpation in the tho - using fine-wire intramuscular EMG procedures and used a reli - racic PVG were substantially more sensitive to pressure than able method for EMG normalization. The purpose of the pre - adjacent sites. One year later, the same researchers 20 mea - sent study was to determine whether abnormal motor activity sured the anteroposterior cross-sectional dimension (thick - plays a role in deep paraspinal tissues that appear abnormal ness) of the paraspinal muscle bulk directly underlying sites to palpation. in the thoracic PVG using diagnostic ultrasonography. Normal and abnormal palpated regions had similar mean dimensions, Methods suggesting that factors other than paraspinal muscle thick - Participants ness were responsible for the apparently abnormal tissue tex - Students and staff from two university campuses in Kirksville, ture. 20 Missouri, were recruited to participate in the present study Given that Denslow 15 and Denslow et al 16 are commonly through e-mails and posted flyers. Participants were included cited as evidence of the facilitated segment concept of somatic if they had current or frequent thoracic spinal pain during the dysfunction, 10 -12 it is surprising that few researchers have preceding 3 weeks, were aged 18 to 50 years, and had an iden - attempted to re-examine and expand on this body of work. tifiable paraspinal region that appeared abnormal to palpation There is little direct evidence to support the proposition that by the examiners. Participants were excluded if they had abnormal muscle contraction or spasm is associated with obvious spinal deformities or pathologic processes or any paraspinal regions identified as abnormal. A large volume of medical condition that precluded them from fine-wire EMG research demonstrates lumbar paraspinal
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