Flexion-relaxation ratio in sitting: application in low back pain rehabilitation

Spine (Phila Pa 1976). 2010 Jul 15;35(16):1532-8. doi: 10.1097/BRS.0b013e3181ba021e.


Study design: A multiple-comparative study between normal and low back pain (LBP) patients before and after rehabilitation.

Objective: To examine whether there is a change in flexion-relaxation phenomenon in sitting in LBP patient following a rehabilitation treatment.

Summary of background data: There is an association between LBP and seated spine posture. Previous study has reported an absence of flexion-relaxation phenomenon in LBP patients during sitting. However, it is unknown whether there is a difference in flexion-relaxation phenomenon in sitting in LBP patients before and after rehabilitation treatment.

Methods: A total of 20 normal subjects and 25 chronic LBP patients who underwent a 12 weeks rehabilitation program were recruited. Surface electromyography recordings during upright sitting and flexed sitting were taken from the paraspinal muscles (L3) bilaterally from the normal subjects, and in the LBP patients before and after the rehabilitation treatment. The main outcome measures for patients include the visual analogue scale, Oswestry disability index, subjective tolerance for sitting, standing and walking, trunk muscle endurance, lifting capacity, and range of trunk motion in the sagittal plane. Flexion-relaxation phenomenon in sitting, expressed as a ratio between the average surface electromyography activity during upright and flexed sitting, was compared between normal and patients; and in LBP patients before and after rehabilitation.

Results: Flexion-relaxation ratio in sitting in normal subjects (Left: 6.83 +/- 3.79; Right: 3.45 +/- 2.2) presented a significantly higher (Left: P < 0.001; Right: P < 0.05) value than LBP patients (Left: 3.04 +/- 2.36; Right: 2.02 +/- 1.49). An increase in flexion-relaxation ratio in sitting was observed in LBP patients after rehabilitation (Left: 4.69 +/- 3.94, P < 0.05; Right: 3.58 +/- 2.97, P < 0.001), together with a significant improvement (P < 0.05) in subjective tolerance in sitting and standing, abdominal and back muscle endurance, lifting capacity, and range of motion. There were no significant changes in disability and pain scores, and subjective tolerance in walking.

Conclusion: Flexion-relaxation ratio in sitting has demonstrated its ability to discriminate LBP patients from normal subjects, and to identify changes in pattern of muscular activity during postural control after rehabilitation.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease
  • Disability Evaluation
  • Exercise Tolerance / physiology
  • Female
  • Humans
  • Low Back Pain / diagnosis
  • Low Back Pain / physiopathology*
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Muscle, Skeletal / anatomy & histology
  • Muscle, Skeletal / physiopathology*
  • Outcome Assessment, Health Care / methods
  • Physical Therapy Modalities / trends*
  • Postural Balance / physiology*
  • Range of Motion, Articular / physiology
  • Recovery of Function / physiology
  • Treatment Outcome
  • Walking / physiology
  • Young Adult