Individuals With and Without Low Back Pain Use Different Motor Control Strategies to Achieve Spinal Stiffness During the Prone Instability Test

J Orthop Sports Phys Ther. 2019 Dec;49(12):899-907. doi: 10.2519/jospt.2019.8577. Epub 2019 Aug 3.


Background: The prone instability test is used to identify individuals with low back pain (LBP) who would benefit from trunk stabilization exercises. Although activity from muscles during the leg-raising portion of the prone instability test theoretically enhances spinal stiffness and reduces pain, evidence for this is lacking.

Objectives: To compare and contrast (1) pain and stiffness changes between prone instability testing positions, and (2) muscle activation patterns during the prone instability test leg raise in individuals with and without LBP.

Methods: Participants with (n = 10) and without (n = 10) LBP participated in this laboratory case-control study. Spinal stiffness was measured using a beam-bending model and 3-D kinematic data. Stiffness changes were compared across the test positions and between groups. Surface electromyographic data were collected on trunk and limb musculature. Principal-component analysis was used to extract muscle synergies.

Results: Spinal stiffness increased across testing positions in all participants (P<.05). Participants with LBP experienced reduced pain during the test (P<.001). No between-group difference was found in spinal stiffness during leg raising during the test (P>.05). Participants without LBP used 3 muscle synergies during the leg raise and participants with LBP used 2 muscle synergies.

Conclusion: Spinal stiffness increased in all participants; however, participants without LBP demonstrated a muscle synergy pattern where each synergy was associated with a distinct function of the prone instability test. Participants with LBP used a more global stabilization pattern, which may reflect a maladaptive method of enhancing spinal stability. J Orthop Sports Phys Ther 2019;49(12):899-907. Epub 3 Aug 2019. doi:10.2519/jospt.2019.8577.

Keywords: EMG; clinical test; lumbar; movement coordination.

MeSH terms

  • Adult
  • Biomechanical Phenomena
  • Case-Control Studies
  • Electromyography
  • Female
  • Humans
  • Low Back Pain / physiopathology*
  • Male
  • Motor Skills / physiology*
  • Muscle, Skeletal / physiopathology*
  • Postural Balance / physiology*
  • Principal Component Analysis
  • Prone Position
  • Spine / physiopathology*
  • Task Performance and Analysis