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Journal of Electromyography and Kinesiology 31 (2016) 6371

Contents lists available at ScienceDirect

Journal of Electromyography and Kinesiology


journal homepage: www.elsevier.com/locate/jelekin

A hip abduction exercise prior to prolonged standing increased


movement while reducing cocontraction and low back pain perception
in those initially reporting low back pain
Daniel Viggiani, Jack P. Callaghan
University of Waterloo, Department of Kinesiology, Waterloo, ON N2L 3G1, Canada

a r t i c l e

i n f o

Article history:
Received 10 March 2016
Received in revised form 16 September
2016
Accepted 20 September 2016

Keywords:
Low back pain
Prolonged standing
Muscle cocontraction
Fatigue
Spine posture
Movement

a b s t r a c t
Persons who develop low back pain from prolonged standing exhibit increased muscle cocontraction,
decreased movement and increased spine extension. However, it is unclear how these factors relate to
pain development. The purpose of this study was to use hip abductor fatigue to manipulate muscle activity patterns and determine its effects on standing behaviours and pain development. Forty participants
stood for two hours twice, once following a hip abductor fatigue exercise (fatigue), and once without
exercise beforehand (control). Trunk and gluteal muscle activity were measured to determine cocontraction. Lumbo-pelvic angles and force plates were used to assess posture and movement strategies. Visual
analog scales differentiated pain (PDs) and non-pain developers (NPDs). PDs reported less low back pain
during the fatigue session, with females having earlier reductions of similar scale than males. The fatigue
session reduced gluteal and trunk cocontraction and increased centre of pressure movement; male and
female PDs had opposing spine posture compensations. Muscle fatigue prior to standing reduced cocontraction, increased movement during standing and reduced the low back pain developed by PDs; the timing of pain reductions depended on spine postures adopted during standing.
2016 Elsevier Ltd. All rights reserved.

1. Introduction
The study of low back pain is a multi-faceted discipline, a reflection of the breadth and scope of the low back pain problem
(Balagu et al., 2012). Despite tremendous heterogeneity, there
has been success in uncovering pain pathways using homogenous
sub-groups (Fritz et al., 2007; Fairbank et al., 2011). One subgrouping method uses prolonged standing to dichotomize persons
based on whether or not asymptomatic persons develop acute
transient pain (Gregory and Callaghan, 2008; Nelson-Wong et al.,
2008).
Around half of asymptomatic adults develop low back pain during a 2-h standing exposure (Gregory and Callaghan, 2008; NelsonWong and Callaghan, 2010a; Sorensen et al., 2015). These persons,
termed pain developers (PDs), are up to three times more likely to
develop chronic low back pain requiring medical intervention in
the future than non-pain developers (NPDs) (Nelson-Wong and
Callaghan, 2014). Prolonged standing exposures are also common
in many work places (Tissot et al., 2009; Waters and Dick, 2015).

Corresponding author.
E-mail address: jack.callaghan@uwaterloo.ca (J.P. Callaghan).
http://dx.doi.org/10.1016/j.jelekin.2016.09.005
1050-6411/ 2016 Elsevier Ltd. All rights reserved.

Understanding the pain development pathway in prolonged standing could help reduce work-related low back pain and its associated occupational burdens (Gore et al., 2012; Murray and Lopez,
2013).
There have been three standing behaviours that differentiate
PDs from NPDs. First, PDs have increased gluteal and trunk muscular cocontraction (Nelson-Wong et al., 2008; Nelson-Wong and
Callaghan, 2010b; Marshall et al., 2011). Second, PDs move less frequently near the start of a prolonged standing exposure (Gallagher
et al., 2011; Gallagher and Callaghan, 2015). Lastly, PDs stand in
postures of greater spine extension (Gallagher et al., 2014;
Sorensen et al., 2015). These behaviours may interact to cause
the pain developed by PDs. Cocontraction about the hip and trunk
can hinder transient motion during standing (Nelson-Wong et al.,
2008; Nelson-Wong and Callaghan, 2010b), which may increase
cumulative loading, a factor previously related to low back pain
development (Norman et al., 1998; Marras et al., 2014).
Attempts have been made to address each of these behaviours
in isolation to varying degrees of success. A trunk stabilization
training program reduced low back pain in PDs, but only corrected
gluteus medius cocontraction in males (Nelson-Wong and
Callaghan, 2010a). Incorporating a 15-min sitting break after
45 min of standing temporarily reduced low back pain, but did

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D. Viggiani, J.P. Callaghan / Journal of Electromyography and Kinesiology 31 (2016) 6371

not prevent its accelerated development upon returning to standing (Gallagher et al., 2014). Standing on sloped surfaces was effective at reducing low back pain in PDs, but the resulting postures
were inconsistent between individuals (Nelson-Wong and
Callaghan, 2010c).
Muscle fatigue can be used to perturb natural standing behaviours in order to better understand how PDs develop low back
pain (Salavati et al., 2007; Enoka and Duchateau, 2008; Fox et al.,
2008). Since fatigue is exercise-dependent (Enoka and Duchateau,
2008), an exercise targeting muscles relevant to prolonged standing would be a logical starting point. The hip abductors (gluteus
medius, gluteus minimus and tensor fascia latae) are associated
with the low back pain developed during standing (Nelson-Wong
et al., 2008; Nelson-Wong and Callaghan, 2010b) and the postural
control of standing (Winter et al., 1996; Salavati et al., 2007), and
are therefore a target for muscle fatigue likely to influence the
way PDs or NPDs may stand.
The purpose of this study was to determine the role of muscular
activity in the development of low back pain during prolonged
standing using a hip abductor fatigue protocol to perturb standing
patterns in PDs and NPDs. It was hypothesized that the hip abductor fatigue protocol would reduce hip and trunk muscle cocontraction during standing, and consequently reduce pain developed
while standing.
2. Methods
2.1. Participants
Twenty males (23.7 2.7 years; 1.82 0.06 m; 85.0 12.8 kg)
and 20 females (22.7 3.0 years; 1.65 0.06 m; 62.0 9.2 kg) were
recruited from a university population. Participants were excluded
if: (1) they reported low back or hip surgery, (2) experienced low
back pain that required rest from daily activities, (3) they were
employed in an occupation requiring prolonged standing, or (4)
could not stand continuously for 2 h. This study was approved by
an ethics review committee at the university and all participants
gave their written informed consent prior to participating.
2.2. Instrumentation and protocol
Participants completed two, 2-h standing sessions at the same
time of day separated by at least seven days. Instrumentation consisted of surface electromyography of three muscles bilaterally
(EMG), motion capture of the lumbar spine and pelvis segments,
centre of pressure measures of each foot using force plates, and
self-reported low back pain using a 100 mm visual analog scale
(VAS).
Muscle activity was measured bilaterally of the lumbar-level
erector spinae (LES 5 cm lateral to the L3 spinous process, oriented superiorly), gluteus medius (GMD halfway between the
iliac crest and posterior aspect of the greater trochanter, oriented
superiorly), and external oblique (EXO along a line joining the
ipsilateral costal margin to the contralateral pubic tubercle, oriented supero-laterally). Electrode placements were confirmed
through palpation and muscle testing. A reference electrode was
placed on the rib cage. For each muscle, the skin was shaved using
disposable razors and cleaned using an abrasive cloth soaked in a
60% ethanol solution prior to electrode application. Two Ag/Ag-Cl
disc electrodes (Blue Sensor, Medicotest Inc., lstykke, Denmark)
were applied over each muscle with a 2 cm inter-electrode distance; signals were differentially amplified (AMT-8, Bortec, Calgary, AB, Canada; CMRR: 115 dB; Impedance: 1010 X; Gain range
utilized: 5002000) and band pass filtered from 10 to 1000 Hz
prior to sampling at 2048 Hz (1st Principles, Northern Digital,

Waterloo, ON, Canada; 10 V input range; 16-bit A/D conversion


card).
Maximal voluntary isometric contractions (MVICs) were used to
normalize EMG signals. Participants were given instructions to
ramp up and hold a maximal effort over a 5 s window and given
practice prior to each MVIC. MVICs were re-performed if the signal
quality (i.e. saturation) or participant effort was deemed inadequate. The LES MVIC was performed using the Beiring-Sorensen
position (Dankaerts et al., 2004). MVICs for GMD were performed
bilaterally, and consisted of a straight leg abduction and bentknee external rotation while side-lying, considering both sides to
determine maximal activity (Bolgla and Uhl, 2007). EXO MVICs
were performed using resisted trunk flexion and bilateral axial
twist in a modified sit-up position (Ng et al., 2003; Dankaerts
et al., 2004). Five second resting trials were collected with participants lying prone and supine; the lowest mean activity of the two
trials was taken as resting activity for each muscle.
An optoelectronic motion capture system (Optotrak Certus,
Northern Digital, Waterloo, ON, Canada) was used to acquire 3D
positions of rigid clusters of infrared-emitting markers at 32 Hz.
Clusters were adhered over the L1 and S1 spinous processes using
double-sided and flexible medical tape. A neutral standing posture
defined zero degrees between segments.
Upon completion of instrumentation, two sessions were performed in a randomized order: a control session (2-h standing protocol), and a fatigue session (fatiguing protocol then 2-h standing
protocol). The standing protocol consisted of participants transcribing a document using a word processor and sorting cards at
a height-adjustable standing workstation, with tasks counterbalanced between sessions. Participants stood with each foot confined
to a 50 cm square force platform (left foot on OR6-7, right foot on
BP900900; AMTI, Watertown, MA, USA) but could move freely
within these boundaries. Force plate data were sampled at 64 Hz.
Workstation height was initially set to 5 cm below elbow height
(CSA, 2000), then adjusted to participant comfort; once set, this
height was constant for both sessions. EMG, motion capture and
force data were recorded continuously for each 2-h session. VAS
scores were taken upon arrival (baseline), prior to, and every
15 min during the standing protocol. All subsequent VAS scores
had the baseline VAS removed, and participants were classified
as PDs or NPDs using a 10 mm threshold during the control session
(Kelly, 1998, 2001; Nelson-Wong and Callaghan, 2010a).
The fatigue protocol consisted of a repetitive, side-lying leg raising exercise performed to a metronome with five seconds of rest
following every ten seconds (1 repetition/2 s) of activity. Each repetition was performed to 30 of abduction. The exercise was terminated by the experimenter using movement-control criteria.
Briefly, participants were asked to perform the exercise in a
smooth and controlled manner, and were told each time their leg
or pelvis was not sufficiently controlled. The experimenter stopped
the exercise when these instances occurred twice consecutively or
five times in total. This exercise resulted in quantifiable fatigue in
GMD bilaterally based on mean power frequency decreases of at
least 10% and requiring a mean effort level of 9.1 0.8 on a
10-point Borg scale (Viggiani and Callaghan, submitted for
publication). This exercise likely also resulted in some fatigue of
LES and EXO due to their role in active hip abduction (Ekstrom
et al., 2007) combined with the movement-control cessation criteria (Viggiani and Callaghan, submitted for publication).
2.3. Data analysis
Each 2-h session was sectioned into eight 15-min blocks to
align dependent measures with VAS scores.
Normalized EMG activity levels were obtained using the data
processing algorithm shown in Fig. 1 (Brereton and McGill, 1998;

D. Viggiani, J.P. Callaghan / Journal of Electromyography and Kinesiology 31 (2016) 6371

65

Fig. 1. EMG data processing algorithm.

Drake and Callaghan, 2006; Mello et al., 2007), down sampled to


32 Hz, and used to compute four pairs of cocontraction indices
(CCIs) (Nelson-Wong and Callaghan, 2010b). Eq. (1) was used to
compute CCIs for the R-GMD/L-GMD, R-LES/L-LES, R-LES/R-EXO,
and L-LES/L-EXO muscle pairs over 1-min intervals and averaged
within a 15-min block.

CCI


N 
X
EMGlowi
i1

EMGhighi


 EMGhighi EMGlowi

3. Results

1
3.1. VAS scores

Motion capture data were used to compute two threedimensional time-varying angles using Visual 3D software (v5,
C-Motion Inc., Germantown, MD, USA): pelvic tilt (S1 cluster relative to global coordinate system) and lumbar curvature (L1 cluster
relative to S1 cluster). The sagittal plane components of each angle,
assumed to be the first rotation, were extracted and averaged in
each 15-min block.
Force plate data were used to compute indicators of transient
movements. For the anterior-posterior direction, centre of pressure
data, computed separately for both feet, were combined into a single centre of pressure measure (Winter, 2009). The anteriorposterior component was identified and used to compute shifts
and fidgets (Duarte and Zatsiorsky, 1999; Gallagher et al., 2011).
The shift and fidget frequencies within each 15-min block were
recorded, and the anterior posterior movement index (APMI) was
computed using Eq. (2). For the medial-lateral direction, the relative weighting of the vertical ground reaction force was computed,
and used to determine medial-lateral body weight transfers (BWT)
(Gallagher and Callaghan, 2015). Two threshold magnitudes were
selected, representing a transfer of 10% (small) and 30% body
weight (large). The frequency of each size of BWT was summed
within a 15-min block.

APMI

q
2
2
shifts fidgets

tions of sphericity in repeated measures were detected using


Mauchlys test and addressed using Hyunh-Feldt adjusted
probabilities.

Statistical testing was performed using SAS software (v9.4, The


SAS Corporation, Cary, NC, USA). All dependent measures were
entered in general linear models with between factors of GENDER
(M/F) and PAIN (PD/NPD), and within factors of SESSION (control/
fatigue) and TIME (15/30/45/60/75/90/105/120). Significant findings (p 6 0.05) were investigated using Tukeys HSD test. Viola-

Sixteen (8 male, 8 female) of 40 participants were classified as


PDs; PDs and NPDs had similar physical characteristics and baseline VAS scores to each other (Table 1). Although female PDs
reported more low back pain than male PDs across sessions (GENDERPAIN, p = 0.0099; Fig. 2), PDs of both genders reported lower
peak VAS scores during the fatigue session (Male PD:
11.5 15.7 mm reduction; Female PD: 10.3 5.1 mm reduction;
PAINSESSION, p = 0.0002), with female reductions beginning after
90 min and male reductions beginning after 120 min (Fig. 2). NPDs
showed minimal changes in pain reporting between sessions
(p > 0.2240; Fig. 2).

3.2. Electromyographic variables


There were different responses between pain groups in R-GMD/
L-GMD CCIs with fatigue during the first 15 min of standing (PD:
398.8 792.4 %MVIC reduction with fatigue; NPD: 282.5 966.6
%MVIC increase with fatigue; PAINSESSIONTIME, p = 0.0331). Differences were no longer present after the 15-min block
(p > 0.1490; Fig. 3). There were SESSIONTIME interactions in all
other CCIs (Fig. 4). In the fatigue session compared to the control
session: the R-LES/R-EXO CCI was smaller in the 15-min
(p = 0.0421) and 30-min blocks (p = 0.0199) with a nonsignificant trend persisting in the 45-min (p = 0.0939) and 60min blocks (p = 0.1093). The L-LES/L-EXO CCI was smaller in the
45-min block (p = 0.0285), and the R-LES/L-LES CCI was smaller
in the 30- to 60-min blocks (p < 0.0239) with a similar trend in
the 15-min block (p = 0.0764) (Fig. 4).

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D. Viggiani, J.P. Callaghan / Journal of Electromyography and Kinesiology 31 (2016) 6371

Table 1
Physical characteristics of PDs and NPDs.
Measure

PDs

NPDs

Probability

Age (years)
Height (m)
Mass (kg)
Baseline VAS (mm)

23.4 3.0
1.75 0.10
74.1 13.4
0.4 1.5
1.0 3.5

23.0 2.8
1.73 0.11
73.2 15.8
0.6 2.9
0.3 1.0

0.7108
0.2093
0.4866
0.3764
0.2526

Control
Fatigue

Fig. 2. Low back pain development in PDs and NPDs during the control and fatigue sessions. Asterisks denote differences between sessions within PDs (p < 0.05). Female PDs
reported more pain than male PDs, and earlier onsets of pain reduction than males with fatigue. Error bars show standard deviations.

3.3. Postural variables


There were interactions between gender, pain group and session in motion capture angles. Male PDs had more anterior pelvic
tilt during the fatigue session compared to the control session
and female PDs had more posterior pelvic tilt than female NPDs
during the fatigue session (GENDERPAINSESSION, p = 0.0344;
Fig. 5). For lumbar curvature angles, male PDs stood in postures
of greater lumbar spine extension in the fatigue session compared
to the control session, and female PDs stood in postures of greater
lumbar spine flexion than female NPDs during the fatigue session
(GENDERPAINSESSION, p = 0.0314; Fig. 6). All participants stood
in greater posterior pelvic tilt and lumbar flexion at later time
points into standing (TIME, p < 0.0001; Figs. 5 and 6).
Fatigue introduced greater movement responses for all participants with larger APMIs during the 30-min block of the fatigue session compared to the control session (Control: 40.1 23.5; Fatigue:

53.2 32.8; SESSIONTIME, p = 0.0445), with a similar trend


extending to the 45-min block (Control: 32.2 17.8; Fatigue:
41.4 21.9; SESSIONTIME, p = 0.0509). Both the small (GEN
DERSESSSIONTIME, p = 0.0005) and large BWTs (GEN
DERSESSIONTIME, p = 0.0078) increased with time for all participants except for females (PDs and NPDs) during the control session
(Fig. 7).

4. Discussion
PDs reported less low back pain while standing following a hip
abductor fatiguing exercise. Reduced trunk and hip muscle cocontraction and increased APMIs in the first hour of standing were
common to both male and female PDs. Changes in standing behaviour occurring prior to the onset of low back pain development
agrees with previous research aimed at differentiating PDs from

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67

Fig. 3. Changes in gluteal cocontraction from the control to fatigue sessions. A


positive number indicates higher gluteal cocontraction in the control session. An
asterisk denotes time blocks when PDs are significantly different from NPDs
(p < 0.05). Error bars show standard errors.

Fig. 5. Sagittal pelvic tilt angles split by gender. Male PDs (top) and female PDs
(bottom) had opposite responses with fatigue. Circles on the top panel denote
differences between the PD Control and PD Fatigue lines (p < 0.05). Asterisks on the
bottom panel denote differences between the PD Fatigue and NPD Fatigue lines
(p < 0.05). Error bars show standard errors.

Male and female PDs showed divergent lumbo-pelvic postural


responses and medial-lateral weight support movement strategies
during the fatigue session. NPDs exhibited similar responses to the
fatigue protocol as PDs without any change in pain reporting
patterns.

4.1. Muscular cocontraction and movement

Fig. 4. Changes in trunk cocontraction indices from the control to fatigue sessions.
Asterisks denote time blocks where the two sessions differ significantly (p < 0.05),
daggers denote trends (0.05 < p < 0.10). Error bars show standard errors.

NPDs (Nelson-Wong and Callaghan, 2010b; Gallagher and


Callaghan, 2015). There were discrepancies in timings of changes
between cocontraction measures potentially caused by asymmetries inherent in the fatigue protocol, however all changes occurred
within the first hour.

Reductions in muscular rigidity, seen through smaller cocontraction indices, would be beneficial during prolonged standing
as it would facilitate increased movement and reduce the amount
of continuous static loading. Standing in itself does not appear to
be harmful, but can become a risk factor for pain development or
injury in the absence of muscular or postural variability
(Callaghan and McGill, 2001; Wells et al., 2007). Longer continuous
standing exposures should increase the cumulative loading of the
low back as there would be less movement to shift the load to
other tissues of the body, leading to a greater risk of local pain or
injury (Norman et al., 1998; Marras et al., 2014). Movement prior
to the development of pain interrupts static loading scenarios,
and can be effective at reducing low back pain development; seen
in the current study and previous work on sit-to-stand workstations (Davis and Kotowski, 2014; Karakolis and Callaghan, 2014).
While trunk cocontraction is often desired in dynamic tasks to mitigate shear loading and displacement of the lumbar spine
(Cholewicki and McGill, 1996; Granata and Marras, 2000), it

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D. Viggiani, J.P. Callaghan / Journal of Electromyography and Kinesiology 31 (2016) 6371

Fig. 6. Lumbar flexion angles split by gender. Male PDs (top) and female PDs
(bottom) had opposite responses with fatigue. Circles on the top panel denote
differences between the PD Control and PD Fatigue lines (p < 0.05). Asterisks on the
bottom panel denote differences between the PD Fatigue and NPD Fatigue lines
(p < 0.05). Error bars show standard errors.

appears to be counter-productive during prolonged standing


(Nelson-Wong and Callaghan, 2010b).
The timing of changes is also important; movement should
occur prior to rather than in response to pain development. Differences in PD and NPD muscular and postural strategies were
previously found in the first 30 min of a 2-h standing exposure
(Nelson-Wong and Callaghan, 2010b; Gallagher and Callaghan,
2015). Sitting breaks occurring after 45 min of standing, while able
to transiently reduce low back pain while seated, did not prevent
pain from recurring at an accelerated rate upon returning to standing (Gallagher et al., 2014), emphasizing the importance of early
movement.
The combination of early reductions in muscular cocontraction,
early increases in APMIs, and reduced low back pain development
during the fatigue session support the hypothesis that more movement during a prolonged standing exposure is beneficial for the
prevention of low back pain development during standing
(Gallagher and Callaghan, 2015). A potential source for this
increase in movement was the reduction in trunk and hip cocontraction that followed the hip abduction exercise (Nelson-Wong
and Callaghan, 2010b).

4.2. Gender differences


Two gender factors reported here that could have resulted in
the different onsets in low back pain with fatigue were altered
sagittal spinal postures and BWTs with fatigue.

Gender and pain group kinematic changes with fatigue seemed


to be driven by the pelvis; female PDs showed a kyphotic response
and male PDs showed a lordotic response. Of these two, the female
response aligns with pain reductions associated with standing aids
(Whistance et al., 1995; Betsch et al., 2011) and pain group differences (Sorensen et al., 2015); an induced posterior pelvic tilt drives
lumbar spine flexion (Day et al., 1984; Levine and Whittle, 1996).
Conversely, the compensation by male PDs into anterior pelvic tilt
appeared maladaptive with this rationale. Differences between
male and female PD postures could have resulted in the different
time-varying low back pain progressions during the fatigue session; the kyphotic response in females resulted in an earlier pain
reduction than males.
Unlike males, females did not have increases in the number of
small or large BWTs during the second hour of standing in the control session. Early increases in this measure can differentiate NPDs
from PDs (Gallagher and Callaghan, 2015), however the gender difference observed here occurred after PDs were experiencing low
back pain. Also, its commonality to both groups suggests that this
lack of movement was not in response to low back pain (Mientjes
and Frank, 1999; Mazaheri et al., 2013). The reversion to the
male pattern of BWTs over time during the fatigue session likely
played a negligible role in the reduction of low back pain in female
PDs with fatigue as: (1) movement provoked by low back pain does
not completely reduce the severity of that low back pain after
development (Mientjes and Frank, 1999; Gallagher et al., 2014),
and (2) it was likely not related to the development of that pain
during the control session. The change in medial-lateral movement
during the second half of the fatigue session in females may have
been related to fatigue, not pain (Madigan et al., et al., 2006; Fox
et al., 2008).
Spinal posture may have modulated the pain responses of male
and female PDs than BWTs. Gender differences in posture were relatively constant throughout the 2-h standing protocol, whereas the
BWT reductions in females occurred after low back pain had developed in PDs and was not specific to PDs.
4.3. Altering perceived pain
There may have been other factors related to the reductions in
low back pain than those measured here. Exercise can reduce the
intensity of perceived pain in those with patellofemoral pain (Rio
et al., 2015), or when induced via heat or capsaicin (Koltyn,
2000; Hoffman et al., 2004; Ellingson et al., 2014). This phenomenon appears to be spatially confined to the exercise site
(Koltyn, 2000) and temporally to a 45-min period after exercise
cessation (Hoffman et al., 2004; Rio et al., 2015). While the muscles
of the low back were likely active isometrically during active hip
abduction (Ekstrom et al., 2007; Davis et al., 2011), participants
were not in pain during the exercise; pain was only developed well
after the exercise was completed. Also, differences in reported pain
between sessions did not occur until after 90 min in female PDs
and 120 min in male PDs. Hypoalgesia induced by the fatiguing
exercise was unlikely to reduce perceived pain between sessions
since pain was not present before the fatiguing exercise, and pain
reductions occurred later into standing than would be expected.
Personal expectations can influence the perception of pain; simply being told that an exposure can reduce pain has resulted in
reductions in reported pain (Goffaux et al., 2007). Participants were
not given any indication if they should feel more or less low back
pain following the fatigue protocol; some participants may have
developed their own conceptions as this was not controlled for.
The threshold chosen for a clinically relevant change in perceived pain is also important. The current study used a 10 mm
threshold since this change in pain is specific to classifying PDs
and NPDs (Nelson-Wong and Callaghan, 2010a). Other thresholds

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69

Fig. 7. Changes in small (top) and large (bottom) Body weight transfers between genders and sessions. Shaded area shows the standard error about the mean (line without
markers). Females in the control session did not follow the steadily increasing pattern of the three other Gender-Session pairs.

for meaningful pain intensity differences in 100 mm VAS scores


have ranged from 8 to 13 mm (Todd et al., 1996; Kelly, 1998;
Bird and Dickson, 2001; Gallagher et al., 2001; Hgg et al., 2003).
The selection of a more conservative threshold would reduce the
number of time points when clinically significant pain reductions
were observed.

4.4. Limitations
The sample size was fairly small and the variability in reported
low back pain was quite high. Corrections for multiple comparisons were advised against due to the small sample size to retain
statistical power. A larger sample should be tested using more con-

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D. Viggiani, J.P. Callaghan / Journal of Electromyography and Kinesiology 31 (2016) 6371

servative statistics before definitive conclusions can be drawn. The


fatiguing exercise primarily targeted the hip abductors but likely
also affected other muscles of the trunk (Ekstrom et al., 2007).
Changes due to fatigue cannot be solely linked to altered hip
abductor muscle patterns but rather the functional action of hip
abduction. Future work should focus on more muscle-specific techniques such as relaxation training.
5. Conclusions
In conclusion, a reduction in trunk and hip muscular rigidity
and greater anterior-posterior movement during the fatigue session coincided with reduced low back pain in PDs. Low back pain
developed during standing may also be moderated by sagittal
plane pelvic angles.
Conflict of Interest
None
Acknowledgments
Funding for this study was provided by the Natural Science and
Engineering Research Council. JPC is supported by the Canada
Research Chair in Spine Biomechanics and Injury Prevention.
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Daniel Viggiani received his MSc in Kinesiology from


the Faculty of Applied Health Sciences at the University
of Waterloo in 2015. He is currently completing his PhD
at the University of Waterloo. His research interests
include determining mechanisms of pain generation,
sensation and quality and establishing relations to
altered movement and injury.

Jack P. Callaghan received his Ph.D. in Kinesiology


from the Faculty of Applied Health Sciences at the
University of Waterloo in 1999. From 1998 to 2003 he
was a faculty member in the Department of Human
Biology at the University of Guelph. In 2003, he was
awarded a Canada Research Chair in Spine Biomechanics and Injury Prevention. In 2014, he was given a
Career Achievement Award by the Canadian Society
for Biomechanics. He is currently a Professor in the
Kinesiology Department at the University of Waterloo. He has also received an Ontario Distinguished
Researcher Award and a Canada Foundation for
Innovation infrastructure grant. He is a project leader
in the AUTO21 Network of Centres of Excellence and
an NSERC, CIHR and WSIB funded researcher. He holds certifications as a
Kinesiologist (CK) and a Canadian Certified Professional Ergonomist (CCPE). He is
cross-appointed to Mechanical and Mechatronics Engineering and sits on the
steering committee of the Waterloo Centre for Automotive Research (WATCAR).
He is currently the Associate Director of The WSIB funded Centre of Research
Expertise for the Prevention of Work-Related Musculoskeletal Disorders and
Disabilities (CRE-MSD). His main research interest is injury mechanisms from
exposure to cumulative loading exposure including the development of low back
pain.