Pain catastrophizing and trunk muscle activation during walking in patients with chronic low back pain

It has been hypothesized that individuals with low back pain (LBP) will have higher trunk muscle activity during gait, in an attempt to limit spine motion, and that this "guarding strategy" may be influenced by the person's psychological response to pain. This study investigated whether the amplitude of trunk muscle activation differs between persons with chronic LBP and healthy individuals during walking, and whether changes in muscle activation were related to pain catastrophizing. Thirty persons with chronic non-specific LBP, stratified into 2 groups of high (HLBP) and low (LLBP) pain catastrophizing, were contrasted with a control group of 15 healthy individuals during walking on a treadmill at a self-selected speed. Surface electromyographic (EMG) data were recorded from 10 trunk muscles. The effects of Group and gait Sub-phase on EMG activation amplitudes were assessed. The HLBP group exhibited higher activation of certain muscles throughout the gait cycle, and reduced variability of others at specific sub-phases of gait. A significant correlation was found between activation amplitude and pain catastrophizing in most muscles, when controlling for gait speed and pain intensity. These data indicate that altered trunk muscle activation is present in some patients with LBP during walking, but does not represent a universal increase in activation for all muscles. This altered neuromotor control is, however, more strongly associated with pain catastrophizing than with pain intensity, and appears to represent a non-functional, maladaptive behavior, as it alters the normal, phasic pattern of activation in certain trunk muscles.