What is the best surface EMG measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls?

OBJECTIVES:: Lumbar flexion-relaxation (FR) is a well-known phenomenon that can reliably be seen in normal subjects but not in most chronic low back pain (CLBP) patients. The purpose of this study was to determine which surface electromyographic (SEMG) measures of FR best distinguish CLBP patients from pain-free control subjects. Standing SEMG and lumbar flexion range of motion (ROM) were also evaluated. METHODS:: A cohort of 218 CLBP patients, who were admitted to a functional restoration program, received a standardized SEMG and ROM assessment during standing trunk flexion and reextension. An asymptomatic control group of 30 nonpatients received an identical assessment. Both groups were compared on 8 separate SEMG and 3 flexion ROM measures. RESULTS:: A receiver operating characteristic curve analysis was used to determine how well each measure distinguished between the CLBP patients and the pain-free control subjects. All SEMG measures of FR performed acceptably. Between 79% and 82% of patients, and 83% and 100% of controls were correctly classified. Standing SEMG performed less well. Gross flexion ROM was the best single classification measure tested, correctly classifying 88% of patients and 83% of controls. A series of discriminant analyses found that certain combinations of SEMG and ROM performed slightly better than gross ROM alone for correctly classifying the 2 subjects groups. DISCUSSION:: Because all SEMG measures of FR performed acceptably, the determination of which SEMG measure of FR is "best" is largely dependent on one's specific purpose. In addition, ROM measures were found to be important components of the FR assessment.