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Low back pain (LBP) is commonly associated with paraspinal muscle dysfunctions. A method to study deep lumbar paraspinal (i.e. multifidus) muscle function and neuromuscular activation pattern is intramuscular electromyography (EMG). Previous studies have shown that the procedure does not significantly impact muscle function during activities involving low-level muscle contractions. However, it is currently unknown how muscular function and activation are affected during high-exertion contractions.


To examine the effects of insertion and presence of fine-wire EMG electrodes in the lumbar multifidus on muscle strength, endurance, and activation profiles during high-exertion spinal extension muscle contractions.


Single-blinded, repeated measures intervention trial.


University clinical research laboratory


Twenty individuals between the ages of 18-40 free of recent and current back pain.


Muscle performance was assessed during 3 conditions (with [WI] and without [WO] presence of intramuscular electrodes, and insertion followed by removal [IO]). Isometric spinal extension strength was assessed with a motorized dynamometer. Muscle endurance was assessed using the Sorensen test with neuromuscular activation profiles analyzed during the endurance test.

Main Outcome Measurements

Spinal extensor muscle strength, endurance, and activation.


Our data showed no significant difference in isometric strength (p=.20) between the 3 conditions. A significant difference in muscle endurance was found (p=.03). Post-hoc analysis showed that the muscle endurance in the IO condition was significantly higher than the WO condition (161.3±58.3 vs. 142.1±48.2 sec, p=.04), likely due to a learning effect. All 3 conditions elicited minimal pain (range 0-4/10) and comparable muscle activation profiles.


Our findings suggested the sonographically guided insertion and presence of fine-wire intramuscular EMG electrodes in the lumbar multifidus muscles had no significant impact on spinal extension muscle function. This study provides evidence that implementing intramuscular EMG does not affect muscle performance during high-exertion contractions in individuals with no current back pain.

Level of Evidence



NOTICE: this is the author’s version of a work that was accepted for publication in PM&R. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in PM&R in 2018. DOI:10.1016/j.pmrj.2018.05.006

The Creative Commons license below applies only to this version of the article.

Peer Reviewed



American Academy of Physical Medicine and Rehabilitation

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