Journal of Electromyography and Kinesiology 13 (2003) 305–318

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Surface electromyography assessment of back muscle intrinsic

properties
Christian Larivière a,∗, A. Bertrand Arsenault b, Denis Gravel b, Denis Gagnon c,
Patrick Loisel d
a
Occupational Health and Safety Research Institute Robert-Sauvé, Montreal, Quebec, Canada
b
School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada
c
Department of Kinanthropology, University of Sherbrooke, Sherbrooke, Quebec, Canada
d
Department of Surgery, Faculty of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada

Received 2 October 2002; received in revised form 27 November 2002; accepted 29 November 2002

Abstract

The purpose of this study was to assess (1) the reliability and (2) the sensitivity to low back pain status and gender of different
EMG indices developed for the assessment of back muscle weakness, muscle fiber composition and fatigability. Healthy subjects
(men and women) and chronic low back pain patients (men only) performed, in a static dynamometer, maximal and submaximal
static trunk extension tasks (short and long duration) to assess weakness, fiber composition and fatigue. Surface EMG signals were
recorded from four (bilateral) pairs of back muscles and three pairs of abdominal muscles. To assess reliability of the different
EMG parameters, 40 male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three occasions. Reliable
EMG indices were achieved for both healthy and chronic low back pain subjects when specific measurement strategies were applied.
The EMG parameters used to quantify weakness and fiber composition were insensitive to low back status and gender. The EMG
fatigue parameters did not detect differences between genders but unexpectedly, healthy men showed higher fatigability than back
pain patients. This result was attributed to the smaller absolute load that was attributed to the patients, a load that was defined
relative to their maximal strength, a problematic measure with this population. An attempt was made to predict maximal back
strength from anthropometric measurements but this prediction was prone to errors. The main difficulties and some potential sol-
utions related to the assessment of back muscle intrinsic properties were discussed.
 2003 Elsevier Science Ltd. All rights reserved.

Keywords: Low back pain; Back muscles; Fatigue; Recovery; Electromyography; Impairment evaluation; Reliability; Weakness; Dynamometry;
Muscle composition

1. Introduction muscles, namely their fiber composition, strength and

Chronic low back pain (CLBP) is associated with sev-
eral anatomical or structural abnormalities such as atro-
phy of muscle mass or alteration of muscle fiber [43,57]
characteristics and organizational abnormalities such as
altered muscle coordination patterns [76,30], impaired
proprioceptive abilities or slow psychomotor reaction
time [15]. The focus of the present paper was placed on
the evaluation of some intrinsic properties of back
∗
Corresponding author. Tel.: +1-514-288-1551x217; fax: +1-514-
288-6097.
E-mail address: lariviere.christian@irsst.qc.ca (C. Larivière).
endurance. To fully understand these ‘muscle intrinsic
properties’, the influence of some control mechanisms
must be also considered. For example, muscle synergies
and co-contraction as well as sharing of moment across
muscles will be discussed in this paper. The assessment
of control mechanisms of trunk muscles is certainly a
field of research that needs developments to better under-
stand the way the central nervous operates to compensate
for lumbar instability [60].
The alterations in the structure of back muscles might
lead to weakness and fatigability, two back muscle
impairments recognized as a potential cause of the recur-
rent nature of LBP [43]. Muscle composition is usually
assessed through biopsy techniques [43]. Back muscle

1050-6411/03/$ - see front matter  2003 Elsevier Science Ltd. All rights reserved.
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306 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
strength is generally assessed under volitional effort
using dynamometry, while endurance is quantified by
measuring the maximum time that the subject can hold
a given load. However, biopsy measurements are invas-
ive and maximal performance measurements (strength,
endurance) depend heavily on psychological [20,29] fac-
tors and the capacity of subjects to activate all motor
units [1]. Previous findings suggest that it may also be
possible to assess muscle weakness [10,55], muscle
composition [24,35,77] and muscle fatigue [43] through
the use of surface electromyography (EMG).
The assessment of muscle intrinsic properties is poss-
ible only if the influence of control mechanisms is con-
sidered. This can be achieved with adequate standardiz-
ation of the measurement protocol, but previous studies
indicate that it is a difficult task. Some investigators
show poor reliability of EMG spectral variables for test-
ing the left–right difference between back muscles
[62,69], or for estimating the rate of increase in back
muscle fatigue through the slope decay of the median or
mean frequency [54]. This might be explained by the
variability in the electromyographic (EMG) signal
caused by the variability of load-sharing between bilat-
eral muscles [75]. This could be particularly true if varia-
bility of load sharing increases with muscle fatigue and
back pain to minimize fatigue and pain symptoms. If this
is correct, it would explain the poor reliability results
reported by the only reliability study on EMG fatigue
parameters involving CLBP subjects [54]. However,
most studies assessing back muscle function have not
controlled the coupled lumbar moments (lateral bending,
axial rotation) during ‘purely sagittal’ extension efforts.
This has often been identified as a possible cause of the
alternating EMG activity or the uneven EMG activity
between the left and right muscles of the erector spinae
[3,44,64,72]. In an effort to further standardize previous
measurement protocols, our group developed a triaxial
static dynamometer to control coupled lumbar moments
(lateral bending, axial rotation) during trunk extension
tasks [38] and then reduce the variability in EMG vari-
ables by potentially decreasing the load-sharing between
back muscles. The present paper summarizes results
obtained using this measurement protocol.
More specifically, the purpose of this study was to
assess (1) the reliability and (2) the sensitivity to low
back pain status and gender of different EMG indices
developed for the assessment of back muscle weakness,
muscle fiber composition and fatigability. Another
objective was to discuss the main difficulties related to
the use of these indices and to propose some potential
solutions.
2. Methods
This section describes the general methodology used
in the different articles that were summarized in the
present paper [22,37,39–41]. Different sub-samples of
subjects and tasks were analyzed in these studies. The
reader is referred to the original articles for details con-
cerning the inclusion–exclusion criteria and demo-
graphic characteristics of each sub-sample. The number
of subjects and specific analyses corresponding to each
of these studies were summarized in the results section.
2.1. Subjects and tasks
Healthy subjects (men and women) and male patients
with a chronic low back pain (CLBP) syndrome were
recruited. The healthy females (n = 13; age: 26 ± 4 yr;
height: 1.67 ± 0.05 m; mass: 61 ± 7 kg) were similar in
age to the healthy males (n = 12; age: 27 ± 5 yr; height:
1.75 ± 0.05 m; mass: 74 ± 11 kg). Briefly, CLBP was
defined as a daily or almost daily lumbar or lumbosacral
pain with or without proximal radicular pain (limited dis-
tally to the knees) for at least three months. Exclusion
criteria for the healthy subjects (men and women) were
as follows: had back pain in the previous year or
exceeding one week; lost a working day because of back
pain; and consulted for a back problem. All subjects
(healthy and CLBP) that went through a surgery of the
pelvis or spinal column were excluded.
At the arrival in the laboratory, questionnaires about
perception of functional disability (Oswestry question-
naire [19]), pain intensity (10 cm visual analogue scale),
physical activity level [2] were self-administered and
anthropometric measures were collected. The effect of
electromechanical delay was neglected in the compu-
tation of both NME EMG indices and MFT10–80. Each
electrode site was marked and the thickness of the sub-
cutaneous tissues was measured twice (left side electrode
sites only) with a Harpenden skinfold caliper.
The subjects performed, while standing in a dyna-
mometer (Fig. 1), different static trunk extension efforts
using the L5/S1 extension and axial rotation moments
(to be minimized) as visual feedback. The minimization
of lateral bending moments with the use of an extra vis-
ual feedback was not possible without interfering with
the extension task (too much visual feedback at a time).
The protocol followed the following sequence: two to
four submaximal contractions to become familiar with
the visual feedback, two maximal voluntary contractions
(MVC), three 7 s ramps (0–100% MVC) and two static
trunk extension tasks at 75% MVC, that correspond to
a 30 s fatigue task and a 5 s contraction task to estimate
the recovery. These two tasks were separated by a 60 s
rest period. At the end of the measurement protocol, two
MVC trials were performed to obtain the maximal EMG
of abdominal muscles. A padded bar was fixed to the
apparatus in front of the subject to stabilize the thorax
when producing trunk flexion or rotation efforts. Three
4 s maximal efforts were produced consecutively in the
same trial: (1) flexion, (2) rotation to the left and (3)
 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
Fig. 1. Experimental setup. The dynamometer consists of a triaxial
force platform (Advanced Mechanical Technology Incorporated,
model MC6-6-1000) mounted on a steel frame that allows the stabiliz-
ation of the feet, knees and pelvis (details in [38]). The subjects stood
in the dynamometer with the trunk erect and the knees straight. Trunk
extension was generated against a padded bar fixed on the surface of
the force platform and adjusted at the T4 level.
rotation to the right. At least two minutes of rest was
given between efforts except between the 75% MVC
fatigue and recovery tasks (60 s rest).
2.2. Electromyography
The EMG signals from four pairs of back muscles
(Fig. 2) and three pairs of abdominal muscles were col-
lected (bandpass filter: 20–450 Hz; preamplification
gain: 1000; sampling rate: 2048 Hz) with active surface
electrodes (Delsys Inc., MA). After the skin was shaved
and abraded with alcohol, the electrodes on the back
muscles were positioned. Fig. 2 shows the selected
muscles and the corresponding abbreviations. Electrodes
on the abdominal muscles (rectus abdominis, external
oblique and internal oblique) were positioned according
to McGill [50].
2.3. Data processing
For the best MVC contraction, the EMG root mean
square (RMS) value of a 250 ms window centered at the
307
Fig. 2. EMG recording and nomenclature used to identify the elec-
trode sites. The active bipolar electrodes were positioned bilaterally
on the multifidus at the L5 level (MU-L5-Left and MU-L5-Right),
iliocostalis lumborum at L3 (IL-L3-L and IL-L3-R), longissimus at L1
(LO-L1-L and LO-L1-R) and over the belly of the longissimus at the
T10 level (LO-T10-L and LO-T10-R) following the recommendations
of Defoa et al. [14] with regard to muscle fiber direction. A reference
silver-silver chloride electrode was positioned over the T8 spinous pro-
cess.
peak L5/S1 extension moment was computed. For each
ramp contraction, EMG RMS values of 250 ms windows
at each 5% force level from 10 to 80% MVC were com-
puted and spectral analysis (512 points, Hanning window
processing, fast Fourier transform) was applied to extract
the corresponding median frequency (MF) values.
Finally, a series of 250 ms windows of EMG data, 75%
overlapping, were taken from the data of the fatigue and
recovery tests and spectral analysis was applied to each
time-window to obtain the corresponding MF values.
Different EMG indices were then calculated (list of
abbreviations in Table 1) as described below.
2.3.1. Weakness EMG indices [37]
Back muscle weakness was assessed using the neuro-
muscular efficiency (NME) concept which was defined
as the slope of the relationship (quantified by linear
regression) between the extension moment at L5/S1 (Y
axis) and RMS (X axis) across the force levels (NME10–
80). A second NME parameter was computed from the
MVC contraction as the ratio of the peak L5/S1 exten-
sion moment to its RMS value (NMEmvc). More efficient
muscle contractions are characterised by steeper slope
(NME10–80) and higher ratio (NMEmvc).
2.3.2. Muscle composition EMG indices [37]
Back muscle composition was assessed by three EMG
parameters presumably sensitive to muscle fiber compo-
sition: (1) the slope (MFT10–80) and (2) the intercept
308 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318

Table 1
List of abbreviations (by category) used to identify the EMG indices and recording sites (muscles)

EMG index Description (units)

Weakness EMG indices (neuromuscular efficiency)

NME10-80 Gradient (slope) of the linear relationship between the extension moment at L5/S1 (Y axis) and RMS (X axis) across
the force levels (ramp contractions)
NMEmvc Ratio of the peak L5/S1 extension moment to its RMS value (MVC contraction)
Muscle composition EMG indices
IMF75 Initial median frequency of the EMG power spectrum (intercept of time-series) at the start of the fatigue test (Hz)
IMFT10-80 Intercept of the linear relationship between the MF (Y axis) and the extension moment at L5/S1 (X axis) across the
force levels (ramp contractions)
MFT10-80 Gradient (slope) of the linear relationship between the MF (Y axis) and the extension moment at L5/S1 (X axis) across
the force levels (ramp contractions)
Fatigue and recovery EMG indices
IMF Initial median frequency of the EMG power spectrum (intercept of time-series) at the start of the fatigue test (Hz)
IMFrec Initial median frequency of the EMG power spectrum (intercept of time-series) at the start of the recovery test (Hz)
IRMS Initial EMG root mean square (intercept of time-series) at the start of the fatigue test (µV)
MFslp Gradient (slope of time-series) of the Median Frequency of the EMG power spectrum during the fatigue test (Hz/s)
REC Recovery of IMF (absolute value in Hz)
%REC Relative recovery of IMF (%)
RMSslp Gradient (slope of time-series) of the EMG root mean square during the fatigue test (µV/s)
EMG recording sites (muscles)
IL-L3-L & R Iliocostalis lumborum at the L3 level, left & right sides
LO-L1-L & R Longissimus at the L1 level, left & right sides
LO-T10-L & R Longissimus at the T10 level, left & right sides
MU-L5-L & R Multifidus at the L5 level, left & right sides

(IMFT10–80) of the relationship between the MF (Y axis)
and the extension moment at L5/S1 (X axis) across the
force levels (ramp contractions) as quantified by linear
regression, and (3) the intercept (IMF75) of the linear
regression applied to the time-series of MF (fatigue
contraction). Analyses of the power in different fre-
quency bands (20–60, 60–120, 120–180, 180–240, 240–
300 Hz) of the power spectrum were also examined
between healthy and CLBP male subjects.
2.3.3. Fatigue and recovery EMG indices [40]
Linear regression was applied to the time-series of
RMS and MF to get their initial values or intercept
(IRMS, IMF) and to estimate their rate of change (slope
of their respective linear regression) corresponding to the
fatigue increase (RMSslp, MFslp). The lowest MFslp
and the highest RMSslp among all muscles, correspond-
ing to the most fatigable muscle, were also retained as
EMG fatigue indices. The same procedure (spectral
analysis, linear regression) was applied on the MF esti-
mates of the 75% MVC recovery test to compute the
corresponding IMF (IMFrec). Two recovery EMG indices
(%REC and REC) were computed as illustrated in Fig. 3.
All the EMG indices described above were computed
for each muscle (n = 8), all muscle pairs (mean of left
and right homologous muscles), and for the back
muscles as a whole (mean of all eight muscles). The
effect of electromechanical delay was neglected in the
computation of both NME EMG indices and MFT10–80.
Each EMG parameters computed from the ramp contrac-
tions (NME10–80; MFT10–80; IMFT10–80) were averaged
across bilateral muscle pairs and the three ramps.
2.4. Reliability assessment
Forty (20 healthy and 20 CLBP male subjects) were
assessed on three sessions at least two days apart within
a two-week period. The generalizability theory [67] was
used as a framework to estimate the reliability of EMG
indices and to estimate the reliability for various
measurement designs. Reliability was assessed for all
EMG parameters, each group (healthy and CLBP male
subjects) and each muscle or muscle pair by the intra-
class correlation coefficient (ICC) and standard error of
measurement (SEM) expressed as a percentage of the
grand mean (across days) [37,40,41].
2.5. Estimation of recovery time required after the
fatigue test to perform a second fatigue trial
It was predicted from the reliability assessment of
EMG fatigue indices that the averaging of measures
across two fatigue tests performed within the same ses-
sion would increase the reliability by about 13% [40].
However, enough rest between fatigue tests is required
to allow a complete recovery. Thus, a study was conduc-
ted to evaluate if rest intervals of 10 or 15 min allow
the back muscles to recover completely, from an EMG
point of view, after performing a fatiguing contraction
[41]. Twelve healthy males performed the fatigue trials
 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318 309

Fig. 3. Illustration of the computation of fatigue and recovery EMG indices based on median frequency (MF) estimates. The upper plots show
the L5/S1 extension moment during the 30 s fatigue (upper-left) and 5 s recovery (upper-right) contractions separated by a 60 s rest period. The
lower plots show the corresponding MF estimates for a given back muscle. The fatigue index is represented by the slope of the MF-time linear
relationship (lower-left plot). Two recovery indices were computed (lower-right plot): (1) the percent recovery of the IMFr (%REC), where IMFf
and IMFr represents the intercept of the linear regression equation computed from the fatigue and recovery MF time-series and FMFf the final MF
of the fatigue contraction MF time-series, and (2) the difference between IMFr and FMFf (REC).

(30 s contractions at 75% MVC) three times separated instant of the task. This was performed for the first and
successively by a 15 min (between trial 1 and 2) and a last 5 s of the fatigue test to quantify the effect of fatigue
10 min (between trial 2 and 3) rest period. on coactivity.

2.6. Assessment of abdominal coactivity during the

fatigue test
The flexion moment produced by the antagonist
muscles (abdominals) during the extension fatigue test
was estimated for 22 healthy males [22]. The maximal
EMG of each back and abdominal muscle was computed
across the corresponding MVC contractions to normalize
EMG signals. A detailed lumbar spine model [8,51] was
implemented to partition the L5/S1 joint moment
between 54 muscle fascicles and estimate joint forces.
An EMG-assisted by optimization (EMGAO) approach
[7] was used to adjust EMG predicted muscle forces to
balance the joint moment. For all back muscles, the aver-
age EMG signals recorded during the first 5 s of the 30
s fatigue test were used as constant values to compensate
for fatigue progression. To estimate the degree of trunk
muscle coactivity produced by the abdominals, all the
individual muscle moments were summed signwise.
Coactivity was resolved axis by axis at each instant of
the fatigue cycle by comparing the net L5/S1 moment
about a given axis to the signed sum of the individual
muscle moments about the same axis. The sum of all
the individual muscle moments opposed to the net joint
moment about a given axis represented coactivity at this
2.7. Prediction of back strength using anthropometric
data
The assessment of back muscle relative endurance (%
maximal strength) requires the measurement of maximal
back strength which remains problematic with CLBP
patients. A study was conducted to evaluate if a multiple
regression equation using anthropometric measurements
could predict the back strength of healthy men subjects
with accuracy [39]. Briefly, several anthropometric mea-
sures were collected on 42 healthy men. The possible
anthropometric correlates to back strength were ident-
ified based on previous literature and included global
indices of body size, specific measures of the trunk seg-
ment and limbs, and derived variables related to body
composition and muscularity. Stepwise multiple linear
regression analysis was performed to predict back
strength with age and 26 anthropometric variables as
independent variables.
310 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
3. Results
3.1. Assessment of weakness
3.1.1. Reliability
The NME parameters (NME10–80 and NMEmvc) aver-
aged across bilateral muscles showed good to excellent
reliability results for both healthy and CLBP groups
(ICCs from 0.65 to 0.96; SEMs from 12 to 25%).
3.1.2. Sensitivity
The healthy subjects showed higher (t-test, P =
0.004) peak extension moment at L5/S1 (n = 20; 252
Nm, SD: 40) than CLBP subjects (n = 20; 202 Nm, SD:
62) and men generated a significantly (P = 0.000) higher
extension moment (n = 12; 274 Nm, SD: 38) than
women (n = 13; 191 Nm, SD: 26). However, only the
NMEmvc index showed significant differences (P ⱕ
0.05) between these groups. These differences occurred
for the MU-L5 (healthy vs CLBP subjects) and for the
LO-L1 (men vs women) muscles. However, higher
values (more efficient muscle contractions) were
obtained for the CLBP and female groups, which was
in opposition to our expectations.
3.2. Assessment of muscle composition
3.2.1. Reliability
The IMFT10–80 and IMF75 parameters showed excel-
lent reliability for both groups (ICCs from 0.68 to 0.91;
SEMs ⱕ10%) while modest results were achieved for
MFT10–0 (ICCs from 0.36 to 0.71; SEMs from 189 to
598%).
3.2.2. Sensitivity
The MF based parameters (MFT10–80, IMFT10–80,
IMF75) were not sensitive to the differences in muscle
composition expected between groups. Between group
differences were observed in the MF data across the
force levels (especially between healthy and CLBP men
for the MU-L5 muscles, Fig. 4) but large inter-individual
variability was present. Consequently, the difference was
not significant.
3.2.3. Frequency banding analysis
The power contained in the different frequency bands
of the EMG power spectrum was equivalent for the same
extension moment at L5/S1. A typical example is
depicted in Fig. 5 for the MU-L5 muscle group.
3.3. Assessment of fatigability
3.3.1. Reliability
The level of reliability obtained in the present study
for individual muscles was, at best, acceptable. How-
ever, it was demonstrated that measurement strategies
Fig. 4. Median frequency (MF in Hz) as a function of the L5/S1
extension moment (Nm) during a 0–100% ramp contraction of the
multifidus muscles (MU-L5). Each curve represents the mean of all
healthy males (n = 20) and all CLBP (n = 20) subjects. The non-linear
appearance of both curves and their apparent difference (not statisti-
cally significant) were observed only for this muscle group.
involving the averaging of multiple measurements sites
can, at times, increase the reliability to an acceptable
level. Only the EMG indices based on MF estimates
(MFslp) showed acceptable reliability. Reliable EMG
indices were achieved for both healthy and CLBP sub-
jects in particular conditions, namely when (1) electrodes
are positioned on medial back muscles (MU-L5 level
and LO-L1) instead of more laterally positioned back
muscles such as IL-L3 and LO-T10 and (2) measures
were averaged across bilateral muscles. The most
reliable EMG indices were the bilateral average of
medial back muscles (ICC range: 0.68–0.91; SEM range:
5–35%) and the average of all back muscles (ICC range:
0.77–0.91; SEM range: 5–30%). With regards to EMG
indices of fatigue, the identification of the most fatigable
muscle also lead to satisfactory results (ICC range: 0.74–
0.79; SEM range: 21–26%). However, among the EMG
recovery indices, only REC was reliable for medial
muscles (MU-L5 and LO-L1) and when bilateral averag-
ing was performed. According to the results of the D-
study (generalizability theory), it was predicted that the
averaging of measures across two fatigue tests perfor-
med within the same session would increase the
reliability by about 13%.
3.3.2. Sensitivity
The EMG fatigue indices (RMSslp, MFslp) showed
no difference between men and women (Table 2). Even
accounting for skinfold thickness in an analysis of
covariance was unsuccessful because this covariate
remained statistically unsignificant. Significant differ-
ences were observed between healthy and CLBP men
for all but one comparison (MFslp, LO-T10) (Table 2).
Unexpectedly, the corresponding results suggest that the
back muscles of healthy men fatigued more rapidly than
 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318 311

Fig. 5. L5/S1 extension moment (Nm) as a function of power in the different frequency bands (µV2×Hz) during a 0–100% ramp contraction for
the multifidus muscles (MU-L5). From top to bottom, the plots corresponding to the frequency band 1 (20–60 Hz) to 5 (240–300 Hz). Each curve
represents the mean of all healthy (n = 20) and all CLBP (n = 20) subjects. The curve corresponding to the CLBP men follow exactly the course
of the curve corresponding to healthy men, and this at each frequency band.

Table 2
Effect of gender (healthy men vs healthy women) and low back status (healthy and CLBP men) on EMG fatigue indicesa

Healthy men Healthy women P (t-test) Healthy men CLBP Men P (t-test)
(n=12) (n=13) (n=20) (n=20)

MFslp: slope of the MF to time relationship (Hz/s)

Multifidus ⫺1.50 (0.91) ⫺1.27 (0.54) 0.441 ⫺1.34 (0.52) ⫺0.82 (0.49) 0.003
Ilioc. lumb. ⫺0.60 (0.42) ⫺0.60 (0.34) 0.977 ⫺0.60 (0.33) ⫺0.35 (0.23) 0.008
Longissimus-L1 ⫺0.99 (0.58) ⫺0.75 (0.29) 0.203 ⫺0.79 (0.45) ⫺0.46 (0.30) 0.010
Longissimus-T10 ⫺0.49 (0.39) ⫺0.58 (0.29) 0.496 ⫺0.40 (0.27) ⫺0.26 (0.22) 0.088
Mean all muscles ⫺0.89 (0.54) ⫺0.80 (0.32) 0.594 ⫺0.78 (0.35) ⫺0.47 (0.28) 0.004
Most fatigable ⫺1.64 (0.93) ⫺1.39 (0.54) 0.400 ⫺1.46 (0.55) ⫺0.97 (0.52) 0.006
RMSslp: slope of the RMS to time relationship (µV/s)
Multifidus 1.50 (1.47) 0.87 (0.52) 0.159 0.93 (0.70) 0.29 (0.32) 0.000
Ilioc. lumb. 2.59 (3.38) 1.24 (0.60) 0.168 1.84 (1.91) 0.52 (0.58) 0.005
Longissimus-L1 1.34 (1.08) 1.24 (0.83) 0.798 1.27 (0.83) 0.41 (0.44) 0.000
Longissimus-T10 1.44 (1.43) 1.52 (1.03) 0.880 1.51 (0.99) 0.61 (0.54) 0.001
Mean all muscles 1.72 (1.80) 1.22 (0.55) 0.346 1.39 (0.97) 0.45 (0.42) 0.000
Most fatigable 3.01 (3.54) 2.42 (1.45) 0.583 2.66 (2.09) 1.02 (0.85) 0.002

a
Significant differences (P ⱕ 0.05) are identified by bold characters

those of CLBP men and both fatigue indices demon- 3.4. Estimation of recovery time required after the
strates consistent results in this respect. fatigue test to perform a second fatigue trial

No significant differences (one-way ANOVAs

3.3.3. Assessment of the cocontraction of abdominals
During the fatigue test, coactivity increased for most
subjects (18 out of 22) while the L5/S1 moments
(extension, lateral bending, axial rotation) remained
stable. The model predicted an average coactivity
increase from 21 Nm (SD: 15) to 33 Nm (SD: 21).
between the three trials, α = 0.05) were obtained for the
different EMG indices (RMSslp, MFslp, IRMS, IMF)
computed across the three fatigue trials. This suggested
that complete muscle recovery was allowed with either
a 10 or 15 min rest period. The corresponding reliability
results showed that the averaging of two measures lead
312 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
to an ICC increase ranging from 0.02 to 0.10 and a SEM
decrease ranging from 2 to 10% depending on the EMG
index of fatigue.
3.5. Prediction of back strength using anthropometric
data
The peak L5/S1 extension moment identified as the
back strength was used as the dependent variable. The
Pearson correlation coefficients revealed poor to valu-
able relationship (range: 0.01–0.60) between inde-
pendent variables and back strength. The final prediction
regression model included two variables (FFM: fat free
mass and THORD: thoracic depth) that accounted for
39% of the variance and the corresponding equation was:
Back strength ⫽ 14.740 ⫹ 5.814 ⫻ FFM ⫺ 4.959
⫻ THORD
(adjusted R 2 = 0.391, standard error of the estimate =
42.5 Nm)
4. Discussion
4.1. Reliability
In general, similar reliability was obtained for the con-
trol subjects and CLBP patients for all EMG indices.
These results were not expected because the only
reliability study available for CLBP patients [54] demon-
strates moderate ICCs of 0.47 and 0.39 for the left and
right longissimus at L3, respectively, for the MFslp
index. We attribute our satisfactory results to the stable
clinical status of the CLBP patients (Oswestry score,
VAS pain rating) during the reliability assessment and
to the minimization of axial rotation moments using the
visual feedback from the dynamometer [40].
In most cases (especially for MFslp), averaging meas-
ures across bilateral muscles or across all electrode sites
increased the reliability of EMG indices of back
muscles. The averaging across bilateral muscles ignores
the difference that may exist between bilateral muscles
when, for example, unilateral pain occurs. However,
even if these bilateral differences exist, it appears that
they cannot be detected reliably as shown in our
reliability study [40] and in other studies [62,69]. We
conclude from our reliability studies that the assessment
of back muscle impairments through EMG analysis
necessitates the use of multiple electrodes to achieve
reliable results.
The reliability of the MFT10–80 slope parameter com-
puted during ramp contractions was the only EMG index
showing poor reliability. This was attributed to the flat-
ness of the MF to moment relationship (slopes close to
zero), which was explained by either a lack of sensitivity
of MF estimates to muscle force or by a curvilinear
relationship (bell shaped), depending on the back muscle
investigated [36].
4.2. Back muscle weakness
Even though CLBP male and healthy female subjects
showed lower back strength than healthy male subjects
according to the dynamometry results, the NME EMG
parameter showed no between group difference with the
exception of the counter-intuitive results (CLBP men
and healthy women with higher NME than healthy men)
obtained for 2 of the 16 comparisons.
Pain and fear of injury may have confounded the
strength measures for CLBP subjects. Hence, the use of
dynamometry to report back muscle weakness might at
least partly explain the lower strength results observed
for CLBP subjects relative to healthy individuals in some
studies. Studies that report no differences between CLBP
and healthy subjects support this assertion [31,70].
Nevertheless, it appears reasonable to hypothesize that
back muscle weakness occurs for some CLBP patients
given that the muscle structure (decrease of muscle
mass, alteration of muscle fiber characteristics) is modi-
fied [28,43] and that these modifications are time depen-
dent relative to pain symptoms [46].
The pain or fear of injury bias was unlikely between
healthy males and females, which confirmed that the
NME parameter was not a sensitive indicator of back
strength. The NME concept, which might be a useful
tool to assess weakness at simple joints, does not seem
applicable to the spine where multiple muscles span sev-
eral joints. The use of the net moments to compute the
NME parameter might represent a significant problem
when load sharing among back synergic muscles and
coactivation of abdominal antagonist muscles occurs.
4.3. Back muscle composition
None of the EMG spectral parameters were sensitive
to low back status or gender. However, it is possible that
the CLBP subjects involved in the present study were
not impaired enough to show detectable changes in mus-
cle fiber size and/or proportion. In the present study, the
CLBP subjects were at work at the time of testing and
showed minimal disability according to the gradation
proposed by Fairbank et al. [19]. However, females have
smaller muscle fiber than in men irrespective of fiber
types or back muscles [44,71]. Then, the absence of dif-
ference between men and women suggested that these
spectral parameters were not sensitive to muscle fiber
size.
Given the discrepancy between the MF curves of heal-
thy and CLBP (Fig. 4), MU-L5 muscle), it was hypo-
thesized that between group differences could be com-
prised in specific frequency bands of the power
 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
spectrum. Unfortunately, this was not the case. However,
time-frequency analyses such as wavelet transforms
might give different results, given their expected ability
to analyze the EMG signal with specific time resolutions.
Wavelet analysis decrease the variability of spectral esti-
mates [34]. This might be especially useful for ramp
contractions where the force level is changing through
the contraction, also implying a possible change in mus-
cle length. However, the relationship between muscle
fiber composition (proportions, areas) and spectral para-
meters is confusing [4,25,26,35]. Our results suggested
that the role of many confounding factors must be clari-
fied before EMG can provide a non invasive alternative
to muscle biopsy.
4.4. Back muscle fatigability
4.4.1. Sensitivity to gender
The effect of gender on back muscle fatigability is not
trivial. Muscle physiology studies generally demonstrate
a higher muscular endurance in women [11,21]. This
could be explained by the greater capacity of women to
use oxidative phosphorylation to produce ATPs [21],
given that muscle composition in terms of muscle fiber
proportion type (type I vs type II) is the same in both
genders for back muscles [44,71] and that the absolute
load produced is apparently unrelated to gender differ-
ences [21].
Many studies comparing men to women through the
Sorensen test report lower fatigue in women
[13,33,45,59,73]. However, the relative weight of the
trunk is generally lower for women resulting in a longer
holding time in this test [32,33,59] but this hypothesis
has yet to be tested adequately.
Few studies contrasting men and women involved a
fatigue test with the subject standing erect (trunk
vertical) to eliminate the possible bias of relative trunk
weight [16,32]. They showed conflicting results with
Jorgensen & Nicolaisen [32], who demonstrate lower
fatigue in women using a mechanical muscle fatigue cri-
terion, and Elfving et al. [16] and the present study who
show no difference using an EMG muscle fatigue cri-
terion. It is possible that EMG is not sensitive enough
to detect differences in muscle fatigue. However, these
three studies also use a high intensity relative load
(Elfving et al. [16]: 80% MVC; Jorgensen & Nicolaisen
[32]: 60% MVC; the present study: 75% MVC) that
would halt the circulation of blood flow within the back
muscles [5]. The use of a fatigue test allowing partial or
intermittent blood circulation might magnify the gender
effect if women use more the oxidative phosphorylation
pathway to produce ATPs. This is supported by previous
studies performed on other muscle groups [18,49].
313
4.4.2. Sensitivity to low back status
Unexpectedly, healthy males showed more back mus-
cle fatigue than CLBP males. This concurred with other
findings [6] and strongly suggested that our CLBP did
not produce a ‘true’ MVC at the beginning of the assess-
ment so that the ‘true’ relative load (function of the
MVC) during the fatigue test was smaller (in absolute
and relative terms) for them. It becomes evident that the
main drawback in the measurement of relative endurance
is the need to get a valid estimate the MVC level. Thus,
an attempt was made to predict back strength with the
use of anthropometric measurements [39]. However, as
demonstrated previously [48,53] and further substan-
tiated in the present paper, this prediction was prone to
errors. Thus, other measurement protocols must be
developed to overcome this situation.
The task generally used for EMG fatigue assessments
does not correspond to a work task, and hence the mus-
cle fatigue mechanisms involved are different, a con-
dition which makes difficult the inference to muscle
endurance in relation to work. The use of a fixed load
to induce muscle fatigue would eliminate the need for
measurement of back strength. At first sight, this
measurement approach may appear inappropriate for the
evaluation of endurance because absolute endurance
partly depends on subject strength [63]. Practically, it is
however important to test this form of endurance con-
sidering that a same force level is required for all indi-
viduals to be able to perform many working tasks.
Another common characteristic of most EMG fatigue
assessments is the use of a sustained static effort at a
high level of back strength [44,65]. Although this allows
the phenomenon of muscle fatigue to be quickly revealed
through EMG, muscle endurance is not evaluated in con-
ditions that correspond to tasks performed in the work-
place (intermittent contractions at a low to moderate
level of strength). The endurance of muscle fibers at high
levels of strength (60–80% of the MVC) would be evalu-
ated with complete occlusion of intramuscular blood
flow instead of conditions with low to moderate levels
of strength (25–60% of the MVC) creating partial inter-
mittent occlusion of blood flow, and completely different
fatigue mechanisms [17]. There is a need to apply EMG
measurements to quantify muscle fatigue in more com-
plex tasks performed intermittently at low to moderate
intensity to better mimic occupational tasks [58]. Given
the larger proportion of type II fibers in CLBP subjects
[47], this form of muscle fatigue assessment should be
efficient to demonstrate their reduced capacity to use the
aerobic energy pathways (oxidative phosphorylation)
which is generally more developed in type I fibers. Fur-
thermore, given that changes in muscle capillarity gener-
ally accompany the oxidative capacity of a muscle [27],
allowing partial blood flow could possibly highlight the
impairment in muscle capillarity that would be expected
in CLBP subjects (more type II fibers = decrease of oxi-
314 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
dative capacity = decrease of capillarity) relative to heal-
thy individuals. This should affect the EMG signal con-
tent, the MF being sensitive to the accumulation of
metabolic byproducts that is amplified by muscle
ischemia [52] or in other words, by an impairment in
muscle blood flow that would go along with a low capil-
larity density. Unfortunately, this latter hypothesis is not
supported in the literature because back muscle biopsy
studies contrasting healthy and CLBP subjects do not
include data on capillarity.
4.4.3. Assessment of the cocontraction of abdominals
It was assumed that abdominal muscles would not
fatigue during sustained trunk extension so that time-
related changes in the EMG of these muscles would
reflect force modulations after EMGAO adjustment. This
assumption appears reasonable because the relative level
activation of the abdominal muscle remained below 20%
of the maximal voluntary EMG on average (rectus abdo-
minis (left and right): 6 ± 4% and 7 ± 6%; external
oblique: 19 ± 13% and 17 ± 16%; internal oblique: 15
± 10% and 18 ± 15%) at the beginning of the fatigue
test (first 5 s) and the contraction was relatively short
(30 s). The increase in trunk muscle coactivity might
indicate a protective strategy to stabilize the lumbar
spine but at the expense of additional shear and com-
pression forces on lumbar joints. Furthermore, the back
muscles must counteract this additional net flexion
moment produced by the abdominals, a situation that
should precipitate muscle fatigue. We can hypothesize
that CLBP subjects employ more abdominal coactivity
to stabilize their lumbar spine [9,60,61], so they would
be more prone to back muscle fatigue. However, the
verification of these hypotheses requires the modification
of present EMG driven models to process adequately
CLBP subjects data who cannot produce the required
MVC to normalize EMG.
4.4.4. Load sharing between back muscles
A phenomenon that also deserves attention in the
assessment of back muscle fatigue is the variability of
load sharing between the different components of the
erector spinae. Van Dieën et al. [75] have shown the
presence of this phenomenon in back muscles, but others
also suggest that it occurs in some circumstances. A drop
in the activation of the lumbar muscles is reported for
some subjects at the end of a fatigue test while the lum-
bar net moment is kept constant [12,59]. We inspected
the results of our sample of 20 healthy subjects and
observed this phenomenon in four of them (typical case
in Fig. 6). Interestingly, the lowest MFslp among the
eight electrode sites corresponding to the most fatigable
muscle were all smaller than ⫺1.49 (MFslp range at all
electrode sites: ⫺0.67 to ⫺3.00 in our 20 healthy
subjects) for all of them meaning that these subjects were
getting more fatigued than the others. This concurred
with Cooper and Stokes [12] who observed variable load
sharing only with the more strenuous tasks involving
higher levels of fatigue. Moreover, Oddsson et al. [59]
observed this phenomenon only for their male sample
(n = 10) because seven of them reached exhaustion
before the end of their 60 s Sorensen test. None of the
women (n = 10) reached exhaustion and no drop in EMG
activation was apparent.
The drop in the EMG activation of lumbar muscles
might be linked to specific muscles (multifidus for
instance which are generally fatigued earlier than the
other components of the erector spinae (see MFslp—
Table 2 and [64,68]). These muscles would be progress-
ively switched off by the central nervous system when
they reach exhaustion. Thus, the load must be taken by
other erector spinae components to keep the net moment
constant. Scheerlink-Bunkens and Jorgensen [66]
observed a shift of the load from the lumbar to the tho-
racic erector spinae. However, the additional load put on
these muscles cannot be sustained for a long time and
the subject rapidly reach exhaustion. An additional
increase of EMG of the LO-T10 level was observable
in only two of our four cases (as in Fig. 6) but it is
possible that the load was sometimes shifted to muscles
not recorded with our EMG setup.
Variable load sharing between synergic muscles is
hypothesized as a muscle strategy to delay muscle
fatigue [75]. This phenomenon might partly explain the
weak reliability of RMSslp relative to MFslp EMG para-
meters because EMG RMS amplitude is more sensitive
than MF to the load [56]. The standardization of the task
and measurement protocol cannot exclude the influence
of the central nervous system on the muscle recruitment
patterns. Thus, appropriate quantification of load sharing
would be required to act as a complementary EMG para-
meter to explain muscle fatigue. However, to achieve
this, the changes in amplitude and spectral EMG para-
meters due to fatigue and variations in muscle load must
be differentiated. A method has been proposed to achi-
eve this goal [42] but it is based on the premise that MF
increase monotonously with muscle force. Unfortu-
nately, we observed that the MF remains stable or even
decreases across the force levels [36] so that this method
would be useless when applied to back muscles. Other
methods must be developed and tested to resolve this
problem.
In summary, the assessment of back muscle fatigue to
infer back muscle capacity at work is a complex task
that should be addressed in different ways. Van Dieen
et al. [75] identified three factors that explain muscular
endurance: (1) anatomical factors (muscle composition,
capillarization), (2) physiological factors (hormones,
enzymes, energy stores), and (3) functional factors
(motor control). Anatomical and physiological factors
can be accommodated by fatigue tests involving the
recruitment of the motor units commonly used in daily
 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318 315

Fig. 6. L5/S1 moment components (Nm) and electromyographic signals at eight electrode sites in function of time (s). The L5/S1 extension
moment (upper left plot) was kept constant throughout the fatigue test, while the L5/S1 moments coupled to the extension moment (upper right
plot: Mlat = lateral bending and Mrot = axial rotation) stayed at negligible values. See the decrease of MU-L5 activation (lower plots) and the
corresponding increase of LO-T10 activation at the end of the fatigue test (these events are identified with arrows). The decrease of activation was
also observed at IL-L3 and LO-L1 electrode sites but never at LO-T10 in other subjects.

activities and to some extent, allowing aerobic energy
pathways to come into play (e.g. intermittent
contractions). However, even with the level of task stan-
dardization of our measurement protocol, control mech-
anisms were not adequately controlled to isolate intrinsic
muscle properties. Thus, these control mechanisms must
be quantified and accounted for in future studies. The
functional factors, which are defined by the muscle
recruitment strategies (load sharing between synergetic
muscles and coactivity of antagonistic muscles) have
never been considered before but could help to explain
why muscle fatigue occur more or less rapidly for some
subjects. EMG driven models partitioning the lumbar net
moments into individual muscle forces must be
developed to account for the effect of muscle fatigue on
the EMG signal, to estimate muscle forces from EMG
without requiring the production of MVC contractions
(problematic for CLBP subjects), and finally to built new
biomechanical variables capturing the essential features
of load sharing and cocontraction. Efforts have been
initiated in this respect [23,48,74] and should be
further encouraged.
Acknowledgements
We acknowledge the financial support from the
Réseau de recherche en adaptation réadaptation
(REPAR/FRSQ) and by the Occupational Health and
Safety Research Institute Robert-Sauvé (IRSST: Institut
de recherche Robert-Sauvé en santé et en sécurité du
travail). Christian Larivière was supported by a post-
doctoral fellowship from the IRSST.
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Christian Larivière received a B.Sc. in physi-
cal education, a M.Sc. in kinanthropology and a
Ph.D. in Clinical sciences from the University
of Sherbrooke, Sherbrooke, Canada, in 1992,
1994 and 1999, respectively. From 1999 to
2000, he was a post-doctoral fellow in biomed-
ical sciences at the University of Montreal, Que-
bec, Canada. He is currently researcher at the
Occupational Health and Safety Research Insti-
tute Robert-Sauvé, Montreal, Quebec, Canada.
Since 1991, his research has focused on the
development of linked models applied to lifting
tasks and on the quantification of lumbar impairments through kinematic,
kinetic and electromyographic measures.
318 C. Larivière et al. / Journal of Electromyography and Kinesiology 13 (2003) 305–318
A. Bertrand Arsenault received a B.Sc.
(Physical Therapy), M.Sc. (Kinesiology) and
Ph.D. (Kinesiology) from University of Mon-
treal, Simon Fraser University and University of
Waterloo respectively. He practiced physical
therapy for several years before joining, in 1980,
the School of Rehabilitation of the University of
Montreal and the Research Center of the Mon-
treal Rehabilitation Institute. Since 1980, he has
acted as a professor, director of graduate studies
and director of the physical therapy program at
the University of Montreal and as a researcher
and director of this research center. He is now director of the School of
Rehabilitation, Faculty of Medicine, University of Montreal. He has been
involved in research activities focussing on the evaluation of the musculos-
keletal system of stroke patients as well as of subjects suffering from back
and neck pain.
Denis Gravel is Professor at the School of
Rehabilitation of the University of Montreal and
researcher at the Research Center of the Mon-
treal Rehabilitation Institute. After he received
his B. Sc. in Physical Therapy in 1970, he prac-
ticed physical therapy for two years. Then, he
completed his M.Sc. degree at the department
of anatomy of the University of Montreal. From
1976 to 1983, he acted as a Professor at the
School of Rehabilitation of the University of
Montreal. From 1984 to 1991, he completed his
Ph.D. degree in neurobiology at Laval Univer-
sity. From 1992 to 1996, he was granted from the FRSQ (Fonds de
Recherche en Santé du Québec) as a clinical researcher. His research inter-
est focus on the evaluation of normal and pathologic motor function using
electromyography, biomechanics and dynamometry techniques.
Denis Gagnon received a B.Sc. in physical edu-
cation (1980) and M.Sc. in kinanthropology
(1985) from University of Sherbrooke, and a
Ph.D. in biomechanics in 1990 from University
of Montreal. He is a Professor at the Department
of Kinanthropology of the University of Sher-
brooke and Director of the Occupational Biome-
chanics Laboratory. His research interests focus
on the study of trunk muscle coactivity stra-
tegies during dynamic lifting and on the investi-
gation of back muscle fatigue during static effort
in healthy and low back pain individuals.
Patrick Loisel received his MD degree in 1971
from the Faculty of Medicine of Paris VI
(France). He is a Fellow of the Royal College
of Physicians and Surgeons of Canada
(orthopaedic surgery) since 1986. He is full pro-
fessor at the Faculty of Medicine of the Univers-
ité de Sherbrooke and presently involved in
research, practice and teaching in work rehabili-
tation at Charles LeMoyne teaching Hospital
(South Shore Montreal). His research work is in
the development and validation of programs and
tools for the prevention of work disability for
musculoskeletal disorders. He is the head of the PREVICAP multidiscipli-
nary clinical research team in work disability prevention. He is the director
of the Quebec network for work rehabilitation (RRTQ) and the head of
the work disability prevention CIHR strategic training program. He holds
the research chair Bombardier/Pratt & Whitney in work rehabilitation at
the Université de Sherbrooke.