Cross-sectional study of electromyographic onsets of trunk and hip muscles. Onset of obliquus internus abdominis, multifidus, and gluteus maximus delayed. Biceps femoris electromyographic activity was earlier in subjects with sacroiliac joint pain.
Original Description:
Original Title
3.- Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of SI Joint Pain.
Cross-sectional study of electromyographic onsets of trunk and hip muscles. Onset of obliquus internus abdominis, multifidus, and gluteus maximus delayed. Biceps femoris electromyographic activity was earlier in subjects with sacroiliac joint pain.
Cross-sectional study of electromyographic onsets of trunk and hip muscles. Onset of obliquus internus abdominis, multifidus, and gluteus maximus delayed. Biceps femoris electromyographic activity was earlier in subjects with sacroiliac joint pain.
Evidence of Altered Lumbopelvic Muscle Recruitment in the Presence of Sacroiliac Joint Pain Barbara Hungerford, PhD,* Wendy Gilleard, PhD, and Paul Hodges, PhD Study Design. Cross-sectional study of electromyo- graphic onsets of trunk and hip muscles in subjects with a clinical diagnosis of sacroiliac joint pain and matched control subjects. Objectives. To determine whether muscle activation of the supporting leg was different between control subjects and subjects with sacroiliac joint pain during hip exion in standing. Background. Activation of the trunk and gluteal muscles stabilize the pelvis for load transference; however, the tem- poral pattern of muscle activation and the effect of pelvic pain on temporal parameters has not been investigated. Methods. Fourteen men with a clinical diagnosis of sacroiliac joint pain and healthy age-matched control sub- jects were studied. Surface electromyographic activity was recorded from seven trunk and hip muscles of the supporting leg during hip exion in standing. Onset of muscle activity relative to initiation of the task was com- pared between groups and between limbs. Results. The onset of obliquus internus abdominis (OI) and multidus occurred before initiation of weight trans- fer in the control subjects. The onset of obliquus internus abdominis, multidus, and gluteus maximus was delayed on the symptomatic side in subjects with sacroiliac joint pain compared with control subjects, and the onset of biceps femoris electromyographic activity was earlier. In addition, electromyographic onsets were different be- tween the symptomatic and asymptomatic sides in sub- jects with sacroiliac joint pain. Conclusions. The delayed onset of obliquus internus abdominis, multidus, and gluteus maximus electromyo- graphic activity of the supporting leg during hip exion, in subjects with sacroiliac joint pain, suggests an alteration in the strategy for lumbopelvic stabilization that may dis- rupt load transference through the pelvis. [Key words: Sacroiliac joint, pelvic stabilization, motor control, elec- tromyography, low back pain, pelvic pain] Spine 2003;28: 15931600 Research in the past decade has indicated that the pelvic girdle, rather than being an inherently stable structure, maintains its stability by regulated activation of sur- rounding myofascial components. 1 The articular sur- faces of the sacroiliac joint (SIJ) are relatively at and are aligned close to the vertical plane. 1 Flat joint surfaces are optimal for transfer of loads; however, the alignment of the SIJ close to the vertical plane makes it vulnerable to vertical shear loads, such as gravitational force. 2 The ligamentous structures that surround the SIJ and the pu- bic symphysis provide joint compression and limit the available range of intrapelvic motion. 3 The visco-elastic properties of these ligaments, however, show a tendency for creep under prolonged loading. 4 Active compression of the pelvic articulations via the muscles and fascia of the lumbopelvic region is therefore required to stabilize intrapelvic motion during transference of loads between the spine and lower limbs. 2 The contribution of muscle force to active control of intrapelvic motion is dependent on the optimal control of the nervous system. 5 Little is known, however, about the timing of activation of muscles in the lumbopelvic region to stabilize intrapelvic motion against vertical loading. Stability of intersegmental lumbar motion is maintained by a variety of strategies controlled by the central nervous system, which modulates the timing and pattern of muscle recruitment according to the demands placed on the lumbar spine. 6 Deep trunk muscles, includ- ing the transversus abdominis (TrA), the multidus, the lower bers of the obliquus internus abdominis (OI), and the diaphragm, activate before limb or trunk motion and exhibit patterns of cocontraction to increase spinal stiff- ness and limit intersegmental motion. 7,8,9,10 Stability of intrapelvic motion for transference of loads, as occurs during single leg standing, may also be controlled by cocontraction of the TrA, OI, and multidus via connec- tions to the posterior layer of the thoracolumbar fas- cia. 2,5,11 Compressive forces across the pubic symphysis are increased by activation of the OI and adductor lon- gus, whereas activation of the OI, TrA, gluteus maximus, latissimus dorsi, and lumbar erector spinae increase com- pressive forces across the SIJ. 1,2,12 Investigation of the temporal relation of muscle activation during a task in- volving vertical load transference may produce a greater understanding of the relative importance of trunk and hip musculature in active stabilization of the pelvis. When the left hip is exed from standing, the distri- bution of vertical forces between the spine and lower limbs will alter. With initiation of the task, weight is shifted to the left to increase the vertical force required for lateral transfer of the center of mass toward the right supporting leg. 13 Displacement of body mass is preceded and accompanied by muscle activation to provide pos- tural support for load transfer to the new single leg sup- port conguration. Hodges and Richardson 9 observed From the *School of Exercise and Sport Science, University of Sydney, Sydney, the School of Exercise Science and Sport Management, Southern Cross University, Lismore, and the Department of Physio- therapy, The University of Queensland, Brisbane, Australia. Supported by the National Health and Medical Research Council Na- tional Health and Medical Research Council (NHMRC) of Australia (PH). Acknowledgment date: June 12, 2002. First revision date: November 13, 2002. Acceptance date: December 10, 2002. Address reprint requests to Barbara Hungerford, PhD, P.O. Box 1305, Rozelle, NSW, 2039 Australia The manuscript submitted does not contain information about medical device(s)/drug(s). Federal funds were received in support of this work. No benets in any form have been or will be received from a commer- cial party related directly or indirectly to the subject of this manuscript. 1593 early activation of the TrA, OI, obliquus externus abdo- minis, and multidus before limb motion. It is hypothe- sized that preactivation of the TrA, OI, multidus, pubo- coccygeus, and gluteus maximus may also induce posterior rotation of the innominate relative to the sa- crum, and increase tension onto the posterior SI liga- ments and posterior layer of the thoracolumbar fas- cia 11,14 before load transfer onto the supporting leg. Coactivation of trunk and hip muscles may therefore increase spinal stiffness 3 and increase compression and stiffness at the sacroiliac joint. 1,15,16 Further investiga- tion is required to determine whether there is an alter- ation to recruitment of trunk and hip muscles in associ- ation with pain in the sacroiliac joint region, as has previously been shown in association with low back pain. 17,18,19 Specically, recruitment patterns of the oblique abdominal muscles and TrAhave been shown to alter during lower limb movements in the presence of pain of lumbar origin. 17 The aims of this study were to determine the normal pattern of recruitment of trunk and hip muscles as subjects stood on one leg and to compare this response with that in a group of subjects with sacroiliac joint pain (SIJP). Materials and Methods Sacroiliac Joint Pain Subject Group. Fourteen men with SIJP and a mean age of 32.7 years (range 2447), mean height of 176.8 cm (range 168184), and mean weight of 77.0 kg (range 7190) volunteered for the study. Inclusion Criteria. Each subject in the SIJP group reported unilateral pain over the posterior pelvic/SI region without pain above the lumbosacral junction 20 for longer than 2 months. The SIJP was consistently and predictably aggravated by an activity of vertical pelvic loading, for example, walking or sit- ting. All subjects in the SIJP group were required, at the time of data collection, to have positive responses to two clinical as- sessment tests that assess the subjects ability to maintain lum- bopelvic stability for transfer of loads between the lumbosacral spine and legs. 21,22,23 The clinical tests were as follows: Active straight leg raise test (ASLR) 22 : The pelvis should remain in a neutral alignment during elevation of a straight leg in supine. A perceived difference of effort, or pain pro- duction/aggravation, was recorded as a positive test result. Stork test: During a left stork test 21,24 (standing hip exion test), the subject stands on the right leg and exes the left hip toward 90. The right innominate should remain posteri- orly rotated (sacrum relatively mutated) during right single leg support 25 as the self-bracing mechanism of the pelvis is activated for load transfer. 1 The left innominate should pos- teriorly rotate relative to the sacrum during left hip ex- ion. 26 A positive test result was indicated when anterior rotation of the innominate was palpated relative to the sa- crum. It was recognized that the reliability of the stork test to assess pelvic stability remains uncertain, 26,27,28 and therefore both clinical test results were required to be posi- tive for a subject to be included in the SIJP group. Exclusion Criteria. Subjects were excluded if they could not ex each hip to 90 without pain, had undergone spinal sur- gery, or displayed overt neurologic signs such as sensory par- esthesia or motor paresis. Control Subjects. The SIJP group were age and height matched to a control group of 14 men with a mean age of 33.5 years (range 2250), mean height of 176 cm (range 168182), and mean weight of 72.5 kg (range 6185). Inclusion Criteria. The control subjects had no history of low back pain in the previous 12 months, no history of con- genital lumbar or pelvic anomalies, and normal results on the ASLR and stork tests. Exclusion Criteria. Control subjects were excluded if no palpable motion was clinically observed between the PSIS and S2 spinous process during unilateral hip exion in standing (because this pattern has previously been identied in subjects with impaired pelvic function) 29 or if they experienced any pain during the clinical assessment. All subjects were assessed by the same experienced physio- therapist to maintain continuity. Informed consent was given by each subject before participation in the study, and all rights of the subjects were protected. The study was approved by the institutional human ethics committee. Procedures. Recordings of electromyographic (EMG) activity were made using pairs of Ag/AgCl surface electrodes (Medit- race, Graphic Controls, Buffalo, NY, USA). The seven elec- trode sites were (1) adductor longus (adductors), upper third of the inner thigh over the muscle belly determined by a resisted isometric contraction 30 ; (2) long head of biceps femoris (biceps femoris), mid distance between the gluteal fold and the knee joint 15 ; (3) tensor fascia latae (TFL), the midpoint of an oblique line connecting the anterior superior iliac spine (ASIS) and the greater trochanter 30 ; (4) gluteus medius, mid distance between the ASIS and posterior superior iliac spine and inferior to the iliac crest 30 ; (5) gluteus maximus, at the midpoint of a line between the inferior lateral angle of the sacrum and the greater trochanter 15 ; (6) lumbar multidus, 2 cm lateral to the spinous process at the L4L5 interspace 9 ; (7) OI, in the center of the triangle formed by a horizontal line between the anterior supe- rior iliac spine of the innominate and the umbilicus, midline, and the inguinal ligament. 2 Crosstalk from the psoas major recorded at this location is likely to be small; however, activity from the TrA, which lies deep to the OI, may be recorded with electrodes at this site. 31 Because our interest was to record activity from the transversely oriented abdominal muscles, dif- ferentiation between their activation was considered unneces- sary. All electrodes were placed with an interelectrode distance of 20 mm (center to center) and aligned parallel to the under- lying muscle bers. A reference electrode was placed laterally over the tenth rib. Before electrode placement the skin was shaved, abraded, and cleaned with alcohol. The EMG data were collected and amplied (amplication factor range 4501350) by use of a telemetered EMG system (Noraxon Telemyo 8, Glonner Electronics, GmbH, Munich, Germany). The EMG data were ltered between 10 and 500 Hz and sam- pled at 960 Hz. Before data collection, practice trials were performed to en- sure that 90 hip exion was attainable without pain. After the performance of a single quiet standing trial, EMG data were recorded from the seven trunk and hip muscles on the side of standing on one leg during ve left and ve right trials of hip 1594 Spine
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2003 exion in standing. Subjects were asked to stand on one leg, ex the contralateral hip and knee toward 90 hip exion, then lower the foot back down. Subjects stood in a relaxed manner between trials, and they performed the hip exion task imme- diately after a verbal instruction. Data Analysis. Force platform data were used to determine initiation of motion as body mass was transferred onto the supporting leg during hip exion in standing. The hip exion maneuver involved a weight transfer phase that preceded the limb movement phase, and the pattern of increased vertical loading onto the hip exion leg (Figure 1), before weight shift onto the supporting leg, was consistent with previous stud- ies. 13,32 The vertical ground reaction force data provided a means of determining whether trunk or hip musculature was activated before initiation of motion, and gave a common point for comparison of the temporal relation of muscle activation between control subjects and subjects with SIJP. The initial onset of motion was determined by use of an algorithmadapted fromSims 32 that identied the initiation of motion as the point at which the vertical ground reaction forces rose greater than three standard deviations from the mean baseline activity for more than 50 ms (MATLAB, The Mathworks Inc., Natick, MA, USA). The EMG data were analyzed in two ways. First, the onset of EMG activity was identied visually as the rst increase in EMGactivity above the premovement baseline level of activity. The EMG recordings were enlarged to a resolution of 0.5 ms and were randomly and individually displayed with- out reference points to exclude observer bias. 33 Second, to con- rm the ndings of the temporal analysis in a manner that was independent of the detection of EMG onset of each muscle, the mean amplitude of full wave rectied EMG data were calcu- lated in 50-ms epochs before (5 epochs) and after (10 epochs) the initiation of motion. The mean of the baseline (100 ms) was subtracted from the epoch data, and the remainder was ex- pressed as a proportion of maximum magnitude of muscle ac- tivation recorded during each trial. The temporal relation between the initiation of motion and the onset of EMG activity for all muscles was determined on the side of the supporting leg during exion of the hip. Because of the time required for nerve conduction and synaptic trans- mission, the earliest reex response to initiation of a task is unable to occur less than 20 ms after the onset of motion. 34 Any EMGactivity of a muscle before initiation of motion, or within 20 ms of initiation of motion, was regarded as occurring within the criteria of feedforward muscle activity and was not medi- ated by feedback from the motion. 9,34 The onset of EMG activity was expressed relative to the initiation of motion. Onsets before the initiation of motion were given a negative value. Onsets were compared between sides and between groups. To determine whether there was a signicant difference in the mean onset of EMG between groups, independent groups two-tailed Students t tests assum- ing unequal variance 35 were performed for all variables. Two tailed paired Students t tests 35 were also performed for all variables between the left and right sides in the control group, and between the symptomatic side and the asymptomatic side in the SIJP group. Trial-to-trial reliability of the onset of EMG activity in the control subjects and the SIJP group was established by use of intraclass correlations (ICC) 2,1 and percentage close agreement within 100 ms (PCA 100 ms) 35 for each of the seven muscles over ve trials. Results When subjects with no history of lumbopelvic pain ex their hip in standing, the onset of OI and multidus EMG activity on the side of standing on one leg occurred be- fore initiation of the task, that is, before the initial alter- ation to vertical ground reaction forces (Figures 1 and 2A). By contrast, the onset of biceps femoris, adductor longus, gluteus maximus, gluteus medius, and TFL EMG occurred after initiation of motion. There was no signif- icant difference in onset of EMGactivity between the left and right sides in control subjects for all seven muscles (Figure 2A). In general, the ndings of the epoch analysis were consistent with the temporal characteristics of EMG data. The epoch data veried that OI and multi- dus were the rst muscles active, followed by adductors (Figure 3). It is important to note that the epoch analysis was used as a conrmation of the general features of the response of the trunk and hip muscles. Because of the 50-ms duration of each epoch, the resolution was lim- ited. There was little change in EMG amplitude of glu- teus maximus, gluteus medius, and TFL until four to ve Figure 1. Electromyographic (EMG) and vertical ground reaction force data from a representative control subject during a single trial of hip exion in standing. The onset of motion as determined by the vertical ground reaction force is depicted. EMG activity is shown for obliquus internus abdominis (OI), multidus, gluteus maxi- mus, gluteus medius, tensor fascia latae (TFL), biceps femoris, and adductor longus (adductors). Note the early onset of OI and multidus and decrease in biceps femoris activity at initiation of motion. 1595 Lumbopelvic muscle in sacroiliac joint pain
Hungerford et al epochs (200250 ms) after initiation of motion, and bi- ceps femoris EMGdecreased in comparison with activity during quiet standing (Figure 3). In comparison with the control subjects, the EMG onsets of OI, multidus, and gluteus maximus were sig- nicantly delayed on the symptomatic side in subjects with SIJP (OI, multidus, and gluteus maximus (all P 0.01) (Figure 2B). The onset of OI and multidus EMG occurred more than 20 ms after the onset of motion and therefore failed to meet the criteria for feedforward acti- vation. By contrast, the onset of biceps femoris EMG occurred signicantly earlier (P 0.03) on the symptom- atic side in the SIJP group, in comparison with control sub- jects (Figure 2B). The general features of the temporal nd- ings were consistent with the epoch data (Figure 3). Onset of OI EMG was delayed until approximately the seventh epoch after onset of motion, and onset of multidus and gluteus maximus activation occurred in the fourth epoch after onset of motion on the symptomatic side. In compar- ison, onset of biceps femoris activity was appreciably in- creased before and after onset of motion (Figure 3). Comparison of EMG onsets at the initiation of stand- ing on one leg on the asymptomatic side between the SIJP group and control subjects also showed a signicant differ- ence in temporal parameters for OI and multidus activa- tion (Figure 2C). Activation of OI was signicantly delayed Figure 2. Mean time of electromyographic onset for the supporting leg during hip exion in standing in control subjects (A), control subjects versus subjects with sacroiliac joint pain (SIJP) on the symptomatic side (B), control subjects versus subjects with SIJP on the asymptomatic side (C), and asymptomatic versus symptomatic side in subjects with SIJP (D). Standard errors of the mean are shown. *P 0.05; **P 0.01. Note the signicant delay in OI, multidus, and gluteus maximus activity on the symptomatic side in subjects with SIJP in comparison with control subjects, and the asymptomatic side. 1596 Spine
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2003 (P 0.01) in the SIJP group in comparison with control subjects, as was onset of activationof multidus (P0.05). Activation of both OI and multidus on the asymptomatic side, however, still met the criteria of feedforward activity. There was no signicant difference in temporal parameters for the other ve muscles (Figure 2C). When onset of EMG activity on the symptomatic side was compared with that on the asymptomatic side in the SIJP group, there was a signicant difference in the onset of activation in OI, multidus, and gluteus maximus (Figure 2D). Onset of OI and multidus activation on the symptomatic side was signicantly delayed (P 0.01), as was gluteus maximus (P 0.05). There was no sig- nicant difference in onsets of biceps femoris, adductors, gluteus medius, or TFL between sides for the SIJP group (Figure 2D). Figure 3. Electromyographic (EMG) amplitude during 50-ms epochs before and after initiation of motion for control subjects and subjects with sacroiliac joint pain (SIJP) on the symptomatic side. EMG amplitude in each epoch was normalized to maximum amplitude during the task and averaged across subjects. Activity above zero indicates an increase in EMG activity. Note that the onset of the obliquus internus abdominis (OI) and multidus occurred within 1 or 2 epochs of the initiation of motion (dotted line) in control subjects, and onset of OI and multidus was delayed more than three epochs after initiation of motion in subjects with SIJP. 1597 Lumbopelvic muscle in sacroiliac joint pain
Hungerford et al The trial-to-trial reliability of onset of EMG activity on the supporting leg during hip exion trials is summa- rized in Table 1. In the control subjects (Table 1), trial- to-trial reliability of EMG onsets of multidus, biceps femoris, and gluteus medius activation over ve trials was high (ICC 2,1 range 0.700.86). Reliability of onset of activation of OI, adductor longus, gluteus maximus, and TFL was good (ICC 2,1 range 0.620.68). Percentage close agreement showed that greater than 60.7% of EMGdata occurred within 100 ms at initiation of stand- ing on one leg during the standing hip exion motion. Trial-to-trial reliability over ve trials on the symptom- atic side in subjects with SIJP was high for biceps femoris, adductors, and gluteus maximus (ICC 2,1 range 0.74 0.83). Onset of activation of OI and multidus showed good reliability (ICC 2,1 range 0.540.58). Gluteus me- dius and TFL showed fair reliability (ICC 2,1 range 0.41 0.42). Percentage close agreement showed that greater than 70.7% of EMG data occurred within 100 ms of initiation of the task for all muscles except biceps femoris (PCA (100 ms) 60.0%) (Table 1). Discussion This study has shown for the rst time, as far as we are aware, that subjects with a clinical diagnosis of SIJP show delayed onset of EMG activity of OI, multidus, and gluteus maximus in comparison with control sub- jects. The delay in onset of OI and multidus EMG as subjects stood onto one leg occurred on both the symp- tomatic and the asymptomatic sides in the SIJP group. In comparison, biceps femoris activation occurred earlier in subjects with SIJP. The present results indicate that onset of EMG of OI and multidus occurred before initiation of motion in control subjects. This is consistent with previous re- search that has identied feedforward activation of TrA, OI, and multidus in association with limb movements that challenge the stability of the spine. 9,10,36 Previous studies have suggested that TrA and OI, in particular the lower bers that are orientated horizontally, may con- tribute to compression of the SIJ. 1 Similarly, lumbar mul- tidus activation may increase tension on posterior SI ligaments and posterior layer of the thoracolumbar fas- cia 3 and induce a nutation force on the sacrum. 37 Preac- tivation of OI and multidus, as determined in this study, may therefore contribute to compression of the SIJ be- fore initiation of single leg stance, to produce optimal pelvic stabilization for load transference. Pelvic stability may have been further enhanced by the combined activ- ity of OI and adductor longus, producing compression of the pubic symphysis. 5 By contrast, biceps femoris EMG was decreased at initiation of motion in control subjects. This reects the ndings of previous research in which little activity of biceps femoris was identied during standing on one foot. 38 In the SIJP group, the onset of OI, multidus, gluteus maximus, and biceps femoris EMG was signicantly dif- ferent on the symptomatic side compared with the asymptomatic side and with control subjects. Activation of OI and multidus occurred more than 80 ms after initiation of motion and cannot be considered to be feed- forward. This would suggest a change in the motor con- trol strategy on the symptomatic side in subjects with SIJP. Similar results have been observed in subjects with pain of the lumbar origin. 8,17 The delayed onset of OI and multidus activation on the symptomatic side may have diminished the effectiveness of stabilizing mecha- nisms at the SIJ before increased vertical loading through the pelvis at initiation of standing on one leg. Delayed activation of gluteus maximus may also have altered compression of the SIJ, 14 with a subsequent failure of the mechanisms required for optimal load transference through the pelvis. The early onset of biceps femoris activation on the symptomatic side in comparison with control subjects may therefore have occurred to assist hip extension because of delayed onset of gluteus maxi- mus activity, or to augment force closure across the SIJ via connections of biceps femoris to sacrotuberous liga- ment and the posterior layer of thoracolumbar fascia. 39 This latter alternative has been argued to generate alter- nate forces that assist lumbopelvic stability. 40 It is inter- esting to note that the altered pattern of OI and multi- dus EMG activity also occurred on the asymptomatic side. Altered recruitment of OI and multidus was not specic to the side of SIJ pain and positive clinical assess- ment testing; however, onset of gluteus maximus was only delayed on the symptomatic side. Further investiga- tion is required to determine whether different mecha- nisms affect the recruitment patterns of the deep abdom- Table 1. Trial to Trial Reliability of EMG Onset Over Five Trials During Hip Flexion in Control Subjects and Subjects with Sacroiliac Joint Pain (SIJP) Muscle Control Subjects: Single Leg Support SIJP Subjects: Symptomatic Single Leg Support ICC (2, 1) PCA (100ms) ICC (2, 1) PCA (100ms) OI 0.62 72.86 0.54 75.71 multidus 0.74 80.00 0.58 76.43 bicep femoris 0.86 65.71 0.83 60.00 adductor longus 0.64 60.71 0.83 87.14 gluteus maximus 0.66 67.86 0.74 72.86 gluteus medius 0.70 66.43 0.41 75.71 TFL 0.68 70.71 0.42 70.71 1598 Spine
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2003 inal and back muscles in comparison with the phasically active gluteus maximus. It is recognized that although the electrical signal cap- tured by surface electrodes originates primarily from the supercial muscle directly beneath the electrode, there may be a component of crosstalk from deeper or neigh- boring muscles. Future studies may benet from the in- clusion of data collected with ne wire electrodes. Trial-to-trial reliability in all subjects was generally good to high for all parameters. The decreased reliability of gluteus medius and TFL activation may have been due to a greater variability in the strategy used by subjects with SIJP to maintain single leg stance when their ability to transfer loads through the pelvis was altered. The number of subjects included in this study was determined to provide adequate statistical power. Comparison of data within and between groups pro- duced a large number of variables. Because of the large number of variables, and consequent large number of statistical tests performed, the probability of a type I error was increased. Dividing the alpha level by the number of variables may have reduced the probability of a type I error; however, this method would also reduce the power of each test. 34 Future studies of larger subject numbers may benet from multivariate or multifactorial procedures. Identication of an altered pattern of muscle re- cruitment in subjects with SIJP is signicant for the conservative management of lumbopelvic pain. Previ- ous research has shown that specic exercise treat- ments are effective in altering pain and functional dis- ability in patients with segmental lumbar instability and altered motor recruitment patterns. 41,42 Further research is required to determine whether the altered pattern of muscle recruitment identied in subjects with SIJP may be similarly improved with specic ex- ercise intervention. Key Points Activation of obliquus internus abdominis (OI) and lumbar multidus occurred before onset of motion in control subjects. Subjects with a clinical diagnosis of sacroiliac joint pain showed delayed onset of EMGactivity of OI, multidus, and gluteus maximus compared with control subjects. The delay in onset of OI and multidus EMG as subjects stood on one leg occurred on both symp- tomatic and asymptomatic sides in the group with sacroiliac joint pain. In comparison, biceps femoris activation occurred earlier in the group with sacro- iliac joint pain. The delayed onset of OI, multidus, and gluteus maximus EMG on the supporting leg during hip exion, in subjects with sacroiliac Acknowledgment The authors thank Ray Patton and Dr. Roger Adams of the Faculty of Health Sciences, University of Sydney, for technical and statistical advice, respectively. References 1. Snijders C, Vleeming A, Stoeckart R. Transfer of lumbosacral load to iliac bones and legs. 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