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SPINE Volume 28, Number 14, pp 15931600

2003, Lippincott Williams & Wilkins, Inc.


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
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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.
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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.
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(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
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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.
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1600 Spine

Volume 28

Number 14

2003

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