The objective of this study was to determine the electromyographic (EMG) activity of the superficial muscles during the treatment of low back patients during a conservative procedure known as the Cox flexion-distraction procedure. A total of 33 low back pain patients were recruited for this study from chiropractic and allopathic orthopedic clinics. EMG signals were collected while the patient was in a prone relaxed position, during the treatment using the flexion-distraction procedure, and during maximum voluntary exertions in the three planes (flexion, extension, left and right lateral bending, and left and right twisting). The mean values of the Root Mean Square (RMS) values of EMG ratios during treatment versus resting indicate that the muscles are active during the treatment. This activity is more than the activity at rest. However the mean values of the RMS EMG ratios (during treatment versus maximum voluntary contraction) are small indicating that the muscle activity during treatment may not influence the treatment loads. The left and right muscles in all muscle groups were similarly active. During the treatment, erector spinae muscles were the most active, followed by the external oblique, and the rectus abdominus muscles. The results from this study provide quantitative data for the muscle activity during the flexion-distraction treatment. This information can be incorporated into computer models to estimate the loads generated during the flexion-distraction treatment due to the muscle activity compared to the loads generated by the chiropractic physician.

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