1. The document discusses the use of EMG to guide and evaluate lumbar spine manual therapy. Several studies have used real-time EMG to monitor paraspinal muscle activity during manual therapy techniques. 2. One study found increased spinal stiffness and positive neuromuscular responses during thrust techniques compared to those with less back pain. Another found increased paraspinal muscle strength immediately following spinal manipulation. 3. A third study observed paraspinal EMG patterns mimicking stretching responses during myofascial treatments, relating clinical effectiveness to tonic muscle reactions detected by EMG.

1. Introduction to EMG & EMG guided manual therapy of lumbar spine Satyajit Mohanty MSPT,MIAP, MHPC (UK) Senior Physiotherapist

3. Place of EMG as a investigating tool

5. How MSK conditions are investigated? After having roughly identified the origin of Pain, investigations are carried out to confirm the source of pain. Investigative strategies in musculoskeletal sciences takes a comprehensive approach called THE PHYSIO-ANATOMIC APPROACH Though function & structure are inseparable aspects of existence, physiological properties & structural integrity of the faulty tissues are separately studied in this approach.

8. Question 2: Whether it is permitted to employ EMG in the context of studying & guiding manual therapy? Physicians have been vehemently protesting EMG use by physiotherapists till 2005. One can check the stance of american acedamy of family physicians 14 . However, the next recommendation by Braddock et al (2007) ; Manual medicine guidelines for musculoskeletal injuries, National guideline clearinghouse (USA) 7 electrodiagnostic studies for the application of manual therapy are indicated under following diagnostic circumstances: 1. Persistent neurological symptoms 2. Conditions non-responsive to conservative care requiring determination of the severity of the deficit

10. Performing & interpreting Paraspinal EMG

12. Surface & needle EMGs

16. Typical spinal nerve

25. The multifidus & Iliocostalis muscles: Lumbar area muscles for EMG studies

27. Studies of EMG guiding Lumbar spine manual therapy

31. Colloca et al employed surface EMG recordings obtained from electrodes (8 leads) located over the L3 and L5 paraspinal musculature to monitor the bilateral neuromuscular activity of the erector spinae group during the PA thrusts. Results: 1. Increased spinal stiffness index and positive neuromuscular reflex responses in subjects with frequent or constant LBP as compared with intermittent or no LBP.

38. Pandiculation

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