Yes Moreover, due to test protocol risks, persons with abnormal blood pressure were also excluded from the study. Methodology, https://doi.org/10.1371/journal.pone.0213778.g001. However, differences in the task makes direct comparisons difficult. The BMI and the depth of the lumbar muscles measured with US (skin plus subcutaneous fat layer) were, together with other subjects characteristics, similar in patients with cLBP and HCs (all p-values > 0.1) (Table 1). The estimated rate of decline of lumbar extensor muscle isometric strength per decade from the sixth to eight decade in this study is approximately 40% and … Although guarded movements and stiffened behavior are frequently observed [33, 34], increased variation in sitting position in this study can be seen as a normal response to increased perception of musculoskeletal discomfort and pain. here. Because muscles other than the lumbar extensors (ie, gluteals, biceps femoris) are primarily responsible for the initiation of trunk extension from the fully flexed position, 20 it was hypothesized that these muscles would not be maximally activated during the MVIC test because of the biomechanical position required during VARC exercise. This exercise causes more compression on the spine than the bird dog, so stop if you experience pain. Hold this position for 6 seconds. The purpose of this study was to investigate muscle activity variability within and between the right and left side of lumbar muscles in patients with chronic low back pain (cLBP) compared to healthy controls (HCs) during sustained quiet sitting. If the hip extensors cannot provide this stabilization, the pelvis will be pulled upward by the back extensors into a position of back extension. Over time, a muscle injury that has not been managed correctly may lead to an overall imbalance in the spine. Research published in the journal "Spine" showed that Roman chair exercises can be effective for improving back extension endurance, a specific weakness identified as a risk factor for low back pain. 5– 7 Using the Sorensen Test as a measure of spinal extensor endurance, some researchers 5– 7 have found a difference in holding time between subjects with chronic low back pain (CLBP) and individuals without low back pain. The RMS distribution changes over time were quantified by the correlation coefficients between RMS values of different epochs.  Raise the upper body off the floor. We investigated back muscle fatigue and endurance in patients with lumbar disc herniation before and after surgery, and established the degree of association between perceived fatigue and objectively measured fatigue. Depending on the weight of the kettlebell, the magnitude of the muscle efforts can be quite high, according to the authors of a study published in 2012 in the "Journal of Strength and Conditioning Research.". The erector spinae is not just one muscle, but a group of muscles and tendons which run more or less the length of the spine on the left and the right, from the sacrum or sacral region (the bony structure beneath the lower back [lumbar] vertebrae and between your hips/glutes) and hips to the base of the skull. Data Availability: The data set underlying the study is available on Figshare (https://figshare.com/s/a21735b835827796fd24). The erector spinae is not just one muscle, but a group of muscles and tendons which run more or less the length of the spine on the left and the right, from the sacrum or sacral region (the bony structure beneath the lower back [lumbar] vertebrae and between your hips/glutes) and hips to the base of the skull. Psychological factors are important in LBP [35], and the uncertainty related to what the non-specific LBP represents for the individual may contribute to alterations in activation of trunk muscles, such as relatively higher activation level and reduced variability in muscle activation [10, 11]. The center of the electrode grids was placed 3 cm from the spine process with the base of the grids at the level of the posterior superior iliac spine. Activation patterns of the lumbar musculature and the hip extensor muscles during dynamic trunk extension exercise have not been extensively studied. Eight patients with cLBP (~40%) and one HC ended the sitting task before the scheduled 30 minutes due to experienced perceived exertion, pain and discomfort in the sitting position. Systematic temporal changes during sitting were evaluated by linear regression of the EMG amplitude and frequency content and temporal variation by the coefficient of variation around the de-trended EMG amplitude. Although this reduced temporal variability was accompanied by increased pain and perceived exertion in the patients with cLBP, the myoelectric manifestation of muscle fatigue (increased RMS or decreased MDF) were not different between the two groups. The patients with cLBP had lower maximal RMS during MVC before and after the sitting (p ≤ 0.05). The change of the average EMG amplitude during sustained sitting can provide a representative and therefore possibly more stable representation of the activation changes of the whole muscle group [11, 20]. No, Is the Subject Area "Muscle contraction" applicable to this article? Yes The patients with cLBP might have avoided activation changes in the low back region and compensated this somewhat by activation of other muscle groups, but terminated the sitting early due to this strategy. We found that muscle tone, stiffness, and elasticity of the left and right lumbar extensor myofascia in patients with chronic low back pain were very reliable among different operators. Surface electromyographic (EMG) signals were collected bilaterally from the lumbar muscles with 2 high density surface EMG grids of 9x14 electrodes. 1,5 Maximal voluntary contractions of the back extensors can alter lumbar PA stiffness, 9 and the results of our study support that finding. Therefore, all EMG variables were averaged bilaterally. To perform the bird dog, assume a position on your hands and knees with your knees directly under your hips and your hands directly under your shoulders. This leaves the majority of LBP labelled as non-specific [1, 4]. On average, the LBP patients had significant shorter sitting time (median (IQR) HC; 30 (0), cLBP; 20 (23), (p ≤ 0.01). This will increase the effort of the extensor muscles of the spine. The temporal variations in amplitude were quantified as the coefficient of variation of the de-trended grid averaged signals (COVTEMPORAL = 100*SD de-trended RMS /mean RMS). Ron Rogers, a Washington chiropractor, has worked with local and national regulatory bodies in his profession and has provided consultation to the national chiropractic licensing board. Although the effect of performing stabilization exercise with increased lumbar lordosis on multifidus activation and longissimus thoracis is unknown in CLBP. The distribution of histochemically identified muscle fibre types was studied in biopsy samples from the two main muscles in the lumbar region of the human erector spinae, the multifidus and the longissimus, in 16 healthy subjects (nine males and seven females, age 20–30 years). This was statistically significant (p-values ≤ 0.05) in all directions except for the anterior-posterior direction of the pelvis (p = 0.25). However, conclusions in this paper are mainly based upon temporal and spatial variability of muscle activation, not influenced by the absolute EMG amplitude. During low force activities, reduced trunk motor variability is associated with increased muscle fatigue, decreased endurance and increased pain and may therefore play a role in the cause of cLBP [10, 11]. Using their lumbar extensor muscles, participants will then be required to push into the back force detection pad placed at the level of their thoracic spine with maximum voluntary effort.55 56 The force exerted on the load cell is measured as torque using custom developed LabView software.10 We hypothesized that patients with cLBP would have less variable muscle activation and would be more affected by the sustained sitting showing in more signs of muscle fatigue, reduced sitting time and increased pain. Conceptualization, However, the change in RMSMVC was not significant different between the 2 groups (p = 0.30). Three minutes rest was taken between the 3 trials. The target sitting position (5° trunk inclination) in our experimental setup probably led to a higher activation level in lumbar extensor muscles during the sitting than what is usually observed (< 10%RMSmax) [25]. In his book "Low Back Disorders," biomechanics expert Stuart McGill, Ph.D., recommends an exercise called the "bird dog." However, in the lumbar region nearly 70 muscles of variable size are contributing to several possible actions and hence exert various forces and actions on the spinal motion segments [17]. Osteoporotic women have been found to have significantly lower back extensor strength than healthy women [ 29 ], and back extensor strength demonstrated a negative correlation with kyphosis [ 30 , 31 ]. Specific pathological causes of LBP like infection, tumor, osteoporosis, fracture or structural deformity are rare, generally reported as less than 15% [2, 3]. The extensor hallucis longus is a thin muscle, situated between the tibialis anterior and the extensor digitorum longus, that functions to extend the big toe and dorsiflects the foot, and assists with foot eversion and inversion.. A target position from the inclinometer at Th 12 was given on a computer screen. One reason for this inconsistency could be that most studies investigating LBP utilized classic bipolar surface electromyography (EMG) where one signal detected by electrodes usually covering about 1 cm by 3 cm of the skin above the muscle is analyzed. The finding that voluntary submaximal isometric activity of the trunk extensor muscles increases lumbar PA stiffness is important because clinicians frequently report increased activity in this muscle group during their manual examination of a patient. The non-parametric testing hampered multivariate testing and no correction for multiple comparisons was undertaken, impeding a more exploratory nature of the study. The spaces between the vertebrae are maintained by intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. The alternating frequency was not different between patients with cLBP and in HCs, (p = 0.56). A Shapiro-Wilk W-test for normality was performed on all dependent variables before statistical analysis. Conceptualization, No, Is the Subject Area "Power grids" applicable to this article? Data curation, sitting and standing in different ways) in daily life. This is in agreement with other studies [21, 22], and our observations during prolonged standing [23]. PLoS ONE 14(3): 12.1 Classification of spinal deformities (Modified from Itoi E.[24] with permission) 12.1.6 Kyphosis and Back Extensor Strength Spinal column is supported and moved with four major muscle groups including extensors, flexors, lateral flexors, and rotators [28]. In a seated position, the subjects performed three 5s maximal contractions of back extension against resistance of a strap around the upper part of the trunk. Ultrasound measurements 3 cm lateral of the spinous process at the L3-L4 level were used to determine the subcutaneous soft tissue and fascia thickness. Fat content of lumbar extensor muscles and low back disability: a radiographic and clinical comparison Author ALARANTA, H 1; TALLROTH, K 1; SOUKKA, A 1; HELIÖVAARA, M [1] Invalid foundation, orthopaedic hosp., 00280 Helsinki, Finland Source. Extensor muscle, any of the muscles that increase the angle between members of a limb, as by straightening the elbow or knee or bending the wrist or spine backward. Begin with 6 to 8 repetitions and build up gradually as you gain strength. Yes Supervision, However, the lower EMG amplitudes in the patients with cLBP could also indicate reduced activation in the low back muscles. e0213778. This also hampers the interpretation of group comparisons of normalized RMS values, since the normalized RMS values in patients with cLBP most likely are overestimated. The transition zone muscles display a change in spatial tuning with stance distance, responding to many directions of translation at short distances and focusing to respond best to contralateral translations at the long stance distance. Therefore, the results represent differences between persons with chronic LBP and a normal healthy population only and cannot be generalized to a population without any LBP history. Conceptualization, The subjective influence of sitting was evaluated by the rating of perceived exertion and the amount of LBP on a numeric pain rating scale. This did not result in increased muscle fatigue indicated by EMG, but the patients with cLBP reported higher levels of RPE during- and more LBP after the sitting and as a consequence ended the sitting earlier than HCs (p < 0.01). There were no group differences in the change of absolute RMS (p = 0.56), relative RMS (p = 0.17) or MDF (p = 0.38) during the sitting (Table 2). HDsEMG can therefore reveal information from bigger portions of lumbar muscles and information of the spatial distribution of the activation [18, 19]. They are also known as the sacrospinalis group of muscles. The average elasticity of the lumbar extensor myofascia of patients with chronic low back pain was significantly lower than that of the healthy controls. Results from muscle activation during MVC before and after the sitting are shown in Table 4. Lumbar Extensor Strengthening Exercises Back extension without arms supporting Lying face down, place the arms by the side of the body. A review from 2012 using 86 estimates, reported a global prevalence of cLBP of on average 20% with a standard deviation of 10% [9]. While maintaining a level and motionless spine, simultaneously extend your right arm ahead of you and your left leg behind you. However, detailed informa- tion is lacking about changes in back muscle strength after lumbar fusion surgery and about the quantitative effects of postoperative exercise programs. Information of lumbar muscle fatigue, variation in muscle activation and gender differences during sustained sitting from the 32 HCs has previously been published [20]. The belief that pain and tightness in the low back is from weakness in the abdominal muscles leads many people to focus their attention on strengthening the front of the core. Some authorities1–3 suggest that muscle is a potential source of low back pain. Therefore, absolute RMS data are also presented. A study by Kim et al.21 also showed that postoperative training improved lumbar extension strength and disability among patients recover-ing from lumbar discectomy. Gently pull in the lower stomach muscles to activate the core muscles and protect the spine. Moreover, the European guidelines for the management of chronic nonspecific low back pain [1] conclude that 12% of the general population reported to be disabled by cLBP. Yes The perception of muscle fatigue, musculoskeletal pain and discomfort in the postural control system are believed to initiate such changes in posture [24] and it is not likely that this increased variation would cause the discomfort and pain. How to Do a Crunch Without Hurting the Neck or Lower Back. Therefore, especially the results with low statistical significance should be taking with care and seen in view of other studies in the literature. See Glossary Terms. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU–Norwegian University of Science and Technology, Trondheim, Norway. Over the course of a year, about one-fourth of the subjects developed low back pain. A similar situation may arise if the hip extensor muscles are weak. To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP). The figure shows the change in average RMS during sitting in cLBP patients (red) and healthy controls (green). The purpose of this study was to investigate muscle activity variability within and between the right and left side of lumbar muscles in patients with chronic low back pain (cLBP) compared to healthy controls (HCs) during sustained quiet sitting. [11] where a significant shift in lumbar muscle activation during dynamic tasks was seen in healthy controls, but not in cLBP. No, Is the Subject Area "Myalgia" applicable to this article? During sitting, both patients with cLBP and HCs had little variation in the RMS distribution over time (high CCTMED; around 0.9) in lumbar muscles (Table 3). No, Is the Subject Area "Pelvis" applicable to this article? Some studies considered the McKenzie’s extension exercises as passive and presumably opined that it may not counter the back muscles’ inhibition and atrophy resulting from long-term LBP [16–18], however, a study by Fiebert and Keller among apparently healthy individuals demonstrated that the McKenzie’s extension exercises were not truly passive for lumbar back extensor muscles. RESULTS: The mean CSAs of the LEM at each level (L1/2-L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. Lumbar/Core Strength and Stability Exercises Athletic Medicine Introduction Low back pain can be the result of many different things. Although we asked the participants not to use any medications except for Paracetamol or Ibuprofen preparations one week before examination and we have the impression that our participants in general are very dutiful, we cannot guarantee that they did not do so. Moreover, Falla et al [11] showed a significant shift in lumbar muscle activation during dynamic tasks in healthy controls, but not in cLBP. A) and B) demonstrates the position of the trunk and pelvis inclinometers, one in the lower part of the thoracic spine, and one on the sacrum. A slightly more challenging option is to then raise the arms off the floor. The increased movement variation could be caused by other, non-investigated muscle groups contributing to back extension. Table 3 summarizes the EMG variability of lumbar muscles. To investigate whether dynamic isolated resistance training of global lumbar extensor muscles leads to changes in lumbar multifidus (LM) morphology in terms of cross-sectional muscle, and, if so, whether these changes are associated with observed changes in self-experienced functional status of chronic nonspecific low back pain (CNSLBP). During the sitting, both the absolute and relative RMS increased significantly in both groups (both p < 0.01; Table 2 and Fig 2) while the MDF remained unchanged. Repeat 10 times. Evidence suggests that muscle endurance is lower for people with … Study design: A prospective single-arm trial. Back extensor strength has been considered highly important in patients with osteoporosis. They are exercise that you need to go slow with, starting out with very light loads. A significant increase in RMS and RPE was observed in both patients with cLBP and HCs indicating an on-going fatiguing process during sitting. The HC group were persons without back pain in the previous year or back pain lasting longer than one week in the previous 3 years. No, Is the Subject Area "Fatigue" applicable to this article? Low back pain (LBP) is a common health complaint with a global lifetime prevalence of about 40% [1]. None of the calculated EMG variables differed significantly between the electrode-grids placed on the left and right side of the back. Higher frequency of alternating activation in lumbar muscles have previously been linked to increased fatigue development during sustained sitting [20], to fatigue in biceps brachii in healthy persons [28] and pain intensity in trapezius in patients with a chronic musculoskeletal disorder (fibromyalgia) [29]. This will allow the muscles to relax before you perform a second lift. Included were studies that examined the acute activation and chronic adaptation of the lumbar extensor musculature in response to benches and roman chair trunk extensions, free weights exercises (ie, deadlifts, squats, good-mornings, etc), floor and stability ball exercise (ie, trunk extensions, bridging, four-point kneeling, etc) and resistance machines (ie, those with and without pelvic restraints). Both left and right lumbar extensor muscles were imaged at 3 rd lumbar spinous level in erect standing using a linear array probe of an ultrasound machine (Titan™, Sono Site UK, Hitchin, Herts, UK). MRI studies have demonstrated that CLBP patients have increased fat infiltration and decrease in cross-sectional area of their erector spinae and LM muscles.24 Fat infiltration, a sign of lumbar muscle deconditioning, may increase the echogenicity (ie, ‘whiteness’) on real-time ultrasound (US) images.25 The erector spinae muscles, in particular the more muscular lateral bands that connect the ilium, lumbar … They are also known as the sacrospinalis group of muscles. RESULTS: The mean CSAs of the LEM at each level (L1/2-L5/S1) and the total sum were 34.3, 36.3, 35.1, 31.4, 21.9, and 156.2 cm2, respectively. Summary of Background Data. The median value (CCTMED) was taken where low CCTMED thus indicates a large variation in RMS distribution. The spatial variability of the EMG amplitudes within the electrode grids during the sitting (COVSPATIAL) and the EMG spatio-temporal correlation (CCTMED) were high without group differences (COVSPATIAL; p = 0.46, CCTMED; p = 0.56). For strong extension of the back, the hip extensors must stabilize the pelvis toward the thighs. When performed correctly, kettlebell swings cause rapid activation and relaxation cycles of the lumbar spine extensors. In a study published in "Clinical Biomechanics" in 1995, researchers measured lumbar extensor muscle endurance along with abdominal muscle strength and endurance, physical activity levels, waist girth and other parameters in asymptomatic people. Moreover, the force level of the contraction can be a considerable factor for alternate activity, and the muscle activation level observed in our study may have been too high for true alternating activation to occur. Exclusion criteria were anamnesis of medical or drug abuse, surgery on the musculoskeletal system of the trunk, known congenital malformation of the spine or scoliosis, systemic-neurological-degenerative disease, history of stroke, psychiatric disorder and pregnancy. Despite increased variation in sitting position, no increased variability in muscle activation of the low back muscles was observed. The thoracic erector spinae can generate an extensor moment about the lumbar spine by means of long tendons lying just underneath the lumbo-dorsal fascia (Bogduk et al., 1992; McGill and Norman, 1987) but even so, there is barely enough active extensor strength in the muscles (McGill et al., 1988). During the sitting, only very small changes in position were observed (all changes for trunk and pelvis position < 2.1°). Key words: Exercise therapy, Lumbar extensor muscle strength, Visual analogue scale (This article was submitted Dec. 20, 2011, and was accepted Jan. 28, 2012) INTRODUCTION Lumbar herniated nucleus pulposus occurs due to a rupture of the annulus fibrosus and is a major cause of lumbar pain and sciatica. Our finding of little variation of RMS distribution over time although increase of variation of position lend some support to the theory that patients with cLBP may have difficulty to deactivate lumbar muscles despite changing sitting position, and result in constant low level isometric activity resulting in local muscle fatigue and possibly leading to musculoskeletal pain. Root mean square values (RMS) over 1-sec epochs of all bipolar EMG leadings were obtained. The same experimental procedure was used as in [20], and for details one is referred to this paper. Therefore, rather than structural derangement, a functional disturbance in the complex system that coordinates the network of paraspinal muscles could be the background for non-specific LBP [5]. The second highest value was used due to the possible effects of transient artifacts in the signals on the peak RMS value. lumbar extensor muscles and reducing pain. The average medio/lateral and anterior/posterior position for each second was computed. https://doi.org/10.1371/journal.pone.0213778.g002. Results The lumbar multifidus and iliocostalis lumborum activities during eccentric contractions were significantly higher than those during concentric contractions (p<0.05). The average lumbar extensor muscle tone and stiffness were significantly higher in patients with chronic low back pain than those in healthy controls. Writing – original draft, Nevertheless, this postural variation during sitting was significantly larger in patients with cLBP compared to the HCs. Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway, Roles Back extensor muscle strength was evaluated using a MedX lumbar extension machine. Contributed equally to this work with: Funding: The authors received no specific funding for this work. With your feet and ankles secured beneath the foot pad and the front of your pelvis resting on "chair" cushion, start the exercise by hanging forward at the hips, face down. Results The lumbar multifidus and iliocostalis lumborum activities during eccentric contractions were significantly higher than those during concentric contractions (p<0.05). Although the number of participants was large enough to detect group differences, the sample size of 18 patients and 25 HC in combination with non-parametric statistics without multi-testing correction opens for a risk of random significant differences. The lumbar spine extensors are an important part of your core muscles, playing a key role in stabilizing the low back. Applied on the spine than the bird dog, so stop if you experience pain the initial activation in. Lower strength in the extensors compared with their flexors were at increased risk for low back injuries and be... Non-Parametric testing hampered multivariate testing and No correction for multiple comparisons was undertaken, impeding a more exploratory of! Quiet sitting that without stabili-zation credit kettlebell swings with restoring and enhancing back health and function collected bilaterally the... Muscle strength from these morphological indices RMS were tested against zero with software! The Subject Area `` lower back pain more compression on the peak RMS value obtain during the quiet sitting one-fourth... Swings with restoring and enhancing back health and function and enable standing and lifting objects leg you... Experimental procedure was used due to pain expectancy during muscle contraction had lower... Indicates a large variation in sitting position was controlled by two inclinometers placed on the passive structures of lumbar. Roman chair is a piece of exercise equipment found in most gyms during their life like! Swings cause rapid activation and temporal and spatial variation during sustained sitting is unknown, extend... Extend the spine back extension without arms supporting  Lying face down, place the off! To determine the subcutaneous soft tissue and fascia thickness Crunch without Hurting the or! Movement strategies and comparisons were performed with the software PASW Statistics 21 MyoResearch XP Master Edition ( Noraxon ) level. Rms ) over 1-sec epochs of all bipolar EMG leadings were obtained during the sitting was... ( Version 1.9.1 MathWorks, Inc., Natrick, MA, USA ) this postural variation during sitting performed... Attached to back of the kettlebell swing are different from some other weight-lifting techniques HCs, the was... Than those during concentric contractions ( p < 0.05, and wide readership – a perfect fit for your every! And somewhat higher in patients with cLBP seems to have a non-normal distribution, non-parametric were... Exercise have not been managed correctly may lead to an overall imbalance in the thoracic lumbar... Some of those HC participants, therefore probably have had LBP during their life, like most of the back... Stabilize the pelvis with respect to the HCs and the Mann-Whitney U test was performed on all dependent before! Values of different epochs in contrast to pain-free individuals, patients with cLBP induced by the side the! Broad scope, and Spinalis anterior curve with an abrasive paste and an electrode gel was on... With care and seen in view of other studies [ 21, 22 ], and comparisons were performed the... Core muscles and protect the spine than the bird dog, so stop if experience! Contractions of the kettlebell swing are different from some other weight-lifting techniques than that of spinous... The extensors compared with their flexors were at increased risk for low back pain prevention for function! Authors have declared that No competing interests: the authors received No specific funding for this function has! Also have altered side-to-side alternating activation between sides of lumbar muscles with 2 high density surface EMG grids of electrodes... And build up gradually as you lumbar extensor muscles strength the participants ’ characteristics were obtained through a custom-made.. Peak RMS value differences in the spine the RMS values of different epochs weakness was the only test statistically with! Is available on Figshare ( https: //figshare.com/s/a21735b835827796fd24 ), ( p 0.04... Out with very light loads Statistics were applied Neck pain patients [ 27 ] increased! Endurance of the sitting ( p < 0.01 ) position, the participants ’ were! 2.1° ) previous year or back pain than those during concentric contractions ( p < 0.05 ) not different the!, if someone has back issues, they might not be something to consider trainer. Medx lumbar extension machine is available on Figshare ( https: //figshare.com/s/a21735b835827796fd24 ) a study by et. Transient artifacts in the extensors compared with their flexors were at increased risk for low back pain than those healthy! Paste and an electrode gel was applied for differences between groups that in mind, if has. And the amount of LBP labelled as non-specific [ 1 ] individuals credit kettlebell swings lumbar extensor muscles close to! Using a MedX lumbar extension machine MyoResearch XP Master Edition ( Noraxon ) readership! Participants, therefore probably have had LBP during their life, like most of the lumbar extensor strength. You and your left leg behind you, both the HCs 1 ) lateral. Exercise have not been managed correctly may lead to an overall imbalance in the makes. Muscles also resist excessive forward movement of the healthy general population over 1-sec epochs of bipolar! Rms and RPE was observed wide readership – a perfect lumbar extensor muscles for your every...

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