Journal of Isfahan Medical School

Journal of Isfahan Medical School

The effect of neuromuscular training on the frequency spectrum of lower limb muscles in individuals with foot pronation movement disorder syndrome accompanied by low back pain during running

Document Type : Original Article (s)

Authors
Farhad Rezazadadeh 1
Shirin Aali 2
Parinaz Fahimi 3
Hamed Sheikhalizadeh 4
Marjan Zareyan 5
Parsa Forghani 6
1 Assistant Professor, Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
2 Assistant Professor, Department of Physical Education, Farhangian University, Tehran, Iran
3 MSc Student of Sports Biomechanics, Department of Sports Biomechanics, Faculty of Psychology and Educational Sciences, Mohaghegh Ardabili University, Ardabil, Iran
4 PhD Candidate of Sports Biomechanics, Department of Sports Biomechanics, Faculty of Psychology and Educational Sciences, Mohaghegh Ardabili University, Ardabil, Iran
5 PhD in Information Science and Epistemology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
6 Kinesiology and Health Sciences Student, Faculty of Health, York University, Toronto, Ontario, Canada
10.48305/jims.v43.i846.1933
Abstract
Background: Chronic low back pain accompanied by foot pronation is often associated with inefficient neuromuscular patterns during running. This trial aimed to investigate the effects of eight weeks of Dynamic Neuromuscular Stabilization exercises on the frequency spectrum indices of selected lower limb muscles during running.

Methods: 28 men with chronic low back pain (aged 22–25 years) were randomly assigned to an exercise group (n=14) or a control group (n=14). The exercise group performed an eight-week DNS training program, three sessions per week. Surface electromyography was used to record muscle electrical activity, and frequency spectrum indices were analyzed during the loading response, mid-stance, and push-off phases of running.

Findings: A significant effect of time was observed in the loading response phase for the vastus lateralis, vastus medialis, rectus femoris, adductor, semitendinosus, and gluteus medius muscles (p<0.05). In the mid-stance phase, the frequency of the vastus medialis increased (p=0.004), and in the push-off phase, the frequency of the vastus lateralis increased (p=0.020). A significant time*group interaction was reported for the hamstring and vastus medialis muscles (p<0.05), with post-test results showing higher frequency values in the control group compared to the experimental group.

Conclusion: After an eight-week period, significant time-dependent changes were observed in the frequency spectrum indices of several key muscles, especially the latissimus dorsi (mid-stance) and latissimus dorsi (push-off). Also, the between-group difference in the push-off phase favored the control group, indicating the variability of muscle frequency spectrum indices during running.

Highlights

Farhad Rezazadeh: Google Scholar, PubMed

Shirin Aali : Google Scholar, PubMed

Parinaz Fahimi :Google Scholar

Hamed Sheikhalizadeh: Google Scholar

Keywords
low back pain
pronation
Lower Extremity
electromyography
running

Subjects

1.     Rahimi A, Arab AM, Nourbakhsh MR, Hosseini SM, et al. Lower limb kinematics in individuals with chronic low back pain during walking. J Electromyogr Kinesiol 2020; 51: 102404.
2.     McIntosh G, Hall H. Low back pain (acute). BMJ Clin Evid 2011; 2011: 1102.
3.     Cramer H, Mehling WE, Saha FJ, Dobos G, et al. Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain. BMC Musculoskelet Disord 2018; 19(1): 109.
4.     Alshehri MA, van den Hoorn W, Klyne DM, Hodges PW. Postural control of the trunk in individuals with and without low back pain during unstable sitting: A protocol for a systematic review with an individual participant data meta-analysis. PLoS One 2022; 17(5): e0268381.
5.     Najafi Ghagholestani B, Gandomi F, Asar S. The effect of eight weeks aquatic and dynamic neuromuscular stabilization exercises on postural sways and foot pressure distribution symmetry in patients with nonspecific chronic low back pain [in Persian]. Journal for Research in Sport Rehabilitation 2022; 10(19): 143–63.
6.     Koch C, Hänsel F. Chronic non-specific low back pain and motor control during gait. Front Psychol 2018; 9: 2236.
7.     Southwell DJ, Hills NF, McLean L, Graham RB. The acute effects of targeted abdominal muscle activation training on spine stability and neuromuscular control. J Neuroeng Rehabil 2016; 13: 19.
8.     Farahpour N, Younesian H, Bahrpeyma F. Electromyographic activity of erector spinae and external oblique muscles during trunk lateral bending and axial rotation in patients with adolescent idiopathic scoliosis and healthy subjects. Clin Biomech (Bristol). 2015; 30(5): 411–7.
9.     Ippersiel P, Dussault-Picard C, Mohammadyari SG, De Carvalho GB, et al. Muscle coactivation during gait in children with and without cerebral palsy. Gait Posture 2024108: 110–6.
10.  Yang J, Ou Z, Mao Z, Wang Y, et al. Reliability and validity of Foot Posture Index (FPI-6) for evaluating foot posture in participants with low back pain. Sci Rep 2022; 12(1): 21168.
11.  Madadi-Shad M, Jafarnezhadgero AA, Sheikhalizade H, Dionisio VC. Effect of a corrective exercise program on gait kinetics and muscle activities in older adults with both low back pain and pronated feet: A double-blind, randomized controlled trial. Gait Posture 2020; 76: 339–45.
12.  Gevers-Montoro C, Murray KJ, Santamaría B, Dominguez-Vera G, et al. Combined Chiropractic and Podiatric Treatment for Chronic Low Back Pain Concomitant With a Unilateral Pronated Foot: Protocol for a Multicenter Pilot Randomized Controlled Trial. J Chiropr Med 2021; 20(4): 177–82.
13.  Tirtashi FH, Eslami M, Taghipour M. Effect of shoe insole on the dynamics of lower extremities in individuals with leg length discrepancy during walking. J Bodyw Mov Ther. 2022; 31: 51–6.
14.  Castro-Méndez A, Munuera PV, Albornoz-Cabello M. The short-term effect of custom-made foot orthoses in subjects with excessive foot pronation and lower back pain: a randomized, double-blinded, clinical trial. Prosthet Orthot Int 2013; 37(5): 384–90.
15.  Linsiński P. Surface EMG in chronic low back pain. Eur Spine J 2000; 9(6): 559–62.
16.  Lima M, Ferreira AS, Reis FJJ, Paes V, et al. Chronic low back pain and back muscle activity during functional tasks. Gait Posture 2018; 61: 250–6.
17.  Sung W, Abraham M, Plastaras C, Silfies SP. Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement. Spine J 2015; 15(8): 1772–82.
18.  Frank C, Kobesova A, Kolar P. Dynamic neuromuscular stabilization & sports rehabilitation. Int J Sports Phys Ther 2013; 8(1): 62–73.
19.  Rabieezadeh A, Mahdavinejad R, Sedehi M, Adimi M. The effects of an 8-week dynamic neuromuscular stabilization exercise on pain, functional disability, and quality of life in individuals with non-specific chronic low back pain: a randomized clinical trial with a two-month follow-up study. BMC Sports Sci Med Rehabil 2024; 16(1): 161.
20.  Mantashloo Z, Sadeghi H, Khaleghi Tazji M. The effect of foot pronation on postural control of body and electrical activity of selected ankle muscles during V-Cut motion. Journal of Sport Biomechanics 2017; 2(4): 61–9.
21.  Fasihi A, Siahkouhian M, Sheikhalizade H, Jafarnezhadgero A. Effect of fatigue at the heart rate deflection point on the frequency components of ground reaction forces during walking in individuals with pronated feet. The Scientific Journal of Rehabilitation Medicine 2020; 9(2): 228–38.
22.  Huang H, Xie H, Zhang G, Xiao W, et al. Effects of dynamic neuromuscular stabilization training on the core muscle contractility and standing postural control in patients with chronic low back pain: a randomized controlled trial. BMC Musculoskelet Disord 2025; 26(1): 213.
23.  Williams JR. The Declaration of Helsinki and public health. Bull World Health Organ 2008; 86(8): 650–2.
24.  Mahdieh L, Zolaktaf V, Karimi MT. Effects of dynamic neuromuscular stabilization (DNS) training on functional movements. Hum Mov Sci 2020; 70: 102568.
25.  Picciano AM, Rowlands MS, Worrell T. Reliability of open and closed kinetic chain subtalar joint neutral positions and navicular drop test. J Orthop Sports Phys Ther 1993; 18(4): 553–8.
26.  Farahpour N, Jafarnezhadgero A, Allard P, Majlesi M. Muscle activity and kinetics of lower limbs during walking in pronated feet individuals with and without low back pain. J Electromyogr Kinesiol. 2018; 39: 35–41.
27.  Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000; 10(5): 361–74.
28.  Chang JS, Kwon YH, Kim CS, Ahn SH, et al. Differences of ground reaction forces and kinematics of lower extremity according to landing height between flat and normal feet. J Back Musculoskelet Rehabil 2012; 25(1): 21–6.
29.  Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11: S240–52.
30.  Ghorbanloo F, Jafarnezhadgero A, Fatollahi A. Investigating the effect of 8 weeks of corrective exercise with an elastic band on the frequency spectrum of ground reaction forces in young boys with genu valgum during running: a randomized clinical trial study [in Persian]. Studies in Medical Sciences 2021; 31(11): 893–81.
31.  Jafarnezhadgero AA, Oliveira AS, Mousavi SH, Madadi-Shad M. Combining valgus knee brace and lateral foot wedges reduces external forces and moments in osteoarthritis patients. Gait Posture 2018; 59: 104–10.
32.  Rezazadeh F, Aali S, Imani F, Sheikhalizadeh H, et al. Effects of dynamic neuromuscular stabilization on lower limb muscle activity, pain, and disability in individuals with chronic low back pain: a randomized controlled trial. Medicina (Kaunas) 2025; 61(11): 1961.
33.  Ghadehri K, Jafarnezhadgero A, fakhri Mirzanag E, Dehghani M. Effect of long-term sand training on the electrical activity of lower limb muscles in men with foot pronation during walking: a randomized clinical trial [in Persian]. J Guilan Univ Med Sci 2025; 34(1): 80–91.
34.  Alavi Mehr SM, Mousavi SH, Jafarnezhadgero A. The effect of a selected exercise protocol on trunk and lower limb muscle activity of older adults with both low back pain and pronated feet during walking [in Persian]. Sport Sciences and Health Research 2021; 14(1): 129–40.
Journal of Isfahan Medical School
Volume 43, Issue 846
2nd Week, March
March and April 2026
Pages 1933-1942

  • Receive Date 21 February 2026
  • Accept Date 28 April 2026