ORIGINAL PAPER
Immediate changes in lumbar multifidus thickness during faradic and interferential current stimulation in recurrent low back pain: a randomized crossover pilot study
1
Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
2
Motor Control and Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
Submission date: 2025-09-22
Acceptance date: 2026-06-15
Online publication date: 2026-11-09
Corresponding author
Peemongkon Wattananon
Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170 Thailand
Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170 Thailand
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Neuromuscular electrical stimulation has been widely used to stimulate muscles. Although faradic current (FRD) is commonly used, it may not be suitable for lumbar multifidus activation. Interferential current (IFC) may reduce skin impedance and improve current delivery to the lumbar multifidus muscle. The aim of this study was to explore the lumbar multifidus response to different electrical currents.
Methods:
Five participants (age = 24.0, SD = 3.9) with recurrent low back pain (rLBP) and at least two episodes in the past 3 months that interfered with activities of daily living or required treatment, and five age, sex, and BMI-matched healthy controls (HC; age = 23.0, SD = 2.5) were recruited. FRD and IFC were each applied once per side using a continuous incremental protocol from levels of discomfort (LOD 0–10); no repeated series, repetitions, or fixed on/off duty cycle were used. Ultrasound imaging was used to measure the percent change in lumbar multifidus thickness (primary outcome) at rest and across LOD 0–10. Normality and homogeneity of variances were assessed, and no violations were found. A three-way mixed ANOVA was used to examine the interaction between groups and within-groups (currents) and LOD (0–10), with Greenhouse-Geisser corrections. Post-hoc Bonferroni was also performed.
Results:
A significant interaction was found (p = 0.023; partial n2 = 0.36). In the rLBP group, IFC elicited greater LM thickness change than FRD from LOD 3–10 with large effects (Cohen’s dz = 1.06–2.08), reaching 22.35(12.18)% vs. 7.08(1.83)% at LOD 10. Between-group differences under IFC were significant at LOD 3–8 with large effects (Cohen’s d = 1.72–2.92), with 20.45(13.00)% in rLBP vs. 4.16(2.79)% in HC at LOD 7.
Conclusions:
IFC elicited greater immediate lumbar multifidus thickness change than FRD in participants with rLBP. These pilot findings reflect single-session ultrasound-based responses and do not establish clinical or long-term rehabilitation effectiveness.
Neuromuscular electrical stimulation has been widely used to stimulate muscles. Although faradic current (FRD) is commonly used, it may not be suitable for lumbar multifidus activation. Interferential current (IFC) may reduce skin impedance and improve current delivery to the lumbar multifidus muscle. The aim of this study was to explore the lumbar multifidus response to different electrical currents.
Methods:
Five participants (age = 24.0, SD = 3.9) with recurrent low back pain (rLBP) and at least two episodes in the past 3 months that interfered with activities of daily living or required treatment, and five age, sex, and BMI-matched healthy controls (HC; age = 23.0, SD = 2.5) were recruited. FRD and IFC were each applied once per side using a continuous incremental protocol from levels of discomfort (LOD 0–10); no repeated series, repetitions, or fixed on/off duty cycle were used. Ultrasound imaging was used to measure the percent change in lumbar multifidus thickness (primary outcome) at rest and across LOD 0–10. Normality and homogeneity of variances were assessed, and no violations were found. A three-way mixed ANOVA was used to examine the interaction between groups and within-groups (currents) and LOD (0–10), with Greenhouse-Geisser corrections. Post-hoc Bonferroni was also performed.
Results:
A significant interaction was found (p = 0.023; partial n2 = 0.36). In the rLBP group, IFC elicited greater LM thickness change than FRD from LOD 3–10 with large effects (Cohen’s dz = 1.06–2.08), reaching 22.35(12.18)% vs. 7.08(1.83)% at LOD 10. Between-group differences under IFC were significant at LOD 3–8 with large effects (Cohen’s d = 1.72–2.92), with 20.45(13.00)% in rLBP vs. 4.16(2.79)% in HC at LOD 7.
Conclusions:
IFC elicited greater immediate lumbar multifidus thickness change than FRD in participants with rLBP. These pilot findings reflect single-session ultrasound-based responses and do not establish clinical or long-term rehabilitation effectiveness.
REFERENCES (38)
1.
Alrwaily M, Schneider M, Sowa G, Timko M, Whitney SL, Delitto A. Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: a randomized controlled trial. Braz J Phys Ther. 2019;23(6):506–15; doi: 10.1016/j.bjpt.2018.10.003.
2.
Langeard A, Bigot L, Chastan N, Gauthier A. Does neuromuscular electrical stimulation training of the lower limb have functional effects on the elderly?: a systematic review. Exp Gerontol. 2017;91:88–98; doi: 10.1016/j.exger.2017.02.070.
3.
Lee J-H, Baker LL, Johnson RE, Tilson JK. Effectiveness of neuromuscular electrical stimulation for management of shoulder subluxation post-stroke: a systematic review with meta-analysis. Clin Rehabil. 2017;31(11):1431–44; doi: 10.1177/0269215517700696.
4.
Nussbaum EL, Houghton P, Anthony J, Rennie S, Shay BL, Hoens AM. Neuromuscular electrical stimulation for treatment of muscle impairment: critical review and recommendations for clinical practice. Physiother Can. 2017;69(5):1–76; doi: 10.3138/ptc.2015-88.
5.
Volpato HB, Szego P, Lenza M, Milan SL, Talerman C, Ferretti M. Femoral quadriceps neuromuscular electrical stimulation after total knee arthroplasty: a systematic review. Einstein. 2016;14(1):77–98; doi: 10.1590/S1679-45082015RW3140.
6.
Hwang U-J, Kwon O-Y, Jung S-H, Kim H-A, Gwak G-T. Effect of neuromuscular electrical stimulation training for abdominal muscles on change of muscle size, strength, endurance and lumbopelvic stability. J Sports Med Phys Fitness. 2020;60(2):206–13; doi: 10.23736/S0022-4707.19.09998-5.
7.
Hauger AV, Reiman MP, Bjordal JM, Sheets C, Ledbetter L, Goode AP. Neuromuscular electrical stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):399–410; doi: 10.1007/s00167-017-4669-5.
8.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):192–300; doi: 10.1007/s00586-006-1072-1.
9.
Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ. 2003;327(7410):323; doi: 10.1136/bmj.327.7410.323.
10.
Stanton TR, Henschke N, Maher CG, Refshauge KM, Latimer J, McAuley JH. After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine. 2008;33(26):2923–8; doi: 10.1097/BRS.0b013e31818a3167.
11.
Van Swearingen J. Electrical stimulation for improving muscle performance. In: Nelson RM, Hayes KW, Currier DP (eds.). Clinical Electrotherapy. 3rd ed. Stamford: Appleton and Lange; 1999; pp. 143–82.
12.
Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM R. 2010;2(2):142–6; quiz 1 p following 67; doi: 10.1016/j.pmrj.2009.11.006.
13.
Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine. 1996;21(23):2763–9; doi: 10.1097/00007632-199612010-00011.
14.
Songjaroen S, Sungnak P, Piriyaprasarth P, Wang HK, Laskin JJ, Wattananon P. Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain. Sci Rep. 2021;11(1):14815; doi: 10.1038/s41598-021-94402-2.
15.
Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain: Different time points, observations, and mechanisms. J Orthop Sports Phys Ther. 2019;49(6):464–76; doi: 10.2519/jospt.2019.8827.
16.
Wallwork TL, Stanton WR, Freke M, Hides JA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther. 2009;14(5):496–500; doi: 10.1016/j.math.2008.09.006.
17.
Goats GC. Interferential current therapy. Br J Sports Med. 1990;24(2):87–92; doi: 10.1136/bjsm.24.2.87.
18.
Ward AR. Electrical stimulation using kilohertz-frequency alternating current. Phys Ther. 2009;89(2):181–90; doi: 10.2522/ptj.20080060.
19.
Fuentes JP, Armijo Olivo S, Magee DJ, Gross DP. Effectiveness of interferential current therapy in the management of musculoskeletal pain: a systematic review and meta-analysis. Phys Ther. 2010;90(9):1219–38; doi: 10.2522/ptj.20090335.
20.
Wattananon P, Sungnak P, Songjaroen S, Kantha P, Hsu W-L, Wang H-K. Using neuromuscular electrical stimulation in conjunction with ultrasound imaging technique to investigate lumbar multifidus muscle activation deficit. Musculoskelet Sci Pract. 2020:102215; doi: 10.1016/j.msksp.2020.102215.
21.
Kiesel KB, Uhl TL, Underwood FB, Rodd DW, Nitz AJ. Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging. Man Ther. 2007;12(2):161–6; doi: 10.1016/j.math.2006.06.011.
22.
Kim C-Y, Choi J-D, Kim S-Y, Oh D-W, Kim J-K, Park J-W. Comparison between muscle activation measured by electromyography and muscle thickness measured using ultrasonography for effective muscle assessment. J Electromyogr Kinesiol. 2014;24(5):614–20; doi: 10.1016/j.jelekin.2014.07.002.
23.
Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine. 2005;30(13):1541–8; discussion 9; doi: 10.1097/01.brs.0000167536.60002.87.
24.
Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753–62; doi: 10.1016/j.apmr.2005.03.033.
25.
Wattananon P, Ibrahim AA, Kongoun S, Klahan K. Validity of a 6-item movement control test battery for evaluation of movement control impairment in the lumbar spine. PLOS ONE. 2025;20(6):e0325996; doi: 10.1371/journal.pone.0325996.
26.
Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, De Cuyper HJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J. 2000;9(4):266–72; doi: 10.1007/s005860000190.
27.
Mannion AF. Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. J Electromyogr Kinesiol. 1999;9(6):363–77; doi: 10.1016/s1050-6411(99)00010-3.
28.
Demidaś A, Zarzycki M. Touch and pain sensations in diadynamic current (DD) and transcutaneous electrical nerve stimulation (TENS): a randomized study. Biomed Res Int. 2019;2019:9073073; doi: 10.1155/2019/9073073.
29.
Demidas A. Electrical stimulation: then and now. Applications and limitations. Physiother Quart. 2021;29(4):81–6; doi: 10.5114/pq.2021.11098.
30.
AlHarthi H, Bilal A, AlMalki H, Alzahrani F, Ibrahim A, Hussein H, Abdel-fattah M, Omar D, Dewir I. Variations in pain, disability, and psychosocial functioning among non-specific chronic low back pain patients with and without anxiety. Adv Rehabil. 2025;39(1):33–45; doi: 10.5114/areh.2025.146633.
31.
Frasuńska J, Stypińska B, Tarnacka B. Physiotherapy management strategies for chronic pain control in patients with lumbosacral transitional vertebrae and low back pain: a review of the literature. Reumatol. 2025;63(4):251–65; doi: 10.5114/reum/202295.
32.
Jo H-D, Kim M-K. Frequency-specific neuromuscular adaptations: comparative effects of high- and low-frequency neuromuscular electrical stimulation on muscle function and quality. J Exerc Rehabil. 2025;21(3):151–8; doi: 10.12965/jer.2550222.111.
33.
Pinto Damo NL, Modesto KA, Neto IVS, Bottaro M, Babault N, Durigan JLQ. Effects of different electrical stimulation currents and phase durations on submaximal and maximum torque, efficiency, and discomfort: a randomized crossover trial. Braz J Phys Ther. 2021;25(5):593–600; doi: 10.1016/j.bjpt.2021.03.001.
34.
Ward AR, Robertson VJ, Ioannou H. The effect of duty cycle and frequency on muscle torque production using kilohertz frequency range alternating current. Med Eng Phys. 2004;26(7):569–79; doi: 10.1016/j.medengphy.2004.04.007.
35.
Gregory CM, Bickel CS. Recruitment patterns in human skeletal muscle during electrical stimulation. Phys Ther. 2005;85(4):358–64.
36.
Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98; doi: 10.2165/00007256-200636030-00001.
37.
Proske U, Gandevia SC. Kinesthetic senses. Compr Physiol. 2018;8(3):1157–83; doi: 10.1002/cphy.c170036.
38.
Opara J, Polak A. The role of daily physical activity in preventing low back pain. Physiother Quart. 2025;33(3):13–9; doi: 10.5114/pq/191126.
| eISSN: | 2544-4395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
