Research Review: Delayed Trunk Muscle Reflex Responses Increase the Risk of Low Back Injuries

By Stefanie DiCarrado DPT, PT, NASM CPT & CES

Edited by Amy Martinez DPT, PT

Edited by Brent Brookbush DPT, PT, COMT, MS, PES, CES, CSCS, ACSM H/FS

Original Citation: 

Cholewicki, J., Silfies, S. P., Shah, R. A., Greene, H. S., Reeves, N. P., Alvi, K., & Goldberg, B. (2005). Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine, 30(23), 2614-2620. ARTICLE


A variety of factors contribute to the onset of low back pain (LBP) and injury (1-8). Several studies have demonstrated that impaired motor control is one factor that is predictive of future injury (9 - 11). This 2005 study by U.S. researchers demonstrated that delayed trunk muscle response to sudden unloading was correlated with future low back injury. Human movement professionals should consider screening for impairments in trunk muscle activation and addressing any issues with the intent of reducing the risk of injury.

Dr. Brookbush instructs model, Melissa Ruiz, on proper form during a Kneeling Chop

Study Summary

Study DesignProspective cohort study
Level of EvidenceIII - Observational and prospective research
Participant CharacteristicsDemographics

  • Age: average 19.4 years
  • Height: average 1.77 meters (m)
  • Weight: average 72.7 kilograms (kg)
  • Gender: 148 female, 144 male
  • Number of participants: 292

    • 60 participants had a history of low back injury (LBI) lasting longer than 3 days
    • 232 participants had no history of LBI
  • Collegiate athletes participating in 22 different sports

Inclusion Criteria:

  • Collegiate athletes at Yale University

Exclusion Criteria:

  • N/A

  • Participants filled out a questionnaire with demographic data, athletic experience, varsity level sport(s) affiliation, history and detail of LBI and level of pain and disability while injured
  • Baseline trunk response to sudden unloading was tested
  • Low back injuries were tracked over a 2- to 3-year period

    • Tracked through self-report, regularly scheduled electronic mailings and athletic training room