Key points• It is often assumed that automatic movements such as walking require little conscious attention and it has therefore been argued that these movements require little cortical control.• In humans, however, the gait function is often heavily impaired or completely lost following cortical lesions such as stroke.• In this study we investigated synchrony between cortical signals recorded with electroencephalography (EEG) and electromyographic signals (EMG activity) recorded from the tibialis anterior muscle (TA) during walking.• We found evidence of synchrony in the frequency domain (coherence) between the primary motor cortex and the TA muscle indicating a cortical involvement in human gait function.• This finding underpins the importance of restoration of the activity and connectivity between the motor cortex and the spinal cord in the recovery of gait function in patients with damage of the central nervous system.Abstract Indirect evidence that the motor cortex and the corticospinal tract contribute to the control of walking in human subjects has been provided in previous studies. In the present study we used coherence analysis of the coupling between EEG and EMG from active leg muscles during human walking to address if activity arising in the motor cortex contributes to the muscle activity during gait. Nine healthy human subjects walked on a treadmill at a speed of 3.5-4 km h −1 . Seven of the subjects in addition walked at a speed of 1 km h −1 . Significant coupling between EEG recordings over the leg motor area and EMG from the anterior tibial muscle was found in the frequency band 24-40 Hz prior to heel strike during the swing phase of walking. This signifies that rhythmic cortical activity in the 24-40 Hz frequency band is transmitted via the corticospinal tract to the active muscles during walking. These findings demonstrate that the motor cortex and corticospinal tract contribute directly to the muscle activity observed in steady-state treadmill walking.

Movement perception relies on sensory feedback, but the involvement of efference copies remains unclear. We investigated movements without proprioceptive feedback using ischemic nerve block during fMRI in healthy humans, and found preserved activation of the primary somatosensory cortex. This activation was associated with increased interaction with premotor cortex during voluntary movements, which demonstrates that perception of movements relies in part on predictions of sensory consequences of voluntary movements that are mediated by the premotor cortex.

Corticospinal drive has been shown to contribute significantly to the control of walking in adult human subjects. It is unknown to what extent functional change in this drive is important for maturation of gait in children. In adults, populations of motor units within a muscle show synchronized discharges during walking with pronounced coherence in the 15-50 Hz frequency band. This coherence has been shown to depend on cortical drive. Here, we investigated how this coherence changes with development. Forty-four healthy children aged 4-15 years participated in the study. Electromyographic activity (EMG) was recorded from pairs of electrodes placed over the right tibialis anterior (TA) muscle during static dorsiflexion and during walking on a treadmill (speed from 1.8 to 4.8 km h −1 ). A significant increase of coherence with increasing age was found in the 30-45 Hz frequency band (gamma) during walking and during static ankle dorsiflexion. A significant correlation with age was also found in the 15-25 Hz frequency band (beta) during static foot dorsiflexion. χ 2 analysis of differences of coherence between different age groups of children (4-6, 7-9, 10-12 and 13-15 years of age) revealed a significantly lower coherence in the gamma band for recordings during walking in children aged 4-6 years as compared to older children. Recordings during static dorsiflexion revealed significant differences in both the beta and gamma bands for children in the 4-6 and 7-9 years age groups as compared to the older age groups. A significant age-related decrease in step-to-step variability of toe position during the swing phase of walking was observed. This reduction in the step-to-step variability of gait was correlated with increased gamma band coherence during walking. We argue that this may reflect an increased ability to precisely control the ankle joint position with age, which may be contingent on maturation of corticospinal control of the foot dorsiflexor muscles.

BackgroundClinical examination findings are used in primary care to give an initial diagnosis to patients with low back pain and related leg symptoms. The purpose of this study was to develop best evidence Clinical Diagnostic Rules (CDR] for the identification of the most common patho-anatomical disorders in the lumbar spine; i.e. intervertebral discs, sacroiliac joints, facet joints, bone, muscles, nerve roots, muscles, peripheral nerve tissue, and central nervous system sensitization.MethodsA sensitive electronic search strategy using MEDLINE, EMBASE and CINAHL databases was combined with hand searching and citation tracking to identify eligible studies. Criteria for inclusion were: persons with low back pain with or without related leg symptoms, history or physical examination findings suitable for use in primary care, comparison with acceptable reference standards, and statistical reporting permitting calculation of diagnostic value. Quality assessments were made independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies tool. Clinical examination findings that were investigated by at least two studies were included and results that met our predefined threshold of positive likelihood ratio ≥ 2 or negative likelihood ratio ≤ 0.5 were considered for the CDR.ResultsSixty-four studies satisfied our eligible criteria. We were able to construct promising CDRs for symptomatic intervertebral disc, sacroiliac joint, spondylolisthesis, disc herniation with nerve root involvement, and spinal stenosis. Single clinical test appear not to be as useful as clusters of tests that are more closely in line with clinical decision making.ConclusionsThis is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. In some diagnostic categories we have sufficient evidence to recommend a CDR. In others, we have only preliminary evidence that needs testing in future studies. Most findings were tested in secondary or tertiary care. Thus, the accuracy of the findings in a primary care setting has yet to be confirmed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1549-6) contains supplementary material, which is available to authorized users.

The McKenzie method and intensive dynamic strengthening training seem to be equally effective in the treatment of patients with subacute or chronic low back pain.