Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care

Anke Hofste,Remko Soer,Gerbrand J Groen,Job Van Der Palen,Frank J.B Geerdink,Frits G.J Oosterveld,Henri Kiers,André P Wolff,Hermie Hermens

doi:10.1016/j.msksp.2021.102429

Abstract

BackgroundSince the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. ObjectivesThis study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DesignMulticenter case control study. MethodSubacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. ResultsA total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11–0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10–0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). ConclusionsTrunk ROM and LM thickness show differences between LBP patients and healthy controls.

Highlights

Low back pain is a common problem in developed countries, with a reported life-time prevalence up to 84% (Airaksinen et al, 2006)
85% is classified as multifactorial or ‘-non-specific low back pain-’ (LBP) (Steele et al, 2014) and most are firstly seen in primary care (Foster Nadine, 2018)
Reliable relevant differences have been identified between subgroups of acute and chronic LBP patients and healthy controls in physical aspects in the lumbar spine by the use of imaging and investigation. (Anders et al, 2005; Kiesel et al, 2007a; Hebert et al, 2015; Lariviere et al, 2002; Goubert et al, 2016; Williams et al, 2013)

Summary

Introduction

Low back pain is a common problem in developed countries, with a reported life-time prevalence up to 84% (Airaksinen et al, 2006). Reliable relevant differences have been identified between subgroups of acute and chronic LBP patients and healthy controls in physical aspects in the lumbar spine by the use of imaging and investigation (e.g. spine range of motion, muscle function and morphology). Method: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Results: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). Conclusions: Trunk ROM and LM thickness show differences between LBP patients and healthy controls

Objectives

Results

Conclusion