Potential role of thoracolumbar fascia in younger middle-aged patients with chronic low back pain

Abstract

Aim This study aimed to quantitatively assess the thickness of the thoracolumbar fascia (TLF) and lumbar multifidus muscle through ultrasound imaging in younger-middle aged individuals, both those experiencing chronic low back pain (LBP) and those without LBP. Additionally, the study sought to explore the potential significance of these anatomical structures in relation to clinical and sonographic findings. Method A cross-sectional study was conducted involving a cohort of 50 participants, divided into two groups: chronic LBP group (Group LBP, n = 30) and a group without LBP (Group control, n = 20). Participants from both groups underwent assessments pertaining to pain characteristics (intensity and quality), functional impairment, and kinesiophobia. The thicknesses of the thoracolumbar fascia and lumbar multifidus muscle were measured using ultrasonography. Results Among participants with chronic LBP, the thoracolumbar fascia displayed a statistically significant increase in thickness on the left side, whereas the lumbar multifidus muscle exhibited reduced thickness on the left side. Notably, positive correlations were observed between the thickness of the thoracolumbar fascia and scores from the Numerical Rating Scale (NRS) for pain intensity (r = 0.472, p = 0.008) as well as the McGill Pain Questionnaire (MPQ) (r = 0.547, p = 0.002). Moreover, a positive correlation was established between the thickness of the lumbar multifidus muscle and the modified Schober test (r = 0.174, p = 0.040). However, the thickness of the lumbar multifidus muscle demonstrated a negative correlation with age (r = −0.304, p = 0.032). Multiple logistic regression analysis did not identify any significant predictors for the presence of LBP based on demographic or clinical variables. Conclusions Individuals afflicted with chronic LBP exhibited pronounced thickening of the thoracolumbar fascia and attenuation of the lumbar multifidus muscle in comparison to asymptomatic counterparts. Notably, increased thickness of the thoracolumbar fascia corresponded to heightened pain intensity, while reduction in lumbar multifidus muscle thickness was associated with decreased lumbar flexion ability. These findings underscore the importance of incorporating tailored regimens targeting both fascial and muscular components in the rehabilitation of individuals with LBP.