Lumbar Multifidus Muscle Size Research Articles

The association between size and symmetry of the lumbar multifidus muscle, and injuries in adolescent rugby union players

ObjectivesThis study aimed to investigate the association between size and symmetry of the lumbar multifidus muscle, and season injuries in adolescent rugby union players. DesignProspective longitudinal cohort study. SettingPre-season assessment of the size (cross-sectional area) of the lumbar multifidus (L2-5) muscles using ultrasound imaging. ParticipantsSeventy-one adolescent rugby union players (aged 15–18 years). Main outcome measures“Time-loss” injuries were recorded during the season and divided into four injury regions (head and neck, upper limb, trunk and lower limb). ResultsThirty-nine injuries were recorded during the season. Players who sustained an upper limb injury during the season had smaller lumbar multifidus muscles at the L5 vertebral level (effect size = 0.7, p = 0.03) and asymmetry in muscle size at the L2 (p = 0.05) and L5 (p = 0.04) in the pre-season. There was no association between size of the lumbar multifidus muscle and other injuries (p > 0.05). ConclusionLumbar multifidus muscle size and symmetry may impact lumbopelvic control which may increase the risk of sustaining an upper limb injury during rugby union. Future research should aim to identify whether lumbar multifidus muscle size is a modifiable risk factor for rugby union injuries to guide future intervention programs.

Correlation between Body Composition and Inter-Examiner Errors for Assessing Lumbar Multifidus Muscle Size, Shape and Quality Metrics with Ultrasound Imaging.

Ultrasound imaging (US) is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics such as muscle morphology and quality. Since measuring instruments are required to demonstrate their reliability, accuracy, sensitivity, and specificity prior to their use in clinical and research settings, identifying factors affecting their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are correlated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the fifth lumbar vertebral level (L5) were acquired and analyzed in 49 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, muscle perimeter and mean echo intensity were calculated bilaterally. A multivariate correlation matrix was calculated for assessing the inter-examiner differences with body composition metrics. Results demonstrated excellent reliability (intraclass correlation coefficient, ICC > 0.9) for assessing the muscle cross-sectional area and perimeter, and good reliability for assessing the muscle shape and mean echo intensity (ICC > 0.7). Inter-examiner errors for estimating muscle size were correlated with participants' age (p value, p < 0.01), weight (p < 0.05), total and trunk lean mass (both, p < 0.01) and water volume (p < 0.05). Greater shape descriptors and mean brightness disagreements were correlated with older ages (p < 0.05) and total lean mass (p < 0.05). No correlations between age and body composition metrics were found (p > 0.05). This study found US to be a reliable tool for assessing muscle size, shape and mean brightness. Although aging showed no correlations with body composition changes in this sample, it was the main factor correlated with US measurement errors.

Sensorimotor system changes in adolescent rugby players post-concussion: A prospective investigation from the subacute period through to return-to-sport

BackgroundThe pathophysiology of concussion is complex. Altered sensorimotor function post-concussion may contribute to the wide range of symptoms and impairments reported. There is currently limited evidence documenting changes in sensorimotor function during the recovery period. The aim of this study was to investigate the effect of concussion on the sensorimotor system in adolescents post-concussion using a multifaceted approach. Study designProspective nested case-control study. MethodsA total of 285 male adolescent rugby players underwent assessment of sensorimotor function during preseason. Players who sustained a concussion during the season and control players, matched for age and playing position, were assessed in the subacute period (3–5 days) and after return-to-sport (3 weeks). Tests of sensorimotor function included balance, cervical spine and vestibulo-ocular function, and measurement of the size and contraction of lumbopelvic muscles (ultrasound imaging). ResultsTwenty-three players (8%) sustained a concussion. Of these, 20 players were assessed during the subacute period and 17 players following return-to-sport. The prevalence of vestibulo-ocular dysfunction increased from 38.9% to 72.2% during the subacute period and dysfunction was present in 83.3% of players after return-to-sport (p = 0.01). Changes in lumbar multifidus muscle size (p = 0.002) and thickness (p = 0.05) at the L5 vertebral level were observed. No statistically significant changes in balance, cervical spine proprioception, or contraction of lumbopelvic muscles were found (p > 0.05). ConclusionChanges in sensorimotor function were observed in the subacute period post-concussion, with some persisting after return-to-sport. Using symptom-based criteria for return-to-sport may not adequately reflect the sequelae of concussion on the sensorimotor system.

Recovery of the lumbar multifidus muscle size in chronic low back pain patients by strengthening hip abductors: A randomized clinical trial

IntroductionDecrease in cross-sectional thickness of lumbar multifidus (MF) muscles during prolonged low back pain episodes commonly occurs. Restoration of the MF muscle size can be an effective way of treating chronic low back pain (CLBP) patients. Traditionally, clinicians apply muscle stabilization exercises for these patients. Recent studies support the need for active strengthening exercises for treatment of the CLBP patients. ObjectiveThe MF muscles provide lumbar stability, and therefore we hypothesized that strengthening of these muscles can be more effective than the MF muscle stabilization exercises in restoration of the muscle size. DesignStudy design was a randomized allocation control trial with two groups of adult female CLBP patients (n = 12 each; age range of 20–45). Patients in the control group underwent stabilization exercises and the patients in the intervention group underwent the hip abductor strengthening exercises. SettingFor all subjects of each group, the trials continued in 24 sessions distributed over 8 weeks and the MF muscles were measured in the beginning of the first session and one week after completion of the last session. Main outcome measuresStatistical significance (p-value) of the change in the average MF muscle thickness, pain, and disability scores along with for each group were estimated. ResultsBoth regimens of exercises can significantly decrease the pain and disability: average pain and disability reductions of 46% (p-value of 0.001) and 33% (p-value of 0.02) via stabilization versus average pain and disability reductions of 65% (p-value of 0.001) and 59% (p-value of 0.001) via hip abductor strengthening. However, the hip abductor strengthening is the sole statistically significant exercise regimen (p-value of 0.014 vs 0.94) for increasing the MF muscle size. ConclusionReplacement of the traditional stabilization exercises with the hip abductor strengthening exercises for effective treatment of female adults with CLBP is recommended.

What is the clinical utility of measuring lumbar multifidus muscle size in a professional AFL setting? A prospective clinical study

What is the clinical utility of measuring lumbar multifidus muscle size in a professional AFL setting? A prospective clinical study

A Comparison of the Abdominal and Lumbar Multifidus Muscle Size in Patients With Lumbar Spondylolisthesis and Healthy Patients at Rest and During Contraction Using Ultrasonography

ObjectiveUsing ultrasonography, this study investigated the abdominal and lumbar multifidus muscle size in patients with lumbar spondylolisthesis compared with healthy patients at rest and during contraction. MethodsThis research was a nonexperimental, analytic case-control study. Ultrasound imaging was used to assess the thickness of the abdominal and lumbar multifidus muscles in 25 healthy patients and 25 patients with spondylolisthesis. For the purpose of this study, both men and women, aged 30 to 70 years, were recruited from physiotherapy clinics affiliated with the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Measurements were taken at rest and during contraction. ResultsThere was a significant difference in abdominal and lumbar multifidus muscle size between the healthy and spondylolisthesic groups, both at rest and contraction (P < .05 in all instances). No significant difference was found between the right and left for all measurements (P > .05). ConclusionPatients with spondylolisthesis had smaller stabilizer muscle thickness at rest and during contraction compared with the healthy group.

Worksite back and core exercise in firefighters: Effect on development of lumbar multifidus muscle size

Firefighting is a dangerous occupation with a high incidence of low back pain and injury. Abnormal back muscle function and morphology has been linked to low back pain and poor physical performance. The effect of exercise training on back muscle size and symmetry has not been investigated in firefighters. The purpose of this study was to assess the effect of worksite exercise training for eliciting lumbar multifidus muscle hypertrophy in firefighters. A cluster randomized controlled trial was conducted with healthy, career firefighters (n=64) from a medium-sized fire department. Participants were randomized by fire station to exercise training (n=36) (supervised back and core exercise performed on duty, 2X/week, 24 weeks) or control (n=28). The cross-sectional area (CSA) of the L4 and L5 lumbar multifidus muscle was assessed with ultrasonography at baseline and following the intervention. At 24 weeks, no significant differences were noted between the groups in the adjusted (by baseline scores and body mass) L4 and L5 lumbar multifidus muscle CSA and asymmetry values. A worksite exercise training program targeting the back and core is not effective for eliciting hypertrophy of the lumbar multifidus muscle in healthy firefighters.

Comparison the effect of stabilization and McKenzie exercises on pain, disability and lumbar multifidus muscle size in women with chronic non-specific low back pain

Introduction : Low back pain may cause clinical symptoms such as: reflex inhibition and atrophy of multifidus muscles, lumbar paraspinal muscles atrophy, dysfunction and disability. The atrophy of multifidus muscles could be a main cause of recurring back pain.. Therefore, present study compared the effect of stability and McKenzie exercises on pain, disability and multifidus size in women with chronic non-specific low back pain. Materials and Methods: 60 non-athletic women with chronic non-specific low back pain allocated in this research. They randomly and equally divided in to two experimental groups, 30 subjects (Mean ± SD age, 33.37 ± 7.92 year) in stabilization exercise group and 30 participants (Mean ± SD age, 37.00 ± 9.97 year) in McKenzie exercises group. Both groups performed exercise training for 6 weeks. The level of pain, disability, and the cross sectional area of lumbar multifidus muscle was respectively measured by visual analog scale (VAS), Ostwestry disability index and Ultrasonography imaging. These data were collected just before intervention, after 6 weeks of exercise intervention, and also at the end of 4 weeks follow-up period. Independent sample t-test was used to analyze the data and P 0.05). Conclusion: Stabilization and McKenzie exercises may improve pain and disability in patients with chronic non-specific low back pain, while stabilization exercise results in size improvement of lumbar multifidus muscles at L5 level. Therefore stabilization exercises may be more effective to prevent recurrent chronic low back pain. Keywords : Non-specific chronic low back pain, Stabilization exercises, McKenzie exercises, Lumbar multifidus muscle

Abdominal and Lumbar Multifidus Muscle Size and Symmetry at Rest and During Contracted States

The purpose of this study was to establish reference values for abdominal and lumbar multifidus muscles at rest and while contracted in a sample of active healthy adults. Three hundred forty participants (mean age ± SD, 21.8 ± 3.9 years; 96 females and 244 males) completed the study. Ultrasound imaging was used to assess the thickness of the transversus abdominis, internal and external oblique, rectus abdominis, and lumbar multifidus muscles. Additionally, the cross-sectional area of the rectus abdominis was assessed. Although males had significantly thicker muscles than females (P < .05), the relative change in thickness during specified tasks was equivalent. Overall, relative muscle thickness and symmetry were similar to previous studies using smaller sample sizes. These findings provide a robust data set of muscle thickness values measured by ultrasound imaging and can be used for comparison to those with pain, abnormal function, and pathologic conditions.

Ultrasound transducer shape has no effect on measurements of lumbar multifidus muscle size

ObjectiveEvidence is currently lacking for guidance on ultrasound transducer configuration (shape) when imaging muscle to measure its size. This study compared measurements made of lumbar multifidus on images obtained using curvilinear and linear transducers. MethodFifteen asymptomatic males (aged 21–32 years) had their right lumbar multifidus imaged at L3. Two transverse images were taken with two transducers (5 MHz curvilinear and 6 MHz linear), and linear and cross-sectional area (CSA) measurements were made off-line. Reliability of image interpretation was shown using intra-class correlation coefficients (0.78–0.99). Muscle measurements were compared between transducers using Bland and Altman plots and paired t-tests. Relationships between CSA and linear measurements were examined using Pearson's Correlation Coefficients. ResultsThere were no significant differences (p > 0.05) in the measurements of the two transducers. Thickness and CSA measurements had small differences between transducers, with mean differences of 0.01 cm (SDdiff = 0.21 cm) and 0.03 cm2 (SDdiff = 0.58 cm2) respectively. Width measures had a mean difference of 0.14 cm, with the linear transducer giving larger measures. Significant correlations (p < 0.001) were found between all linear measures and CSA, with both transducers (r = 0.78–0.89). ConclusionMeasurements of multifidus at L3 were not influenced by the configuration of transducers of similar frequency. For the purposes of image interpretation, the curvilinear transducer produced better definition of the lateral muscle border, suggesting it as the preferable transducer for imaging lumbar multifidus.

Lumbar multifidus muscle size does not differ whether ultrasound imaging is performed in prone or side lying

This methodological study examined the influence of body position when measuring multifidus muscle size using real-time ultrasound imaging. Previous studies examined multifidus with the subject prone but people with certain conditions cannot be studied in this position, so side lying was investigated as an alternative posture. In 20 normal females (aged 19–45 years), the cross-sectional area (CSA) of lumbar multifidus was measured at the level of the fifth lumbar vertebra (L5) on both the right and left sides, with the subject in prone and in side lying. Multifidus CSA was highly correlated between the two positions on both the right ( r=0.90) and left ( r=0.91) sides. Paired t-tests found no significant differences between the measurements made in the two scanning postures (right P=0.77; left P=0.16). Bland and Altman plots showed good agreement between the two positions, with no systematic difference. These findings demonstrate that measurements of lumbar multifidus at L5 can be made in either prone or side lying and a valid comparison of the results obtained in both positions can be made.