Lumbar Multifidus Thickness Research Articles

Spinal stabilization exercises for transversus abdominis and lumbar multifidus thickness via telerehabilitation and face-to-face approaches in patients with nonspecific chronic neck pain: a randomized controlled trial.

Strengthening the muscles of the lumbar region in individuals with neck pain may be protective against future back problems. In addition, telerehabilitation applications, which gained momentum in the literature and clinical practice during the COVID-19 pandemic, are among the applications preferred by patients thanks to their various advantages. This study aimed to compare the effects of telerehabilitation and spinal stabilization exercises applied with face-to-face approaches on the thickness of the transversus abdominis (M.TrA) and lumbar multifidus (M.LM) muscles in patients with nonspecific neck pain. The primary outcomes were the thickness of the M.TrA and M.LM. Neck pain intensity and neck disability were secondary outcomes. Muscle thickness was evaluated with an ultrasound device, neck pain intensity was assessed with a visual analog scale, and disability was assessed with the Neck Disability Index. Patients were randomly assigned to the telerehabilitation group (TRG) (n = 13) or the control group (CG) (n = 13). While the TRG did the exercises with live videos and video recordings, the CG did exercises face-to-face in the clinic. Both groups performed the same exercises for 45 minutes per session 3 days a week for 8 weeks. At the end of the treatment, the thicknesses of the M.TrA and M.LM were increased and neck pain intensity and neck disability were decreased in both groups (p < 0.05). The groups were similar in terms of these variables (p > 0.05). Telerehabilitation and face-to-face spinal stabilization exercises are both beneficial for spinal muscle architecture and clinical variables as a preventive measure against future lower back problems in individuals with neck pain.

Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study

Vaginal laxity (VL) is a common condition among multiparous women, especially those who have delivered vaginally. Since pelvic floor muscles (PFMs) work synergistically with other core muscles, physical therapy protocols that aim to treat VL should train the PFMs in combination with other core muscles. To investigate the activity of core muscles in multiparous women with and without VL, and its relation to sexual function. An observational, cross-sectional study. The study included 100 multiparous women, who were divided into two groups according to their scores on the vaginal laxity questionnaire (VLQ). Women who scored between 1 and 3 on the VLQ were categorized as having VL (n = 48), while those who scored between 5 and 7 were placed in the control group (n = 52). The primary outcomes were PFM displacement, diaphragmatic excursion, transversus abdominis activation ratio, and lumbar multifidus thickness measured by ultrasound imaging. The secondary outcome was sexual functioning, evaluated using the Arabic female sexual function index (ArFSFI). The VL group had significantly lower PFM displacement (mean difference (MD) − 0.42; 95% confidence interval (CI) − 0.49 to − 0.33; p = 0.001), diaphragmatic excursion (MD − 2.75; 95% CI − 2.95 to − 2.55; p = 0.001), lumbar multifidus thickness (MD − 10.08; 95% CI − 14.32 to − 5.82; p = 0.02), and ArFSFI scores (MD − 9.2; 95% CI − 10.59 to − 7.81; p = 0.001) in comparison to the control group (p < 0.05). Nevertheless, the transversus abdominis activation ratio demonstrated no significant difference between the two groups (MD 0.06; 95% CI − 0.05 to 0.17; p = 0.33). Multiparous women with VL had significantly lower PFM displacement, diaphragmatic excursion, lumbar multifidus thickness, and sexual function index scores than women in the control group. The only exception was transversus abdominis activation, which did not differ significantly between the VL and control groups.

Lumbar Multifidus Characteristics in University Level Athletes May be Predictors of Low Back Pain and Lower Limb Injury

Introduction: Low back pain (LBP) is highly prevalent in athletes, with decreased lumbar multifidus (LM) crosssectional area (CSA) reported in athletes with LBP and lower limb injury (LLI) as well as decreased LM thickness in athletes with LLI. Previous research has only investigated connections between LM, LBP, and LLI in small samples of athletes in a single sport at a time. This study aimed to (1) examine LM morphology and function across a general sample of male and female university level varsity athletes; (2) investigate whether LM characteristics were predictors of LBP and LLI. Methods: Ultrasound images of LM at L5 were acquired in prone and standing. Body composition was assessed with DEXA and a self-reported questionnaire provided demographics and history of injury. Paired t-tests and independent t-tests compared LM measurements between the sides and sex, respectively. Univariate and multivariate logistic regression analyses were used to assess possible LM characteristic predictors of LBP and LLI. Results: 134 university varsity athletes were evaluated. LM CSA was larger on the non-dominant side in prone. Increased LM thickness was associated with decreased odds of LBP in the previous 4-week (OR=0.49 [0.27, 0.88], p=0.02) and 3-month (OR=0.43 [0.21, 0.89], p=0.02) in the multivariable model, while a greater number of years playing at the university level was associated with increased odds of LBP (OR=1.29 [1.01, 1.65], p=0.04). Greater LM CSA asymmetry (OR=1.14 [1.01, 1.28], p=0.03) and sport (OR=1.44 [1.04, 1.96], p=0.02) were significant predictors of LLI in the previous 12 months. Conclusion: Leg dominance may play a role in unilateral differences. LM thickness and LM CSA asymmetry were predictors of injury. Preseason screening of LM morphology and function could help identify athletes at risk of LBP and LLI, allowing coaches, medical staff, and training staff to target these individuals and provide specific injury prevention programs.

The Association among Physical Activity, Sociodemographic, Trunk Muscles Thickness and Low Back Pain-Related Disability in Amateur Soccer Players: An Observational Study

Abstract Objective Although low back pain (LBP) is one of the most common musculoskeletal disorders, there is limited evidence assessing which factors contribute LBP severity in amateur athletes. We aimed to analyze relationships between sociodemographic, clinical, lifestyle and lumbar multifidus (LM) at L4 and L5 levels, rectus abdominis (RA), external and internal obliques (EO and IO) and transversus abdominis (TrA) muscles thickness assessed with ultrasound imaging (US) variables with lumbar disability in amateur athletes with LBP and lumbar disc herniation. Methods Eighty-two male amateur soccer athletes were analyzed. Demographic data, internal hip rotation, finger-floor distance, pain intensity, number of LBP episodes within the last year, metabolic equivalent of tasks for physical activity, sitting time, muscle thickness and disability caused by LBP were collected. Results Pain intensity showed significant associations with LBP recurrence, disability, sedentarism, trunk and hip flexibility, vigorous physical activity and TrA, EO and RA muscles thickness (p&lt;0.05). Similarly, disability was associated with number of LBP episodes, vigorous activity, sitting time, finger floor distance, and RA, EO and IO muscles thickness (p&lt;0.05). TrA thickness and internal hip rotation were not associated with lumbar disability (p&gt;0.05). Conclusion LBP intensity and pain-related disability were significantly associated with LBP episodes, vigorous activity, sitting time, finger floor distance, and thickness of abdominal muscles were associated with pain intensity and disability. However, lumbar multifidus thickness at rest, ankle dorsiflexion and walking time were not associated with clinical severity.

Lumbar multifidus characteristics and body composition in university level athletes

IntroductionBody composition is well known to affect sport performance and previous studies suggested that structural and functional lumbar multifidus (LM) impairments in athletes were associated with low back pain and lower leg injuries. However few studies have examined the relationship between LM characteristics and body composition in athletic populations.MethodsThis cross-sectional study included a total of 134 university varsity athletes (hockey, soccer, rugby, and football players). Ultrasound imaging was used to examined LM characteristics at the L5 bilaterally [e.g., size, thickness at rest, thickness during contraction, echo-intensity (EI) and % thickness change from rest to contraction] and body composition parameters (dual-energy x-ray absorptiometry). Pearson correlations were used to assess the relationship between LM characteristics and body composition parameters. One-way ANOVA assessed differences in LM characteristics and body composition between sports. All analyses were performed separately by sex.ResultsLM size and thickness were positively correlated with weight, height, lean body mass and total bone mass (male: r = 0.23–0.55, p &amp;lt; 0.01–0.05; female: r = 0.30–0.39, p &amp;lt; 0.01–0.05). LM EI was strongly correlated with % body fat (male: r = 0.62, female: r = 0.71, p &amp;lt; 0.01). LM thickness at rest (r = 0.42, p &amp;lt; 0.01) and contracted (r = 0.27, p &amp;lt; 0.05) were positively correlated and % thickness change was negatively correlated with % body fat in male athletes (r = −0.43, p &amp;lt; 0.01).DiscussionThe significant differences in body composition and LM characteristics between sports may be attributed to sport specific demands. Understanding connections between body composition and LM may aid in preseason screening for athletes at risk of low back pain or lower leg injuries during the season.

Trunk muscles’ characteristics in adolescent gymnasts with low back pain: a pilot study on the effects of a physiotherapy intervention including a postural reeducation program

ABSTRACT Background Trunk muscles’ function and characteristics are of great importance for both static and dynamic tasks in different sports, and abnormalities of trunk flexors and extensors might be associated with low back pain (LBP). The aim of this study was to provide a comprehensive evaluation of the functional, morphological and contractile properties in trunk flexors and extensors of young gymnasts with and without LBP. Methods Young gymnasts (14/25 females, 14–18 y) were screened for the presence of chronic LBP. Abdominal and lumbar muscles were tested for function (McGill’s endurance tests), thickness (ultrasound), and contractile responses (tensiomyography). An 8-sessions physiotherapy intervention including postural reeducation was performed by a subsample of 10 subjects with LBP. Results LBP was found to be associated to higher flexors-to-extensors endurance ratio (OR 11.250, 95% CI: 1.647–76.849, p = 0.014), reduced mean lumbar multifidus thickness (OR 16.500, 95% CI: 2.246–121.228, p = 0.006), and reduced mean erector spinae radial displacement (OR 16.500, 95% CI: 2.246–121.228, p = 0.006). The physiotherapy intervention was found to reduce LBP symptoms and it was associated with a significant improvement in the flexors-to-extensors ratio (p < 0.001). Conclusions This study provides preliminary evidence of functional, morphological, and contractile trunk muscles’ alterations associated with chronic LBP in young gymnasts, and presents the effects of a postural reeducation program on symptoms and muscles’ functional properties.

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study.

Patients with chronic low back pain (CLBP) exhibit remodelling of the lumbar soft tissues such as muscle fatty infiltrations (MFI) and fibrosis of the lumbar multifidus (LuM) muscles, thickness changes of the thoracolumbar fascia (TLF) and perimuscular connective tissues (PMCT) surrounding the abdominal lateral wall muscles. Rehabilitative ultrasound imaging (RUSI) parameters such as thickness and echogenicity are sensitive to this remodelling. This experimental laboratory study aimed to explore whether these RUSI parameters (LuM echogenicity and fascia thicknesses), hereafter called dependent variables (DV) were linked to independent variables (IV) such as (1) other RUSI parameters (trunk muscle thickness and activation) and (2) physical and psychological measures. RUSI measures, as well as a clinical examination comprising physical tests and psychological questionnaires, were collected from 70 participants with LBP. The following RUSI dependent variables (RUSI-DV), measures of passive tissues were performed bilaterally: (1) LuM echogenicity (MFI/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1); (2) TLF posterior layer thickness, and (3) PMCT thickness of the fasciae between subcutaneous tissue thickness (STT) and external oblique (PMCTSTT/EO ), between external and internal oblique (PMCTEO/IO ), between IO and transversus abdominis (PMCTIO/TrA ) and between TrA and intra-abdominal content (PMCTTrA/IA ). RUSI measures of trunk muscle's function (thickness and activation), also called measures of active muscle tissues, were considered as independent variables (RUSI-IV), along with physical tests related to lumbar stability (n=6), motor control deficits (n=7), trunk muscle endurance (n=4), physical performance (n=4), lumbar posture (n=2), and range of motion (ROM) tests (n=6). Psychosocial measures included pain catastrophizing, fear-avoidance beliefs, psychological distress, illness perceptions and concepts related to adherence to a home-based exercise programme (physical activity level, self-efficacy, social support, outcome expectations). Six multivariate regression models (forward stepwise selection) were generated, using RUSI-DV measures as dependent variables and RUSI-IV/physical/psychosocial measures as independent variables (predictors). The six multivariate models included three to five predictors, explaining 63% of total LuM echogenicity variance, between 41% and 46% of trunk superficial fasciae variance (TLF, PMCTSTT/EO ) and between 28% and 37% of deeper abdominal wall fasciae variance (PMCTEO/IO , PMCTIO/TrA and PMCTTrA/IA ). These variables were from RUSI-IV (LuM thickness at rest, activation of IO and TrA), body composition (percent fat) and clinical physical examination (lumbar and pelvis flexion ROM, aberrant movements, passive and active straight-leg raise, loaded-reach test) from the biological domain, as well as from the lifestyle (physical activity level during sports), psychological (psychological distress-cognitive subscale, fear-avoidance beliefs during physical activities, self-efficacy to exercise) and social (family support to exercise) domains. Biological, psychological, social and lifestyle factors each accounted for substantial variance in RUSI-passive parameters. These findings are in keeping with a conceptual link between tissue remodelling and factors such as local and systemic inflammation. Possible explanations are discussed, in keeping with the hypothesis-generating nature of this study (exploratory). However, to impact clinical practice, further research is needed to determine if the most plausible predictors of trunk fasciae thickness and LuM fatty infiltrations have an effect on these parameters.

Mapping of lumbar multifidus stiffness Quantification in ankylosing spondylitis with shear-wave elastography

BackgroundLower back pain and stiffness are the typical symptoms of ankylosing spondylitis (AS). In this study, muscle mass was assessed by muscle density, mechanical elasticity, and area. We investigated the characteristics of lumbar paraspinal-muscle (PSM) mass using muscle ultrasound shear-wave elastography (SWE), as well as the validity of this method for identifying patients with AS.MethodsWe recruited a representative cohort of 30 AS patients, and 27 healthy volunteers who were age- and sex-matched to the patient study group, investigated the Young’s modulus (YM), cross-sectional area (CSA) and thickness of lumbar multifidus (LM) muscle using SWE. This study did not need to be randomized. Data were collected at the department of ultrasonography of Guangdong Provincial Hospital of Chinese Medicine. We analyzed the data using SPSS version 18.0 (IBM Corp, Armonk, NY, USA). Normal distribution was evaluated by the Shapiro–Wilk test and Q–Q plots. Demographic and baseline data will be analyzed with standard descriptive statistics. Data will be presented as the mean ± standard deviation (SD). Non-normally distributed data are presented as medians with interquartile ranges (IQR).ResultsYoung’s modulus (YM) of SWE in AS patients was significantly higher than that in volunteers. Percentage change in lumbar multifidus (LM) muscle cross-sectional area (CSA) and thickness were significantly lower in AS patients than in healthy volunteers on the left side of the body. Correlation analysis showed a positive correlation between percentage change in CSA and thickness in both volunteers and AS patients. In AS patients, YM was negatively correlated with percentage change of CSA and thickness on the right side, while increased disease duration in AS was associated with increased YM on the left.ConclusionAS patients showed reductions in LM muscle mass and function as the disease progressed, SWE could reflect these changes well.Trial registration.Chinese Clinical Trial Registry, ChiCTR2000031476. Registered 02/04/2020. http://www.chictr.org.cn/index.aspx.

Lumbar multifidus thickness changes during active leg raising with ultrasound imaging can detect patients with chronic non-specific low back pain

BackgroundAltered lumbar multifidus (LM) activation has been found in populations with non-specific chronic low back pain (NSCLBP). Objective: To detect differences in LM muscle thickness at rest and during active manoeuvres between patients with NSCLBP and pain-free controls and to analyze the ability of LM thickness change during the active straight leg raise (ASLR) with rehabilitative ultrasound imaging to detect patients with NSCLBP. DesignCross-sectional observational study. MethodsSeventy volunteers (50% patients NSCLBP) were recruited. 18 B-mode images of LM at L4-L5 or L5-S1 level selecting the most symptomatic level (both sides, six at rest and three during ASLR) were collected by a blinded assessor. Differences between patients and controls in LM muscle thickness at rest, during ASLR (holding 3sec), and 5 s after ASLR were calculated. In addition, discriminant validity was evaluated by calculating the area under the receiver operating characteristic curve (ROC), sensitivity, specificity and positive and negative likelihood ratio. ResultsSignificant LM thickness change differences during ASLR were found within and between groups: bilaterally, LM thickness change during ASLR was significantly higher in healthy controls than in NSCLBP patients. Ipsilateral LM muscle thickness change was sensitive to detect individuals with NSCLBP (ROC = 0.79–0.80). ConclusionPain-free individuals exhibited significantly greater LM thickness changes bilaterally during the ASLR compared to patients with NSCLBP. LM thickness change during the ASLR has good validity for discriminating patients with NSCLBP. Further studies should assess benefits of LM training programs in the management of these patients.

The Application of Image Texture Analysis Techniques on the Effects of Dry Needling versus Placebo in Low-Back Pain Patients: A Pilot-Study

Low back pain is the leading cause of disability in the world, with a significant socio-economic impact. Deep dry needling is effective in the treatment of this pain, and it is one of the techniques preferred by physiotherapists. In this field, the use of ultrasound provides information of interest such as length, thickness, diameter, cross-sectional area, or muscle volume, among others. Objective: To find out whether the tissue changes (thickness, histogram, and contraction rate) that occur in the lumbar multifidus after application of the deep dry needle are related to changes in the pain and the disability of the patient. Design: Randomized, double-blind, parallel-group clinical trial. Setting: University of Alcalá, Department of Physiotherapy. Subjects: 21 voluntary patients (women and men) with non-specific low-back pain aged 18–65 years. Intervention: Patients were randomly divided into two groups. One group received dry needling and the other group a dry needling placebo. Initial post-needling and one week post-needling assessments were performed by a therapist blinded to the intervention. Variables: Lumbar multifidus thickness measured by RUSI, contraction time measured by M-mode, histograms measured by image analysis, muscle area, pain measured by VAS, pressure pain threshold measured by pressure algometer, and disability measured by Roland–Morris questionnaire. Conclusions: The contraction speed, resting thickness, and pain demonstrated significant differences within each group, but not between groups. There were significant differences in contraction ratio and in PPT between groups. There was excellent intra-examiner reliability in image collection for histogram analysis. Histogram analysis showed no significant differences between groups and measurements, neither for the parameters nor for the parameters combined with the outcome variables. A robust method for the image texture analyses in future histogram muscle analyses has been performed.

A Preliminary Study on the Equivalence between Standing Back-Extension and Superman Training in Lumbar Multifidus Exercise.

Objective To explore the equivalence of an easier and more convenient lumbar multifidus (LM) muscle exercise pattern among standing back-extension, static standing, and superman training. Methods A total of 26 healthy young volunteers were enrolled, including 14 males and 12 females, aged from 22 to 44 years with an average of 31.77 ± 7.06 years. Ultrasonography was used to measure the thickness of the left LM of the transverse process of the L5 vertebra during static standing, static prone decubitus, standing back-extension, and prone superman training. In this study, measurement data were expressed as Mean ± SD and compared using the t-test. Results The left LM thickness of the L5 vertebra was 2.92 ± 0.46 cm during static standing and 2.78 ± 0.39 cm during static prone decubitus, showing no statistical difference between the two groups (P > 0.05). The left LM thickness of the L5 vertebra was 3.16 ± 0.51 cm during standing back-extension and 3.33 ± 0.41 cm during the prone superman training, indicating no statistical difference between the two groups (P > 0.05). Conclusions There is no significant statistical difference in the LM thickness between static standing and static prone decubitus and between standing back-extension and prone superman training, indicating the equivalence of the two methods in LM exercise, providing a simpler and easier way for clinical exercise of lumbodorsal muscles.

Individuals With Impaired Lumbopelvic Control Demonstrate Lumbar Multifidus Muscle Activation Deficit Using Ultrasound Imaging in Conjunction With Electrical Stimulation: A Cross-sectional Study

ObjectiveTo determine lumbar multifidus (LM) muscle activation deficits in individuals with impaired lumbopelvic control (iLPC) based on musculoskeletal ultrasound in conjunction with electrical stimulation approach and the correlation between back extension force and LM activation. DesignA cross-sectional study design. SettingA university laboratory. ParticipantsFifty participants (25 iLPC and 25 no low back pain [NoLBP]) were recruited from the university physical therapy clinic and surrounding areas. Main Outcome MeasuresThe musculoskeletal ultrasound was used to measure LM thickness at rest, maximum voluntary isometric contraction (MVIC), and electrical stimulation combined with MVIC, and a handheld dynamometer was used to record force during MVIC and electrical stimulation combined with MVIC. These data were used to derive LM activation (LMACT) and percentage force generation (ForceGEN). ResultsThe iLPC group had significantly lower LMACT (17%) than the NoLBP group (P<.05). No significant difference was seen in ForceGEN between the NoLBP and iLPC groups (P>.05). No significant correlation was seen between LMACT and ForceGEN (P>.05). ConclusionsThe findings support the utility of our protocol to determine LM activation deficits. The lower LM activation in iLPC group suggests that individuals with iLPC were unable to fully recruit the motor units available in LM. Force generation measurements may not be an appropriate approach to determine such deficits in LM.

Reliability of lumbar multifidus ultrasound assessment during the active straight leg raise test.

Previous evidence showed altered lumbar multifidus (LM) activation in populations with chronic nonspecific low back pain (LBP). We aimed to investigate the test-retest and inter-examiner reliability of ultrasound imaging (US) for assessing LM thickness at rest and activation during the active straight leg raise test (ASLR) and the association between thickness changes with clinical outcomes. Fifty-two patients with LBP and two examiners (one experienced and one novice) participated in this study. A total of 18 B-mode images at L4-L5 or L5-S1level (both sides, 3 at rest and 6 during ASLR) were collected. For assessing test-retest reliability, the experienced examiner repeated the procedure after 7days. Intraclass correlation coefficients (ICC), standard error of measurements (SEM) and minimal detectable changes (MDC) were calculated. Inter-examiner agreement was good to excellent (ICC3,2=0.71-0.92) and test-retest reliability was excellent (ICC3,1= 0.91-0.98). Mean average of multiple measurements improved the agreement. Greater LM thickness at rest (p<.05) and greater thickness change after 3s (p<.01) and 10s (homolateral side, p<.01; contralateral side, p<.05) were associated with less pain intensity. US is a reliable method to assess the LM thickness at rest and contracted during the ASLR in patients with LBP. The measurement at 3s after maintaining ASLR, as well as the use of the mean of three measurements, has been shown to be the most reliable method for measuring LM muscle thickness during ASLR.

Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial

BackgroundTherapeutic exercises are used in clinical practice for patients with low back pain (LBP). Core stabilization exercises can retrain the important function of local trunk muscles and increase the accuracy of the sensory integration process for stability of the spine in individuals with LBP. The aim of this study was to compare the effects of two different exercise regimes, Core stabilization exercises (CSE) and Strengthening exercise (STE), on proprioception, balance, muscle thickness and pain-related outcomes in patients with subacute non-specific low back pain (NSLBP).MethodsThirty-six subacute NSLBP patients, [mean age, 34.78 ± 9.07 years; BMI, 24.03 ± 3.20 Kg/m2; and duration of current pain, 8.22 ± 1.61 weeks], were included in this study. They were randomly allocated into either CSE (n = 18) or STE groups (n = 18). Exercise training was given for 30 min, three times per week, for up to 4 weeks. Proprioception, standing balance, muscle thickness of transversus abdominis (TrA) and lumbar multifidus (LM), and pain-related outcomes, comprising pain, functional disability and fear of movement, were assessed at baseline and after 4 weeks of intervention.ResultsThe CSE group demonstrated significantly more improvement than the STE group after 4 weeks of intervention. Improvements were in: proprioception [mean difference (95% CI): − 0.295 (− 0.37 to − 0.2), effect size: 1.38, (p < 0.001)], balance: single leg standing with eyes open and eyes closed on both stable and unstable surfaces (p < 0.05), and percentage change of muscle thickness of TrA and LM (p < 0.01). Although both exercise groups gained relief from pain, the CSE group demonstrated greater reduction of functional disability [effect size: 0.61, (p < 0.05)] and fear of movement [effect size: 0.80, (p < 0.01)]. There were no significant adverse effects in either type of exercise program.ConclusionDespite both core stabilization and strengthening exercises reducing pain, core stabilization exercise is superior to strengthening exercise. It is effective in improving proprioception, balance, and percentage change of muscle thickness of TrA and LM, and reducing functional disability and fear of movement in patients with subacute NSLBP.Trial registrationThai Clinical Trial Registry (TCTR20180822001; August 21, 2018).

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

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.

Lumbar Multifidus Muscle Morphology Changes in Patient with Different Degrees of Lumbar Disc Herniation: An Ultrasonographic Study.

Background and Objective: Previous studies demonstrated that the prevalence of lumbar disc herniation (LDH) is relatively high. This investigation aimed to evaluate the size of lumbar multifidus (LM) muscle in patients with different degrees of LDH compared to healthy group, during rest and contraction, using ultrasonography. Materials and Methods: In this non-experimental, analytic, and case control study, ultrasound imaging was used to assess cross-sectional area (CSA) and thickness of the LM muscle in 15 healthy subjects and 60 patients with different stages of LDH (bulging group = 15, protrusion group = 15, extrusion group = 15, sequestration group = 15). Measurements were taken bilaterally at the L4–L5 level, during rest and contraction and results were compared between groups. Results: There was a significant difference between healthy subjects and the extrusion and sequestration groups during rest and contraction for LM muscle CSA and thickness (p = 0.001), as LM muscle CSA and thickness were significantly smaller in extrusion and sequestration patient groups compared to healthy subjects. LM atrophy was greater in patients with extrusion and sequestration groups than in patients with bulging and protrusion, both at rest and during contraction. Significant correlations were also observed between functional disability and intensity of pain with LM CSA and thickness measurements. Conclusions: Patients with extrusion and sequestration LDH had smaller LM muscle at rest and during contraction compared to healthy subjects. Larger LDH lesions were associated with decreased LM muscle size. Patient with more pain, disability, and extrusion and sequestration LDH had greater LM size changes. LM muscle size was not correlated with symptom duration. Further investigation with greater sample size is warranted.

Reliability of lumbar multifidus and iliocostalis lumborum thickness and echogenicity measurements using ultrasound imaging.

To establish the test-retest and inter-rater reliability of lumbar multifidus (LM) and iliocostalis lumborum (IL) muscle thickness and echogenicity as derived using ultrasound imaging. Ultrasound images of the LM and IL were collected from 11 healthy participants on two occasions, 1week apart, by two independent assessors. Measures of LM and IL thickness and echogenicity were subject to test-retest and inter-rater reliability, which was assessed by calculation of an F statistic, the interclass correlation coefficient (ICC), the standard error of measurement, 95% confidence intervals and Bland-Altman plots. This study was given approval by The University of Melbourne Behavioural and Social Sciences Human Ethics Sub-Committee (ref: 1749845). Assessors A and B showed good to excellent test-retest reliability for LM thickness (ICC3,3 A: 0.89 and B: 0.98), LM echogenicity (ICC3,3 A: 0.93 and B: 0.95) and IL echogenicity (ICC3,3 A: 0.87 and B: 0.83). Test-retest reliability for IL thickness was poor for Assessor A but excellent for Assessor B. Both assessors demonstrated excellent inter-rater reliability for LM thickness and echogenicity (ICC2,3: 0.79 and 0.94), but poor reliability for IL thickness and echogenicity (ICC2,3: 0.00 and 0.39). Inter-rater and test-retest reliability was excellent for LM but was less reliable for measures of the IL muscle.

Reliability of Sonography Measures of the Lumbar Multifidus and Transversus Abdominis during Static and Dynamic Activities in Subjects with Non-Specific Chronic Low Back Pain.

Purpose: The purpose of this study was to investigate the test-retest reliability of ultrasound (US) thickness measurements and the muscle contraction ratio (CR) of lumbar multifidus (LM) and transversus abdominis (TA) muscles in participants with and without nonspecific chronic low back pain (NCLBP). Methods: A total of 62 participants (37 with NCLBP, 25 without NCLBP) with participated in the study. The within-day and between-day reliability of US thickness measurements and CR in a lying (supine for TA and prone for LM) and sitting positions for both muscles (sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. Reliability analysis was performed with intraclass correlations (ICCs) for these two static and dynamic positions. Results: Test-retest reliability was calculated to be good to high for the static position (ICC = 0.72–0.95) and the dynamic position (ICC = 0.74–0.94) sonographic measurements in both group of TA measurement. Test-retest reliability of LM measurements was good to high for the static position (ICC = 0.82–0.95) and the dynamic position (ICC = 0.85–0.97) sonographic measurements in both groups. Conclusions: US imaging is a highly reliable method for the assessment of TA and LM thickness muscles in the dynamic position in participants with and without NCLBP. The CR measures may be adequately reliable in assessing the function of the TA and LM muscles in participants with NCLBP and healthy ones.

Effect of real-time ultrasound imaging for biofeedback on trunk muscle contraction in healthy subjects: a preliminary study

BackgroundReal-time ultrasound imaging (RUSI) has been increasingly used as a form of biofeedback when instructing and re-training muscle contraction. However, the effectiveness of the RUSI on a single sustained contraction of the lumbar multifidus (LM) and transversus abdominis (TrA) has rarely been reported. This preliminary study aimed to determine if the use of RUSI, as visual biofeedback, could enhance the ability of activation and continuous contraction of the trunk muscles including LM and TrA.MethodsForty healthy individuals were included and randomly assigned into the experimental group and control group. All subjects performed a preferential activation of the LM and/or TrA (maintained the constraction of LM and/or TrA for 30 s and then relaxed for 2 min), while those in the experimental group also received visual feedback provided by RUSI. The thickness of LM and/or TrA at rest and during contraction (Tc-max, T15s, and T30s) were extracted and recorded. The experiment was repeated three times.ResultsNo significant differences were found in the thickness of LM at rest (P > 0.999), Tc-max (P > 0.999), and T15s (P = 0.414) between the two groups. However, the ability to recruit LM muscle contraction differed between groups at T30s (P = 0.006), with subjects in the experimental group that received visual ultrasound biofeedback maintaining a relative maximum contraction. Besides, no significant differences were found in the TrA muscle thickness at rest (P > 0.999) and Tc-max (P > 0.999) between the two groups. However, significant differences of contraction thickness were found at T15s (P = 0.031) and T30s (P = 0.010) between the two groups during the Abdominal Drawing-in Maneuver (ADIM), with greater TrA muscle contraction thickness in the experimental group.ConclusionsRUSI can be used to provide visual biofeedback, which can promote continuous contraction, and improve the ability to activate the LM and TrA muscles in healthy subjects.

Transversus Abdominis and Lumbar Multifidus Thickness Among Three Dance Positions in Argentine Tango Dancers

Transversus Abdominis and Lumbar Multifidus Thickness Among Three Dance Positions in Argentine Tango Dancers