Lumbar Multifidus Thickness Research Articles

Relationship Between Electromyographic Signal Amplitude and Thickness Change of the Trunk Muscles in Patients With and Without Low Back Pain.

To compare the relative thickness change of the transversal abdominal (TrA) and lumbar multifidus (LM) muscles during activation in individuals with and without low back pain (LBP), and to establish a relationship between surface electromyography (sEMG) signal amplitude and the relative thickness change of the corresponding muscle during clinically relevant activity, with preferential activation of TrA/LM. Thirty-seven pain-free participants and 36 LBP patients were assessed by ultrasound for thickness changes of TrA and LM and by sEMG for changes of electrical activity of the same muscles. sEMG is done with wireless LUMBIA system. The position of the sEMG sensors and activation maneuvers were chosen carefully. Significant group effect was found for relative thickness change of TrA (F1,142=60.69, P<0.0001) and LM (F1,142=36.01, P<0.0001). We found significant correlations between relative thickness change of TrA and sEMG signal amplitude on both sides for LBP (r=0.46 to 0.63, P<0.05) and pain-free patients (r=0.43-0.47, P<0.05). The correlation between LM thickness change and sEMG was significant in pain-free participants for both sides (r=0.36 to 0.38 P<0.05), and right LM in LBP participants (r=0.43, P<0.05), but not for LM in LBP group (r=0.16, P=0.351). US and sEMG measurements can be used for objective TrA/LM assessment. Correlation results suggest that the relative change of the muscle thickness could be used as the indicator of the muscle activity. Insight into the activity of TrA/LM in pain-free individuals and LBP patients during and after painful episodes may clarify the role of functional abnormalities of these muscles in LBP.

Interrater and intrarater reliability of transverse abdominal and lumbar multifidus muscle thickness in subjects with and without low back pain.

Two-group, repeated-measures reliability study. To determine interrater and intrarater reliability of ultrasound measurements of transverse abdominal (TrA) and lumbar multifidus (LM) muscle thickness, during rest and contraction, in subjects with low back pain (LBP) and healthy subjects over 3 consecutive days, performed by an experienced and a novice rater. Previous reliability studies of TrA or LM thickness did not simultaneously account for muscle state, rater experience, and multiday assessment in large subject samples. The 2 raters measured TrA and LM thickness on 3 consecutive days in 42 healthy subjects and 56 subjects with LBP, during rest and contraction, and calculated the percent thickness change from rest to contraction. Intraclass correlation coefficients (ICC(2,k)) and 95% minimal detectable change in thickness were derived for a single measure (day 1) and an average measure (days 1-3). The interrater ICC(2,1) values for single-measure thickness (LBP group, 0.71-0.87; healthy group, 0.94-1.00) were similar to those for average-measure thickness (LBP group, 0.73-0.84; healthy group, 0.93-1.00). Both interrater ICC(2,1) and ICC(2,3) were lower for the relative thickness change (0.61-0.96). Intrarater ICC(2,1) values across 3 consecutive days were high for both raters across the 2 groups (LBP group, 0.95-1.00; healthy group, 0.93-1.00), albeit lower for the relative thickness change (0.79-0.99). The 95% minimal detectable changes were < 0.3 mm for the TrA and < 2 mm for the LM (but, in most cases, less than 10% of average thickness). Both experienced and trained novice raters provided reliable measurements of TrA and LM thickness in participants with LBP and healthy participants, during rest and contraction. One-time measurements were similar to averaged measurements. Small absolute errors were observed. Public trial registry: Australian New Zealand Clinical Trials Registry ACTRN12613001077752.

Multifidus muscle size and percentage thickness changes among patients with unilateral chronic low back pain (CLBP) and healthy controls in prone and standing

The aim of this study was to determine if differences exist in lumbar multifidus (LM) thickness at rest and during activation, between individuals with chronic low back pain (CLBP) and controls. Lumbar multifidus thickness was assessed via rehabilitative ultrasound imaging (RUSI), and was performed in prone and standing both at rest and during muscle activation i.e. with a contralateral arm lift (CAL). Twenty participants were assessed; ten CLBP participants and ten controls. Rehabilitative ultrasound imaging was used to measure LM thickness and percentage thickness change at L4/L5 and L5/S1 in four positions; prone at rest, prone during activation with a CAL, standing at rest, and standing during activation with a CAL. Independent and paired t-tests were used to calculate differences in LM thickness and percentage thickness change between groups, and also between sides in the CLBP group. There was a significant difference in LM percentage thickness change in standing during activation with a CAL; the CLBP demonstrated a greater percentage thickness increase at L5/S1 compared to the controls, (p = 0.05). There were no differences between groups at the L4/L5 level for this position. There were no differences between the groups for LM thickness or percentage thickness change in prone or standing at rest, or during activation with a CAL in prone. Within the CLBP group, no significant between side differences were found. These results give preliminary insight into possible differences in LM contractile behaviour during functional movements in CLBP, however, larger scale research is warranted.

Verification of an optimized stimulation point on the abdominal wall for transcutaneous neuromuscular electrical stimulation for activation of deep lumbar stabilizing muscles

Background contextTranscutaneous neuromuscular electrical stimulation (NMES) can stimulate contractions in deep lumbar stabilizing muscles. An optimal protocol has not been devised for the activation of these muscles by NMES, and information is lacking regarding an optimal stimulation point on the abdominal wall. PurposeThe goal was to determine a single optimized stimulation point on the abdominal wall for transcutaneous NMES for the activation of deep lumbar stabilizing muscles. Study designUltrasound images of the spinal stabilizing muscles were captured during NMES at three sites on the lateral abdominal wall. After an optimal location for the placement of the electrodes was determined, changes in the thickness of the lumbar multifidus (LM) were measured during NMES. MethodsThree stimulation points were investigated using 20 healthy physically active male volunteers. A reference point R, 1 cm superior to the iliac crest along the midaxillary line, was used. Three study points were used: stimulation point S1 was located 2 cm superior and 2 cm medial to the anterior superior iliac spine, stimulation point S3 was 2 cm below the lowest rib along the same sagittal plane as S1, and stimulation point S2 was midway between S1 and S3. Sessions were conducted stimulating at S1, S2, or S3 using R for reference. Real-time ultrasound imaging (RUSI) of the abdominal muscles was captured during each stimulation session. In addition, RUSI images were captured of the LM during stimulation at S1. ResultsThickness, as measured by RUSI, of the transverse abdominis (TrA), obliquus internus, and obliquus externus was greater during NMES than at rest for all three study points (p<.05). Transverse abdominis was significantly stimulated more by NMES at S1 than at the other points (p<.05). The LM thickness was also significantly greater during NMES at S1 than at rest (p<.05). ConclusionsNeuromuscular electrical stimulation at S1 optimally activated deep spinal stabilizing muscles, TrA and LM, as evidenced by RUSI. The authors recommend this optimal stimulation point be used for NMES in the course of lumbar spine stabilization training in patients having difficulty initiating contraction of these muscles.

Ultrasound Measures of the Lumbar Multifidus: Effect of Task and Transducer Position on Reliability

To (1) assess the intra- and inter-rater reliability of different ultrasound (US) measures of the lumbar multifidus muscle in subjects with and without chronic low back pain and (2) test 3 different ways to enhance reliability, that is, by testing different tasks, using a template, and averaging trials within or between days. Cross-sectional repeated-measures design. Laboratory setting. Fifteen subjects with chronic low back pain and 15 control subjects. Subjects (n = 30) performed contralateral arm lifting and contralateral leg lifting while in the prone position. Two 7-second videos of the lumbar multifidus (from rest to contraction) were collected with and without a template (transparency) to reposition the transducer on the skin. One of the two raters repeated the testing 7 to 14 days later to assess intrarater reliability in addition to inter-rater reliability. Reliability was assessed with the generalizability theory as a framework. US imaging measures of the lumbar multifidus thickness were obtained in patients at rest and during standardized contractions (hereafter called primary measures) at 2 vertebral levels and on both sides. These primary measures were used to calculate different, potentially useful US parameters (hereafter called derived measures). Intrarater reliability was better than inter-rater reliability, and primary measures were more reliable than derived measures. The tasks investigated showed comparable reliability results, and the use of the transducer position template was not effective to increase reliability. Averaging the measures of 3 images increased reliability substantially. Optimal reliability requires the use of a single rater and the averaging of at least 3 images per visit. In these conditions, primary measures reach acceptable levels of reliability, which was more difficult to achieve for most derived measures. Arm or leg lifting tasks showed similar reliability, and thus the arm-lifting task is recommended for comparisons with previous studies. The use of a transducer position template is not recommended.

Reliability of 2 Ultrasonic Imaging Analysis Methods in Quantifying Lumbar Multifidus Thickness

Reliability study. To compare the within- and between-day intrarater reliability of rehabilitative ultrasound imaging (RUSI) using static images (static RUSI) and video clips (video RUSI) to quantify multifidus muscle thickness at rest and while contracted. Secondary objectives were to compare the measurement precision of averaging multiple measures and to estimate reliability in individuals with and without low back pain (LBP). Although intrarater reliability of static RUSI in measuring multifidus thickness has been established, using video RUSI may improve reliability estimates, as it allows examiners to select the optimal image from a video clip. Further, multiple measurements and LBP status may affect RUSI reliability estimates. Static RUSI and video RUSI were used to quantify multifidus muscle thickness at rest and during contraction and percent thickness change in 27 volunteers (13 without LBP and 14 with LBP). Three static RUSI images and 3 video RUSI video clips were collected in each of 2 sessions 1 to 4 days apart. Reliability and precision were assessed using intraclass correlation coefficients, standard error of measurement, minimal detectable change, bias, and 95% limits of agreement. Using an average of 2 measures yielded optimal measurement precision for static RUSI and video RUSI. Based on the average of 2 measures obtained under the same circumstance, there was no significant difference in the reliability estimates between static RUSI and video RUSI across all testing conditions. Reliability point estimates (intraclass correlation coefficient model 3,2) of multifidus thickness were 0.99 for within-day comparisons and ranged from 0.93 to 0.98 for between-day comparisons. The within- and between-day intraclass correlation coefficients (model 3,2) of percent thickness change ranged from 0.97 to 0.99 and from 0.80 to 0.90, respectively. The exploratory analysis showed no significant difference in the reliability estimates between asymptomatic and LBP participants across most testing conditions. Both RUSI methods yielded high reliability estimates for multifidus muscle measurements. Using an average of 2 measures obtained optimal measurement precision. Overall, video RUSI is a reliable surrogate for static RUSI for multifidus muscle measurements and has the additional advantage of requiring shorter data collection time.

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

Understanding the clinical characteristics of patients with low back pain (LBP) who display improved lumbar multifidus (LM) muscle function after spinal manipulative therapy (SMT) may provide insight into a potentially synergistic interaction between SMT and exercise. Therefore, the purpose of this study was to identify the baseline historical and physical examination factors associated with increased contracted LM muscle thickness one week after SMT. Eighty-one participants with LBP underwent a baseline physical examination and ultrasound imaging assessment of the LM muscle during submaximal contraction before and one week after SMT. The relationship between baseline examination variables and 1-week change in contracted LM thickness was assessed using correlation analysis and hierarchical multiple linear regression. Four variables best predicted the magnitude of increases in contracted LM muscle thickness after SMT. When combined, these variables suggest that patients with LBP, (1) that are fairly acute, (2) have at least a moderately good prognosis without focal and irritable symptoms, and (3) exhibit signs of spinal instability, may be the best candidates for a combined SMT and lumbar stabilization exercise (LSE) treatment approach.