Thoracolumbar Fascia Research Articles

Thoracolumbar fascia ultrasound shear strain differs between low back pain and asymptomatic individuals: expanding the evidence

ObjectivesTo compare thoracolumbar fascia (TLF) shear strain between individuals with and without nonspecific low back pain (NSLBP), investigate its correlation with symptoms, and assess a standardized massage technique’s impact on TLF shear strain.MethodsParticipants were prospectively enrolled between February 2021 and June 2022. Pre- and post-intervention TLF ultrasound and pain/disability questionnaires were conducted. Cumulated (C|ShS|L) and maximum (Max|ShS|L) shear strain parameters were computed from radiofrequency data, and TLF thickness was measured on reconstructed B-mode images. Statistical analysis included linear mixed-effects regression.ResultsThirty-two NSLBP participants (mean age, 57 ± 9 years [standard deviation]; 21 women) and 32 controls (51 ± 10 years; 22 women) (p = 0.02) were enrolled. The mean shear strain was higher in NSLBP participants (C|ShS|L: 327.1% ± 106.0 vs 290.2% ± 99.8, p < 0.0001; Max|ShS|L: 8.1% ± 2.8 vs 7.0% ± 2.4, p < 0.0001) than controls, while mean TLF thickness (1.6 mm ± 1.0 vs 1.5 mm ± 0.9; p = 0.43) was comparable. Elastography parameters correlated with pain [C|ShS|L estimate [β], 0.01 [95% CI: 0.002, 0.02]; p = 0.02); Max|ShS|L [β], 0.003 [95% CI: 0.001, 0.005]; p < 0.001)] and disability [C|ShS|L [β] 0.02 [95% CI: 0.005, 0.03]; p = 0.009); Max|ShS|L [β] 0.003 [95% CI: 0.001, 0.006]; p = 0.002)] scores. Neither C|ShS|L (β, 0.13 [−0.27, 0.53]; p = 0.53) nor Max|ShS|L (β, −0.02 [−0.10, 0.05]; p = 0.59) changed post-intervention.ConclusionIndividuals with NSLBP demonstrated elevated TLF shear strain compared to controls, with similar TLF thickness. The shear strain correlated with pain and disability scores, yet a brief massage did not influence shear strain.Trial registrationClinicaltrials.gov, NCT04716101. Registered 14 January 2021, https://clinicaltrials.gov/study/NCT04716101.Critical relevance statementUltrasound shows elevated TLF shear strain in lower back pain sufferers compared to controls. This correlates with symptoms, suggesting a role as a pain generator. Further investigation into its anatomy, mechanical characteristics, and pathophysiology is crucial for better understanding.Key PointsStructural and mechanical alterations of the TLF may contribute to low back pain.Elevated TLF lateral shear strain was found in patients with NSLBP.A brief standardized massage therapy technique did not influence elastography parameters.Graphical

Association between vertebral bone quality score and residual back pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures.

Residual back pain (RBP) is one of the complications following percutaneous vertebroplasty (PVP) in older people with osteoporotic vertebral compression fractures (OVCFs). The vertebral bone quality (VBQ) score obtained from magnetic resonance imaging (MRI) can be used to evaluate bone quality. The objective of this study aimed to explore the potential relationship between the VBQ score and RBP after PVP. From January 2018 to January 2022, patients with OVCFs who underwent PVP in our hospital were retrospectively reviewed. Each patient's lumbar VBQ score was recorded. The RBP was defined as a visual analog scale (VAS) score ≥ 4 for back pain postoperatively. Other variables included demographic, clinical, radiological, and surgical data. The univariate and multivariate logistic regression analyses were used to determine the independent risk factors. The incidence of RBP was 8.0% among 598 patients. The results of the multivariate regression analysis showed that preoperative VBQ score (OR 3.295, P < 0.001), BMD (OR 0.545, P = 0.007), lumbodorsal fascia contusion (OR 4.297, P = 0.034), and cement distribution (OR 4.556, P = 0.006) were risk factors associated with RBP after PVP. The preoperative high VBQ score was an independent risk factor associated with RBP after PVP. Moreover, other risk factors included low BMD, lumbodorsal fascia contusion, and cement distribution. The MRI-VBQ score may serve as a useful tool for assisting in evaluating patients at risk of RBP following PVP.

Risk factors of short-term residual low back pain after PKP for the first thoracolumbar osteoporotic vertebral compression fracture

ObjectivesTo investigate the risk factors for short-term residual low back pain (SRBP) following percutaneous kyphoplasty (PKP) in patients with initial thoracolumbar osteoporotic vertebral compression fractures (OVCFs).MethodsThe clinical data of 389 patients with primary thoracolumbar OVCFs treated with PKP in our hospital from January 2018 to December 2022 were retrospectively analysed. A numerical rating scale (NRS) was used to evaluate whether SRBP was present 2 days after the operation. Patients with NRS scores > 4 were assigned to the SRBP group, and those with NRS scores ≤ 4 were assigned to the non-SRBP group. The general clinical data and surgical imaging-related data of the two groups were statistically analysed. Risk factors were analysed using binary logistic regression analysis.ResultsBinary logistic regression analysis showed four independent predictors of SRBP after PKP, including bone mineral density (BMD) (OR = 0.087, P = 0.044), preoperative injured vertebral kyphosis (OR = 1.26, P = 0.01), preoperative thoracolumbar fascia injury (TLFI) (OR = 8.929, P < 0.001), and cement distribution type (OR = 5.921, P < 0.001) and bone cement filling ratio (OR = 0.651, P < 0.001).ConclusionsA decreased BMD, a larger preoperative kyphosis angle of the injured vertebra, preoperative TLFI, bone cement distributed in blocks and a low cement filling ratio of the injured vertebra are closely related to the occurrence of SRBP in OVCF patients after PKP. Clinicians should pay more attention to the prevention and treatment of risk indicators to further improve the therapeutic effect of PKP.Trial registrationThe trial was registered in the China Trial Registry (ChiCTR 2200067164).

Shear wave elastography based analysis of changes in fascial and muscle stiffness in patients with chronic non-specific low back pain.

The quantitative assessment of individual muscle and fascial stiffness in patients with low back pain remains a challenge. This study aimed to compare the stiffness of the thoracolumbar fascia (TLF), erector spinae (ES), and multifidus (MF) in patients with and without chronic non-specific low back pain (CNLBP) using shear wave elastography (SWE). It also sought to explore the relationship between muscle and fascial stiffness and the levels of pain and dysfunction in patients with CNLBP. In this cross-sectional study, 30 patients with CNLBP (age 27.40 ± 4.57 years, 19 males, 11 females, BMI 22.96 ± 2.55kg/m2) and 32 healthy controls (age 27.94 ± 4.94 years, 15 males, 17 females, BMI 22.52 ± 2.26kg/m2) were enrolled. Stiffness of the TLF, ES, and MF was measured using SWE, and Young's modulus values were recorded. The numeric rating scale (NRS) for quantifying pain intensity and the Oswestry Disability Index (ODI) scores were recorded for the case group to examine their correlations with the resilience index. The CNLBP group exhibited significantly higher shear modulus values at the L4-5 bilateral TLF (left: p = 0.014, d = 0.64; right: p = 0.002, d = 0.86), ES (left: p = 0.013, d = 0.66; right: p = 0.027, d = 0.58), and MF (left: p = 0.009, d = 0.69; right: p = 0.002, d = 0.85) compared to the control group. Comparable findings were observed for the right ES (p = 0.026, d = 0.59) and left MF (p = 0.020, η 2 = 0.09) at L1-2. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.57, p = 0.001; right: r = 0.65, p < 0.001) at L4-5 and the NRS scores. Moderate correlations were noted between the shear modulus of the ES (left: r = 0.42, p = 0.022; right: r = 0.48, p = 0.007) and MF (left: r = 0.50, p = 0.005; right: r = 0.42, p = 0.023) at L4-5 and the NRS scores. Additionally, the shear modulus of the MF (r = 0.50, p = 0.005) on the left side of L1-2 showed similar correlations. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.60, p < 0.001; right: r = 0.58, p < 0.001) at L4-5 and the ODI scores. Moderate correlations were observed between the shear modulus of the right TLF (r = 0.43, p = 0.017), ES (r = 0.38, p = 0.037), and MF (r = 0.44, p = 0.015) at L1-2, as well as the bilateral MF (left: r = 0.46, p = 0.011; right: r = 0.45, p = 0.012) at L4-5, and the ODI scores. No significant correlations were found at other measurement sites. In patients with CNLBP, the stiffness of the lumbar fascia and muscles is generally higher than in individuals without LBP. However, this increase is not uniform across all lumbar regions, with the most significant changes observed in the L4-5 segments. In addition, higher stiffness may be associated with pain and dysfunction, primarily manifested in the TLF.

Myofascial force transmission between latissimus dorsi and contralateral gluteus maximus in runners: a cross-sectional study

The anatomical connection between latissimus dorsi (LD), thoracolumbar fascia, and contralateral gluteus maximus (GM) enables myofascial force transmission (MFT) between the shoulder, trunk, and hip. This study investigates whether regular sports practice, specifically running, influences this MFT pathway. Given the potential changes in tissue stiffness from sports practice and the importance of this property for MFT, we hypothesize that runners may exhibit greater MFT between the LD and GM, resulting in altered passive properties of the lumbar and hip regions during LD contraction. This study aimed to investigate whether runners present a higher modification in lumbar stiffness and passive properties of the contralateral hip due to LD contraction than sedentary individuals. The lumbar stiffness, hip resting position, passive hip torque, and stiffness of fifty-four individuals were assessed using an indentometer and an isokinetic dynamometer, respectively, in two conditions: LD relaxed, and LD contracted. The main and interaction effects were assessed using a two-way ANOVA. The LD contraction increased lumbar stiffness (p < 0.001; ηp2 = 0.50), externally rotated the hip resting position and increased the passive hip torque and stiffness (p < 0.05; ηp2 > 0.1) in both groups. In addition, runners presented higher lumbar stiffness compared to sedentary in the LD contracted condition (p = 0.017, ESd = 0.54). Although runners exhibited increased lumbar stiffness during LD contraction, the MFT from the shoulder to the hip joint occurred similarly in both groups.

Dynamic neuromuscular stabilization and its efficiency on sports performance

Neuromuscular stability is necessary for optimal sport performance. Stability is not achieved only by abdominal muscles, spine extensors and gluteals, but it is accomplished by precise coordination of these muscles and intra-abdominal pressure by the central nervous system. A primary role of the core muscles stability is to raise the intra-abdominal pressure and to increase the tension in the thoracolumbar fascia. Postural core instability is associated with poor dynamic balance control and with a high risk of injury or fall. Dynamic neuromuscular stabilization (DNS) is a rehabilitative approach to optimize the movement system based upon the scientific principles of developmental kinesiology and provides an effective tool in rehabilitation of sport injuries.

Effects of percussive massage therapy on fascia echo intensity and fascia thickness in firefighters with chronic non-specific low back pain: a randomized controlled trial

BackgroundChronic non-specific low back pain (CNSLBP) is prevalent among firefighters and may negatively affect their job performance. Alterations in the thoracolumbar fascia (TLF) structure are associated with CNSLBP. Percussive massage therapy (PT) has demonstrated potential in modifying fascial properties and alleviating pain. However, its effects on TLF structure in CNSLBP patients have not been thoroughly investigated. This study evaluates the effects of 6 weeks of PT on TLF echo intensity, thickness, pain, and disability in firefighters with CNSLBP, utilizing ultrasound imaging as a primary assessment tool.MethodsThis six-week randomized controlled trial involved 38 firefighters with CNSLBP. Participants were randomly assigned 1:1 to either the PT group (receiving PT and core stability exercise) or the control group (receiving only core stability exercise). TLF echo intensity and thickness were measured using ultrasound imaging, and disability was assessed using the Roland-Morris Disability Questionnaire (RMQ) at baseline and post-intervention. Pain was measured using the Visual Analog Scale (VAS) at baseline, immediately after the first intervention, three weeks post-intervention, and post-intervention. Paired t-tests were conducted to analyze within-group changes in RMQ and ultrasound data, while ANCOVA was used to assess between-group differences, and repeated measures ANOVA for VAS scores.ResultsParticipants in the PT and control groups were aged 26.6±4.1 and 23.6±1.7 years, respectively, with BMI of 23.1±1.8 and 21.8±1.2 kg/m². The PT group showed significant reductions in bilateral TLF echo intensity post-intervention (left side: mean difference -6.4, 95% CI -9.7 to -3.1, p < 0.001, effect size 0.67; right side: mean difference -7.6, 95% CI -11.8 to -3.3, p < 0.01, effect size 0.60). Changes in TLF thickness were not statistically significant (p > 0.05). The PT group demonstrated significantly lower VAS scores than the control group (mean difference - 0.626, 95% CI -1.087 to -0.165, p = 0.009, effect size 0.63). RMQ scores decreased by -1.3 (95% CI -2.1 to -0.4, p < 0.01, effect size 0.5).ConclusionSix weeks of percussive massage therapy significantly reduced thoracolumbar fascia echo intensity, alleviated pain, and improved functional disability in firefighters with chronic non-specific low back pain, but was not effective in altering fascia thickness. Percussive massage therapy emerges as an effective and safe strategy for managing chronic non-specific low back pain in firefighters.Trial registrationRetrospectively registered in Thai Clinical Trials Registry (TCTR20221223001) on December 22, 2022.

Novel muscular anomaly along the iliac crest: Innervation from the superior cluneal nerves and topographical relationship to the thoracolumbar fascia.

Aberrant muscle bundles of approximately 10cm in length, running subcutaneously from the posterior surface of sacrum to the iliac crest, were found on both sides of three males among 93 cadavers of anatomical courses for medical students. Since no precedent of this anomaly has been described in the literature, we present its morphology and discuss the significance of this muscle. This muscle originated from the tendinous fibers of the superficial-most layer of the sacral part of thoracolumbar fascia, became muscularized near the posterior superior iliac spine, passed over the origins of the gluteus maximus and medius, and inserted on the iliac crest. Some bundles crossed the iliac crest to insert between sublayers of the posterior layer of the thoracolumbar fascia. The superior cluneal nerves passed above, below, or penetrated the muscle. Branches from the segmentally lowest one or the conjoined lowest two entered the aberrant muscles. Considering its location and multi-layered structure, the muscle is likely to be a muscularized bundle of the thoracolumbar fascia. The aberrant muscle is also similar to the serratus posterior inferior in its location at the lateral end of the thoracolumbar fascia and below the latissimus dorsi. Nevertheless its innervation from the posterior rami of the spinal nerves and partial fusion at its origin implies a close relationship to the iliocostalis. This aberrant muscle may also be of clinical interest since it is potentially involved in the entrapment of the superior cluneal nerves as it runs along the caudolateral edge of the thoracolumbar fascia.

Ultrasound-guided core needle biopsy of deep fascia: A cadaveric study evaluating feasibility, accuracy and reliability.

Over the past few decades, researchers and clinicians have dedicated significant attention to fascial tissues. Current interest focuses on their anatomical and pathophysiological features. Breakthroughs in ultrasound (US) and magnetic resonance imaging (MRI) have enhanced our ability to study the dynamics and alterations of the tissue structures. However, a microscopic perspective is also essential for a comprehensive understanding of some pathologies of the fasciae. The aim of this study was to investigate, using a cadaveric study: (1) the ease of visualization of the landmarks used for the US-guided fascial core needle biopsy (CNB); (2) the consistency and accuracy of needle placement inside fascial layers using US guidance and confirmed by histological examination; (3) inter-rater reliability. We assessed the feasibility of US-guided CNB in different topographical regions of human cadavers: the thoracolumbar fascia (TLF), fascia lata (FL), and crural fascia (CF). The results, confirmed by histological examination, revealed no significant difference in needle placements between the in-plane approaches in the long and short axes for all locations and fasciae studied (long axis: 91.88%; short axis: 96.22%); p > 0.05. US-guided core needle biopsy with the in-plane approach is feasible, consistent and reliable. It could provide most or all of high-quality fascial tissue samples required for pathological examination. It could also reveal changes in fascial pathologies, capturing the exact site of pathology thanks to US guidance, in particular in patchy diseases such as eosinophilic fasciitis.

Immediate effects of thoracic mobilization versus soft tissue release on trunk motion, pain, and lumbar muscle activity in patients with chronic low back pain

IntroductionThoracic mobilization and tissue release are common manual techniques in clinical practice. However, the relative effects of these two treatments on chronic low back pain (CLBP) have not yet been explored. Thus, this study aimed to investigate and compare the immediate effects of thoracic mobilization with those of soft tissue release on trunk movement, pain sensation, and muscle activity in patients with CLBP. Methods28 participants were randomly assigned to two intervention groups. The mobilization group received mobilization treatment at the hypomobile joints of the trunk segment, while the soft tissue release group received thoracolumbar fascia release and massage in the lumbar region. The trunk range of motion (ROM), tissue hardness, pressure pain threshold (PPT), and erector spinae activity during light-weight lifting tasks were measured before and immediately after both interventions. FindingsAll measured outcomes in both groups improved after intervention (p < 0.05). The mobilization technique significantly improved side bending and rotation, PPT, and tissue hardness compared to soft tissue release. However, lumbar muscle activation reduced to a greater extent in the soft-tissue release group. ConclusionBoth techniques improved trunk ROM and PPT and reduced tissue hardness and muscle activation. Therefore, both these techniques are recommended for patients with CLBP. Trial registrationISRCTN75190733.

Exercise for patients with low back pain

Background: Low back pain (LBP) is a common symptom that imposes a significant socioeconomic burden. Appropriate exercises that enhance the recovery of anatomical structures using biomechanical methods and improve lumbar stability are recommended for patients with LBP. Therefore, clinicians should prescribe appropriate exercises to alleviate LBP, improve function, and prevent recurrence.Current Concepts: Individualized and structured multimodal exercises (strengthening, aerobic, core stability exercises, and stretching) under the supervision of healthcare professionals are recommended for patients with LBP. It is preferable to focus on isometric trunk muscle exercises for strengthening, and strengthening the large muscles (back and gluteal muscles) attached to the thoracolumbar fascia is recommended rather than exercises that involve repeated extension and flexion of the trunk muscles. Individualized aerobic and core stability exercises are recommended, and stretching exercises focusing on extension movements are preferred. It is also important to educate patients regarding the etiology of LBP, harmful postures for LBP, and methods to maintain lumbar lordosis in daily life.Discussion and Conclusion: An appropriate exercise prescription can contribute to better clinical outcomes in patients with LBP. Although exercise is important for recovery and prevention of recurrence, inappropriate exercise can potentially exacerbate LBP; therefore, careful consideration is required.

Mechanical Evaluation of Human Cadaveric Lumbar Soft Tissues Suggests Possible Physiological Stress Shielding Within Musculoskeletal Soft Tissues by the Thoracolumbar Fascia.

This study investigates the potential for stress shielding within musculoskeletal soft tissues through analysis of stress distributions between lumbar fascial and muscle tissues via mechanical testing. Using a custom apparatus, 51 posterior thoracolumbar fascia (TLF) samples and 18 erector spinae (ES) cadaveric samples underwent tensile testing involving three loading-unloading cycles, followed by loading to 6% strain, to mechanically characterize samples. Parallel tensile testing using 20 pairs of two TLF samples, and seven pairs of TLF and ES samples was then conducted for stress distribution analysis between tissues. P<0.05 was deemed significant. The TLF and ES exhibited an average elastic modulus of 150.9 MPa and 0.69 MPa, respectively. At 6% strain, parallel testing of the TLF pairs yielded an average tensile stress of 8.49 MPa and 1.7MPa (p<0.001) exhibited by the stiffer and less stiff TLF samples, respectively. Similarly, TLF-ES parallel testing resulted in average tensile stresses of 7.19 MPa and 0.079 MPa of the TLF and ES (p<0.002). Results suggest elevated loading towards stiffer TLF samples relative to less stiff TLF and ES samples. In soft tissues affected by LBP, skewed stress distributions may result in the TLF withstanding the majority of stress, yielding cyclical stress shielding that may contribute to and/or promote LBP. This novel study demonstrates a potential load allocation bias towards the TLF, laying the foundation for stress shielding within lumbar musculoskeletal soft tissues affected by degenerative musculoskeletal conditions.

Complications of intrathecal baclofen therapy in children and young adults.

The primary objective of this study was to determine the frequency and nature of complications that occur during intrathecal baclofen (ITB) therapy, including nonsurgical complications as well as complications associated with both implantation surgeries and subsequent revisions. The authors retrospectively reviewed the medical records of all patients who had baclofen pumps implanted at a tertiary children's hospital from 2006 through June 2019. The study employed appropriate descriptive statistics and statistical models to analyze patient demographics, improvements in tone, and clinical complications. The authors evaluated the associations of complications as well as changes in modified Ashworth Scale (MAS) scores with various preexisting conditions (e.g., presence of gastrostomy tubes [G-tubes] and ventriculoperitoneal [VP] shunts) and surgical variations (e.g., use of newer [Ascenda] catheters and subfascial versus subcutaneous catheter tunneling). One hundred forty-two pumps were implanted. Complications occurred in 111 patients (78.2%). The most frequent complications were catheter complications and pseudomeningoceles, each of which occurred in 63 (44%) patients. On multivariable analysis, pseudomeningoceles and percutaneous CSF leaks were significantly less likely when intrathecal catheters were placed via laminotomy versus spinal needle (OR 4.6, p = 0.044), and when catheters were passed from the posterior incision to the abdominal pump pocket deep to the thoracolumbar fascia rather than superficial to it (OR 2.7, p = 0.008). Preexisting G-tubes and VP shunts at the time of pump implantation were not associated with a significantly increased likelihood of pump malfunction or infection. Ascenda catheters were significantly less likely to have disconnections (p < 0.001) and obstructions (p = 0.016), and overall were less likely to have any catheter-related complications (p = 0.01). Patients with preexisting VP shunts at the time of implantation had a significantly greater mean decrease in MAS scores in both their lower extremities (1.8, p = 0.003) and upper extremities (1.3, p = 0.002) than did patients without shunts. Various complications are associated with ITB therapy, most commonly catheter complications and pseudomeningoceles. There have been fewer catheter complications associated with the newest catheter model, while pseudomeningoceles have become less frequent since the surgical technique was modified to prevent them. VP shunts and G-tubes are not associated with significantly higher complication rates and shunts seem to be associated with greater efficacy of ITB therapy, as represented by a greater mean improvement in MAS scores.

Quantifying thoracolumbar fascia deformation to discriminate acute low back pain patients and healthy individuals using ultrasound

Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.

The Impact of Sciatic Nerve Injury on Extracellular Matrix of Lower Limb Muscle and Thoracolumbar Fascia: An Observational Study.

Peripheral nerve injury (PNI) is a complex clinical challenge resulting in functional disability. Neurological recovery does not always ensure functional recovery, as extracellular matrix (ECM) alterations affect muscle function. This study evaluates hyaluronan (HA) and collagen concentration in the gastrocnemius muscle and thoracolumbar fascia (TLF) in unilateral lower limb PNI rats to explore systemic ECM alterations following PNI and their impacts on functional recovery. Eighteen 8-week-old male Sprague-Dawley rats were divided into experimental (n = 12 left sciatic nerve injury) and control (n = 6) groups. After six weeks, motor function was evaluated. Muscle and TLF samples were analysed for HA and collagen distribution and concentrations. SFI and gait analysis confirmed a functional deficit in PNI rats 6 weeks after surgery. HA concentration in both sides of the muscles decreased by approximately one-third; both sides showed significantly higher collagen concentration than healthy rats (12.74 ± 4.83 µg/g), with the left (32.92 ± 11.34 µg/g) significantly higher than the right (20.15 ± 7.03 µg/g). PNI rats also showed significantly lower HA (left: 66.95 ± 20.08 µg/g; right: 112.66 ± 30.53 µg/g) and higher collagen (left: 115.89 ± 28.18 µg/g; right: 90.43 ± 20.83 µg/g) concentrations in both TLF samples compared to healthy rats (HA: 167.18 ± 31.13 µg/g; collagen: 47.51 ± 7.82 µg/g), with the left TLF more affected. Unilateral lower limb PNI induced HA reduction and collagen accumulation in both the lower limb muscles and the TLF, potentially exacerbating motor function impairment and increasing the risk of low back dysfunctions.

Effect of exercise on cluneal nerve entrapment neuropathy: a case report

BackgroundLow back pain is an important disability problem frequently encountered in the clinic. In the literature, it has been shown that neuropathic pain in chronic low back pain is quite common in patients. Although superior cluneal nerve entrapment syndrome is an underdiagnosed cause of low back and leg pain, differential diagnosis is very important anatomically and clinically. The superior cluneal nerves are pure sensory nerves that innervate the skin of the upper part of the buttocks. In the literature, methods such as surgery, nerve blockade, prolotherapy, and acupuncture have been used in the treatment of cluneal nerve entrapment syndrome, but there are no studies on exercise. In this case report, our aim is to explain the importance of differential diagnosis in cluneal nerve entrapment syndrome, which is one of the common causes of low back pain in the clinic, and the effects of exercise in this disease.Case presentationA 22-year-old, Turkish-ethnicity, male patient with complaints of low back pain, neck–back pain, and weakness did not use alcohol or cigarettes. In his family history, there was a history of diabetes in the mother and diabetes and heart failure in the father. He had a history of osteoporosis, epilepsy, asthma, sarcoidosis, and cardiac arrhythmia. The patient reported that he suffered from constipation three to four times a month. As a result of the detailed evaluation, the planned exercise prescription was taught to the patient, and after it was confirmed that the patient did the exercises correctly for 3 days, the exercise brochure was given and followed as a home exercise program for 8 weeks.ConclusionsLumbar stabilization exercises, gluteal muscle strengthening exercises, thoracolumbar fascia mobilization, and stretching exercises, which will be given in accordance with the clinical anatomy of the disease after the correct diagnosis in cluneal nerve entrapment syndrome, have been beneficial for the patient. However, we think that randomized controlled studies with a large sample will contribute to the literature.

Ultrasound Imaging of Thoracolumbar Fascia: A Systematic Review.

Over the past decade, there has been a notable increase in research focused on ultrasound imaging of thoracolumbar fascia (TLF). Nevertheless, published papers' results about the application of US imaging in TLF examination are still sparse. Background and Objevtives: Hence, this systematic review was performed aiming to firstly investigate the use and the methodology of ultrasound imaging to assess pathologic and healthy TLF. Secondarily, we aim to assess intra- and inter-observer reproducibility of US imaging in TLF assessment. Materials and Methods: The search was done on PubMed and Web of Science database from inception to April 2024. Furthermore, the references of included papers were thoroughly checked to find eligible publications. The MeSH keywords used were: "Thoracolumbar fascia", "Ultrasound Imaging", "Ultrasound", "Ultrasonography", and "Ultrasound examination". Results: Studies were aimed primarily at TLF diagnosis, treatment monitoring, or evaluating movement-related changes, underscoring the diverse clinical applications. The US parameters assessed included TLF thickness, echogenicity, stiffness, deformation, shear strain, and displacement, providing comprehensive insights into TLF features. Conclusions: Advanced US imaging holds promise as a reliable tool in musculoskeletal assessment, offering insights into TLF pathology/disfunction, treatment outcomes, and movement dynamics.

The immediate effect of thoracolumbar fascia taping on biomechanical properties, low back pain and balance in individuals with transfemoral amputation.

In individuals with transfemoral amputation (TFA), adaptations caused by prosthesis use may adversely affect contractile/noncontractile structures. To investigate the immediate effect of the thoracolumbar fascia (TLF) kinesiology taping (KT) on the tone and stiffness of the fascia, low back pain (LBP) and standing balance in individuals with TFA. Syrian male participants with TFA were enrolled in the prospective, single-blind, randomised controlled trial. Participants were divided into two groups: Experimental (EG with KT, n= 15) and Control (CG with sham KT, n= 14). A 6-minute walk test (6MWT) was performed, after which KT was applied. Measurements were taken at baseline, immediately after the 6MWT and 30minutes after KT. Although pain decreased below baseline in both groups at 30minutes post intervention (p< 0.001), the rate of pain reduction was significantly higher in the EG (p= 0.016). Anterior-posterior sway with eyes open improved significantly 30minutes after KT application only in the EG (p= 0.010). In the eyes closed condition, anterior-posterior and medio-lateral sway decreased significantly compared to baseline 30minutes after taping in the EG (p= 0.010-0.032). KT can be used as an effective method to support standing balance and reduce LBP in individuals with TFA.

The acute effect of releasing the thoracolumbar facia by osteopatic technique on lower extremity functional performance on lumbar extensor endurance and mobility in soccer players

Introduction: The aim of this study is to examine the acute effect of osteopathic release of the thoracolumbar fascia on lower extremity functional performance, lumbar extensor endurance and mobility in professional soccer players. Materials and Methods: 30 volunteer male athletes who professionally play soccer participated in the study, and the participants were randomly divided into experimental and control groups. The functional performance of the lower extremities, lumbar extensor endurance and mobility of the subjects were measured twice – before and immediately after the Still Technique and placebo applications. Subjects' lower extremity functional performance was determined by the Single Leg Hop Test, lumbar extensor endurance by the Beiring-Sorensen Extensor Endurance Test, and mobility skill by the Modified Schober Test. Results: According to the results of the statistical analysis, there was a significant difference between the pre-test and post-test values of the lumbar extensor endurance tests of the experimental group in favor of the post-test; however, there was no significant difference in lower extremity functional performance and mobility values, and it was determined that they improved in the post-test. Conclusions: Releasing the thoracolumbar fascia tissue with osteopathic technique before exercise in athletes can acutely increase performance by positively affecting muscle contraction.

Commercial suture passer improves efficiency and ease of use versus conventional needle in minimally invasive thoracolumbar fascia closure: a cadaveric analysis

BackgroundLow-profile suture passers have been introduced to facilitate thoracolumbar fascia closure in minimally invasive spine (MIS) surgery. The purpose of this study was to evaluate the closure time of a modern suture passer to a conventional curved need for MIS fascia closure in a cadaveric model. MethodsSix clinicians specializing in orthopedic spine surgery were recruited for the study and randomly assigned 1 cadaveric torso. Subcutaneous tissue was resected at L4-L5, replicating MIS surgery, followed by placement of a 60×18-mm or 100×18-mm tubular retractor for access. Clinicians were required to close the fascia with three unknotted, simple interrupted sutures using a swaged curved needle or suture passer (Spine Scorpion™, Arthrex, Inc., Naples, FL). The completion time was recorded, starting immediately before suturing and ending after the last pass. A time cutoff of 10 min was implemented in consideration of reasonable operating room time, and the number of achieved suture passes (of 6) were recorded. Clinicians were asked to qualitatively grade ease of use in relation to prior fascial closure experience per a 0-5 scale, where 0 is impossible and 5 is easiest. ResultsThe mean change in fascial closure completion time (Δ) was significantly reduced with the Spine Scorpion compared to the curved needle with the 60×18-mm retractor (Δ=5.80 min; 95% CI, 2.92-8.67 min; p=.004) and 100 × 18-mm retractor (Δ=5.28 min; 95% CI, 2.76-7.80 min; p=.003). Full closure was achieved within the time limit for all trials of the Spine Scorpion, while the standard needle achieved full closure in 67% (4 of 6) and 50% (3 of 6) of trials with the 60 × 18-mm and 100×18-mm retractors, respectively. Median ease-of-use scores with the 60×18-mm and 100×18-mm retractors, respectively, were 4.5 (range, 4-5) and 4.5 (range, 3-5) for the Spine Scorpion, and both 1.0 (range, 1-2) for the curved needle. ConclusionResults from this laboratory investigation using a suture passer for thoracolumbar fascia closure show a significant reduction in closure time and completion of the procedure compared to a conventional curved needle.