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Background/aim: 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. Materials and methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background: Aberrant movement in chronic low back pain (CLBP) is associated with a deficit in the lumbar multifidus (LM) and changes in cortical topography. Anodal transcranial direct current stimulation (a‐tDCS) can be used to enhance cortical excitability by priming the neuromuscular system for motor control exercise (MCE), thereby enhancing LM activation and movement control. This study aimed to determine the effects of a 6‐week MCE program combined with a‐tDCS on cortical topography, LM activation, movement patterns, and clinical outcomes in individuals with CLBP. Methods: Twenty‐two individuals with CLBP were randomly allocated to the a‐tDCS group (a‐tDCS; n = 12) or sham‐tDCS group (s‐tDCS; n = 10). Both groups received 20 min of tDCS followed by 30 min of MCE. The LM and erector spinae (ES) cortical topography, LM activation, movement control battery tests, and clinical outcomes (disability and quality of life) were measured pre‐ and post‐intervention. Results: Significant interaction (group × time; p < 0.01) was found in the distance between LM and ES cortical locations. The a‐tDCS group demonstrated significantly fewer discrete peaks (p < 0.05) in both ES and LM and significant improvements (p < 0.05) in clinical outcomes post‐intervention. The s‐tDCS group demonstrated a significant increase (p < 0.05) in the number of discrete peaks in the LM cortical topography. No significant changes (p > 0.05) in LM activation were observed in either group; however, both groups demonstrated improved movement patterns. Discussion: Our findings suggest that combined a‐tDCS with MCE can separate LM and ES locations over time while s‐tDCS (MCE alone) reduces the distance. Our study did not find superior benefits of adding a‐tDCS before MCE for LM activation, movement patterns, or clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study explores the effects of different upper limb preload methods and intensities on the maximum voluntary contraction force of lumbar muscles. Methods: 20 subjects were recruited in this study, and each subject participated in 4 groups of experiments in random order. During the experiment, the subjects maintained in a neutral and upright sitting position, and were subjected to full force co-activation of the lumbar and abdominal muscles under no preload, arm lift preload, hand pull preload and hand grip preload, respectively. The preload intensity of each preload method was set at 20% and 40% of the maximum load force. At the same time, the electromyographic signals of the bilateral lumbar multifidus and erector spinalis muscles were recorded. Results: In bilateral multifidus muscles, the root mean square (RMS) and integrated electromyography (IEMG) values of the arm lift and hand pull preload methods were higher than those of the no preload group (P<0.05). There was no statistical difference in RMS and IEMG values between the hand grip preload method and the no preload group (P>0.05); There was no statistically significant difference in RMS and IEMG values between the three preload methods and the no preload group in the bilateral vertical spine muscles (P>0.05). In the comparison of different preload methods, the RMS and IEMG values of the arm lift and hand pull preload methods were higher than those of the hand grip preload method (P<0.05), and the RMS and IEMG values of arm lift preload method were higher than those of hand pull preload method (P＜0.05). Conclusions: The muscle pre-activation brought about by arm lift and hand pull preload methods can effectively improve the voluntary contraction strength of the lumbar multifidus muscle. The greater the preload intensity, the greater the muscle contraction strength may also be, and the arm lift preload method has a better promoting effect. [ABSTRACT FROM AUTHOR]

There is a growing interest in muscle characteristics of the lumbar multifidus related to low back pain, but findings between studies are inconsistent. One of the issues explaining these conflicting findings might be the use of two‐dimensional measures of cross‐sectional area and thickness of the lumbar multifidus in most studies, which might be a suboptimal representation of the entire muscle volume. A three‐dimensional volumetric assessment, combined with standardized imaging and processing measurement protocols, is highly recommended to quantify spinal muscle morphology. Three‐dimensional freehand ultrasonography is a technique with large potential for daily clinical practice. It is achieved by combining conventional two‐dimensional ultrasound with a motion‐tracking system, recording the position and orientation of the ultrasound transducer during acquisition, resulting in a three‐dimensional reconstruction. This study investigates intra‐ and interprocessor reliability for the quantification of muscle volume of the lumbar multifidus based on three‐dimensional freehand ultrasound and its validity, in 31 patients with low back pain and 20 healthy subjects. Two processors manually segmented the lumbar multifidus on three‐dimensional freehand ultrasound images using Stradwin software following a well‐defined method. We assessed the concurrent validity of the measurement of multifidus muscle volume using three‐dimensional freehand ultrasound compared with magnetic resonance imaging in 10 patients with low back pain. Processing reliability and agreement were determined using intraclass correlation coefficients, Bland–Altman plots, and calculation of the standard error of measurement and minimal detectable change, while validity was defined based on correlation analysis. The processing of three‐dimensional freehand ultrasound images to measure lumbar multifidus volume was reliable. Good to excellent intraclass correlation coefficients were found for intraprocessor reliability. For interprocessor reliability, the intraclass correlation coefficients were moderate to good, emphasizing the importance of processing guidelines and training. A single processor analysis is preferred in clinical studies or when small differences in muscle volume are expected. The correlation between magnetic resonance imaging and three‐dimensional freehand ultrasound measurements of lumbar multifidus volume was moderate to good but with a systematically smaller multifidus volume measured on three‐dimensional freehand ultrasound. These results provide opportunities for both researchers and clinicians to reliably assess muscle structure using three‐dimensional freehand ultrasound in patients with low back pain and to monitor changes related to pathology or interventions. To allow implementation in both research and clinical settings, guidelines on three‐dimensional freehand ultrasound processing and training were provided. [ABSTRACT FROM AUTHOR]

Background: The weakening of paraspinal muscles in the paravertebral area may play a role in developing central lumbar spinal stenosis, resulting in lower back discomfort. Objective: The study thoroughly examined the correlation between the Oswestry Disability Index, Dural Sac cross-sectional area, Schizas grading Scale, Body Mass Index, and the cross-sectional areas of Erector Spinae, Multifidus, and Psoas muscles. The findings were also compared between patients with central Lumbar Spinal Stenosis and healthy individuals. Study design: Retrospective monocentric observational study. Methods: The study recruited 168 consecutive patients aged 60 or older diagnosed with central Lumbar Spinal Stenosis between January 2020 and July 2022. The patients' condition was evaluated by administering a preoperative Oswestry Disability Index questionnaire, measuring their Body Mass Index, and performing preoperative Magnetic Resonance Imaging. The analyzed parameters were the cross-sectional area of paraspinal muscles at the L4-L5 level, dural sac cross-sectional area, and Schizas grading Scale at the most stenotic level, using multiple linear univariate analyses. Two groups of healthy individuals were recruited: Group A (under 60 years old) and Group B (over 60 years old). The same data extrapolated from these groups were compared with those of patients with central lumbar stenosis using a two-tailed Mann-Whitney test. Results: As the Erector Spinae degenerates, the Oswestry Disability Index tends to increase. Similarly, an increase in Body Mass Index is often accompanied by a decrease in the cross-sectional area of the Erector Spinae. Low dural sac cross-sectional area is statistically linked to a reduced Multifidus cross-sectional area. Interestingly, the Schizas grading scale does not appear to correlate with changes in the cross-sectional area of the paraspinal muscles. Additionally, there is no significant difference in the cross-sectional area of the Psoas muscle between individuals with central lumbar spinal stenosis and healthy individuals. Conclusions: Our study found that degeneration of the Erector Spinae plays a crucial role in the progression of perceived disability in Lumbar Spinal Stenosis. Prospective studies should investigate the long-term evolution of paraspinal muscles in decompressed patients. [ABSTRACT FROM AUTHOR]

Neuromuscular instability of the lumbar spine resulting from impaired motor control and degeneration of the multifidus muscle is a known root cause of refractory chronic low back pain (LBP). An implantable neurostimulation system that aims to restore multifidus motor control by stimulating the L2 medial branch of the dorsal ramus thereby relieving pain and reducing disability has demonstrated clinically significant benefits in the clinical trial setting. The 1-year results of a single-site real-world cohort study are presented. This study recruited 44 consecutive patients with refractory, predominantly nociceptive axial chronic LBP, evidence of multifidus dysfunction, and no surgical indications or history of surgical intervention for chronic LBP. Each patient was implanted with a neurostimulation device. Pain (numeric rating scale), disability (Oswestry Disability Index), and quality of life (5-level EuroQol 5-Dimension) outcomes were collected at baseline and 3, 6, and 12 months after activation. Statistically significant improvements in pain, disability, and quality of life from baseline were seen at all assessment time points. At 12 months after activation, mean ± standard error of the mean numeric rating scale score was reduced from 7.6 ± 0.2 to 3.9 ± 0.4 (P < 0.001), Oswestry Disability Index score was reduced from 43.0 ± 2.8 to 25.8 ± 3.9 (P < 0.001), and 5-level EuroQol 5-Dimension index improved from 0.504 ± 0.034 to 0.755 ± 0.039 (P < 0.001). No lead migrations were observed. One patient required revision due to lead fracture. Restorative neurostimulation is a new treatment option for well-selected patients with refractory chronic LBP. Clinically meaningful improvements in pain, disability, and quality of life demonstrated in routine clinical practice are consistent with published results of controlled trials. [ABSTRACT FROM AUTHOR]

Background: 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. Methods: 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–S1 level (both sides, 3 at rest and 6 during ASLR) were collected. For assessing test–retest reliability, the experienced examiner repeated the procedure after 7 days. Intraclass correlation coefficients (ICC), standard error of measurements (SEM) and minimal detectable changes (MDC) were calculated. Results: 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 3 s (p <.01) and 10 s (homolateral side, p <.01; contralateral side, p <.05) were associated with less pain intensity. Conclusions: US is a reliable method to assess the LM thickness at rest and contracted during the ASLR in patients with LBP. The measurement at 3 s 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. [ABSTRACT FROM AUTHOR]

Background Context: Prolonged bedrest induces accumulation of intramuscular lipid concentration (ILC) in the lumbar musculature; however, spatial distribution of ILC has not been determined. Artificial gravity (AG) mitigates some adaptations induced by 60 day bedrest by creating a head-to-feet force while participants are in a supine position.Purpose: To quantify the spatial distribution of accumulation of ILC in the lumbar musculature after 60 day bedrest, and whether this can be mitigated by AG exposure.Study Design: Prospective longitudinal study.Patient Sample: Twenty-four healthy individuals (8 females) participated in the study: Eight received 30 min continuous AG (cAG); Eight received 6 × 5 min AG (iAG), interspersed with rests; Eight were not exposed to AG (CRTL).Outcome Measures: From 3T magnetic resonance imaging (MRI), axial images were selected to assess lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 intervertebral disc levels. Chemical shift-based 2-echo lipid and/or water Dixon sequence was used to measure tissue composition. Each lumbar muscle was segmented into four equal quartiles (from medial to lateral).Methods: Participants arrived at the facility for the baseline data collection before undergoing a 60 day strict 6° head-down tilt (HDT) bedrest period. MRI of the lumbopelvic region was conducted at baseline and Day-59 of bedrest. Participants performed all activities, including hygiene, in 6° HDT and were discouraged from moving excessively or unnecessarily.Results: At the L4/L5 and L5/S1 intervertebral disc levels, 60-day bedrest induced a greater increase in ILC in medial and lateral regions (∼+4%) of the LM than central regions (∼+2%; p<.05). A smaller increase in ILC was induced in the lateral region of LES (∼+1%) at L1/L2 and L2/L3 than at the centro-medial region (∼+2%; p<.05). There was no difference between CRTL and intervention groups.Conclusions: Inhomogeneous spatial distribution of accumulation of ILC was found in the lumbar musculature after 60 day bedrest. These findings might reflect pathophysiological mechanisms related to muscle disuse and contribute to localized lumbar spine dysfunction. Altered spatial distribution of ILC may impair lumbar spine function after prolonged body unloading, which could increase injury risk to vulnerable soft tissues, such as the lumbar intervertebral discs. These novel results may represent a new biomarker of lumbar deconditioning for astronauts, bedridden, sedentary individuals, or those with chronic back pain. Changes are potentially modifiable but not by the AG protocols tested here. [ABSTRACT FROM AUTHOR]

Introduction: Patients with chronic non-specific low back pain (CNSLBP) were found with impaired postural control in previous studies. Since the trunk muscle take important efforts on core stability, the study aimed to examine the relationships of postural control during stance tasks and the contractility of trunk muscle in young adults with CNSLBP and without.Methods: Healthy individuals (n = 25) and individuals with CNSLBP (n = 30) were included. The thickness of the bilateral transversus abdominis (TrA) and lumbar multifidus (MF) was measured during rest and maximal voluntary contraction, and the change percentages (TrA%, MF%) were calculated. Regarding postural control, COP path length and sway area during the stance tasks were measured thrice in each group.Results: The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral TrA% of the CNSLBP group was less than that of the HC group (p < 0.05). The bilateral MF% showed no significantly different(p > 0.05) between the two groups. Compared with healthy controls, CNSLBP patients resulted larger path length and sway area of COP during most of static stance tasks. During the EO task in the CNSLBP group, TrA% was found correlate to COP path length (p < 0.05); the right MF% was correlated with COP sway area (p < 0.05). No significant correlations appeared in the healthy controls (p > 0.05).Conclusions: Compared with healthy individuals, impaired postural control during static stance with eyes open in patients with CNSLBP was likely to be related to the poor contraction ability of bilateral transversus abdominis and correlated to the normal contraction ability of right lumbar multifidus. [ABSTRACT FROM AUTHOR]

CONTEXT: Individuals with low back pain (LBP) have reduced function of the transversus abdominis (TrA) and lumbar multifidus (LM) muscles. Biofeedback during exercise may increase the ability to contract the TrA and LM muscles compared with exercise alone. OBJECTIVE: To compare TrA preferential activation ratio (PAR) and the percent change in LM-muscle thickness in patients with LBP history before and after exercise with or without biofeedback. DESIGN: Controlled laboratory study. SETTING: University research laboratory. PATIENTS: 20 LBP individuals, 10 exercise alone and 10 exercise with biofeedback. INTERVENTIONS: Patients were allotted to tabletop exercises in isolation or tabletop exercises with visual, auditory, and tactile biofeedback. MAIN OUTCOME MEASURES: TrA PAR and percent change in LM-muscle thickness. RESULTS: There were no differences between groups at baseline (all P > .05). Nonparametric statistics showed decreased resting muscle thickness for total lateral abdominal-wall muscles (P = .007) but not TrA (P = .410) or LM (P = .173). Percent TrA thickness increased from table to standing positions before (P = .006) and after exercise (P = .009). TrA PAR increased after exercise (pre 0.01 ± 0.02, post 0.03 ± 0.04, P = .033) for all patients and for exercise with biofeedback (pre 0.02 ± 0.01, post 0.03 ± 0.01, P = .037) but not for exercise alone (pre 0.01 ± 0.02, post 0.02 ± 0.05, P = .241). No group differences were observed for TrA PAR before (exercise 0.01 ± 0.02, exercise with biofeedback 0.02 ± 0.01, P = .290) or after exercise (exercise 0.02 ± 0.05, exercise with biofeedback 0.03 ± 0.01, P = .174). There were no group differences in LM percent change before exercise (P = .999) or after exercise (P = .597). In addition, no changes were observed in LM percent change as a result of exercise among all participants (P = .391) or for each group (exercise P = .508, exercise with biofeedback P = .575). CONCLUSION: TrA PAR increased after a single session of exercises, whereas no thickness changes occurred in LM. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective of this study was to examine and compare lumbar multifidus (LM) muscle size, asymmetry, and function in university football players with and without low back pain (LBP). A secondary objective was to examine the relationship between LM characteristics and body composition in football players. Methods: Ultrasound assessments of the LM muscle were performed in 41 university football players during the preseason. LM muscle cross-sectional area, echo intensity (e.g., indicator of fatty infiltration and connective tissue), thickness at rest, and thickness during submaximal contraction (e.g., contralateral arm lift) measurements in prone and standing positions were obtained bilaterally at the L5–S1 level. Body composition measures were acquired using dual-energy x-ray absorptiometry. A self-administered questionnaire was used to obtain LBP history data. Results: The LM muscle thickness at rest in prone and in standing was significantly smaller in football players who reported the presence of LBP in the previous 3 months. The LM cross-sectional area in prone was significantly and positively correlated with weight, height, lean body mass, total fat mass, and total percent body fat. LM echo intensity was strongly correlated with total percent body fat and total fat mass and negatively correlated with the percent thickness change during contraction. Conclusion: The results of this study provide novel information on LM muscle morphology and activation in football players in prone and standing and suggest that players with LBP in the previous 3 months had smaller LM muscle thickness. LM morphology was strongly correlated with body composition measurements. [ABSTRACT FROM AUTHOR]

Background: Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature.Methods: Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system.Results: In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings - particularly for levels L4-S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases.Discussion: Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas.Conclusions: We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology. [ABSTRACT FROM AUTHOR]

Ultrasound imaging has been used to assess muscle function of deeper muscles and to compare individuals with and without low back pain. These measures may be influenced by numerous factors requiring normalization for these comparisons. The purpose of this study was to assess anthropometric normalization variables with muscle thickness of the transversus abdominis and lumbar multifidus across multiple ultrasound testing positions. Numerous anthropometric variables were correlated with muscle thickness. Mass, body mass index, and height times mass show the best promise for normalization, but were not consistent for the transversus abdominis and lumbar multifidus muscles. Normalization strategies should be considered when comparing between groups. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate differences in passive muscular stiffness between the superficial multifidus (SM) and deep multifidus (DM), and to compare their passive and active stiffness in individuals with low back pain (LBP) and asymptomatic individuals. Fifteen LBP individuals and 15 asymptomatic individuals were recruited. Passive stiffness of the SM and DM was measured bilaterally using shear wave elastography (SWE) with participants lying prone. Active stiffness was measured for the SM during trunk extension, and the contraction ratio was calculated. DM displayed higher passive muscular stiffness than SM in both the asymptomatic and LBP groups (14.41 ± 2.62 and 15.40 ± 2.77 kPa respectively; p < 0.001). Individuals with LBP exhibited higher passive muscular stiffness of SM (LBP: 10.15 ± 4.21, asymptomatic: 6.84 ± 1.69 kPa; p < 0.005) and a lower contraction ratio (LBP: 1.54 ± 0.47, asymptomatic: 2.65 ± 1.36 kPa; p < 0.003) compared to the asymptomatic group. The findings support a differentiation in passive muscular stiffness between SM and DM and provide evidence for an alteration in muscular stiffness at rest in individuals with LBP. The lower increase of muscular stiffness with contraction observed for those with LBP may reflect a deficit in activation of the multifidus. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Sleep disorders should be routinely evaluated and treated in low back pain (LBP) patients because they represent an important contributor to pain. However, no study thus far has investigated the potential benefit to LBP management of a device improving the sleep quality. Therefore, aim of this study was to assess the effectiveness of an innovative mattress overlay as add-on treatment to LBP rehabilitation. METHODS: Thirty eight LBP patients were randomized to standard rehabilitation plus mattress overlay use (cases) or standard rehabilitation only (controls). The intervention duration was 2 months and the following assessments were performed before and after: pain intensity; level of perceived back disability and sleep health; spine mobility; thickness and echo intensity of the lumbar multifidus. RESULTS: Significant pre-post-intervention improvements were observed in cases for resting and movement pain, perceived back disability, sleep, fingertip-to-floor distance, multifidus thickness (∼ 6% increase) and echo intensity (∼ 13% decrease). On the contrary, all these variables remained constant between the two experimental phases in controls. CONCLUSIONS: A combination of rehabilitation and mattress overlay use seems an effective approach for improvement of pain, perceived back disability, sleep, spine mobility, and lumbar multifidus size and structure of LBP patients. [ABSTRACT FROM AUTHOR]

Context: Injury-prediction models have identified trunk muscle function as an identifiable factor for future injury. A history of low back pain (HxLBP) may also place athletes at increased risk for future low back pain. Reduced muscle thickness of the lumbar multifidus (LM) and transversus abdominis (TrA) has been reported among populations with clinical low back pain via ultrasound imaging in multiple positions. However, the roles of the LM and TrA in a more functional cohort and for injury prediction are still unknown. Objectives: To (1) assess the reliability of LM and TrA ultrasound measures, (2) compare changes in muscle thickness across positions between persons reporting or not reporting HxLBP, and (3) determine the ability to distinguish between groups. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: Participants were 34 people who did not report HxLBP (age = 22 ± 7 years, body mass index = 23.7 ± 2.7) and 25 people who reported HxLBP (age = 25 ± 10 years, body mass index = 24.0 ± 3.2). Main Outcome Measure(s): Muscle thickness and changes in muscle thickness of the LM and TrA as shown on ultrasound imaging. Results: Intraclass correlation coefficients ranged from 0.641 to 0.943 for all thickness measures and from 0 to 0.693 for all averaged thickness modulations bilaterally. Participants who reported HxLBP had voluntarily reduced TrA thickness modulations compared with those not reporting HxLBP (P = .03), and the testing position influenced TrA thickness modulations (P < .01). No differences were observed for LM thickness modulations between groups or positions (P > .05). A tabletop cutoff value of 1.32 had a sensitivity of 0.640 and a specificity of 0.706, whereas a seated cutoff value of 1.18 had a sensitivity of 0.600 and a specificity of 0.647. Conclusions: In participants reporting HxLBP, TrA thick- ness modulations were lower and both tabletop and seated thickness modulations were able to distinguish reported HxLBP status. These findings suggest that TrA muscle function may be altered by HxLBP. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the relative functional volume of bilateral lumbar multifidus (LM) muscles across different stages and ages of patients with lumbar disc herniation (LDH). The relative functional volumes of LM muscles in both non-affected and affected sides in the L4-L5 and L5-S1 segmental level were measured in a resting prone position, and visual analogue score (VAS) for pain and Japanese Orthopedic Association (JOA) scores were recorded. The correlation between changes in the relative net volume of LM muscles and times of onset, ages, VAS and JOA scores were analyzed. A total of 327 cases were selected. The affected sides of LM muscles could present a certain degree of atrophy in stages >3 weeks. During the duration of the course, all cases presented different degrees of LM muscle atrophy. In addition, the degree of LM muscle atrophy was positively correlated with its duration. Age could influence the degree of LM muscle atrophy. Patients with unilateral LDH had <10% asymmetry on relative functional volume in the youth group. At the L4-L5 segments, patients with unilateral LDH had >10% asymmetry within the course of 3 months in the elderly group. The reduced rate of the relative functional net LM muscle volume was positively correlated with VAS scores, age, duration and JOA scores. In conclusion, the reduced rate of relative functional net LM muscle volume was positively correlated with age, duration, VAS scores and JOA scores. Although these findings are unreliable markers of lumbar pathology in an individual level for use in clinical or research settings, there is a notable importance of early intervention in LM muscle atrophy. [ABSTRACT FROM AUTHOR]

Purpose: Lumbar multifidus (LM) and transversus abdominis (TrA) show altered motor control, and LM is atrophied, in people with low-back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) involves cyclical lower-limb movement against minimal resistance in an upright posture. It has been shown to recruit LM and TrA automatically, and may have potential as an intervention for non-specific LBP. However, no studies have yet investigated the effects of changes in FRED movement amplitude on the activity of these muscles. This study aimed to assess the effects of different FRED movement amplitudes on LM and TrA muscle thickness and movement variability, to inform an evidence-based exercise prescription.Methods: Lumbar multifidus and TrA thickness of eight healthy male volunteers were examined using ultrasound imaging during FRED exercise, normalised to rest at four different movement amplitudes. Movement variability was also measured. Magnitude-based inferences were used to compare each amplitude.Results: Exercise at all amplitudes recruited LM and TrA more than rest, with thickness increases of approximately 5 and 1 mm, respectively. Larger amplitudes also caused increased TrA thickness, LM and TrA muscle thickness variability and movement variability. The data suggests that all amplitudes are useful for recruiting LM and TrA.Conclusions: A progressive training protocol should start in the smallest amplitude, increasing the setting once participants can maintain a consistent movement speed, to continue to challenge the motor control system. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the influence of different verbal instructions on muscle thickness of the lumbar multifidus muscle in asymptomatic individuals and patients with low back pain (LBP).

Introduction Exposure to microgravity has various effects on the human musculoskeletal system. During spaceflight many astronauts experience low back pain and the risk of spine injuries is significantly greater post-flight. Nonetheless, the increased lumbo-pelvic injury risk is not specifically addressed by current countermeasures. Considering this, a novel exercise device has been developed to specifically counteract atrophy of deep spinal and postural muscles. The aim of the present study was to test the possibility of transferring this exercise concept from earth to space using a biomechanical simulation. Methods A biomechanical model of the exercise device was developed and validated using intramuscular electromyographic (EMG) data as previously acquired on a terrestrial prototype of the exercise device. The model was then modified to the needs of a 0- g environment, creating gravity-like conditions using shoulder straps. Results Modelled activation patterns of the investigated muscles were in line with the experimental data, showing a constant activation during exercise. The microgravity modifications of the model lead to increased muscle activation of deep spinal muscles and to decreased activation of superficial moment creating trunk muscles. Discussion The results of the biomechanical model suggest that the exercise concept can be transferred from 1- g to space conditions. The present study is a first step in the investigation process of a novel exercise concept and human studies should be conducted to confirm the present theoretical investigation. [ABSTRACT FROM AUTHOR]

Background context Transcutaneous 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. Purpose The 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 design Ultrasound 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. Methods Three 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. Results Thickness, 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). Conclusions Neuromuscular 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. [ABSTRACT FROM AUTHOR]

Abstract: Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures. [Copyright &y& Elsevier]

Abstract: 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. [Copyright &y& Elsevier]

The article discusses a study which compared the myosin heavy-chain isoform distribution in paraspinal muscles, and tested whether fiber-type gradients are a function of paraspinal muscle depth. The study was conducted on 15 patients requiring spine surgery. A description of the experiment's basis and methodology is provided. It was found that the fiber-type distribution was similar among the posterior paraspinal muscles and composed of relatively high percentage of type I compared to other types.

Abstract: The purpose of this study was to compare the passive mechanical properties and titin isoform sizes of the multifidus, longissimus, and iliocostalis muscles. Given our knowledge of each muscle''s architecture and the multifidus’ operating range, we hypothesized that multifidus would have higher elastic modulus with corresponding smaller titin isoforms compared to longissimus or iliocostalis muscles. Single-fiber and fiber-bundle material properties were derived from passive stress–strain tests of excised biopsies (n=47). Titin isoform sizes were quantified via sodium dodecyl sulfate-vertical agarose gel electrophoresis (SDS-VAGE) analysis. We found that, at the single-fiber level, all muscles had similar material properties and titin isoform sizes. At the fiber-bundle level, however, we observed significantly increased stiffness (∼45%) in multifidus compared to longissimus and iliocostalis muscles. These data demonstrate that each muscle may have a different scaling relationship between single-fiber and fiber-bundle levels, suggesting that the structures responsible for higher order passive mechanical properties may be muscle specific. Our results suggest that divergent passive material properties are observed at size scales larger than the single cell level, highlighting the importance of the extracellular matrix in these muscles. In addition to architectural data previously reported, these data further support the unique stabilizing function of the multifidus muscle. These data will provide key input variables for biomechanical modeling of normal and pathologic lumbar spine function and direct future work in biomechanical testing in these important muscles. [Copyright &y& Elsevier]

Background: The specific training of lumbar local stabilizing muscles is one of the recent focuses in management of patients with chronic LBP. Enhanced stability of the lumbar spine segments is the mechanism for pain relief with this specific exercise. Objective: The aim of this study was to compare the effect of motor control exercises with general exercises on the lumbar local stabilizing muscles thickness, activity limitation and pain in patients with chronic low back pain (LBP). Design: A double-blind, randomized controlled trial. Methods: Forty-nine patients with chronic LBP were randomly assigned to either a motor control (n = 25) or a general exercises group (n = 24). Before and after intervention, we assessed the lumbar multifidus (LM) and Transversus abdominis (TA) muscles thickness (mm) using a 7.5 MHz B-mode transducer ultrasound, pain through visual analog scale and activity limitation through Back Performance Scale (Ordinal). A 16 session's exercise program which lasted 8 weeks, twice per week, and 30 minutes per session was performed for both groups. Results: The mean TA thickness increased from 1.87 ± 0.63 mm to 2.39 ± 0.63 mm in the motor control group and from 1.93 ± 0.49 mm to 2.22 ± 0.47 mm in the general exercise group (P < 0.0001). The mean LM thickness increased from 8.63 ± 2.37 mm to 9.69 ± 2.49 mm in the motor control group and from 8.83 ± 1.53 mm to 9.26 ± 1.56 mm in the general exercise group (P < 0.0001). The mean activity limitation decreased from 8.83 ± 3.38 to 5.42 ± 2.43 in the motor control group and from 10.67 ± 2.81 to 7.25 ± 2.73 in the general exercise group (P < 0.0001). After treatment, there was no significant difference between two groups, with the exception of pain (P > 0.05). Conclusion: The motor control and general exercises decreased pain and increased TA and LM muscles thickness and lumbar mobility in patients with chronic LBP without any signs of spinal instability. Although, the motor control exercises were more effective than general exercises in pain decreasing. [ABSTRACT FROM AUTHOR]

The aim of this review was to evaluate the effects of specific spinal stabilisation exercises in patients with low back pain (LBP). PubMed and PEDro databases were searched. Ten relevant randomised controlled trials (RCTs) with a study population of patients with acute, sub-acute or chronic LBP were reviewed and quality assessed. The intervention method should have included specific spinal stabilisation exercises including co-contraction of multifidus muscles and transversus abdominis muscles. Seven RCTs were high quality and three were low quality. The results indicate moderate evidence of improved disability and/or pain level, increased multifidi cross-sectional area, and limited evidence for improved quality of life after treatment. The outcome measures used showed extensive heterogeneity. Larger, randomised, controlled trials of high quality, in different subgroups of LBP patients, with long-term follow-up are warranted. A standardisation of outcome measures would be beneficial in order to facilitate comparability among studies. [ABSTRACT FROM AUTHOR]

Background: Paravertebral compartment syndrome occurring without trauma is quite rare. We report a case of compartment syndrome that occurred after spinal exercises.Case Presentation: A 23-year-old Japanese rower developed severe back pain and was unable to move 1 day after performing exercises for the spinal muscles. Initial evaluation at a nearby hospital revealed hematuria and elevated creatine phosphokinase levels. He was transferred to our hospital, where magnetic resonance imaging revealed no hematoma but confirmed edema in the paravertebral muscles. The compartment pressure measurements were elevated bilaterally. Despite his pain being severe, his creatine phosphokinase levels were expected to peak and decline; his urine output was normal; and surgery was undesirable. Therefore, we opted for conservative management. The next day, the patient's compartment pressure diminished, and his pain levels decreased to 2/10. After 5 days, he was able to walk without medication.Conclusions: We present a rare case of compartment syndrome of the paravertebral muscles with good resolution following conservative management. We hope our case findings will help avoid unnecessary surgery in cases of paravertebral compartment syndrome. [ABSTRACT FROM AUTHOR]

New trends in ultrasound imaging are focused on exploration of morphology and muscle quality. The main goal of the study was to evaluate the first-order descriptor and echostructure of lumbar multifidus at the L4 vertebral level in athletes with and without chronic lumbopelvic pain (CLPP). A case-control study was performed in 15 semiprofessional athletes with CLPP and 15 without (healthy athletes). Lumbar multifidus echointensity and echovariation were measured for muscle quality assessment. Echostructure was used to evaluate lumbar multifidus cross-sectional area (CSA) at resting and during muscle contraction, respective differences during both phases (CSADif.), activation patterns, and thoracolumbar fasciae morphology and thickness. Significant differences with a large effect size were observed in quantitative data from CLPP and healthy athletes for left lumbar multifidus CSADif. and thoracolumbar fasciae morphology. Categorical data showed statistically significant differences with a small-to-moderate effect size for lumbar multifidus activation pattern and thoracolumbar fasciae morphology. Athletes with CLPP showed a reduced CSA difference between lumbar multifidus contraction and at resting and higher disorganization of thoracolumbar fasciae morphology compared to healthy athletes. These findings suggest the importance of dynamic exploration of the lumbar region and connective tissue in sports performance and injury prevention. [ABSTRACT FROM AUTHOR]