Exercise and tropism of the multifidus muscle in low back pain: a short review
31 Mar 2015-Journal of Physical Therapy Science (The Society of Physical Therapy Science)-Vol. 27, Iss: 3, pp 943-945
TL;DR: A review of the literature revealed that specific supervised and home exercises may improve the symmetry of the multifidus muscle.
Abstract: [Purpose] The purpose of this review was to investigate the types of exercises that can improve the tropism of the multifidus muscles, based on clinical evidence. [Methods] Following to the PICO (Problem, Intervention, Comparison, Outcome) model, we considered studies of subjects with specific or non-specific LBP that used exercises aimed at activating the lumbar multifidus muscle and measured its cross-sectional area or thickness with ultrasound, computed tomography or magnetic resonance imaging. [Results] This review found that most studies compared different types of exercises for lumbar muscles, but without specifically investigating the multifidus muscle. However, a few studies showed that the cross-sectional area and thickness of the multifidus muscle can be increased by activating this muscle, and they progressed from motor control to increased static and dynamic loads. [Conclusion] A review of the literature revealed that specific supervised and home exercises may improve the symmetry of the multifidus muscle.
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TL;DR: Core muscle geometry correlated with pain, functional disability indices and dynamic balance in patients with chronic nonspecific mechanical LBP.
35 citations
TL;DR: This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population and suggests that the state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.
Abstract: The prevalence of low back pain (LBP) among active baseball players ranges between 3 and 15%. The execution of baseball-specific manoeuvres, such as pitching or batting, may be related to the onset of LBP. These baseball motions are complex and require appropriate activation of the core musculature to produce a well-timed motion with forces minimized at the extremities. The spine, core and back musculature are involved with acceleration and deceleration of rotational motions. This narrative review synopsizes the available evidence of the prevalence of and mechanical factors underlying LBP in the baseball population. Possible mechanical mechanisms linking baseball play to LBP include aberrant motion, improper timing, high lumbar stress due to mechanical loading and lumbopelvic strength deficits. Potential clinical implications relating to these possible mechanical mechanisms will also be highlighted. The state of the evidence suggests that there are deficits in understanding the role of baseball motion and playing history in the development of spine conditions.
27 citations
Cites background from "Exercise and tropism of the multifi..."
...With LBP, the paraspinals and multifidus are involved and show signs of atrophy and fatty infiltration (Alaranta, Tallroth, Soukka, & Heliövaara, 1993; Kader, Wardlaw, & Smith, 2000; Pillastrini et al., 2015; Wallwork, Stanton, Freke, & Hides, 2009)....
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TL;DR: The results of endurance and instability tests appear to be related to the amount of pain and the disability in nonspecific low back pain, which significantly reduces anterior and posterior core muscle endurance.
26 citations
TL;DR: In this paper, a study aimed to identify the impact of physiotherapy using complex manual therapy as a part of an integrated treatment for sequelae in the musculoskeletal system of torture survivors.
Abstract: [Purpose] This study aimed to identify the impact of physiotherapy using complex manual therapy as a part of an integrated treatment for sequelae in the musculoskeletal system of torture survivors. [Subjects] This study reviewed 30 male torture survivors presenting with chronic low back pain. They were randomly selected and divided into two groups: an experimental group and a control group. [Methods] For the experimental group, complex manual therapy was performed twice a week for 8 weeks to improve the physical sequelae of patients. Improvement was measured using the PDS-K for Post-traumatic Stress Disorder (PTSD), the Visual Analog Scale (VAS) for pain examination, the Korean Oswestry Disability Index (KODI) for back function assessment, and the Balance System SD as a dynamic balance test. The total period of the intervention for both groups was 8 weeks. [Results] For the experimental group, PDS-K, VAS, KODI, and the dynamic balance test all showed significant improvements after the intervention, which they did not for the control group. In the comparison of the groups, PDS-K, VAS, KODI, and the dynamic balance test all showed significant differences. [Conclusion] Complex manual therapy for torture survivors with chronic low back pain contributes to functional recovery by reducing back pain. The treatment can be considered to have positive effects on sequelae in the musculoskeletal system of torture survivors as they age.
19 citations
01 Jan 2016
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TL;DR: The reliability of ratings of PEDro scale items varied from "fair" to "substantial," and the reliability of the total PEDo score was "fair to "good.
Abstract: Background and Purpose. Assessment of the quality of randomized controlled trials (RCTs) is common practice in systematic reviews. However, the reliability of data obtained with most quality assessment scales has not been established. This report describes 2 studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions. Method. In the first study, 11 raters independently rated 25 RCTs randomly selected from the PEDro database. In the second study, 2 raters rated 120 RCTs randomly selected from the PEDro database, and disagreements were resolved by a third rater; this generated a set of individual rater and consensus ratings. The process was repeated by independent raters to create a second set of individual and consensus ratings. Reliability of ratings of PEDro scale items was calculated using multirater kappas, and reliability of the total (summed) score was calculated using intraclass correlation coefficients (ICC [1,1]). Results. The kappa value for each of the 11 items ranged from .36 to .80 for individual assessors and from .50 to .79 for consensus ratings generated by groups of 2 or 3 raters. The ICC for the total score was .56 (95% confidence interval=.47–.65) for ratings by individuals, and the ICC for consensus ratings was .68 (95% confidence interval=.57–.76). Discussion and Conclusion. The reliability of ratings of PEDro scale items varied from “fair” to “substantial,” and the reliability of the total PEDro score was “fair” to “good.”
3,458 citations
2,219 citations
TL;DR: A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondYLolisthesis.
Abstract: Study design A randomized, controlled trial, test--retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up. Objective To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. Summary of background data A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised. Methods Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner. Results After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up. Summary A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.
1,105 citations
TL;DR: The site of wasting in patients corresponded to the clinically determined level of symptoms in 24 of the 26 patients, but there was no correlation between the degree of asymmetry and severity of symptoms, suggesting that the mechanism of wasting was not generalized disuse atrophy or spinal reflex inhibition.
Abstract: The effect of low back pain on the size of the lumbar multifidus muscle was examined using real-time ultrasound imaging. Bilateral scans were performed in 26 patients with acute unilateral low back pain (LBP) symptoms (aged 17–46 years) and 51 normal subjects (aged 19–32 years). In all patients, mul
923 citations
TL;DR: A comparative study between unoperated CLBP patients and matched control subjects with regard to muscle cross-sectional area (CSA) and the amount of fat deposits at different levels showed that only the CSA of the multifidus and only at the lowest level was found to be statistically smaller in LBP patients.
Abstract: Increasing documentation on the size and appearance of muscles in the lumbar spine of low back pain (LBP) patients is available in the literature. However, a comparative study between unoperated chronic low back pain (CLBP) patients and matched (age, gender, physical activity, height and weight) healthy controls with regard to muscle cross-sectional area (CSA) and the amount of fat deposits at different levels has never been undertaken. Moreover, since a recent focus in the physiotherapy management of patients with LBP has been the specific training of the stabilizing muscles, there is a need for quantifying and qualifying the multifidus. A comparative study between unoperated CLBP patients and matched control subjects was conducted. Twenty-three healthy volunteers and 32 patients were studied. The muscle and fat CSAs were derived from standard computed tomography (CT) images at three different levels, using computerized image analysis techniques. The muscles studied were: the total paraspinal muscle mass, the isolated multifidus and the psoas. The results showed that only the CSA of the multifidus and only at the lowest level (lower end-plate of L4) was found to be statistically smaller in LBP patients. As regards amount of fat, in none of the three studied muscles was a significant difference found between the two groups. An aetiological relationship between atrophy of the multifidus and the occurrence of LBP can not be ruled out as a possible explanation. Alternatively, atrophy may be the consequence of LBP: after the onset of pain and possible long-loop inhibition of the multifidus a combination of reflex inhibition and substitution patterns of the trunk muscles may work together and could cause a selective atrophy of the multifidus. Since this muscle is considered important for lumbar segmental stability, the phenomenon of atrophy may be a reason for the high recurrence rate of LBP.
594 citations