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Journal ArticleDOI

Lumbar multifidus muscle thickness does not predict patients with low back pain who improve with trunk stabilization exercises.

TL;DR: LM-muscle activation does not appear to be a clinical feature that predicts patients with LBP likely to benefit from stabilization exercises, and no relation was found between LM-Muscle activation and the number of clinical features.
About: This article is published in Archives of Physical Medicine and Rehabilitation.The article was published on 2013-06-01 and is currently open access. It has received 23 citations till now. The article focuses on the topics: Multifidus muscle & Low back pain.
Citations
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01 Jan 2008
TL;DR: In this article, the intraexaminer and interexaminer reliability of rehabilitation ultrasound imaging (RUSI) in obtaining thickness measurements of the transversus abdominis (TrA) and lumbar multifidus muscles at rest and during contractions was evaluated.
Abstract: OBJECTIVES To evaluate the intraexaminer and interexaminer reliability of rehabilitative ultrasound imaging (RUSI) in obtaining thickness measurements of the transversus abdominis (TrA) and lumbar multifidus muscles at rest and during contractions. DESIGN Single-group repeated-measures reliability study. SETTING University and orthopedic physical therapy clinic. PARTICIPANTS A volunteer sample of adults (N=30) with current nonspecific low back pain (LBP) was examined by 2 clinicians with minimal RUSI experience. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Thickness measurements of the TrA and lumbar multifidus muscles at rest and during contractions were obtained by using RUSI during 2 sessions 1 to 3 days apart. Percent thickness change was calculated as thickness(contracted)-thickness(rest)/thickness(rest). Intraclass correlation coefficients (ICC) were used to estimate reliability. RESULTS By using the mean of 2 measures, intraexaminer reliability point estimates (ICC(3,2)) ranged from 0.96 to 0.99 for same-day comparisons and from 0.87 to 0.98 for between-day comparisons. Interexaminer reliability estimates (ICC(2,2)) ranged from 0.88 to 0.94 for within-day comparisons and from 0.80 to 0.92 for between-day comparisons. Reliability estimates comparing measurements by the 2 examiners of the same image (ICC(2,2)) ranged from 0.96 to 0.98. Reliability estimates were lower for percent thickness change measures than the corresponding single thickness measures for all conditions. CONCLUSIONS RUSI thickness measurements of the TrA and lumbar multifidus muscles in patients with LBP, when based on the mean of 2 measures, are highly reliable when taken by a single examiner and adequately reliable when taken by different examiners.

234 citations

Journal ArticleDOI
TL;DR: Chronic low back pain is the most prevalent of the painful musculoskeletal conditions, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness).
Abstract: Objectives Chronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non-specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF). Methods This review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP. Results Imaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition. Conclusions Targeting MF control with restorative neurostimulation promises a new treatment option.

104 citations


Cites background from "Lumbar multifidus muscle thickness ..."

  • ...which CLBP patients will benefit from stabilization exercises (85)....

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  • ...The concept of core stability has both its proponents (96) and its critics (85,97) with strongly held views on both sides and much controversy (98)....

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Journal ArticleDOI
01 Dec 2013-Pain
TL;DR: There is conflicting evidence regarding the ability of baseline morphometry of transversus abdominis and lumbar multifidus to predict clinical outcomes of conservatively treated patients with nonspecific low back pain.
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.

63 citations


Cites background or methods from "Lumbar multifidus muscle thickness ..."

  • ...Three included articles investigated TrA [19,59,85] and 2 included studies examined LM (Table 3) [22,102]....

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  • ...The automatic LM contraction during 2 types of contralateral arm lifting task was measured by B-mode USI [22,102]....

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  • ...Of these articles, one evaluated the treatment effect modification of TrA dynamic morphometry [19] and the rest investigated the prognostic ability of TrA/LM dynamic morphometry [22,59,85,102]....

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  • ...The participants of the included studies were recruited from hospitals, physiotherapy and general practice clinics, and community-based advertisements [19,22,59,85,102]....

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  • ...Four of 5 included articles investigated patients with chronic LBP [19,59,85,102]....

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Journal ArticleDOI
TL;DR: It is highlighted that changes in morphometry or activation of transversus abdominis following conservative treatments tend not to be associated with the corresponding changes in clinical outcomes, and the relation between posttreatment changes in characteristics of lumbar multifidus and clinical improvements remains uncertain.

60 citations

Journal ArticleDOI
TL;DR: Patients with clinical identification of trunk MCIs demonstrated decreased trunk motor control, suggesting that impairments in proprioception, motor output, or central processing occur early in the back pain episode.

47 citations


Cites background from "Lumbar multifidus muscle thickness ..."

  • ...However, in some cases, 4 interventions that were successful in improving pain and function did not affect these motor control 5 variables [8-10]....

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References
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Journal ArticleDOI
TL;DR: The conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems is presented, which includes the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals, and directs the active subsystem to provide the needed stability.
Abstract: Presented here is the conceptual basis for the assertion that the spinal stabilizing system consists of three subsystems The vertebrae, discs, and ligaments constitute the passive subsystem All muscles and tendons surrounding the spinal column that can apply forces to the spinal column constitute the active subsystem The nerves and central nervous system comprise the neural subsystem, which determines the requirements for spinal stability by monitoring the various transducer signals, and directs the active subsystem to provide the needed stability A dysfunction of a component of any one of the subsystems may lead to one or more of the following three possibilities: (a) an immediate response from other subsystems to successfully compensate, (b) a long-term adaptation response of one or more subsystems, and (c) an injury to one or more components of any subsystem It is conceptualized that the first response results in normal function, the second results in normal function but with an altered spinal stabilizing system, and the third leads to overall system dysfunction, producing, for example, low back pain In situations where additional loads or complex postures are anticipated, the neural control unit may alter the muscle recruitment strategy, with the temporary goal of enhancing the spine stability beyond the normal requirements

2,001 citations

Journal ArticleDOI
TL;DR: The neutral zone appears to be a clinically important measure of spinal stability function and may increase with injury to the spinal column or with weakness of the muscles, which in turn may result in spinal instability or a low-back problem.
Abstract: SummaryThe neutral zone is a region of intervertebral motion around the neutral posture where little resistance is offered by the passive spinal column Several studies—in vitro cadaveric, in vivo animal, and mathematical simulations—have shown that the neutral zone is a parameter that correlates we

1,527 citations

Journal ArticleDOI
01 Dec 1996-Spine
TL;DR: Multifidus muscle recovery is not spontaneous on remission of painful symptoms, and lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.
Abstract: Study Design. A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain and unilateral, segmental inhibition of the multifidus muscle. Patients were allocated randomly to a control or treatment group. Objectives. To document the natural course of lumbar multifidus recovery and to evaluate the effectiveness of specific, localized, exercise therapy on muscle recovery. Summary of Background Data. Acute low back pain usually resolves spontaneously, but the recurrence rate is high. Inhibition of multifidus occurs with acute, first-episode, low back pain, and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms. Methods. Patients in group 1 received medical treatment only. Patients in group 2 received medical treatment and specific, localized, exercise therapy. Outcome measures for both groups included 4 weekly assessments of pain, disability, range of motion, and size of the multifidus cross-sectional area. Independent examiners were blinded to group allocation. Patients were reassessed at a 10-week follow-up examination. Results. Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1. Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy (P = 0.0001). Other outcome measurements were similar for the two groups at the 4-week examination. Although they resumed normal levels of activity, patients in group 1 still had decreased multifidus muscle size at the 10-week follow-up examination. Conclusions. Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.

1,089 citations

Journal ArticleDOI
TL;DR: The validity of a global rating of change as a reflection of meaningful change in patient status was supported by the stability of the Physical Impairment Index across the study period in patients defined as stable by the global rating and by the decrease in physical impairment across thestudy period.
Abstract: Background and Purpose. The quality of a disability scale should dictate when it is used. The purposes of this study were to examine the validity of a global rating of change as a reflection of meaningful change in patient status and to compare the measurement properties of a modified Oswestry Low Back Pain Disability Questionnaire (OSW) and the Quebec Back Pain Disability Scale (QUE). Subjects. Sixty-seven patients with acute, work-related low back pain referred for physical therapy participated in the study. Methods. The 2 scales were administered initially and after 4 weeks of physical therapy. The Physical Impairment Index, a measure of physical impairment due to low back pain, was measured initially and after 2 and 4 weeks. A global rating of change survey instrument was completed by each subject after 4 weeks. Results. An interaction existed between patients defined as improved or stable based on the global rating using a 2-way analysis of variance for repeated measures on the impairment index. The modified OSW showed higher levels of test-retest reliability and responsiveness compared with the QUE. The minimum clinically important difference, defined as the amount of change that best distinguishes between patients who have improved and those remaining stable, was approximately 6 points for the modified OSW and approximately 15 points for the QUE. Conclusion and Discussion. The construct validity of the global rating of change was supported by the stability of the Physical Impairment Index across the study period in patients defined as stable by the global rating and by the decrease in physical impairment across the study period in patients defined as improved by the global rating. The modified OSW demonstrated superior measurement properties compared with the QUE.

911 citations

Journal ArticleDOI
01 Jun 2001-Spine
TL;DR: Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences thanmedical management and normal activity alone.
Abstract: Study Design. A randomized clinical trial with 1-year and 3-year telephone questionnaire follow-ups. Objective. To report a specific exercise intervention’s long-term effects on recurrence rates in acute, first-episode low back pain patients. Summary of Background Data. The pain and disability associated with an initial episode of acute low back pain (LBP) is known to resolve spontaneously in the short-term in the majority of cases. However, the recurrence rate is high, and recurrent disabling episodes remain one of the most costly problems in LBP. A deficit in the multifidus muscle has been identified in acute LBP patients, and does not resolve spontaneously on resolution of painful symptoms and resumption of normal activity. Any relation between this deficit and recurrence rate was investigated in the long-term. Methods. Thirty-nine patients with acute, first-episode LBP were medically managed and randomly allocated to either a control group or specific exercise group. Medical management included advice and use of medications. Intervention consisted of exercises aimed at rehabilitating the multifidus in cocontraction with the transversus abdominis muscle. One year and three years after treatment, telephone questionnaires were conducted with patients. Results. Questionnaire results revealed that patients from the specific exercise group experienced fewer recurrences of LBP than patients from the control group. One year after treatment, specific exercise group recurrence was 30%, and control group recurrence was 84% (P , 0.001). Two to three years after treatment, specific exercise group recurrence was 35%, and control group recurrence was 75% (P , 0.01). Conclusion. Long-term results suggest that specific exercise therapy in addition to medical management and resumption of normal activity may be more effective in reducing low back pain recurrences than medical management and normal activity alone. [Key Words: multifidus, low back pain, rehabilitation]

838 citations