4 research outputs found
The assessment of paraspinal muscle epimuscular fat in participants with and without low back pain: A case-control study
Get PDFIt remains unclear whether paraspinal muscle fatty infiltration in low back pain (LBP) is i) solely intramuscular, ii) is lying outside the epimysium between the muscle and fascial plane (epimuscular) or iii) or combination of both, as imaging studies often use different segmentation protocols that are not thoroughly described. Epimuscular fat possibly disturbs force generation of paraspinal muscles, but is seldomly explored. This project aimed to 1) compare epimuscular fat in participants with and without chronic LBP, and 2) determine whether epimuscular fat is different across lumbar spinal levels and associated with BMI, age, sex and LBP status, duration or intensity. Fat and water lumbosacral MRIs of 50 chronic LBP participants and 41 healthy controls were used. The presence and extent of epimuscular fat for the paraspinal muscle group (erector spinae and multifidus) was assessed using a qualitative score (0–5 scale; 0 = no epimuscular fat and 5 = epimuscular fat present along the entire muscle) and quantitative manual segmentation method. Chi-squared tests evaluated associations between qualitative epimuscular fat ratings and LBP status at each lumbar level. Bivariate and partial spearman’s rho correlation assessed relationships between quantitative and qualitative epimuscular fat with participants’ characteristics. Epimuscular fat was more frequent at the L4-L5 (X2 = 13.781, p = 0.017) and L5-S1 level (X2 = 27.825, p < 0.001) in participants with LBP compared to controls, which was not found for the higher lumbar levels. The total qualitative score (combined from all levels) showed a significant positive correlation with BMI, age, sex (female) and LBP status (r = 0.23–0.55; p < 0.05). Similarly, the total area of epimuscular fat (quantitative measure) was significantly correlated with BMI, age and LBP status (r = 0.26–0.57; p < 0.05). No correlations were found between epimuscular fat and LBP duration or intensity. Paraspinal muscle epimuscular fat is more common in chronic LBP patients. The functional implications of epimuscular fat should be further explored
Effects of Combined Motor Control and Isolated Lumbar Strengthening Exercises on Multifidus Muscle Morphology, Function, and Physical Disability in Chronic Low Back Pain
Get PDFIntroduction
Low back pain (LBP) is the leading cause of disability and a major public health concern. Literature generally supports the effectiveness of exercise therapy for the treatment of chronic non-specific LBP, but there have only been modest effects. Considerable evidence suggests a link between lumbar multifidus degenerative changes and functional deficits. Recent preliminary evidence suggests that motor control and targeted lumbar extensor strength training may lead to hypertrophy and reduce fatty infiltration, however the optimal exercise intervention for reversing these changes is unknown.
Objectives
To study the effects of combined motor control and extensor strengthening on multifidus morphology and function, and to determine how physiological changes relate to pain, function, and psychological factors.
Participants
The study included 25 participants aged 18 to 65 with moderate-to-severe chronic non-specific LBP.
Intervention
Participants completed a 12-week supervised motor control and isolated lumbar extension intervention at a frequency of two times per week.
Measures
Primary: multifidus morphology
Secondary: multifidus function, lumbar extensor strength, pain, self-reported outcomes
Results
There were significant increases in the paraspinal CSA at L4-5 and L5-S1 between all timepoints and significant decreases in %fat fraction of multifidus and erector spinae at L5-S1 between baseline and both 6 and 12-weeks. There were significant increases in multifidus thickness and lumbar extensor strength between all timepoints.
Conclusion
Our results suggest that an intervention combining motor control and isolated lumbar extensor training has the potential to be successful in improving a large variety of outcomes, both physiological and clinical, in patients with chronic LBP
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Comparison of paraspinal muscle composition measurements using IDEAL fat–water and T2-weighted MR images
No full textPurposeThe purpose of this study was to evaluate the agreement between paraspinal muscle composition measurements obtained from fat-water images using % fat-signal fraction (%FSF) in comparison to those obtained from T2-weighted magnetic resonance images (MRI) using a thresholding method.MethodsA sample of 35 subjects (19 females, 16 males; 40.26 ± 11.3 years old) was selected from a cohort of patients with chronic low back pain (LBP). Axial T2-weighted and IDEAL (Lava-Flex, 2 echo sequence) fat and water MR images were obtained using a 3.0 Tesla GE scanner. Multifidus, erector spinae, and psoas major muscle composition measurements were acquired bilaterally at L4-L5 and L5-S1 using both imaging sequences and related measurement methods. All measurements were obtained by the same rater, with a minimum of 7 days between each method. Intra-class correlation coefficients (ICCs) were calculated to assess intra-rater reliability. Pearson Correlation and Bland-Altman 95% limits of agreement were used to assess the agreement between both measurement methods.ResultsThe intra-rater reliability was excellent for all measurements with ICCs varying between 0.851 and 0.997. Strong positive correlations indicating a strong relationship between composition measurements were obtained from fat-water and T2-weighted images for bilateral multifidus and erector spinae muscles at both spinal levels and the right psoas major muscle at L4-L5, with correlation coefficient r ranging between 0.67 and 0.92. Bland-Altman plots for bilateral multifidus and erector spinae muscles at both levels revealed excellent agreement between the two methods, however, systematic differences between both methods were evident for psoas major fat measurements.ConclusionOur findings suggest that utilizing fat-water and T2-weighted MR images are comparable for quantifying multifidus and erector spinae muscle composition but not of the psoas major. While this suggests that both methods could be used interchangeably for the multifidus and erector spinae, further evaluation is required to expand and confirm our findings to other spinal levels
The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial
No full textLow back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability
