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Zhang Y, Chen M, He Y, Guo Z, Li Y, Yu S, Liang H, Yin J, Sun P, Zhang Z, Liu C. Effect of prone trunk-extension on lumbar and lower limb muscle stiffness. Clin Anat 2024; 37:605-612. [PMID: 37489659 DOI: 10.1002/ca.24090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/15/2023] [Accepted: 06/19/2023] [Indexed: 07/26/2023]
Abstract
This study investigated the effect of the prone trunk extension test (PTE) on lumbar and lower limb muscle stiffness to explore the optimal angle for lumbar muscle training, understand the peripheral muscle force transmission effect, and determine the modulation strategy and interaction mode of different muscles during PTE. Twenty healthy young females were recruited for this study, and the stiffness of the erector spinae (ES), semitendinosus (ST), biceps femoris (BF), medial head of the gastrocnemius (MG), and lateral head of the gastrocnemius (LG) was measured by MyotonPRO under four angular PTE conditions (0° horizontal position, 10°, 20°, and 30°). With the increasing angle, the stiffness of ES decreased gradually, while ST and BF increased first and then decreased. The stiffness of MG and LG increased first, then decreased, then increased. There was a moderate to strong negative correlation between ES stiffness variation and ST (r = -0.819 to -0.728, p < 0.001), BF (r = -0.620 to -0.527, p < 0.05), MG (r = -788 to -0.611, p < 0.01), and LG (r = -0.616 to -0.450, p < 0.05). Horizontal PTE maximizes the activation of ES. There is a tension transfer between the ES, hamstrings, and gastrocnemius, mainly between the ES, ST, and LG. The study provides data to explore the effect of peripheral muscle force transmission and the modulation strategies of different muscles during trunk extension.
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Affiliation(s)
- Yuting Zhang
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mengtong Chen
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanan He
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhenzhen Guo
- Department of Health Management, Henan Key Laboratory of Chronic Disease Management, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, Henan, China
| | - Yuanchao Li
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Suiqing Yu
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hongying Liang
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Junxiao Yin
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Pengtao Sun
- Traditional Chinese Medicine Hospital of Guangdong Province, Guangzhou, Guangdong, China
| | - Zhijie Zhang
- Luoyang Orthopedic-Traumatological Hospital of Henan Province, Luoyang, Henan, China
| | - Chunlong Liu
- Clinical Medical College of Acupuncture, Moxibustion, and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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David M, Devantéry K, Nauche B, Chagnon M, Keezer M, Gaudreault N, Bureau NJ, Cloutier G. Ultrasound elastography of back muscle biomechanical properties: a systematic review and meta-analysis of current methods. Insights Imaging 2024; 15:206. [PMID: 39143409 PMCID: PMC11324641 DOI: 10.1186/s13244-024-01785-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/23/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVES To report the current elastography methods used to quantify back muscles' biomechanical characteristics in patients with musculoskeletal disorders (MSKd) and inform on their reliability, validity, and responsiveness. METHODS MEDLINE, Embase, CINAHL, Cochrane library and grey literature were consulted. Predefined criteria allowed for study selection and data extraction. The quality of evidence was rated using the COSMIN tool. Data were meta-analyzed in terms of pooled intraclass correlation coefficient (pICC) for reliability and pooled standardized mean difference (pSMD) for validity and responsiveness. Heterogeneity was assessed. RESULTS Seventy-nine studies were included in the meta-analysis (total number of participants N = 3178). Three elastography methods were identified: strain imaging (SI; number of cohorts M = 26), shear wave imaging (SWI; M = 50), and vibration sonoelastography (VSE; M = 3). Strain imaging and SWI studies reported good reliability measurement properties (pICC > 0.70) and a medium pSMD (0.58 for SI and 0.60 for SWI; p ≤ 0.020) in discriminating MSKd from controls' condition (validity). Strain imaging studies reported a medium pSMD (0.64; p = 0.005) in detecting within-group changes over time, whereas SWI pSMD was very high (1.24; p = 0.005). Only SWI reported significant but small pSMD (0.30; p = 0.003) in detecting between-group changes over time. The small number of VSE studies could not be meta-analyzed. Heterogeneity was high (I-squared > 90%; p < 0.001). CONCLUSIONS Elastography presents good reliability results and a medium pSMD in discriminating MSKd from control conditions. Responsiveness data suggest detectable changes within groups over time using SI and SWI, calling for long-term longitudinal studies. Assessing changes between groups over time using elastography still needs to be proven. Highly significant heterogeneity limits meta-analytic results. CRITICAL RELEVANCE STATEMENT While still in its early-stage exploration phase, musculoskeletal ultrasound elastography may reliably quantify back muscles' biomechanics in asymptomatic individuals, moderately discriminate back musculoskeletal disorders and detect biomechanical changes over time in these conditions, calling for long-term longitudinal studies. KEY POINTS Ultrasound elastography is reviewed for back pain and related musculoskeletal disorder assessments. Growing literature supports good reproducibility, some validity and responsiveness. Back muscle elastography considers assumptions calling for standardized protocols.
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Affiliation(s)
- Mercedes David
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, QC, H2L 2W5, Canada
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | | | | | - Miguel Chagnon
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, H2C 3J7, Canada
| | - Mark Keezer
- University of Montreal Hospital, Montreal, QC, H3X 0C1, Canada
- Department of Neurology, University of Montreal, Montreal, QC, H2C 3J7, Canada
| | | | - Nathalie J Bureau
- University of Montreal Hospital, Montreal, QC, H3X 0C1, Canada
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, QC, H2L 2W5, Canada.
- Institute of Biomedical Engineering, University of Montreal, Montreal, QC, H3C 3J7, Canada.
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, Montreal, QC, H3C 3J7, Canada.
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Deodato M, Saponaro S, Šimunič B, Martini M, Murena L, Buoite Stella A. Trunk muscles' characteristics in adolescent gymnasts with low back pain: a pilot study on the effects of a physiotherapy intervention including a postural reeducation program. J Man Manip Ther 2024; 32:310-324. [PMID: 37649443 PMCID: PMC11216269 DOI: 10.1080/10669817.2023.2252202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Trunk muscles' function and characteristics are of great importance for both static and dynamic tasks in different sports, and abnormalities of trunk flexors and extensors might be associated with low back pain (LBP). The aim of this study was to provide a comprehensive evaluation of the functional, morphological and contractile properties in trunk flexors and extensors of young gymnasts with and without LBP. METHODS Young gymnasts (14/25 females, 14-18 y) were screened for the presence of chronic LBP. Abdominal and lumbar muscles were tested for function (McGill's endurance tests), thickness (ultrasound), and contractile responses (tensiomyography). An 8-sessions physiotherapy intervention including postural reeducation was performed by a subsample of 10 subjects with LBP. RESULTS LBP was found to be associated to higher flexors-to-extensors endurance ratio (OR 11.250, 95% CI: 1.647-76.849, p = 0.014), reduced mean lumbar multifidus thickness (OR 16.500, 95% CI: 2.246-121.228, p = 0.006), and reduced mean erector spinae radial displacement (OR 16.500, 95% CI: 2.246-121.228, p = 0.006). The physiotherapy intervention was found to reduce LBP symptoms and it was associated with a significant improvement in the flexors-to-extensors ratio (p < 0.001). CONCLUSIONS This study provides preliminary evidence of functional, morphological, and contractile trunk muscles' alterations associated with chronic LBP in young gymnasts, and presents the effects of a postural reeducation program on symptoms and muscles' functional properties.
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Affiliation(s)
- Manuela Deodato
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Serena Saponaro
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Boštjan Šimunič
- Institute for Kinesiology Research, Science and Research Center of Koper, Koper, Slovenia
| | - Miriam Martini
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luigi Murena
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- Orthopaedics and Traumatology Unit, Cattinara Hospital - ASUGI, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Buoite Stella
- School of Physiotherapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Bastos de Oliveira V, Albuquerque Brandão MC, Coelho de Albuquerque Pereira W, Fernandes de Oliveira L. Lumbar multifidus layers stiffness at L5-S1 level in prone and sitting posture measured by shear wave elastography. J Back Musculoskelet Rehabil 2024:BMR230333. [PMID: 38820010 DOI: 10.3233/bmr-230333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Multifidus is an important lumbar muscle with distinct superficial and deep fibers responsible for torque production and stabilization, respectively. Its mechanical properties change when transitioning from lying to sitting positions, necessitating enhanced stability. It holds crucial clinical relevance to assess these layers separately, especially in the sitting posture, which demands increased neuromuscular control compared to the prone position. OBJECTIVE To compare lumbar multifidus stiffness in lying versus sitting postures, analyzing both superficial and deep layers. METHODS Supersonic Shear Imaging captured elastographic images from 26 asymptomatic volunteers in prone and seated positions. RESULTS Left multifidus shear modulus in lying: 5.98 ± 1.80/7.96 ± 1.59 kPa (deep/superficial) and sitting: 12.58 ± 4.22/16.04 ± 6.65 kPa. Right side lying: 6.08 ± 1.97/7.80 ± 1.76 kPa and sitting: 13.25 ± 4.61/17.95 ± 7.12 kPa. No side differences (lying p= 0.99, sitting p= 0.43). However, significant inter-postural differences occurred. CONCLUSION Lumbar multifidus exhibits increased stiffness in sitting, both layers affected, with superior stiffness in superficial versus deep fibers. Applying these findings could enhance assessing multifidus stiffness changes, for classifying tension-induced low back pain stages.
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Affiliation(s)
| | | | | | - Liliam Fernandes de Oliveira
- Programa de Engenharia Biomédica, COPPE/Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Escola de Educação Física e Desportos, Departamento de Biociência, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Haueise A, Le Sant G, Eisele-Metzger A, Dieterich AV. Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography. Clin Physiol Funct Imaging 2024; 44:187-204. [PMID: 38155545 DOI: 10.1111/cpf.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/13/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION AND AIMS Approximately 21% of the world's population suffers from musculoskeletal conditions, often associated with sensations of stiff muscles. Targeted therapy requires knowing whether typically involved muscles are objectively stiffer compared to asymptomatic individuals. Muscle stiffness is quantified using ultrasound shear wave elastography (SWE). Publications on SWE-based comparisons of muscle stiffness between individuals with and without musculoskeletal pain are increasing rapidly. This work reviewed and mapped the existing evidence regarding objectively measured muscle stiffness in musculoskeletal pain conditions and surveyed current methods of applying SWE to measure muscle stiffness. METHODS A systematic search was conducted in PubMed and CINAHL using the keywords "muscle stiffness", "shear wave elastography", "pain", "asymptomatic controls" and synonyms. The search was supplemented by a hand search using Google Scholar. Included articles were critically appraised with the AXIS tool, supplemented by items related to SWE methods. Results were visually mapped and narratively described. RESULTS Thirty of 137 identified articles were included. High-quality evidence was missing. The results comprise studies reporting lower stiffness in symptomatic participants, no differences between groups and higher stiffness in symptomatic individuals. Results differed between pain conditions and muscles, and also between studies that examined the same muscle(s) and pathology. The methods of the application of SWE were inconsistent and the reporting was often incomplete. CONCLUSIONS Existing evidence regarding the objective stiffness of muscles in musculoskeletal pain conditions is conflicting. Methodological differences may explain most of the inconsistencies between findings. Methodological standards for SWE measurements of muscles are urgently required.
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Affiliation(s)
- Andreas Haueise
- Faculty of Health, Security, Society, Furtwangen University, Furtwangen, Germany
| | - Guillaume Le Sant
- CHU Nantes, Movement-Interactions-Performance, MIP, Nantes Université, Nantes, France
- School of Physiotherapy, IFM3R, St-Sebastien/Loire, France
| | - Angelika Eisele-Metzger
- Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Angela V Dieterich
- Faculty of Health, Security, Society, Furtwangen University, Furtwangen, Germany
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Cochrane D, Leyten C. Investigating scapula positioning in individuals with non-specific lower back pain: A preliminary study. J Bodyw Mov Ther 2024; 38:47-53. [PMID: 38763595 DOI: 10.1016/j.jbmt.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Low back pain (LBP) is an economic and physically disabling burden on individuals and society. With 70% of cases classed as non-specific, there is a need for further research into the causes and consequences associated. The involvement of postural balance in musculoskeletal conditions is gaining increasing interest in research and health practice. However, there is a lack of literature surrounding LBP and posture in distal segments of the body. OBJECTIVE The current study investigated scapula positioning in those with non-specific LBP. METHODS Scapula angle of rotation, scapula protraction, and scapula elevation were assessed in nine participants with chronic non-specific LBP and compared with that of nine asymptomatic controls (aged 18-60 years). The degree of pelvic tilt was assessed across both groups as a secondary outcome measure. RESULTS No difference was identified between the two sample groups for scapula angle of rotation (p = 0.707), protraction (p = 0.755), or elevation (p = 0.691). Anterior pelvic tilt was greater in those with LBP (p = 0.046), supporting previous literature. CONCLUSION The findings for the scapula position are novel, given that research in this field is limited. It is concluded that there is no change in scapula positioning in those with non-specific LBP, but there is an increased anterior pelvic tilt.
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Affiliation(s)
- Darryl Cochrane
- School of Sport, Exercise & Nutrition, Massey University, New Zealand.
| | - Cara Leyten
- School of Sport, Exercise & Nutrition, Massey University, New Zealand
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Melo AS, Montóia B, Cruz EB, Vilas-Boas JP, Sousa AS. Scapular muscle dynamic stiffness of asymptomatic subjects and subjects with chronic shoulder pain, at rest and isometric contraction conditions. Proc Inst Mech Eng H 2024; 238:288-300. [PMID: 38403635 DOI: 10.1177/09544119241228082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Muscle stiffness had a crucial role in joint stability, particularly, at the shoulder complex. Although changes in upper trapezius muscle stiffness have been described for shoulder pain, contradictory findings have been obtained. Also, existing data regarding scapular muscles are, majorly, about trapezius. Myotonometry is a method used to assess stiffness; however, the reliability values of scapular muscle stiffness through this method have not been assessed in shoulder pain conditions. The present study aims to compare scapular muscles' stiffness (trapezius, serratus anterior, and levator scapulae) between subjects with and without chronic shoulder pain and to evaluate the related test-retest reliability. Twenty-two symptomatic and twenty-two asymptomatic subjects participated in a cross-sectional study. The dynamic muscular stiffness of scapular muscles, at rest and during an isometric contraction, was measured bilaterally with myotonometry, in two moments. The differences in bilateral averaged values between symptomatic and asymptomatic subjects and the effect of the group (group presenting pain in the dominant or non-dominant side, and asymptomatic group) and of the limb (unilateral painful or asymptomatic limb, and bilateral asymptomatic limbs) were investigated. Test-retest intra-rater reliability was determined. An effect of the group was observed at rest, for middle trapezius stiffness, and during contraction, for middle and lower trapezius stiffness. For middle trapezius, increased values were observed in the group presenting pain in non-dominant side comparing to both groups or to group presenting pain in dominant side. The intraclass correlation coefficient, majorly, ranged between 0.775 and 0.989. Participants with pain in the non-dominant side presented an increased middle trapezius' stiffness. Globally, high reliability was observed for scapular muscles dynamic stiffness.
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Affiliation(s)
- Ana Sc Melo
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
- Centro de Investigação em Actividade Física, Saúde e Lazer (CIAFEL), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro Interdisciplinar de Investigação Aplicada em Saúde (CIIAS), Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Bárbara Montóia
- Escola Superior de Saúde, Politécnico do Porto, Porto, Portugal
| | - Eduardo B Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Centro de Investigação Integrada em Saúde (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - J Paulo Vilas-Boas
- Laboratório de Biomecânica do Porto (LABIOMEP), Universidade do Porto, Porto, Portugal
- Centro de Investigação, Formação, Inovação e Intervenção em Desporto (CIFI2D), Faculdade de Desporto, Universidade do Porto, Porto, Portugal
| | - Andreia Sp Sousa
- Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto, Porto, Portugal
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Vatovec R, Voglar M. Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord 2024; 25:155. [PMID: 38373986 PMCID: PMC10875766 DOI: 10.1186/s12891-024-07241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/29/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP. METHODS We conducted a systematic review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach. RESULTS Nine studies were included in our systematic review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 - 0.81, p < 0.01; I2 = 48 %, p = 0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 - 0.62, p < 0.01; I2 = 39 %, p = 0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory. CONCLUSIONS Based on the findings of this systematic review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.
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Affiliation(s)
- Rok Vatovec
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia
| | - Matej Voglar
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia.
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Navarro-Ledesma S, Aguilar-García M, González-Muñoz A, Casas-Barragán A, Tapia-Haro RM. Association between elasticity of tissue and pain pressure threshold in the tender points present in subjects with fibromyalgia: a cross-sectional study. Sci Rep 2023; 13:22003. [PMID: 38086996 PMCID: PMC10716166 DOI: 10.1038/s41598-023-49550-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/09/2023] [Indexed: 12/18/2023] Open
Abstract
Fibromyalgia (FM) is a multicomponent illness and despite its worldwide prevalence, a complete understanding of its aetiology and pathogenesis remains unclear. The goal of the study is to analyze the level of association between elastic properties of tissue measured by strain elastography (SEL) and pain pressure threshold (PPT) in the characteristic painful points described in patients suffering from FM. This was a cross-sectional, observational study. A sample comprised of 42 subjects with FM was recruited from a private care centre. The occiput, low cervical, trapezius, supraspinatus, paraspinous, lateral pectoral, second rib, lateral epicondyle, medial epicondyle, gluteus, greater trochanter, knee, and anterior tibial PPTs were bilaterally assessed using a standard pressure algometer and elastic properties of tissue were evaluated by SEL. Linear regression analysis showed significant associations between SEL and dominant trapezius PPT (β = 0.487, 95% CI [0.045, 0.930], p = 0.032) after adjustments for the age, body mass index, and menopause status (higher SEL and higher pain sensitivity). No significant associations between SEL and the other PPTs variables were found in women diagnosed with FM. The PPT of the dominant trapezius is associated with SEL measurements in subjects suffering from FM. More studies are required to fully explain the underlying mechanisms.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
| | - María Aguilar-García
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
- Biomedicine PhD Program, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071, Granada, Spain
| | - Ana González-Muñoz
- Department of Physical Therapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Melilla, Spain
- Clinical Medicine and Public Health PhD Program, Faculty of Health Sciences, University of Granada, Av. de la Ilustración, 60, 18071, Granada, Spain
- Clinica Ana Gonzalez, Malaga, Spain
| | - Antonio Casas-Barragán
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
- Faculty of Health Sciencies, University of Granada (UGR), Ave. de la Ilustración, 60, 18016, Granada, Spain.
| | - Rosa María Tapia-Haro
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Faculty of Health Sciencies, University of Granada (UGR), Ave. de la Ilustración, 60, 18016, Granada, Spain
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10
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Tier L, Salomoni SE, Hug F, Besomi M, Hodges PW. Adaptability of the load sharing between the longissimus and components of the multifidus muscle during isometric trunk extension in healthy individuals. Eur J Appl Physiol 2023; 123:1879-1893. [PMID: 37079082 PMCID: PMC10460738 DOI: 10.1007/s00421-023-05193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Redundancy of the musculoskeletal system implies multiple strategies are theoretically available to coordinate back extensor muscles. This study investigated whether coordination between back muscles during a tightly constrained isometric trunk extension task varies within and between individuals, and whether this changes following brief exposure to activation feedback of a muscle. METHODS Nine healthy participants performed three blocks of two repetitions of ramped isometric trunk extension in side-lying against resistance from 0-30% of maximum voluntary contraction over 30 s (force feedback). Between blocks, participants repeated contractions with visual feedback of electromyography (EMG) from either superficial (SM) or deep multifidus (DM), in two conditions; 'After SM' and 'After DM'. Intramuscular EMG was recorded from SM, DM, and longissimus (LG) simultaneously with shear wave elastography (SWE) from SM or DM. RESULTS In the 'Natural' condition (force feedback only), group data showed incremental increases in EMG with force, with minor changes in distribution of activation between muscles as force increased. SM was the most active muscle during the 'Natural' condition, but with DM most active in some participants. Individual data showed that coordination between muscles differed substantially between repetitions and individuals. Brief exposure to EMG feedback altered coordination. SWE showed individual variation, but findings differed from EMG. CONCLUSION This study revealed substantial variation in coordination between back extensor muscles within and between participants, and after exposure to feedback, in a tightly constrained task. Shear modulus revealed similar variation, but with an inconsistent relationship to EMG. These data highlight highly flexible control of back muscles.
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Affiliation(s)
- Louise Tier
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia
| | - Sauro E Salomoni
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia
| | - François Hug
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia
- LAMHESS, Université Côte d'azur, Nice, France
- Institut Universitaire de France (IUF), Paris, France
| | - Manuela Besomi
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld 4072, Australia.
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11
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Opara M, Kozinc Ž. Which muscles exhibit increased stiffness in people with chronic neck pain? A systematic review with meta-analysis. Front Sports Act Living 2023; 5:1172514. [PMID: 37712006 PMCID: PMC10498279 DOI: 10.3389/fspor.2023.1172514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Chronic neck pain (CNP) substantially impacts quality of life, posing both personal challenges and economic strains. This systematic review sought to discern muscle-specific stiffness differences between CNP patients and individuals without CNP. Methods We searched the PubMed, Scopus, and PEDro databases for studies using ultrasound elastography or myotonometry to compare muscle stiffness between CNP patients and asymptomatic controls. Using a meta-analysis with a random-effects model, we derived the pooled effect as standardized mean difference (SMD). Results Out of the six studies selected, the adjusted Newcastle-Ottawa rating scale for cross-sectional studies denoted three as moderate-quality and three as high-quality. Our findings indicate that the upper trapezius (UT) stiffness was elevated in CNP patients compared to their counterparts without CNP (SMD = 0.39, 95% CI = 0.05 to 0.74; p = 0.03; small effect size). The data for other muscles remained inconclusive. Discussion Given the case-control design of all reviewed studies, a direct causative link between UT stiffness and CNP is yet to be confirmed. As such, recommending a reduction in trapezius muscle stiffness as a primary rehabilitation strategy for CNP patients is still inconclusive and further research is needed.
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Affiliation(s)
- Manca Opara
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
- Department of Health Studies, Andrej Marušič Institute, University of Primorska, Koper, Slovenia
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12
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Xie Y, Thomas L, Johnston V, Coombes BK. Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability. J Electromyogr Kinesiol 2023; 69:102754. [PMID: 36773478 DOI: 10.1016/j.jelekin.2023.102754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.
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Affiliation(s)
- Yanfei Xie
- RECOVER Injury Research Centre, The University of Queensland, Australia.
| | - Lucy Thomas
- School of Health and Rehabilitation Science, The University of Queensland, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Science, The University of Queensland, Australia; School of Health and Medical Sciences, University of Southern Queensland, Australia
| | - Brooke K Coombes
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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13
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Gasibat Q, Rani B, Čaušević D, Perveen W, Alexe CI, Albina AE, Alexe DI. A Comparative Electromyographic Analysis of Flying Squirrel and 3-Point Quadripod Exercise for Lumbar Multifidus Muscle Activations among Healthy Female Subjects. Healthcare (Basel) 2023; 11:healthcare11060833. [PMID: 36981490 PMCID: PMC10048022 DOI: 10.3390/healthcare11060833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
Physical therapists employ several exercises to alleviate low back pain (LBP). Electromyography (EMG) examination of exercises can monitor muscle activation to help clinicians determine the exercise’s effect on stabilisation, endurance, or strength. This study evaluated surface EMG activity comparison for Flying Squirrel Exercise (FSE) and the novel 3-Point Quadripod Exercise (3-PQE) to find the most effective exercise for stimulating the lumbar multifidus (LM) muscle. The study recruited 64 healthy young females (19–24 years). Raw data were normalized and are expressed as the percentage of maximum voluntary isometric contraction (%MVIC). The test–retest reliability of the EMG recordings was estimated using intraclass correlation coefficient (ICC3,1). One-way ANOVA was used to statistically analyse and compare the EMG amplitudes during the two exercises. The ICCs for 3-PQE and FSE were 0.94 (SEM, 21.7% MVIC) and 0.87 (SEM, 19.05% MVIC), respectively. The 3-PQE (69 ± 26% MVIC) demonstrated significantly higher activity than did FSE (30 ± 18% MVIC) (F = 15.573, p = 0.001). Thus, 3-PQE might be a feasible strategy for the prevention and rehabilitation of LBP in females.
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Affiliation(s)
- Qais Gasibat
- Department of Sports Studies, Universiti Putra Malaysia UPM, Selangor 43400, Malaysia
| | - Babina Rani
- Department of Physical Rehabilitation & Medicine (Physiotherapy), Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Denis Čaušević
- Faculty of Sport and Physical Education, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina
| | - Wajida Perveen
- School of Allied Health Sciences, CMH Lahore Medical College & IOD (NUMS Rawalpindi), Lahore 54810, Pakistan
| | - Cristina Ioana Alexe
- Department of Physical Education and Sports Performance, Faculty of Movement, Sports and Health Sciences, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania
- Correspondence: (C.I.A.); (A.E.A.)
| | - Alina Elena Albina
- Department of Theory and Methodology of Motor Activities, Faculty of Physical Education and Sports, University of Craiova, Alexandru Ioan Cuza nr.13, 200585 Craiova, Romania
- Correspondence: (C.I.A.); (A.E.A.)
| | - Dan Iulian Alexe
- Department of Physical and Occupational Therapy, Faculty of Movement, Sports and Health Sciences, “Vasile Alecsandri” University of Bacău, 600115 Bacău, Romania
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14
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Preliminary investigation of the effects of sitting with and without short active breaks on muscle stiffness assessed with shear-wave elastography. SPORT SCIENCES FOR HEALTH 2023. [DOI: 10.1007/s11332-023-01051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Abstract
Purpose
The purpose of this preliminary study was to compare the effects of 1-h sitting with and without short active breaks on muscle stiffness as measured by shear-wave elastography (SWE).
Methods
The participants (7 females, 3 males; age: 24.9 ± 1.2 years) completed two (with and without active breaks) 1-h sitting exposures on separate days. Active breaks (2–3 min) were performed at 20 min and 40 min time marks and comprised simple stretching and activation exercises. Before, during (30 min) and after (1 h) of sitting, shear modulus of upper trapezius, lumbar region of erector spinae and rectus femoris muscles was measured with SWE.
Results
Statistically significant effects of sitting exposure in erector spinae muscle stiffness were noted (p = 0.041; η2 = 0.38). There were no other statistically significant effects of sitting exposure or condition (with/without breaks).
Conclusions
Although few statistically significant effects were detected, the trends in this preliminary trial suggest that prolonged sitting increases muscle stiffness and warrants further investigation of short active breaks with larger sample sizes.
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15
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García-Bernal MI, González-García P, Madeleine P, Casuso-Holgado MJ, Heredia-Rizo AM. Characterization of the Structural and Mechanical Changes of the Biceps Brachii and Gastrocnemius Muscles in the Subacute and Chronic Stage after Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1405. [PMID: 36674159 PMCID: PMC9864550 DOI: 10.3390/ijerph20021405] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The objective of this study was to characterize the changes of muscle tone, stiffness, and thickness of upper and lower limb muscles in stroke survivors. Forty patients with subacute or chronic stroke and 31 controls were included and measured using myotonometry (MyotonPRO), with multiple site assessments at muscle belly (MB) and musculotendinous (MT) locations of the biceps brachii and gastrocnemius muscles. Muscle thickness (ultrasonography) was obtained for each muscle. Upper and lower limb motor performance was evaluated with the Fugl−Meyer Assessment for Upper Extremity and the Functional Ambulance Category. Overall, muscle tone and stiffness were significantly higher at MT than at MB sites. Among stroke patients, differences between the paretic and nonparetic limb were found for the biceps brachii, with lower muscle tone, stiffness, and thickness of the paretic side (all, p < 0.05). There were weak to moderate correlations between mechanical (myotonometry) and structural (ultrasound) muscular changes, regardless of the post-stroke stage. This suggests that myotonometry and ultrasonography assess similar, although different, constructs and can be combined in the clinical setting. Their discriminative ability between the paretic and nonparetic sides and between participants with and without stroke differs depending on the muscle, the functional level, and the stroke stage.
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Affiliation(s)
- María Isabel García-Bernal
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBIS), 41013 Sevilla, Spain
| | - Paula González-García
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBIS), 41013 Sevilla, Spain
| | - Pascal Madeleine
- Sport Sciences—Performance and Technology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - María Jesús Casuso-Holgado
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departmento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain
- Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, 41009 Sevilla, Spain
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16
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Tamartash H, Bahrpeyma F, Mokhtari Dizaji M. Ultrasound evidence of altered lumbar fascia in patients with low back pain. Clin Anat 2023; 36:36-41. [PMID: 36199243 DOI: 10.1002/ca.23964] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/14/2022] [Accepted: 10/01/2022] [Indexed: 12/14/2022]
Abstract
Different hypotheses have been proposed about the role of lumbar connective tissue in low back pain (LBP). However, none of the previous studies have examined the change in the elastic behavior of lumbar fascia in patients with LBP. The present study aimed to evaluate the changes in the elastic behavior of lumbar fascia in patients with chronic non-specific LBP based on ultrasound imaging. The sonographic strain imaging assessed the thoracolumbar fascia (TLF) of 131 human subjects (68 LBP and 63 non-LBP). Assessments were done at L2-L3 and L4-L5 levels bilaterally. The points were located 2 cm lateral to the midpoint of the interspinous ligament. There were no significant differences in age, sex, and BMI between LBP and healthy individuals. There is a strong inverse relationship between pain severity (r = -0.76, n = 68, p = 0.004) and the TLF elastic modulus coefficient. No significant relationship were observed between age (r = 0.053, n = 68, p = 0.600), BMI (r = -0.45, n = 68, p = 0.092), and gender (r = -0.09, n = 68, p = 0.231) with the TLF elasticity coefficient. The LBP group had a 25%-30% lower TLF elastic modulus coefficient than healthy individuals. The present study is the first to evaluate the elastic coefficient of TLF using the ultrasound imaging method. The study results showed that the TLF elastic coefficient in patients with LBP was reduced compared to healthy individuals and directly related to LBP severity.
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Affiliation(s)
- Hassan Tamartash
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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17
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Vatovec R, Kozinc Ž, Voglar M. The Effects of Isometric Fatigue on Trunk Muscle Stiffness: Implications for Shear-Wave Elastography Measurements. SENSORS (BASEL, SWITZERLAND) 2022; 22:9476. [PMID: 36502176 PMCID: PMC9735660 DOI: 10.3390/s22239476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
Muscle stiffness has been implicated as a possible factor in low back pain risk. There are few studies on the effects of isometric fatigue on the shear modulus of trunk muscles. This study aimed to investigate the effects of trunk isometric fatigue on the passive and active (during low and high-level contractions) shear moduli of the erector spinae (ES) and superficial and deep multifidus (MF) muscles. We assessed passive and active shear modulus using shear-wave elastography in healthy young participants (n = 22; 11 males, 11 females), before and after an isometric trunk extension fatigue protocol. Maximal voluntary force decreased from 771.2 ± 249.8 N before fatigue to 707.3 ± 204.1 N after fatigue (-8.64%; p = 0.003). Passive shear modulus was significantly decreased after fatigue in the MF muscle (p = 0.006-0.022; Cohen's d = 0.40-46), but not the ES muscle (p = 0.867). Active shear modulus during low-level contraction was not affected by fatigue (p = 0.697-0.701), while it was decreased during high-level contraction for both muscles (p = 0.011; d = 0.29-0.34). Sex-specific analysis indicated the decrease in ES shear modulus was significant in males (p = 0.015; d = 0.31), but not in females (p = 0.140). Conversely, the shear modulus in superficial MF had a statistically significant decrease in females (p = 0.002; d = 0.74) but not in males (p = 0.368). These results have important implications for further investigations of the mechanistic interaction between physical workloads, sex, muscle stiffness (and other variables affecting trunk stability and neuromuscular control), and the development/persistence of low back pain.
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Affiliation(s)
- Rok Vatovec
- Department of Physiotherapy, Faculty of Health Sciences, University of Primorska Polje 42, SI-6310 Izola, Slovenia
| | - Žiga Kozinc
- Department of Kinesiology, Faculty of Health Sciences, University of Primorska Polje 42, SI-6310 Izola, Slovenia
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Matej Voglar
- Department of Physiotherapy, Faculty of Health Sciences, University of Primorska Polje 42, SI-6310 Izola, Slovenia
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18
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Thomas E, Ficarra S, Nakamura M, Paoli A, Bellafiore M, Palma A, Bianco A. Effects of Different Long-Term Exercise Modalities on Tissue Stiffness. SPORTS MEDICINE - OPEN 2022; 8:71. [PMID: 35657537 PMCID: PMC9166919 DOI: 10.1186/s40798-022-00462-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022]
Abstract
AbstractStiffness is a fundamental property of living tissues, which may be modified by pathologies or traumatic events but also by nutritional, pharmacological and exercise interventions. This review aimed to understand if specific forms of exercise are able to determine specific forms of tissue stiffness adaptations. A literature search was performed on PubMed, Scopus and Web of Science databases to identify manuscripts addressing adaptations of tissue stiffness as a consequence of long-term exercise. Muscular, connective, peripheral nerve and arterial stiffness were considered for the purpose of this review. Resistance training, aerobic training, plyometric training and stretching were retrieved as exercise modalities responsible for tissue stiffness adaptations. Differences were observed related to each specific modality. When exercise was applied to pathological cohorts (i.e. tendinopathy or hypertension), stiffness changed towards a physiological condition. Exercise interventions are able to determine tissue stiffness adaptations. These should be considered for specific exercise prescriptions. Future studies should concentrate on identifying the effects of exercise on the stiffness of specific tissues in a broader spectrum of pathological populations, in which a tendency for increased stiffness is observed.
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19
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Do Psychological Factors Influence the Elastic Properties of Soft Tissue in Subjects with Fibromyalgia? A Cross-Sectional Observational Study. Biomedicines 2022; 10:biomedicines10123077. [PMID: 36551833 PMCID: PMC9775315 DOI: 10.3390/biomedicines10123077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
Nowadays, there is evidence related to the impact that psychological factors have on symptoms, specifically vegetative ones, and on the autonomic nervous system in patients with fibromyalgia (FM). However, there are no studies to correlate the level of association between psychological factors and the elastic properties of tissue in the FM population. Elastic properties of soft tissue reflect age- and disease-related changes in the mechanical functions of soft tissue, and mechanical failure has a profound impact on morbidity and mortality. The study has a cross-sectional observational design with 42 participants recruited from a private clinic and rehabilitation service. The Pain Catastrophizing Scale, Tampa Kinesiophobia Scale and Self-Efficacy Scale were used to assess psychological factors. The elastic properties of the tissue in the characteristic painful points, which patients suffering from FM described, were assessed by strain elastography. A low and significant level of association was found between pain catastrophising scale (PCS) and the non-dominant lateral epicondyle (r = -0.318; p = 0.045). Kinesiophobia was found to be related to the dominant lateral epicondyle (r = 0.403; p = 0.010), the non-dominant knee (r = -0.34; p = 0.027) and the dominant forearm (r = 0.360; p = 0.010). Self-Efficacy showed a low level of association with the non-dominant supraspinatus (r = -0.338; p = 0.033) and the non-dominant medial epicondyle (r = -0.326; p = 0.040). Psychological factors and the elastic properties of tissue seem to be associated in patients suffering from FM. The most profound association between psychological factors and non-dominant parts of the body could be related to neglect and non-use of those parts of the body.
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20
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Fortin M, Wolfe D, Dover G, Boily M. The effect of phasic versus combined neuromuscular electrical stimulation using the StimaWELL 120MTRS system on multifidus muscle morphology and function in patients with chronic low back pain: a randomized controlled trial protocol. BMC Musculoskelet Disord 2022; 23:627. [PMID: 35773711 PMCID: PMC9248109 DOI: 10.1186/s12891-022-05578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is used to improve muscle strength clinically when rehabilitating various musculoskeletal disorders. However, the effects of NMES on muscle morphology and function in individuals with non-specific chronic low back pain (CLBP) have scarcely been investigated. Although research links deficits in the paraspinal musculature with subjective reports of pain and disability, it is unknown if treatment with NMES can help reverse these deficits. Therefore, the primary aim of this study is to compare the effects of two muscle therapy protocols with a medium-frequency electrotherapy device (the StimaWELL 120MTRS system) on multifidus muscle morphology and function in CLBP patients. The secondary aims are to determine the effects of these protocols subjective reports of pain intensity, pain interference, disability, and catastrophizing. Methods A total of 30 participants with non-specific CLBP, aged 18–60, will be recruited from local orthopedic clinics and databases. Participants will be randomized (1:1) to either the phasic or combined (phasic + tonic) muscle therapy protocols on the StimaWELL 120MTRS system. Participants will undergo 20 supervised electrotherapy treatments over a 10-week period. The primary outcomes will be multifidus morphology (e.g. cross-sectional area (CSA), fat infiltration) and function (e.g., contraction measured via %thickness change from a rested to contracted state, and stiffness at rest and during contraction). Secondary outcomes will include pain intensity, interference, disability, and catastrophizing. Both primary and secondary outcomes will be obtained at baseline and at 11-weeks; secondary outcomes measured via questionnaires will also be obtained at 6-weeks, while LBP intensity will be measured before and after each treatment. Paired t-tests will be used to assess within-group changes for all primary outcome measures. A two-way repeated-measures analysis of variance will be used to assess changes in secondary outcomes over time. Discussion The results of this trial will help clarify the role of medium-frequency NMES on lumbar multifidus morphology and function. Trial Registration NCT04891692, registered retrospectively on May 18, 2021.
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Affiliation(s)
- Maryse Fortin
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada. .,PERFORM Centre, Concordia University, Montreal, QC, Canada. .,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada.
| | - Daniel Wolfe
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Geoffrey Dover
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, QC, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada
| | - Mathieu Boily
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada.,Department of Diagnostic Radiology, McGill University Health Centre, Montreal, QC, Canada
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21
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Habe T, Numano T, Nishijo H, Iwama Y, Takamoto K, Ito D, Mizuhara K, Osada K, Kanai M. Time-course of physical properties of the psoas major muscle after exercise as assessed by MR elastography. Magn Reson Imaging 2022; 92:133-139. [PMID: 35772585 DOI: 10.1016/j.mri.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 11/15/2022]
Abstract
This study aimed to analyze the time-course of the physical properties of the psoas major muscle (PM) before and after exercise using magnetic resonance elastography (MRE). Muscle stiffness is one of the important properties associated with muscle function. However, there was no research on the stiffness of the PM after exercise. In this study, we investigated time-course changes of the shear modulus of the PM after exercise. Furthermore, T2 values and apparent diffusion coefficient (ADC), as the additional information associated with muscular physical properties, were also measured simultaneously. Healthy young male volunteers were recruited in this study (n = 9) and they were required to perform a hand-to-knee isometric and unilateral exercise (left side). At each time-point before and after exercise, a set of 3 types of MR scans to measure multiple physical properties of the PM [shear modulus (MRE), T2 values, and ADC] were repeatedly taken. On day 1, a single set MR scan was taken before exercise (pre-exercise MR scan), and 6 sets MR scans were taken (5.5 to 38.0 min after exercise). After about 10-min rest (46.0 to 56.0 min after exercise), 4 sets MR scans were taken (57.5 to 77.0 min after exercise). About 10-min rest was taken again (85.0-95.0 min after exercise), 4 sets MR scans were taken (96.5 to 116.0 min after exercise). On days 2 and 7, a single set MR scan (MRE, T2 value, and ADC) was taken on each experimental day. The data were analyzed as relative changes (%) of the given parameters to the pre-exercise values. The results indicated significant decreases in PM shear modulus up to about 30 min after exercise. Then, it gradually increased and showed significant increases at about 100 min after exercise compared to that before exercise. T2 values and ADC showed significant increases up to about 65 min after exercise compared to those before exercise, and then returned to the pre-exercise values. On days 2 and 7, all values showed no significant changes compared to the pre-exercise values. This study is the first to report the time-course of the physical properties of the PM after exercise.
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Affiliation(s)
- Tetsushi Habe
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Tomokazu Numano
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; Human Technology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Ibaraki, Japan.
| | - Hisao Nishijo
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yudai Iwama
- System Emotional Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Kouichi Takamoto
- Department of Sport and Health Sciences, Faculty of Human Sciences, University of East Asia, Yamaguchi, Japan
| | - Daiki Ito
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan; Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Kazuyuki Mizuhara
- Human Technology Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Ibaraki, Japan; Department of Mechanical Engineering, Tokyo Denki University, Tokyo, Japan
| | - Kaito Osada
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Midori Kanai
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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22
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Lin M, Deng W, Liang H, Yu S, Xu Q, Liu C. Effects of Knee Joint Angle and Contraction Intensity on the Triceps Surae Stiffness. Front Bioeng Biotechnol 2022; 10:913423. [PMID: 35814017 PMCID: PMC9256962 DOI: 10.3389/fbioe.2022.913423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Monitoring the contractility of muscles assists the clinician in understanding how muscle functions as part of the kinetic system. This study investigated the effect of knee joint angles under different resistance on the stiffness of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles using the shear wave elastography (SWE) technique. Methods: A total of 22 females were recruited. During isometric plantar flexion, at knee 0-degree (fully extended) and knee 90-degree (flexed 90°), the shear modulus on the MG, LG, and SOL was measured by shear wave elastography at no contraction and two intensities (40% and 80%) of maximal voluntary contraction (MVC). Shear modulus is a mechanical parameter to describe stiffness, and stiffness is a proxy for muscle contractility. Results: There were moderate-to high-positive correlations between the active stiffness of triceps surae muscles and isometric contraction intensity (r: 0.57–0.91, p<0.001). The active stiffness in MG and LG with extended knees was higher than that with flexed knees (p<0.001). The active stiffness in SOL with flexed knee was higher than that with extended knee (p<0.001). Conclusion: Active stiffness can be considered a quantitative indicator generated by the force output of the triceps surae. Different knee joint angles cause three triceps surae muscles to exhibit non-uniform mechanical properties, which may explain part of the mechanism of soft tissue injury during physical exercise.
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Affiliation(s)
| | | | | | | | - Qin Xu
- *Correspondence: Qin Xu, ; Chunlong Liu,
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23
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Chojowski K, Strzelczyk K, Kuszewski M. Assessment of selected muscles reactivity in the lower spinal segment. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0015.8246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Lumbar spine pain is now a common affliction. In 90% of cases, the pain is of ambiguous and multicausal etiology, described as non-specific lower back pain (NLBP). Various models of this dysfunction were examined. The most popular model presents the pain as a result of an insult and secondary to changes in tension and lumbar muscles degeneration. There is no unequivocal solution concerning the cause of lumbar spine pain in the literature.
Aim of the study: To examine the differences in muscles reactivity in the lumbar region in cases who suffer from lumbar spine pain in comparison to otherwise healthy controls.
Material and methods: In total, 50 participants (24 men and 26 women) aged 18–45, including 24 people with pain, and 26 without ailments were included in the study. The visual analogue scale was used to measure pain intensity. The participants were assessed to determine the reactivity of the soft tissues of the lumbar part of the body. Selected muscles of this area were examined using a myotonometer, which shows five parameters relevant to viscoelastic tissues.
Results: There were significant differences in the level of the pain (p<0.001), hypokinesia of the left abdominal rectus (p<0.05), asymmetry indicators for the creep parameter of the erector spinalis and abdominal external oblique muscle, and the stiffness of abdominal rectus (p<0.05). No significant differences for the remaining parameters were found.
Conclusions: Tissue reactivity of selected muscles of the lumbar spine shows slight differences because of pain afflictions occurring in this area.
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Affiliation(s)
- Kacper Chojowski
- Students Scientific Association FASCYnaci, J. Kukuczka’s AWF Katowice, Poland
| | - Kamila Strzelczyk
- Students Scientific Association FASCYnaci, J. Kukuczka’s AWF Katowice, Poland
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24
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Wachi M, Jiroumaru T, Satonaka A, Ikeya M, Noguchi S, Suzuki M, Hyodo Y, Oka Y, Fujikawa T. Effects of capacitive and resistive electric transfer therapy on pain and lumbar muscle stiffness and activity in patients with chronic low back pain. J Phys Ther Sci 2022; 34:400-403. [PMID: 35527841 PMCID: PMC9057676 DOI: 10.1589/jpts.34.400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] In this study, we investigated the therapeutic effects of capacitive and
resistive electric transfer therapy in patients with chronic low back pain. [Participants
and Methods] The study included 24 patients with chronic low back pain (12 patients each
in the intervention and sham groups). Pain intensity, superficial and deep lumbar
multifidus stiffness and maximum forward trunk flexion and associated activation level of
the iliocostalis (thoracic and lumbar component) and lumbar multifidus muscles were
measured. [Results] Post-intervention pain intensity and muscle stiffness were
significantly lower than pre-intervention measurements in the intervention group. However,
no between-group difference was observed in the muscle activation level at the end-point
of standing trunk flexion. [Conclusion] Our findings highlight a significant therapeutic
benefit of capacitive and resistive electric transfer therapy in patients with chronic low
back pain and muscle stiffness.
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Affiliation(s)
- Michio Wachi
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi City, Shiga 527-0145, Japan
| | | | - Ayako Satonaka
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi City, Shiga 527-0145, Japan
| | - Masae Ikeya
- Department of Applied Biology, Kyoto Institute of Technology, Japan
| | - Shinichi Noguchi
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi City, Shiga 527-0145, Japan
| | - Mika Suzuki
- Department of Physical Therapy, Biwako Professional University of Rehabilitation: 967 Kitasaka-cho, Higashiomi City, Shiga 527-0145, Japan
| | - Yutaro Hyodo
- Department of Applied Biology, Kyoto Institute of Technology, Japan
| | - Yasumasa Oka
- Department of Applied Biology, Kyoto Institute of Technology, Japan
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25
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Pinto SM, Cheung JPY, Samartzis D, Karppinen J, Zheng YP, Pang MYC, Wong AYL. Are Morphometric and Biomechanical Characteristics of Lumbar Multifidus Related to Pain Intensity or Disability in People With Chronic Low Back Pain After Considering Psychological Factors or Insomnia? Front Psychiatry 2022; 13:809891. [PMID: 35492728 PMCID: PMC9053572 DOI: 10.3389/fpsyt.2022.809891] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Lumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP. OBJECTIVES This study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders. METHODS Seventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses. RESULTS People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP. CONCLUSION More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.
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Affiliation(s)
- Sabina M Pinto
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, United States
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Selcuk Can T, Kaniye Yilmaz B, Ozdemir S. Multifidus Muscle Stiffness in Single-level Unilateral Lumbar Disc Herniation: Comparison of Two Shear-wave Elastography Methods. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2021.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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27
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Buran Çirak Y, Yurdaişik I, Elbaşi ND, Tütüneken YE, Köçe K, Çinar B. Effect of Sustained Natural Apophyseal Glides on Stiffness of Lumbar Stabilizer Muscles in Patients With Nonspecific Low Back Pain: Randomized Controlled Trial. J Manipulative Physiol Ther 2021; 44:445-454. [PMID: 34456042 DOI: 10.1016/j.jmpt.2021.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/01/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the immediate effect of Mulligan sustained natural apophyseal glides (SNAGs) on muscular stiffness by using ultrasound shear wave elastography, pain, and function in patients with nonspecific low back pain. METHODS In a prospective, randomized, controlled, double-blinded study, 30 participants with nonspecific low back pain were randomly divided into 2 groups: a real SNAG group (aged 21.0 ± 1.7, 5 men, 10 women) and sham SNAG group (aged 20.4 ± 0.5, 4 men, 11 women). Muscular stiffness of the multifidus and erector spinal muscles with ultrasound shear wave elastography, visual analog scale, the sit and reach, flamingo balance, the functional reach, side bridge, and Biering-Sorensen tests were made before and immediately after intervention. The Oswestry Disability Index score was recorded only baseline. RESULTS After intervention, the change in visual analog scale, sit and reach, Biering-Sorensen, and side bridge tests scores were significantly different between real SNAG and sham SNAG groups (P < .05), but there was no significant difference in functional reach and flamingo balance test scores between the groups (P > .05). There was no significant difference for all measurements between pre- and post-intervention in sham SNAG group (P > .05). There was a significant reduction in muscular stiffness in the real SNAG group. But there was no change in muscular stiffness between pre- and postintervention in the sham group (P > .05). CONCLUSIONS This study demonstrated that the Mulligan SNAG technique had a positive effect on pain severity, flexibility, trunk muscle endurance, and muscle stiffness in patients with nonspecific LBP.
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Affiliation(s)
- Yasemin Buran Çirak
- Department of Physiotherapy and Rehabilitation, Istinye University, Istanbul, Turkey.
| | - Işıl Yurdaişik
- Faculty of Medicine, Istinye University, Istanbul, Turkey
| | | | - Yunus Emre Tütüneken
- Department of Physiotherapy and Rehabilitation, Istinye University, Istanbul, Turkey
| | - Kübra Köçe
- Department of Physiotherapy and Rehabilitation, Istinye University, Istanbul, Turkey
| | - Betül Çinar
- Department of Physiotherapy and Rehabilitation, Bezmialem Vakıf University, Istanbul, Turkey
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28
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Tokunaga A, Shimizu M. Age-related change in shear elastic modulus of the thoracolumbar multifidus muscle in healthy Beagle dogs using ultrasound shear wave elastography. J Vet Sci 2021; 22:e3. [PMID: 33522155 PMCID: PMC7850783 DOI: 10.4142/jvs.2021.22.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Multifidus muscle stiffness decreases in patients with lumbar intervertebral disk herniation; however, age-related changes in humans have not been reported. Objectives The reliability of ultrasound shear wave elastography in dogs, and changes in the shear elastic modulus of the thoracolumbar multifidus muscle with aging in dogs, were investigated. Methods Twelve beagle dogs were divided into 2 groups based on the age of onset of intervertebral disk herniation: young (aged not exceeding 2 years; 1.3 ± 0.6 years old, n = 5) and adult (4.9 ± 1.2 years old, n = 7). The shear elastic modulus of the multifidus muscle, from the thirteenth thoracic spine to the fourth lumbar spine, was measured using ultrasound shear wave elastography. The length, cross-sectional area and muscle to fat ratio of the multifidus muscle, and the grade of intervertebral disk degeneration, were assessed using radiographic and magnetic resonance imaging examinations. Results The length and cross-sectional area of the multifidus muscle increased caudally. In the young group, the shear elastic modulus of the multifidus muscle of the thirteenth thoracic spine was less than that of the third lumbar spine. In the adult group, the shear elastic modulus of the multifidus muscle of first and third lumbar spine was lower than that of the same site in the young group. Conclusions Ultrasound can be used to measure shear wave elastography of the thoracolumbar multifidus in dogs. If the multifidus muscle stiffness decreases, we should consider age-related change.
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Affiliation(s)
- Akari Tokunaga
- Department of Veterinary Diagnostic Imaging, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Miki Shimizu
- Department of Veterinary Diagnostic Imaging, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan.
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29
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He K, Zhou X, Zhu Y, Wang B, Fu X, Yao Q, Chen H, Wang X. Muscle elasticity is different in individuals with diastasis recti abdominis than healthy volunteers. Insights Imaging 2021; 12:87. [PMID: 34185190 PMCID: PMC8241952 DOI: 10.1186/s13244-021-01021-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
Objective To determine the value of shear wave elastography (SWE) in assessing abdominal wall muscles, including rectus abdominis (RA), external oblique muscle (EO), internal oblique muscle, and transversus abdominis (TrA) in patients with diastasis recti abdominis (DRA) and healthy controls.
Methods From October 2018 to December 2019, 36 postpartum DRA patients and 24 nulliparous healthy women were identified. Inter-rectus distance (IRD) measurements were taken by B-mode ultrasound. Shear wave speed (SWS) values were acquired by one operator at ten specific locations. Clinical and ultrasound variables, including demographics, IRD, muscle thickness, and muscle SWS, were compared between the two groups using Student’s t test or Fisher's exact test. Pearson correlation analyses were conducted for the variables of IRD, muscle thickness, and SWS in the 36 DRA patients. Results The maximum diameter of recti abdominus separation was located at the umbilicus in DRA patients (4.59 ± 1.14 cm). The SWS value was significantly lower in the RA (p = 0.003) and higher in the TrA muscle (p < 0.001) in DRA patients compared with the age-matched controls. However, SWS in both muscles (RA and TrA) showed a statistically positive correlation with IRD (p < 0.05). In addition, the SWS value in EO statistically decreased in DRA patients compared with the healthy controls (1.65 ± 0.15 vs. 1.79 ± 0.14, p = 0.001). Conclusions The application of SWE to abdominal wall muscles in DRA patients is feasible. The correlation between SWS value and IRD in RA should be interpreted with caution.
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Affiliation(s)
- Kai He
- Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Xiuling Zhou
- Department of Ultrasound, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Yulan Zhu
- Department of Rehabilitation, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Bo Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Xiaojian Fu
- Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Qiyuan Yao
- Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China
| | - Hao Chen
- Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China.
| | - Xiaohong Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, 12 Wulumuqi Road, Shanghai, 200040, China.
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30
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Sarto F, Spörri J, Fitze DP, Quinlan JI, Narici MV, Franchi MV. Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions. Sports Med 2021; 51:1151-1170. [PMID: 33683628 PMCID: PMC8124062 DOI: 10.1007/s40279-021-01436-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) imaging has been widely used in both research and clinical settings to evaluate the morphological and mechanical properties of muscle and tendon. In elite sports scenarios, a regular assessment of such properties has great potential, namely for testing the response to training, detecting athletes at higher risks of injury, screening athletes for structural abnormalities related to current or future musculoskeletal complaints, and monitoring their return to sport after a musculoskeletal injury. However, several practical and methodological aspects of US techniques should be considered when applying this technology in the elite sports context. Therefore, this narrative review aims to (1) present the principal US measures and field of applications in the context of elite sports; (2) to discuss, from a methodological perspective, the strengths and shortcomings of US imaging for the assessment of muscle and tendon properties; and (3) to provide future directions for research and application.
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Affiliation(s)
- Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel P Fitze
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonathan I Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marco V Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CIR-MYO Myology Centre, University of Padova, Padova, Italy
| | - Martino V Franchi
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
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Shear modulus of multifidus and longissimus muscles measured using shear wave elastography correlates with muscle activity, but depends on image quality. J Electromyogr Kinesiol 2020; 56:102505. [PMID: 33248369 DOI: 10.1016/j.jelekin.2020.102505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/20/2022] Open
Abstract
Shear wave elastography (SWE) estimates shear modulus in muscle. This is interpreted as an index of muscle stiffness, but depends on muscle characteristics. This study evaluated relationship between shear modulus and myoelectric activity of lumbar multifidus and longissimus muscles to assess its validity. Intramuscular electromyography (EMG) of multifidus (deep [DM], superficial [SM] fibres) at L4/5, longissimus [LG] at L2, were recorded in nine healthy participants. Participants performed isometric trunk extension in side-lying from 0 to 30% maximal voluntary contraction (MVC) with EMG amplitude feedback. Using SWE, two regions of interest (ROI) were investigated in each muscle. Generally, shear modulus was moderately correlated with root mean squared (RMS) EMG (r = 0.50-0.78). Univariate and multiple regression analyses showed ultrasound/SWE features of 'B-mode quality' (24.5%), '%Void pixels' (17.9%) and 'Connective tissue' (16.2%) explained most variation in the shear modulus/EMG relationship. Regression prediction scores generated using imaging features were correlated with r-coefficients of shear modulus/EMG relationship. When analysis was restricted to high quality data (i.e., regression prediction score above an a priori defined threshold), the shear modulus/EMG relationship increased to r = 0.70-0.96. Although a linear relationship between shear modulus/EMG was confirmed, supporting validity of SWE measures in anatomically distinct back muscles, this depends on image quality.
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Hofste A, Soer R, Hermens HJ, Wagner H, Oosterveld FGJ, Wolff AP, Groen GJ. Inconsistent descriptions of lumbar multifidus morphology: A scoping review. BMC Musculoskelet Disord 2020; 21:312. [PMID: 32429944 PMCID: PMC7236939 DOI: 10.1186/s12891-020-03257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
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.
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Affiliation(s)
- Anke Hofste
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands. .,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands.
| | - Remko Soer
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands.,Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands.,Telemedicine Group, Roessingh Research and Development, Enschede, the Netherlands
| | - Heiko Wagner
- Department of Movement Science, Institute of Sport and Exercise Sciences, Münster, Germany
| | - Frits G J Oosterveld
- Faculty of Physical Activity and Health, Saxion University of Applied Sciences, Enschede, the Netherlands
| | - André P Wolff
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
| | - Gerbrand J Groen
- Anesthesiology Pain Center, University of Groningen, University Medical Center Groningen, Location Beatrixoord, Dilgtweg 5, Haren, the Netherlands
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Mifune Y, Inui A, Nishimoto H, Kataoka T, Kurosawa T, Yamaura K, Mukohara S, Niikura T, Kokubu T, Akisue T, Kuroda R. Assessment of posterior shoulder muscle stiffness related to posterior shoulder tightness in college baseball players using shear wave elastography. J Shoulder Elbow Surg 2020; 29:571-577. [PMID: 31495703 DOI: 10.1016/j.jse.2019.05.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limitations of shoulder range of motion (ROM) have been reported to be at high risk for shoulder disorders in baseball players. In this study, we assessed posterior shoulder muscle stiffness using shear wave elastography in baseball players with and without posterior shoulder tightness. MATERIALS AND METHODS In total, 21 college baseball players volunteered to participate in this study. Passive ROMs for shoulder abduction and horizontal adduction were measured using a goniometer. Subsequently, we divided all participants into 2 groups based on the differences between bilateral shoulder ROMs: STIFF+ and STIFF- groups. Thickness and elasticity of the posterior and inferior shoulder muscles were assessed using ultrasound. RESULTS Shoulder abduction ROM on the throwing side was 114.5° ± 5.3° and 131.3° ± 5.7° in the STIFF+ and STIFF- groups, respectively, which was significantly different between the 2 groups (P = .023). Horizontal adduction ROM on the throwing side was 96.6° ± 4.9° and 110.9° ± 4.8° in the STIFF+ and STIFF- groups, respectively, which was also significantly different between the 2 groups (P = .014). The elasticity of infraspinatus and lower trapezius in the STIFF+ group was significantly greater than that in the STIFF- group (P = .018 and .033, respectively). DISCUSSION In this study, we found that the elasticity of infraspinatus and lower trapezius in stiff shoulders was significantly greater than that in nonstiff shoulders, which indicated that the infraspinatus and lower trapezius could be the key muscles in posterior shoulder tightness.
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Affiliation(s)
- Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Shin-Suma General Hospital, Kobe, Japan
| | | | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Lo WLA, Yu Q, Mao Y, Li W, Hu C, Li L. Lumbar muscles biomechanical characteristics in young people with chronic spinal pain. BMC Musculoskelet Disord 2019; 20:559. [PMID: 31759390 PMCID: PMC6875033 DOI: 10.1186/s12891-019-2935-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/07/2019] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of low back pain is rising among the young adult population. Altered lumbar muscle tone was suggested to be associated with underlying pathologies and symptoms. To date, there is minimum information available on the repeatability of lumbar spine muscle mechanical properties in the young adults who experienced low back pain. This study aimed to assess the reproducibility of mechanical properties of lumbar spinal muscle in young adults with spinal pain by myotonometer and explored the difference in reproducibility when different number of indentations was used. Methods Participants who aged between 18 to 25 and reported chronic LBP were recruited. Lumbar muscle tone (Hz) and stiffness (N/m) were assessed by myotonometer on one occasion by two assessors. Parameters were recorded by triple scans and 5-scans mode. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Bland and Altman analysis were used to assess agreement between two measurements. The relationship between muscle mechanical properties and pain score and disability level were assessed by Spearman’s rank correlation coefficient. Results The results of ICCs indicated excellent repeatability in triple scans and 5-scans mode for each lumbar level bilaterally (ICC > 0.75). SEM and SRD were smaller in triple scans than 5-scans mode for most levels. Bland and Altman analysis revealed no systematic bias. Spearman’s rank correlation analysis indicated significant high correlations between muscle tone and disability level (r = 0.80, p < 0.05), and between muscle stiffness and disability level (r = 0.81, p < 0.05). Conclusions This study found that lumbar spinal muscle tone and stiffness were repeatable parameters when measured by myotonometer. The reproducibility of muscle mechanical parameters did not appear to differ between the two scanning modes with different number of indentations. Muscle tone and stiffness measured by myotonometer may therefore be reliable as outcome measures to assess intervention induced changes. The lack of significant association between intensity of pain and mechanical properties of paraspinal muscles may suggest that muscle properties measured at rest might not be related to pain level at rest but more related to pain elicited during movement.
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Affiliation(s)
- Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yurong Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wenfeng Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Chengpeng Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China. .,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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