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Brandt M, Danneels L, Meirezonne H, Van Oosterwijck J, Willems T, Matheve T. Clinically assessed lumbopelvic sensorimotor control tests in low back pain: are they actually valid? A systematic review according to COSMIN guidelines. Musculoskelet Sci Pract 2024; 71:102953. [PMID: 38604022 DOI: 10.1016/j.msksp.2024.102953] [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: 12/18/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Impairments in lumbopelvic sensorimotor control (SMC) are thought to be one of the underlying mechanisms for the recurrence and persistence of low back pain (LBP). As such, lumbopelvic SMC tests are frequently included in the clinical examination of patients with LBP. OBJECTIVE To evaluate convergent and known-groups validity of clinically assessed lumbopelvic SMC tests in patients with LBP according to COSMIN guidelines. DESIGN Systematic review METHODS: Five electronic databases were searched until December 2023. Studies examining convergent or known-groups validity of lumbopelvic SMC tests assessed via inspection or palpation in patients with LBP were included. Known-groups validity had to be assessed between patients with LBP and pain-free persons. Two independent researchers appraised risk of bias and quality of evidence (QoE) using the COSMIN Risk of Bias checklist and modified GRADE approach, respectively. Results for known-groups validity were reported separately for single tests and test-clusters. RESULTS Twelve studies (946 participants) were included. Three studies investigated convergent validity of three single tests. Regarding known-groups validity, six studies evaluated six single tests and four studies investigated two test-clusters. For only one test, both convergent and known-groups were assessed. The QoE for tests showing sufficient convergent or known-groups validity was (very) low, whereas QoE was moderate for single tests or test-clusters with insufficient known-groups validity. CONCLUSION All clinically assessed lumbopelvic SMC tests with sufficient convergent or known-groups validity had (very) low QoE. Therefore, test outcomes should be interpreted cautiously and strong reliance on these outcomes for clinical decision-making can currently not be recommended.
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Affiliation(s)
- Michiel Brandt
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium.
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium. https://twitter.com/DanneelsLieven
| | - Hannes Meirezonne
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium. https://twitter.com/Hmeirezo
| | - Jessica Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium; Pain in Motion International Research Group, Belgium. https://twitter.com/Jessica_V_O
| | - Tine Willems
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium
| | - Thomas Matheve
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000, Ghent, Belgium; REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, UHasselt, 3590, Diepenbeek, Belgium. https://twitter.com/ThomasMatheve
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Carayannopoulos A, Johnson D, Lee D, Giuffrida A, Poply K, Mehta V, Amann M, Santillo D, Ghandour Y, Koch A, Langhorst M, Heros R. Precision Rehabilitation After Neurostimulation Implantation for Multifidus Dysfunction in Nociceptive Mechanical Chronic Low Back Pain. Arch Rehabil Res Clin Transl 2024; 6:100333. [PMID: 39006113 PMCID: PMC11240036 DOI: 10.1016/j.arrct.2024.100333] [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] [Indexed: 07/16/2024] Open
Abstract
Chronic low back pain (CLBP) is a debilitating, painful, and costly condition. Implantable neuromuscular electrical stimulation targeting the multifidus musculature is growing as a non-pharmacologic option for patients with recalcitrant nociceptive mechanical CLBP who have failed conservative treatments (including medications and physical therapy) and for whom surgery is not indicated. Properly selecting patients who meet specific criteria (based on historical results from randomized controlled trials), who diligently adhere to implant usage and precisely implement neuromuscular rehabilitation, improve success of significant functional recovery, as well as pain medication reductions. Patients with nociceptive mechanical CLBP who underwent implanted multifidus neurostimulation have been treated by physicians and rehabilitation specialists who have honed their experience working with multifidus neurostimulation. They have collaborated on consensus and evidence-driven guidelines to improve quality outcomes and to assist providers when encountering patients with this device. Physicians and physical therapists together provide precision patient-centric medical management with quality neuromuscular rehabilitation to encourage patients to be experts of both their implants and quality spine motion to help override long-standing multifidus dysfunction related to their CLBP.
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Affiliation(s)
- Alexios Carayannopoulos
- Departments of Neurosurgery and Neurology, Brown University/Warren Alpert Medical School, Providence, RI
| | - David Johnson
- A City to Coast Neurosurgery, Brisbane, Queensland, Australia
| | - David Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA
| | - Anthony Giuffrida
- Cantor Spine Center, Paley Orthopedic & Spine Institute, Fort Lauderdale, FL
| | - Kavita Poply
- Queen Mary University of London/St. Bartholomew's Hospital/Health NHS Trust, London, UK
| | - Vivek Mehta
- St. Bartholomew's Hospital/Health NHS Trust, London, UK
| | - Marco Amann
- Orthopädische Klinik Schloss Werneck, Germany
| | | | - Yousef Ghandour
- Physical Rehabilitation Network/University of St. Augustine for Health Sciences, San Diego, CA
| | - Amy Koch
- Methodist Health System, Omaha, NE
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Tieppo Francio V, Westerhaus BD, Carayannopoulos AG, Sayed D. Multifidus dysfunction and restorative neurostimulation: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1341-1354. [PMID: 37439698 PMCID: PMC10690869 DOI: 10.1093/pm/pnad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation. METHODS A scoping review of the literature. RESULTS In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action. CONCLUSIONS Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine & Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, United States
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Benjamin D Westerhaus
- Cantor Spine Institute at the Paley Orthopedic & Spine Institute, West Palm Beach, FL 33407, United States
| | - Alexios G Carayannopoulos
- Department of Neurosurgery and Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
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Lorio M, Lewandrowski KU, Coric D, Phillips F, Shaffrey CI. International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability. Int J Spine Surg 2023; 17:728-750. [PMID: 37562978 PMCID: PMC10623686 DOI: 10.14444/8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
This International Society for the Advancement of Spine Surgery statement has been generated to respond to growing requests for background, supporting literature and evidence, and proper coding for restorative neurostimulation for chronic low back pain. Chronic low back pain describes the diverse experience of a significant proportion of the population. Conservative management of these patients remains the predominant care pathway, but for many patients, symptom relief is poor. The application of new techniques in patients who have exhausted traditional care paradigms should be undertaken with a detailed understanding of the pathology being treated, the mechanisms involved, and the data supporting efficacy. This statement on restorative neurostimulation places this technology in the context of the current understanding of the etiology of mechanical low back pain and the currently available evidence for this technique. In an appropriately selected cohort with a specific subset of chronic low back pain symptoms, this technique may provide benefit to payers and patients.
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Affiliation(s)
- Morgan Lorio
- Advanced Orthopedics, Altamonte Springs, FL, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, The Surgical Institute of Tucson, Tucson, AZ, USA
- Department of Orthopedics, Fundación Universitaria Sanitas, Bogotá, DC, Colombia
- Department of Orthopedics Hospital Universitário Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Domagoj Coric
- Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
| | - Frank Phillips
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Madle K, Svoboda P, Stribrny M, Novak J, Kolar P, Busch A, Kobesova A, Bitnar P. Abdominal wall tension increases using Dynamic Neuromuscular Stabilization principles in different postural positions. Musculoskelet Sci Pract 2022; 62:102655. [PMID: 35998419 DOI: 10.1016/j.msksp.2022.102655] [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: 03/15/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intra-abdominal pressure (IAP) is an important mechanism stabilizing the spine and trunk. IAP regulation depends on the coordination of abdominal muscles, diaphragm and pelvic floor muscles. OBJECTIVE To determine the differences in abdominal wall tension (AWT) of various postural positions, first without any correction, then after verbal and manual instructions according to Dynamic Neuromuscular Stabilization (DNS) principles. METHODS In a cross-sectional observational study, thirty healthy individuals (mean age = 22.73 ± 1.91 years) were fitted with two Ohmbelt sensors contralaterally above the inguinal ligament and in the upper lumbar triangle. AWT was measured during five postural positions: sitting, supine with legs raised, squat, bear and hang position. First, spontaneous AWT was measured, then again after manual and verbal instructions following DNS principles. RESULTS AWT increased significantly with DNS instructions compared to spontaneous activation. Both sensors recorded significant increases (p < .01; Cohen's d = -1.13 to -2.06) in all observed postural situations. The increase in activity occurred simultaneously on both sensors, with no significant differences noted in pressure increases between the sensors. The greatest activation for both sensors occurred in the bear position. Significant increases in activity were identified for both sensors in the supine leg raise position and in the bear position compared to spontaneous activation in sitting (p < .001). There were no statistically significant differences (for both sensors) between women and men in any position. CONCLUSION The amount of AWT significantly increases after verbal and manual instructions according to DNS. The greatest abdominal wall activation was achieved in the bear position.
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Affiliation(s)
- Katerina Madle
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
| | - Petr Svoboda
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Stribrny
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jakub Novak
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Andrew Busch
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, OH, USA
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Petr Bitnar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
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Soer R, Hofste A, Oosterveld FGJ, Hermens H, van Ravensberg R, Wolff AP, Groen GJ. A guide for standardized interpretation of lumbar multifidus ultrasonography; an observational study. BMC Musculoskelet Disord 2022; 23:680. [PMID: 35842637 PMCID: PMC9288015 DOI: 10.1186/s12891-022-05590-5] [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: 12/24/2021] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
Background Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography. Methods An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 μm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1. Results Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images. Conclusion The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05590-5.
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Affiliation(s)
- Remko Soer
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands. .,University of Groningen, University Medical Center Groningen, Pain Center, Groningen, The Netherlands. .,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands.
| | - Anke Hofste
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands.,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands
| | - Hermie Hermens
- Roessingh Research and Development, Telemedicine Group, Enschede, the Netherlands.,Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Ricardo van Ravensberg
- Saxion University of Applied Sciences, Research Group Smart Health, Enschede, the Netherlands
| | - André P Wolff
- University of Groningen, University Medical Center Groningen, Pain Center, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands
| | - Gerbrand J Groen
- University of Groningen, University Medical Center Groningen, Pain Center, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, The Netherlands
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Chakravarthy K, Lee D, Tram J, Sheth S, Heros R, Manion S, Patel V, Kiesel K, Ghandour Y, Gilligan C. Restorative Neurostimulation: A Clinical Guide for Therapy Adoption. J Pain Res 2022; 15:1759-1774. [PMID: 35756364 PMCID: PMC9231548 DOI: 10.2147/jpr.s364081] [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: 03/10/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
In this review, we present a comprehensive clinical approach to restorative neurostimulation, a novel form of stimulation for refractory chronic mechanical low back pain, targeting impaired neuromuscular control and degeneration of the multifidus muscle. We focus on patient identification, technique guidance, and review of the scientific background and clinical evidence. As our understanding of back pain grows, there is clear evidence that impaired neuromuscular control and consequent degeneration of the multifidus muscle contribute to mechanical low back pain development and maintenance. We provide clinical guidance regarding an implantable restorative neurostimulation system that targets impaired neuromuscular control. Supported by results from a randomized, active-sham-controlled clinical trial with long-term follow-up, we provide clinicians with a comprehensive overview and practical clinical guidance for the adoption of this therapy modality.
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Affiliation(s)
- Krishnan Chakravarthy
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - David Lee
- Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Jennifer Tram
- Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA
| | | | | | - Smith Manion
- Advent Health Pain Specialists, Merriam, KS, USA
| | - Vikas Patel
- Department of Orthopedic Surgery, University of Colorado, Denver, CO, USA
| | - Kyle Kiesel
- Department of Physical Therapy, University of Evansville, Evansville, IN, USA
| | - Yousef Ghandour
- Physical Rehabilitation Network (PRN), University of St. Augustine, San Diego, CA, USA
| | - Christopher Gilligan
- Division of Pain Medicine, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
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Huang SJ, Hsiao MC, Lee JH, Chen CM. How I do it? Full endoscopic lumbar rhizotomy for chronic facet joint pain due to failed back surgery syndrome. Acta Neurochir (Wien) 2022; 164:1233-1237. [PMID: 35031892 DOI: 10.1007/s00701-021-05042-4] [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: 10/07/2021] [Accepted: 10/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Failed back surgery syndrome (FBSS) is a general term for persistent postoperative back pain with or without accompanying radicular pain. FBSS may present as chronic facet joint pain. METHODS We introduced full endoscopic lumbar rhizotomy for patients suffering from facet joint pain due to FBSS. Facet joint block was introduced into the facet joint to determine whether pain improved after the injection. CONCLUSION With full endoscopic lumbar rhizotomy, the surgeon can identify the regions involved more clearly and directly. Although it is an invasive procedure, it provides a more effective and safe treatment for patients with FBSS-related facet joint pain.
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Conde-Vázquez O, Mohíno-Fernández C. Intra- and inter-observer concordance of a fascial standing flexion test in children. J Bodyw Mov Ther 2022; 30:95-99. [DOI: 10.1016/j.jbmt.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/08/2021] [Accepted: 02/04/2022] [Indexed: 11/25/2022]
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Hofste A, Soer R, Groen GJ, van der Palen J, Geerdink FJB, Oosterveld FGJ, Kiers H, Wolff AP, Hermens H. Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care. Musculoskelet Sci Pract 2021; 55:102429. [PMID: 34271415 DOI: 10.1016/j.msksp.2021.102429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. OBJECTIVES This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DESIGN Multicenter case control study. METHOD Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. RESULTS A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). CONCLUSIONS Trunk ROM and LM thickness show differences between LBP patients and healthy controls.
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Affiliation(s)
- Anke Hofste
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands.
| | - Remko Soer
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Gerbrand J Groen
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Frank J B Geerdink
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - André P Wolff
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Hermie Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands; Telemedicine Group, Roessingh Research and Development Enschede, the Netherlands
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Nolet PS, Yu H, Côté P, Meyer AL, Kristman VL, Sutton D, Murnaghan K, Lemeunier N. Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review. Chiropr Man Therap 2021; 29:33. [PMID: 34446040 PMCID: PMC8390263 DOI: 10.1186/s12998-021-00384-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults. METHOD We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes. RESULTS We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy. CONCLUSION Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.
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Affiliation(s)
- Paul S. Nolet
- Department of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, Ontario Canada
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario Canada
- CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine, and Life Sciences, Maastricht University, 6211 LM Maastricht, The Netherlands
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
| | | | - Vicki L. Kristman
- EPID@Work Research Institute, Department of Health Sciences, and the Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario Canada
- Institute for Work and Health, Toronto, Ontario Canada
| | - Deborah Sutton
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario Canada
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
| | - Kent Murnaghan
- Canadian Memorial Chiropractic College, Toronto, Ontario Canada
| | - Nadège Lemeunier
- Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Ontario Canada
- UMR1295, Université de Toulouse, UPS, Inserm, Toulouse, France
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Kanamoto H, Orita S, Inage K, Shiga Y, Abe K, Eguchi Y, Ohtori S. Effect of Ultrasound-Guided Hydrorelease of the Multifidus Muscle on Acute Low Back Pain. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:981-987. [PMID: 32840876 PMCID: PMC8247302 DOI: 10.1002/jum.15473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To examine improvement in acute low back pain (LBP) using ultrasound-guided hydrorelease of the multifidus muscle. METHODS This prognostic cohort study was conducted in a private clinic on samples of 75 patients with acute LBP diagnosed based on physical and imaging findings. Hydrorelease of the multifidus muscle was performed at the L4/5 level. The LBP visual analog scale (VAS) scores (cm) before and 5 minutes after hydrorelease were statistically evaluated. We defined improvement rate (%) as {LBP VAS scores (cm) immediately before hydrorelease - LBP VAS scores (cm) 5 minutes after hydrorelease} × 100 / LBP VAS scores (cm) immediately before hydrorelease and examined the correlation of the Heckmatt score and average age with the improvement rate. RESULTS LBP VAS scores (cm) before and 5 minutes after hydrorelease were 7.19 ± 1.01 (mean ± SD) and 2.85 ± 1.25, respectively (p < 0.05). No significant correlations were noted between the LBP improvement rate and the Heckmatt score or age. There were no gender variations in the improvement rate. CONCLUSIONS Ultrasound-guided hydrorelease of the multifidus muscle led to considerable LBP VAS score improvement at the outpatient level. The improvement rate showed no correlations with the Heckmatt score or age, and there were no significant gender variations in the improvement rate. Therefore, fatty degeneration of muscles and change in muscle echogenicity due to age and gender may not be associated with muscular LBP. These findings suggest that multifidus muscle hydrorelease could be useful in the diagnosis and treatment of acute LBP.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopaedic SurgeryKanamoto Orthopaedic Clinic760‐7 Matsunaga, Numazu, Shizuoka410‐0874Japan
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
| | - Sumihisa Orita
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
| | - Kazuhide Inage
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
| | - Koki Abe
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
| | - Yawara Eguchi
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
| | - Seiji Ohtori
- Department of Orthopaedic SurgeryGraduate School of Medicine, Chiba University1‐8‐1 Inohana, Chuo‐ku, Chiba260‐8670Japan
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Intramuscular EMG Versus Surface EMG of Lumbar Multifidus and Erector Spinae in Healthy Participants. Spine (Phila Pa 1976) 2020; 45:E1319-E1325. [PMID: 32796458 DOI: 10.1097/brs.0000000000003624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Clinical Assessment and Thickness Changes of the Oblique and Multifidus Muscles Using a Novel Screening Tool and Exercise Program: A Randomized Controlled Trial. J Sport Rehabil 2020; 30:384-394. [PMID: 32723925 DOI: 10.1123/jsr.2019-0156] [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: 04/15/2019] [Revised: 01/02/2020] [Accepted: 04/26/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Training and assessment of the abdominal and trunk muscles are widely used in the clinical setting. However, it is unknown what types of exercises are most effective in activation of both the global and local stabilizers in these regions. OBJECTIVE The purpose of this study was to establish the reliability of a novel clinical screening tool (sling screen) to assess the muscles of the abdomen and trunk. The second aim was to use the clinical screening tool and musculoskeletal ultrasound to compare the effects of a rotary-based exercise program that targets both the global and local muscles to the effects of a traditional exercise program on the activation of the abdominal and trunk muscles. DESIGN Double-blind, randomized controlled trial. SETTING Sports medicine facility. PARTICIPANTS AND INTERVENTIONS Thirty-one healthy participants were randomly allocated to receive a single-session rotary-based or traditional "core" exercise program. MAIN OUTCOME MEASURES The participants were assessed at the baseline and immediately postintervention. The primary outcome measures were muscle thickness examined by musculoskeletal ultrasound and clinical examination of muscle activation using a screening tool. The data were collected by blind assessors. Reliability and validity of a clinical screening tool (sling screen) were also assessed. RESULTS The analysis of the covariance tests showed a significant increase in oblique thickness for the rotary exercise group. All participants displayed a significant increase in multifidus thickness. The Wilcoxon signed-rank tests revealed a significant increase in clinical assessment scores in the rotary exercise group but not the traditional exercise group. Reliability of the sling screen ranged from moderate to good. CONCLUSION This clinical trial provides evidence that a rotary-based exercise program may be more effective in producing increases in oblique muscle thickness than traditional "core" exercises in young, healthy adults. The sling screen tool was able to identify these muscle thickness changes. Future studies should investigate how these results correlate to injury risk, other populations, and also how to implement the sling screen into clinical practice.
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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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Selhorst M, Allen M, McHugh R, MacDonald J. REHABILITATION CONSIDERATIONS FOR SPONDYLOLYSIS IN THE YOUTH ATHLETE. Int J Sports Phys Ther 2020; 15:287-300. [PMID: 32269862 PMCID: PMC7134351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
UNLABELLED Low back pain in adolescent athletes is quite common, and an isthmic spondylolysis is the most common identifiable cause. Spondylolysis, a bone stress injury of the pars interarticularis, typically presents as focal low back pain which worsens with activity, particularly with back extension movements. Research on spondylolysis has focused on diagnosis, radiographic healing, the effects of bracing, and rest from activity. Although physical therapy is frequently recommended for adolescent athletes with spondylolysis, there have been no randomized controlled trials investigating rehabilitation. Additionally, there are no detailed descriptions of physical therapy care for adolescent athletes with spondylolysis. The purpose of this clinical commentary is to provide a brief background regarding the pathology of isthmic spondylolysis and provide a detailed description of a proposed plan for physical therapy management of spondylolysis in adolescent athletes. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Mitchell Selhorst
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Michael Allen
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Robyn McHugh
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - James MacDonald
- Division of Sports Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
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17
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Ogon I, Takebayashi T, Takashima H, Morita T, Yoshimoto M, Terashima Y, Yamashita T. Quantitative Analysis Concerning Atrophy and Fat Infiltration of the Multifidus Muscle with Magnetic Resonance Spectroscopy in Chronic Low Back Pain. Spine Surg Relat Res 2019; 3:163-170. [PMID: 31435570 PMCID: PMC6690088 DOI: 10.22603/ssrr.2018-0023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Magnetic resonance spectroscopy (MRS) enables detailed analysis of the composition of muscular fat tissues such as intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs). The aim of this study was to analyze the EMCL and IMCL of the multifidus muscle (Mm) using MRS in chronic low-back pain (CLBP) patients and identify their possible correlations with age, body mass index (BMI), low-back pain (LBP) visual analog scale (VAS) score, cross-sectional area (CSA), and fat infiltration of the Mm. METHODS Eighty patients (32 men and 48 women; mean age, 64.7 ± 1.3 years; range, 22-83 years) with VAS scores >30 mm for CLBP were included. We analyzed the gender difference and the possible correlations of age, BMI, LBP VAS, CSA, and fat infiltration of the Mm with the IMCL and EMCL of the Mm. The subjects were divided into five groups as per their age range: < 40s, 50s, 60s, 70s, and 80s. We also analyzed the EMCL and IMCL of the Mm as per the fat infiltration classification. RESULTS CSA was larger in the male group, EMCL was higher in the female group, and there was no significant difference in IMCL between the female and male groups. There was a significant positive correlation of EMCL with age (r = 0.33, p < 0.01) and BMI (r = 0.42, p < 0.01) and a significant negative correlation of EMCL with CSA (r = -0.61, p < 0.01). There was a significant positive correlation between IMCL and VAS (r = 0.43, p < 0.01). The EMCL and CSA of the Mm decreased with age, whereas fat infiltration increased with age. CONCLUSIONS These results suggest that EMCL could indicate Mm degeneration associated with aging, and IMCL could be an effective objective indicator of CLBP. The EMCL and IMCL of the Mm may be useful prognostic markers in rehabilitation strategies.
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Affiliation(s)
- Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan
| | - Hiroyuki Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomonori Morita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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18
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Wattananon P, Thammajaree C. Inter-rater reliability and cross-validation of lumbar stability test. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1494210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Wattananon P, Silfies SP, Tretriluxana J, Jalayondeja W. Lumbar Multifidus and Erector Spinae Muscle Synergies in Patients with Nonspecific Low Back Pain During Prone Hip Extension: A Cross‐sectional Study. PM R 2019; 11:694-702. [DOI: 10.1002/pmrj.12002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/13/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Peemongkon Wattananon
- Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, Mahidol University, Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170 Thailand
| | - Sheri P. Silfies
- Physical Therapy & Rehabilitation Sciences Department,Drexel University Philadelphia PA
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20
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Sung W, Wong A, Pourshogi A, Pourrezaei K, Silfies S. Near infrared spectroscopy confirms recruitment of specific lumbar extensors through neuromuscular electrical stimulation. Physiother Theory Pract 2018; 36:516-523. [DOI: 10.1080/09593985.2018.1488908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Won Sung
- GSPP Penn Therapy and Fitness, Philadelphia, PA
| | - Ardy Wong
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Ahmad Pourshogi
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Rhyton Group, Tehran, Iran
| | - Kambiz Pourrezaei
- School of Biomedical Engineering Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Sheri Silfies
- College of Nursing and Health Professionals, Drexel University, Philadelphia, PA, USA
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Fritz JM, Sharpe JA, Lane E, Santillo D, Greene T, Kawchuk G. Optimizing treatment protocols for spinal manipulative therapy: study protocol for a randomized trial. Trials 2018; 19:306. [PMID: 29866131 PMCID: PMC5987587 DOI: 10.1186/s13063-018-2692-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/17/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low back pain is a common and costly condition. Spinal manipulative therapy (SMT) is a treatment supported in some guidelines, although most clinical trials examining SMT report small effect sizes. Enhancing the effects of SMT requires an understanding of underlying mechanisms and a systematic approach to leverage understanding of mechanisms to create more effective treatment protocols that are scalable in clinical practice. Prior work has identified effects on spinal stiffness and lumbar multifidus activation as possible mechanisms. This project represents a refinement phase study within the context of a multi-phase optimization strategy (MOST) framework. Our goal is to identify an optimized SMT treatment protocol by examining the impact of using co-intervention exercise strategies that are proposed to accentuate SMT mechanisms. The optimized protocol can then be evaluated in confirmation phase clinical trials and implementation studies. METHODS A phased, factorial randomized trial design will be used to evaluate the effects of three intervention components provided in eight combinations on mechanistic (spinal stiffness and multifidus muscle activation) and patient-reported outcomes (pain and disability). All participants will receive two sessions then will be randomly assigned to receive six additional sessions (or no additional treatment) over the next three weeks with factorial combinations of additional SMT and exercise co-interventions (spine mobilizing and multifidus activating). Outcome assessments occur at baseline, and one week, four weeks, and three months after enrollment. Pre-specified analyses will evaluate main effects for treatment components as well as interaction effects. DISCUSSION Building on preliminary findings identifying possible mechanisms of effects for SMT, this trial represents the next phase in a multiphase strategy towards the ultimate goal of developing an optimized protocol for providing SMT to patients with LBP. If successful, the results of this trial can be tested in future clinical trials in an effort to produce larger treatment benefits and improve patient-centered outcomes for individuals with LBP. TRIAL REGISTRATION ClinicalTrials.gov, NCT02868034 . Registered on 16 August 2016.
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Affiliation(s)
- Julie M Fritz
- College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Jason A Sharpe
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Elizabeth Lane
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Doug Santillo
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Tom Greene
- Department of Internal Medicine and Director, Population Health Research Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Gregory Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-44 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
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Takashima H, Takebayashi T, Ogon I, Yoshimoto M, Morita T, Imamura R, Nakanishi M, Nagahama H, Terashima Y, Yamashita T. Analysis of intra and extramyocellular lipids in the multifidus muscle in patients with chronic low back pain using MR spectroscopy. Br J Radiol 2018; 91:20170536. [PMID: 29227152 DOI: 10.1259/bjr.20170536] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To analyse the intra- (IMCL) and extramyocellular lipids (EMCL) concentration in the multifidus muscle (Mm) using MR spectroscopy (MRS) in patients with low back pain (LBP), and to evaluate the correlation between those lipid concentrations and age, obesity, atrophy of the Mm and LBP intensity. METHODS 60 LBP patients underwent routine diagnostic MRI of the lumbar spine before undergoing imaging for the study. Body mass index, as an indicator of obesity and visual analogue scale, as an indicator of LBP were also measured. Proton MRS was acquired with a single-voxel point-resolved spectroscopy sequence. Furthermore, the MRS volume of interest for measuring the IMCL and EMCL concentration at L4/5 for the right Mm was determined, and we measured the cross-sectional area of Mm as an indicator of muscle atrophy. RESULTS Age showed correlation with EMCL concentration (r = 0.314, p = 0.008). The body mass index showed correlation with EMCL concentration (r = 0.358, p = 0.005). The cross-sectional area of Mm showed correlation with EMCL concentration (r = -0.543, p < 0.001). Moreover, the LBP visual analogue scale showed correlation with IMCL concentration (r = 0.367, p = 0.004). CONCLUSION There were correlations between age, obesity, muscle atrophy, and EMCL concentration in Mm. IMCL concentration in Mm showed a correlation with LBP intensity. This may suggest that IMCL concentration could become an effective objective indicator of chronic LBP intensity. Advances in knowledge: We investigated the characteristics of fat content in Mm with LBP patients. This study was demonstrated the association of the IMCL and EMCL concentration in Mm with various patient parameters.
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Affiliation(s)
- Hiroyuki Takashima
- 1 Department Orthopaedic Surgery, Sapporo Medical University School of Medicine , Sapporo, Hokkaido , Japan.,2 Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital , Sapporo, Hokkaido , Japan
| | - Tsuneo Takebayashi
- 3 Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital , Sapporo, Hokkaido , Japan
| | - Izaya Ogon
- 1 Department Orthopaedic Surgery, Sapporo Medical University School of Medicine , Sapporo, Hokkaido , Japan
| | - Mitsunori Yoshimoto
- 1 Department Orthopaedic Surgery, Sapporo Medical University School of Medicine , Sapporo, Hokkaido , Japan
| | - Tomonori Morita
- 1 Department Orthopaedic Surgery, Sapporo Medical University School of Medicine , Sapporo, Hokkaido , Japan
| | - Rui Imamura
- 2 Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital , Sapporo, Hokkaido , Japan
| | - Mitsuhiro Nakanishi
- 2 Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital , Sapporo, Hokkaido , Japan
| | - Hiroshi Nagahama
- 2 Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital , Sapporo, Hokkaido , Japan
| | - Yoshinori Terashima
- 1 Department Orthopaedic Surgery, Sapporo Medical University School of Medicine , Sapporo, Hokkaido , Japan
| | - Toshihiko Yamashita
- 1 Department Orthopaedic Surgery, Sapporo Medical University School of Medicine , Sapporo, Hokkaido , Japan
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Russo M, Deckers K, Eldabe S, Kiesel K, Gilligan C, Vieceli J, Crosby P. Muscle Control and Non-specific Chronic Low Back Pain. Neuromodulation 2017; 21:1-9. [PMID: 29230905 PMCID: PMC5814909 DOI: 10.1111/ner.12738] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022]
Abstract
Objectives Chronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF). Methods This review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP. Results Imaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition. Conclusions Targeting MF control with restorative neurostimulation promises a new treatment option.
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Affiliation(s)
- Marc Russo
- Hunter Pain Clinic, Broadmeadow, NSW, Australia
| | | | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kyle Kiesel
- University of Evansville, Evansville, IN, USA
| | | | - John Vieceli
- Physioscope Pain Medicine of SA, South Australia, Australia
| | - Peter Crosby
- Mainstay Medical International plc, Dublin, Ireland
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Ogon I, Takebayashi T, Takashima H, Morita T, Yoshimoto M, Terashima Y, Yamashita T. Magnetic resonance spectroscopic analysis of multifidus muscles lipid content and association with spinopelvic malalignment in chronic low back pain. Br J Radiol 2017; 90:20160753. [PMID: 28291378 DOI: 10.1259/bjr.20160753] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To analyze intramyocellular lipids (IMCLs) and extramyocellular lipids (EMCLs) of the multifidus muscle (Mm) using MR spectroscopy in chronic low back pain (CLBP) and control groups and to identify correlations with spinopelvic alignment. METHODS 40 patients (16 males, 24 females; mean age, 62.9 ± 1.9 years) whose visual analogue scale scores were >30 mm for CLBP were included. Furthermore, 40 control participants matched with the CLBP group subjects by sample size, gender and age (17 males, 23 females; mean age, 65.0 ± 1.2 years) were included. We compared the body mass index, physical workload, leisure time physical activity level, spinopelvic parameters, and IMCLs and EMCLs of the Mm between the groups. We also evaluated possible correlations of spinopelvic parameters with IMCLs and EMCLs of the Mm in the groups. RESULTS There were no statistically significant differences in body mass index, physical workload, exercise intensity level, spinopelvic parameters and EMCLs between the groups. The IMCLs were significantly higher in the CLBP group than in the control group (p < 0.01). In the CLBP group, there was a significantly negative correlation between IMCLs and lumbar lordosis (r = -0.64, p < 0.01) and a significantly positive correlation between IMCLs and sagittal vertical axis (r = 0.43, p < 0.01). CONCLUSION The measurement of IMCLs might be a characteristic finding of CLBP as well as a precursor to spinal deformity. Advances in knowledge: IMCLs of the Mm may be a useful prognostic marker in rehabilitation strategies for patients with CLBP.
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Affiliation(s)
- Izaya Ogon
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Takashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomonori Morita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mitsunori Yoshimoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshinori Terashima
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Denteneer L, Stassijns G, De Hertogh W, Truijen S, Van Daele U. Inter- and Intrarater Reliability of Clinical Tests Associated With Functional Lumbar Segmental Instability and Motor Control Impairment in Patients With Low Back Pain: A Systematic Review. Arch Phys Med Rehabil 2016; 98:151-164.e6. [PMID: 27568883 DOI: 10.1016/j.apmr.2016.07.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To provide a comprehensive overview of clinical tests associated with functional lumbar segmental instability and motor control impairment in patients with low back pain (LBP), and to investigate their intrarater reliability, interrater reliability, or both. DATA SOURCES A systematic computerized search was conducted on December 1, 2015, in 4 different databases (starting search year is indicated in parentheses, with articles included from that year until December 1, 2015): PubMed (1972-), Web of Science (1955-), Embase (1947-), and MEDLINE (1946-). STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed during design, search, and reporting stages of this review. The included population comprised patients with primary LBP. DATA EXTRACTION Data were extracted as follows: (1) description and scoring of the clinical tests; (2) population characteristics; (3) inclusion and exclusion criteria; (4) description of the used procedures; (5) results for both intra- and interrater reliability; and eventually (6) notification on used statistical method. The risk of bias of the included articles was assessed with the use of the COnsensus-based Standards for the selection of health Measurement INstruments checklist. DATA SYNTHESIS A total of 16 records were eligible, and 30 clinical tests were identified. All included studies investigated interrater reliability, and 3 studies investigated intrarater reliability. The identified interrater reliability scores ranged from poor to very good (κ=-.09 to .89; intraclass correlation coefficient, .72-.96), and the intrarater reliability scores ranged from fair to very good (κ=.51-.86). CONCLUSIONS Three clinical tests (aberrant movement pattern, prone instability test, Beighton Scale) could be identified as having an adequate interrater reliability. No conclusions could be made for intrarater reliability. However, further research should focus on better study designs, provide an overall agreement for uniformity and interpretation of clinical tests, and should implement research regarding validity.
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Affiliation(s)
- Lenie Denteneer
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Gaetane Stassijns
- Antwerp University Hospital, Physical Medicine and Rehabilitation, Edegem, Belgium
| | - Willem De Hertogh
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ulrike Van Daele
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Baseline Examination Factors Associated With Clinical Improvement After Dry Needling in Individuals With Low Back Pain. J Orthop Sports Phys Ther 2015; 45:604-12. [PMID: 26110549 DOI: 10.2519/jospt.2015.5801] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Quasi-experimental. OBJECTIVES To explore for associations between demographic, patient history, and physical examination variables and short-term improvement in self-reported disability following dry needling therapy performed on individuals with low back pain (LBP). BACKGROUND Dry needling is an intervention used with increasing frequency in patients with LBP; however, the characteristics of patients who are most likely to respond are not known. METHODS Seventy-two volunteers with mechanical LBP participated in the study. Potential prognostic factors were collected from baseline questionnaires, patient history, and physical examination tests. Treatment consisted of dry needling to the lumbar multifidus muscles bilaterally, administered during a single treatment session. Improvement was based on percent change on the Oswestry Disability Index at 1 week. The univariate and multivariate associations between 33 potential prognostic factors and improved disability were assessed with correlation coefficients and multivariate linear regression. RESULTS Increased LBP with the multifidus lift test (rpb = 0.31, P = .01) or during passive hip flexion performed with the patient supine (rpb = 0.23, P = .06), as well as positive beliefs about acupuncture/dry needling (rho = 0.22, P = .07), demonstrated univariate associations with Oswestry Disability Index improvement. Aggravation of LBP with standing (rpb = -0.27, P = .03), presence of leg pain (rpb = -0.29, P = .02), and any perception of hypermobility in the lumbar spine (rpb = -0.21, P = .09) were associated with less improvement. The multivariate model identified 2 predictors of improved disability with dry needling: pain with the multifidus lift test and no aggravation with standing (R(2) = 0.16, P = .01). CONCLUSION Increased LBP with the multifidus lift test was the strongest predictor of improved disability after dry needling, suggesting that the finding of pain during muscle contraction should be studied in future dry needling studies. LEVEL OF EVIDENCE Prognosis, level 1b.
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Kim JS, Kang MH, Kim JW, Lee DK, Yoon TH, Oh JS. Selective Activation of Lumbar Paraspinal Muscles during Various Exercises in the Prone Position as Measured by EMG. J Phys Ther Sci 2014; 26:1223-4. [PMID: 25202185 PMCID: PMC4155224 DOI: 10.1589/jpts.26.1223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/16/2014] [Indexed: 12/03/2022] Open
Abstract
[Purpose] This study compared the effects of three exercises performed in a prone
position on the selective activation of the lumbar erector spinae (LES) and lumbar
multifidus (LM) muscles in healthy males to investigate the effective method for selective
activation of the LM. [Subjects] Twenty-two healthy males were recruited. Surface EMG data
were collected from the right LES and LM muscles during three exercises: 1) trunk
extension, 2) hip extension, and 3) the arm lift. [Results] The ratio of LM to LES EMG
activity during hip extension was higher than those during trunk extension and the arm
lift. [Conclusion] Hip extension in a prone position may be effective for selective
activation of the lumbar multifidus muscles in healthy males.
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Affiliation(s)
- Jun-Seok Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Min-Hyeok Kang
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Ji-Won Kim
- Department of Physical Therapy, Nambu University, Republic of Korea
| | - Dong-Kyu Lee
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Tae-Hyung Yoon
- Department of Occupational Therapy, Dongseo University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, INJE University Ubiquitous-healthcare & Anti-aging Research Center, Inje University, Republic of Korea
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Morphology versus function: the relationship between lumbar multifidus intramuscular adipose tissue and muscle function among patients with low back pain. Arch Phys Med Rehabil 2014; 95:1846-52. [PMID: 24814564 DOI: 10.1016/j.apmr.2014.04.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To explore the bivariate and multivariate relations between fatty degeneration of the lumbar multifidus muscle (LMM) and LMM function among patients with low back pain (LBP). DESIGN Cross-sectional clinical study. SETTING Hospital. PARTICIPANTS Patients with LBP (N=70) referred for lumbar spine magnetic resonance imaging. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES LMM morphology and function were measured at the L4/L5 and L5/S1 spinal levels bilaterally. Quantitative measures of LMM intramuscular adipose tissue (IMAT) were derived from T1-weighted magnetic resonance images. Function was assessed with ultrasound imaging by measuring change in LMM thickness during a submaximal contraction task. The study participants self-reported their level of LBP-related disability (Modified Oswestry Index), pain intensity (numerical pain rating scale), and physical activity (International Physical Activity Questionnaire). Bivariate and multivariate relations between LMM morphology and function were explored with correlational and hierarchical linear regression analyses, respectively. Additionally, we explored for possible covariates with potential to modify the relation between LMM IMAT and function. RESULTS There were 70 participants (12 women) enrolled in the study (mean age, 45.4±11.9y). A high level of physical activity was reported by 45.5% of participates. Age, sex, and physical activity level demonstrated variable relations with LMM IMAT and LMM function. There were no significant bivariate or multivariate relations between LMM IMAT and LMM function. CONCLUSIONS We observed higher levels of physical activity and LMM function and less LMM IMAT than previous studies involving patients with LBP. There was no relation between LMM morphology and function in this cohort of patients with LBP. Issues specific to LMM measurement and recommendations for future research are discussed.
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