Changes in Muscle Thickness Across Positions on Ultrasound Imaging in Participants With or Without a History of Low Back Pain

Ultrasound Biofeedback Increases Abdominal Muscle Activation in Golfers With a History of Low Back Pain

OBJECTIVES

To compare activation ratios of the transverse abdominis (TrA) during an abdominal draw-in maneuver (ADIM) and abdominal obliques during a golf swing, with and without ultrasound biofeedback, and to determine intrarater reliability of these ultrasound thickness measures.

DESIGN

Single-session crossover study.

SETTING

Laboratory.

PARTICIPANTS

Sixteen adult golfers with 2 or more episodes of low back pain (LBP) in the past year.

INTERVENTIONS

Verbal cueing alone and verbal cueing with ultrasound biofeedback.

MAIN OUTCOME MEASURES

Bilateral TrA activation ratios were calculated during an ADIM with and without ultrasound biofeedback. Activation ratios of the abdominal obliques were calculated bilaterally during golf swings with and without ultrasound biofeedback. Intraclass correlation coefficients (ICCs) were calculated for average thickness across all muscles and conditions for the nonbiofeedback trials.

RESULTS

Transverse abdominis activation ratios were significantly higher when ultrasound biofeedback was provided bilaterally ( P < 0.001). Abdominal oblique activation ratios during the golf swing were also significantly higher with ultrasound biofeedback for the lead ( P = 0.014) and trail ( P < 0.001) sides. Intraclass correlation coefficient values ranged from 0.92 to 0.97 ( P < 0.001).

CONCLUSIONS

Ultrasound biofeedback can increase activation ratios of the TrA during a supine ADIM in adult golfers with a history of LBP. Postswing ultrasound biofeedback increases activation of the abdominal obliques during a golf swing in golfers with a history of LBP. Ultrasound thickness measures of the TrA and obliques have excellent intrarater reliability.

The automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without low back pain- A cross-sectional study

BACKGROUND

The postural control and abdominal muscles' automatic activity were found to be impaired in subjects with low back pain (LBP) during static activities. However, the studies are predominantly conducted on younger adults and a limited number of studies have evaluated abdominal muscles' automatic activity during dynamic standing activities in subjects with LBP. The present study investigated the automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without LBP.

METHODS

Twenty subjects with and 20 subjects without LBP were included. The thickness of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles was measured during rest (in supine), static, and dynamic standing postural tasks. To estimate automatic muscle activity, each muscle's thickness during a standing task was normalized to its thickness during the rest. Standing postural tasks were performed using the Biodex Balance System.

RESULTS

The mixed-model analysis of variance revealed that task dynamicity significantly affected thickness change only in the TrA muscle (P = 0.02), but the main effect for the group and the interaction were not significantly different (P > 0.05). There were no significant main effects of the group, task dynamicity, or their interaction for the IO and EO muscles (P > 0.05). During dynamic standing, only the TrA muscle in the control group showed greater thickness changes than during the static standing task (P < 0.05).

CONCLUSIONS

Standing on a dynamic level increased the automatic activity of the TrA muscle in participants without LBP compared to standing on a static level. Further research is required to investigate the effects of TrA muscle training during standing on dynamic surfaces for the treatment of older adults with LBP.

Rectus abdominis muscle thickness change and activation increase during planks performed on different surfaces

AIMS

The plank is a common exercise used to evaluate core function. Surface electromyography (sEMG) and ultrasound can be used simultaneously to measure muscle activity. We aimed to compare the %-thickness and %-activation during the plank performed on three surfaces and to determine agreement and relationship between rectus abdominis (RA) %-thickness of a rested tabletop position and %-activation normalized to quiet tabletop position during the plank on three surfaces.

METHODS

In this cross-sectional study, ultrasound and sEMG measured RA muscle function during the first 5-s and last 5-s of a plank performed on a table, yoga mat, and fitness ball. A repeated measures ANOVA compared differences in %-thickness change and Friedman's tests compared differences in %-activation, alpha set a priori p ≤ 0.05. Bland-Altman plots measured agreement between instruments. Spearman's rho determined relationships between instruments.

RESULTS

There was no difference between %-thickness change across surfaces during the first 5-s or last 5-s, or between %-activation during the last 5-s. The %-activation of the RA during the first 5-s performed on the fitness ball was higher than the table and yoga mat (p < 0.001). Ultrasound and sEMG had weak relationships across all surfaces (ρ = - 0.078 to 0.116).

CONCLUSION

The first 5-s of the plank performed on the fitness ball requires a greater RA activation. Ultrasound could not detect changes in %-thickness of the RA during the plank which may be influenced by the type of contraction. Comparison between these measurement tools during isometric exercise should be used with caution.

Functional Alterations of the Basal Ganglia Are Associated with Voluntary Activation of the Core Stabilizing Muscles in Patients with Chronic Low Back Pain: A Cross-Sectional Study

Purpose

Deficits in voluntary activation of the core stabilizing muscles are consistently observed in patients with chronic low back pain (CLBP); however, the underlying neural mechanism remains unclear. This cross-sectional study aimed at testing the hypothesis that the impaired voluntary activation of core stabilizing muscles is associated with structural and functional alterations in the basal ganglia, thalamus, and cortex in patients with CLBP.

Methods

We obtained structural and resting-state functional magnetic resonance imaging (rs-fMRI) data from 53 patients with CLBP and 67 healthy controls and estimated the alterations in grey matter volume (GMV) and functional and effective connectivity (EC) of regions with altered GMV via whole brain analysis. The voluntary activation of the multifidus (MF) and transversus abdominis (TrA) was evaluated by ultrasound imaging in these patients.

Results

Compared with the HCs, they displayed a significant decrease in GMV in the bilateral thalamus and caudate nucleus, a significant increase in GMV in the left middle frontal gyrus, and increased resting-state functional connectivity between the right caudate nucleus and the bilateral precuneus (voxel-level p < 0.005, Gaussian random field-corrected p < 0.05). The patients also showed increased EC from the right caudate nucleus to the bilateral precuneus, which was significantly correlated with voluntary activation of the bilateral MF and TrA (all p < 0.050).

Conclusions

Grey matter alterations may be confined to regions responsible for perception, motor control, and emotion regulation in patients with CLBP. The interrupted EC from the basal ganglia to the default mode network might be involved in the impairment of voluntary activation of the core stabilizing muscles.

Effects of electrical muscle stimulation on core muscle activation and physical performance in non-athletic adults: A randomized controlled trial

BACKGROUND

Electrical muscle stimulation (EMS) activates muscles through electrical currents, resulting in involuntary muscle contractions. This study aimed to evaluate the immediate clinical effects of superimposing EMS on strength training compared with conventional exercise in healthy non-athletic adults.

METHODS

This study was a randomised, controlled, parallel-group trial conducted at a single centre. Forty-one healthy young volunteers were recruited and randomised into two groups: strengthening with superimposed EMS (S+E) and strengthening (S) groups. All participants underwent the 30 minutes of strength training program, three times a week for 8 weeks, consisting of core muscle exercises. Additionally, the S+E group received EMS during training, which stimulated the bilateral abdominal, gluteus, and hip adductor muscles. As the primary outcome measure, we evaluated the changes in muscle thickness, including the abdominal, gluteal, and hip adductor muscles, using ultrasound. Muscle thickness was measured in both resting and contracted states. For secondary outcomes, physical performance (Functional Movement System score, McGill's core stability test, and hip muscle power) and body composition analysis were evaluated. All assessments were performed at the beginning and end of the intervention.

RESULTS

39 participants (S+E group = 20, S group = 19) completed the study. The clinical characteristics and baseline functional status of each group did not differ significantly between the groups. After completion of the training, the S+E group showed more efficient contraction in most of the evaluated muscles. The resting muscle thickness did not differ significantly between the groups; however, the contracted muscle thickness in the S+E group was higher than that in the S group (p < 0.05). Physical performance and body composition were not significantly different between the two groups. No intervention-related complications were reported during the study.

CONCLUSION

EMS seems to be a safe and reasonable modality for improving physical fitness in healthy individuals.

Neuromuscular Consequences of Lumbopelvic Dysfunction: Research and Clinical Perspectives

Injuries involving the lumbopelvic region (ie, lumbar spine, pelvis, hip) are common across the lifespan and include pathologies such as low back pain, femoroacetabular impingement syndrome, labrum tear, and osteoarthritis. Joint injury is known to result in an arthrogenic muscle response which contributes to muscle weakness and altered movement patterns. The purpose of this manuscript is to summarize the arthrogenic muscle response that occurs across lumbopelvic region pathologies, identify methods to quantify muscle function, and propose suggestions for future research. While each lumbopelvic region pathology is unique, there are a few common impairments and a relative consistent arthrogenic muscle response that occurs across the region. Hip muscle weakness and hip joint range of motion limitations occur with both lumbar spine and hip pathologies, and individuals with low back pain are known to demonstrate inhibition of the transversus abdominis and multifidus. Assessment of muscle inhibition is often limited to research laboratory settings, but dynamometers, ultrasound imaging, and electromyography offer clinical capacity to quantify muscle function and inform treatment pathways. Future studies should systematically determine the arthrogenic muscle response across multiple muscle groups and the timeline for changes in muscle function and determine whether disinhibitory modalities improve functional outcomes beyond traditional treatment approaches.

Altered ultrasonographic activity of abdominal muscles during breathing in males with and without nonspecific chronic low back pain

PURPOSE

This study aimed to investigate the altered ultrasonographic activity of abdominal muscles during breathing in males with and without nonspecific chronic low back pain (NSCLBP).

DESIGN

Cross-sectional study.

METHODS

Twenty males with NSCLBP and 20 males without NSCLBP were recruited. Muscle thickness change was measured by ultrasonography during breathing in the end-inspiration and end-expiration phases for the transverse abdominis (TrA), internal oblique (IO), external oblique (EO), and rectus abdominis (RA) muscles. The data were normalized to the end-inspiration thickness. An independent t test was run to analyze the data at a confidence level of 95% (p < 0.05).

RESULTS

The participants with NSCLBP had thicker IO muscles in the end-inspiration (p = 0.030) and end-expiration (p = 0.017) phases as well as greater RA (p = 0.006) and smaller EO (p = 0.003) normalized thickness changes during breathing.

CONCLUSION

The normalized thickness changes during breathing differed between the participants with and without NSCLBP. Reduced EO and increased RA activity may predispose the spine to further injuries. Therefore, normalizing the breathing pattern should be considered in the management of people with NSCLBP.

Prolonged sitting-induced back pain influences abdominal muscle thickness in a sitting but not a supine position

The current study explored whether (i) abdominal muscle thickness differed between non-painful supine and painful sitting positions and (ii) the sitting position was more reliable and useful than the supine position to discriminate between people with and without prolonged sitting-induced lower back pain (LBP). Participants with and without prolonged sitting-induced LBP participated. The thickness of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles was measured using ultrasonography in supine, usual sitting, and upright sitting positions. Analysis of variance was used to compare muscle thickness among the positions. Intraclass correlation coefficients and receiver operating characteristic curves were used to determine which position reliably identified between group. The group with LBP showed significantly greater EO muscle thickness than that without LBP only in the upright sitting position. In the group without LBP, the TrA thickness was significantly greater in the usual and upright sitting positions than in the supine position, but there was no significant difference in TrA thickness among three positions in LBP group. Only EO thickness in the upright sitting position significantly predicted prolonged sitting-induced LBP. The current study suggests that clinicians should assess abdominal activation patterns in the upright sitting rather than supine position before applying abdominal muscle motor control training for patients with prolonged sitting-induced LBP, and to distinguish between those with and without prolonged sitting-induced LBP.

Changes in abdominal muscles architecture induced by different types of breathing

BACKGROUND: The underlying morphology and behavior of abdominal muscles during breathing are still lacking in knowledge in healthy population. OBJECTIVE: To analyze the effects of three different types of breathing on the architectural characteristics of abdominal muscles. METHODS: Ninety-eight healthy subjects were measured to assess the effects of breathing on the abdominal muscles, subjects performed three different types of breathing and the muscular thickness was measured with ultrasound imaging, analyzing also the differences between sexes. RESULTS: During the three different types of breathing and in comparison with the resting state, an increase of the thickness has been reported in the transversus abdominis (p< 0.001; effect size = 2.44, very large) and internal oblique (p< 0.001; effect size = 1.04, moderate) in both sexes, but with a higher increase in men. External oblique and rectus abdominis increased their thickness through breathing only while the lips were with pursed (p< 0.05) with trivial effect sizes and only differences between sexes were found in rectus abdominis. CONCLUSIONS: All breathings activated the deepest abdominal muscles, but the most superficial were only activated with lips pursed. Moreover, men appeared to activate more the deepest abdominal muscles but also the rectus abdominis. Findings in this study support the use of different types of breathing depending on the muscle to be activated or the sex, helping health care professionals to address their interventions on the abdominal muscles with a more focused approach.

Relationship between trunk muscle strength and trunk muscle mass and thickness using bioelectrical impedance analysis and ultrasound imaging

BACKGROUND

Although trunk muscles are involved in many important functions, evaluating trunk muscle strength is not an easy task. If trunk muscle mass and thickness could be used as indicators of trunk muscle strength, the burden of measurement would be reduced, but the relationship between trunk muscle strength and trunk muscle mass and thickness has not been clarified.

OBJECTIVE

The purpose of this study was to clarify the relationship between trunk muscle strength and trunk muscle mass by bioelectrical impedance analysis and trunk muscle thickness by ultrasound imaging in healthy adults.

METHODS

One hundred and twenty-one healthy university students were included in this study. Trunk flexion/extension muscle strength and trunk muscle mass by bioelectrical impedance analysis, and trunk muscle thickness by ultrasound imaging were measured.

RESULTS

Both trunk flexion strength and trunk extension strength were significantly correlated with trunk muscle mass and oblique and rectus abdominis muscle thickness. Multiple regression analysis showed that trunk extension muscle strength had an independent relationship with trunk muscle mass.

CONCLUSIONS

This study demonstrated that trunk muscle mass or trunk muscle thickness can be used as an alternative means for evaluating trunk muscle strength, making the evaluation of trunk muscles less burdensome.

Clinical utility of ultrasonography imaging in musculoskeletal conditions: A Systematic review and Meta-analysis

Optimising ultrasonography imaging (UI) applications for clients is a highly specific and sensitive add-on method. The aim of this meta-analysis was to systematically evaluate the clinical utilisation of UI in musculoskeletal conditions by rehabilitation providers in the past decade. Two reviewers independently assessed relevant research articles from five databases electronically (Medline, Cochrane Library, EMBASE, ProQuest, EBSCO) and screened titles and abstracts based on predefined eligibility criteria (2010- 2020). A total of 147 articles were screened for eligibility by two reviewers independently, and any disagreements were resolved by another reviewer using Rayyan QCRI software. Ninety-seven duplicates were removed, and after excluding 21 studies, 16 randomized controlled trials were included and full texts retrieved. Data were synthesised using Revman 5.4 software for qualitative analysis and risk-of-bias assessment. Four similar studies were statistically analysed for heterogeneity of abdominal muscle contraction ratios. Two interventional studies were also analysed to assess the effect of feedback. The diagnostic application of UI was investigated using a consistent amount of literature, though from a rehabilitation perspective the literature is inconclusive. The clinical utility of UI in rehabilitation by physical therapists is conclusive and has potential to advance clinical practice. Further well-designed randomized controlled trials minimising selection biases will help improve the quality in this domain. Critical reflection, clinical reasoning, and mutual goal setting will help practising physical therapists to scrutinize the clinical practice more objectively.

Lumbopelvic sagittal standing posture associations with anthropometry, physical activity levels and trunk muscle endurance in healthy adults

Background

Various factors, inherited and acquired, are associated with habitual spinal postures.

Objective

The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants.

Methods

In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2-22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected.

Results

LC and SS angles correlated significantly ( r = 0 . 80 , p < 0 . 001 ). Statistically significant differences for both LC ( p = 0 . 023 ) and SS ( p = 0 . 013 ) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC ( r =- 0 . 27 , p = 0 . 004 ); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant ( r =- 0 . 17 , p = 0 . 08 ). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC-SS) in standing and the participants' body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day.

Conclusion

The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.

Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review

A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4^th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.

Reliability of Sonography Measures of the Lumbar Multifidus and Transversus Abdominis during Static and Dynamic Activities in Subjects with Non-Specific Chronic Low Back Pain

PURPOSE

The purpose of this study was to investigate the test-retest reliability of ultrasound (US) thickness measurements and the muscle contraction ratio (CR) of lumbar multifidus (LM) and transversus abdominis (TA) muscles in participants with and without nonspecific chronic low back pain (NCLBP).

METHODS

A total of 62 participants (37 with NCLBP, 25 without NCLBP) with participated in the study. The within-day and between-day reliability of US thickness measurements and CR in a lying (supine for TA and prone for LM) and sitting positions for both muscles (sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. Reliability analysis was performed with intraclass correlations (ICCs) for these two static and dynamic positions.

RESULTS

Test-retest reliability was calculated to be good to high for the static position (ICC = 0.72-0.95) and the dynamic position (ICC = 0.74-0.94) sonographic measurements in both group of TA measurement. Test-retest reliability of LM measurements was good to high for the static position (ICC = 0.82-0.95) and the dynamic position (ICC = 0.85-0.97) sonographic measurements in both groups.

CONCLUSIONS

US imaging is a highly reliable method for the assessment of TA and LM thickness muscles in the dynamic position in participants with and without NCLBP. The CR measures may be adequately reliable in assessing the function of the TA and LM muscles in participants with NCLBP and healthy ones.

Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update

PURPOSE

In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles.

METHODS

A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used.

RESULTS

For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups.

CONCLUSIONS

The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles.

Pain Catastrophizing Is Related to Static Postural Control Impairment in Patients with Nonspecific Chronic Low Back Pain: A Cross-Sectional Study

Purpose

Pain catastrophizing may contribute to the altered trunk muscle activity in patients with nonspecific chronic low back pain (NSCLBP). It is unclear if pain catastrophizing influences static postural control in patients with NSCLBP. This study aimed to investigate the relationship between pain catastrophizing and static postural control in NSCLBP patients.

Methods

Sixty-eight participants with NSCLBP and 40 healthy participants were recruited. Postural control was assessed by the sway area and the sway length of the center of pressure (COP) during balance tests. Pain catastrophizing in participants with NSCLBP was assessed by the Pain Catastrophizing Scale (PCS). Bilateral transversus abdominis (TrA) activation was evaluated by ultrasound imaging-measured percent change in muscle thickness. Associations between COP parameter and PCS/subscales of PCS were examined by multiple linear regression (MLR).

Results

Our results observed a larger COP sway area in NSCLBP group under eyes-closed condition (p < 0.001) and a lower level of voluntary activation of the bilateral TrA (p < 0.001), compared with the healthy control group. The MLR analyses revealed that the COP area sway under eyes-closed condition was significantly associated with the PCS score/helplessness score of PCS, voluntary activation of the left TrA, and age in participants with NSCLBP (β = 0.222/0.236, 0.341/0.344, and 0.328/0.325; p=0.045/0.033, 0.002, and 0.004, resp.).

Conclusions

Static postural control was associated with pain catastrophizing, voluntary activation of TrA, and age in participants with NSCLBP. This indicated that pain catastrophizing may affect postural control and should be considered when interpreting balance test results and managing NSCLBP.

Transverse abdominis activity and ultrasound biofeedback in college golfers with and without low back pain

OBJECTIVES

To compare transverse abdominis (TrA) muscle activity in college golfers with and without a history of low back pain (LBP) and examine the effects of ultrasound biofeedback and a functional golf-setup position on TrA activity.

DESIGN

Crossover study.

SETTING

Laboratory.

PARTICIPANTS

Thirty-two (n = 32) collegiate golfers were stratified into either the LBP group (n = 16, 4.6 ± 4.5 LBP episodes) or non-LBP group (n = 16, 0.1 ± 0.3 LBP episodes) based on LBP episodes in the last 6-months.

MAIN OUTCOME MEASURES

Ultrasound measures of TrA activity were performed during standard contractions and contractions with ultrasound biofeedback. Contraction-type order was randomized between two visits. Testing was performed in two positions, supine and golf-setup positions.

RESULTS

We observed no significant differences in TrA activity between the LBP and non-LBP groups. Overall, TrA activity was greater during biofeedback contractions compared to standard contractions, and TrA activity was lower in the golf-setup position compared to the supine position.

CONCLUSIONS

We observed no differences in TrA activity between college golfers with and without LBP. College golfers with and without LBP demonstrated a greater ability to contract their TrA with real-time ultrasound biofeedback and a lower ability to contract their TrA in the functional golf-setup position compared to the traditional supine position.

Automatic Characterizations of Lumbar Multifidus Muscle and Intramuscular Fat with Fuzzy C-means based Quantization from Ultrasound Images

BACKGROUND

Low Back Pain (LBP) is a common disorder involving the muscles and bones and about half of the people experience LBP at some point of their lives. Since the social economic cost and the recurrence rate over the lifetime is very high, the treatment/rehabilitation of chronic LBP is important to physiotherapists, both for clinical and research purposes. Trunk muscles such as the lumbar multifidi is important in spinal functions and intramuscular fat is also important in understanding pain control and rehabilitations. However, the analysis of such muscles and related fat require many human interventions and thus suffers from the operator subjectivity especially when the ultrasonography is used due to its cost-effectiveness and no radioactive risk.

AIMS

In this paper, we propose a fully automatic computer vision based software to compute the thickness of the lumbar multifidi muscles and to analyze intramuscular fat distribution in that area.

METHODS

The proposed system applies various image processing algorithms to enhance the intensity contrast of the image and measure the thickness of the target muscle. Intermuscular fat analysis is done by Fuzzy C-Means (FCM) clustering based quantization.

RESULTS

In experiment using 50 DICOM format ultrasound images from 50 subjects, the proposed system shows very promising result in computing the thickness of lumbar multifidi.

CONCLUSION

The proposed system have minimal discrepancy(less than 0.2 cm) from human expert for 72% (36 out of 50 cases) of the given data. Also, FCM based intramuscular fat analysis looks better than conventional histogram analysis.

Role of Ultrasound in Low Back Pain: A Review

Low back pain is one of most common musculoskeletal disorders around the world. One major problem clinicians face is the lack of objective assessment modalities. Computed tomography and magnetic resonance imaging are commonly utilized but are unable to clearly distinguish patients with low back pain from healthy patients with respect to abnormalities. The reason may be the anisotropic nature of muscles, which is altered in function, and the scans provide only structural assessment. In view of this, ultrasound may be helpful in understanding the disease as it is performed in real-time and comprises different modes that measure thickness, blood flow and stiffness. By the use of ultrasound, patients with low back pain have been found to differ from healthy patients with respect to the thickness and stiffness of the transversus abdominis, thoracolumbar fascia and multifidus. The study results are currently still not conclusive, and further study is necessary to validate. Future work should focus on quantitative assessment of these tissues to provide textural, structural, hemodynamic and mechanical studies of low back pain. This review highlights the current understanding of how medical ultrasound has been used for diagnosis and study of low back pain and discusses potential new applications.

Influence of phase of respiratory cycle on ultrasound imaging of deep abdominal muscle thickness

BACKGROUND

It is difficult to evaluate the transversus abdominis (TrA) and internal oblique (IO) due to their dual role in both trunk control and breathing.

OBJECTIVES

To investigate whether TrA and IO thickness as measured by ultrasound differs across the respiratory cycle in upright standing.

DESIGN

Observational study.

METHODS

Thickness of TrA and IO was measured with ultrasound in 67 subjects in upright standing. Measures were performed 3 times and by 2 assessors, at the end of relaxed expiration, at the end of a full inspiration, and at the end of full expiration. Differences were assessed by ANOVA. Intra- and inter-rater reliability (of a single measure and the average of 3 measures) were assessed by intra-class correlation (ICC).

RESULTS

Thickness of the TrA and IO was higher at full expiration than at the end of relaxed expiration (p < 0.001), and in turn compared to at full inspiration (p < 0.001). Intra-rater reliability was excellent at all respiratory phases (ICC 0.76-0.87). Whereas inter-rater reliability for a single measure was only fair to good for TrA (ICC 0.52-0.71) and good to excellent for IO (ICC 0.61-0.78), the inter-rater reliability of the average was excellent at all respiratory phases (ICC 0.75-0.90).

CONCLUSIONS

Thickness of TrA and IO increases when lung volume decreases. The intra- and inter-rater reliability of an average measure were excellent at the end of relaxed expiration, full inspiration and full expiration. This provides new opportunities to evaluate the deep abdominal muscles, and their role in respiration, in a physiotherapeutic setting.

Ultrasound Imaging of the Abdominal Wall and Trunk Muscles in Patients with Achilles Tendinopathy versus Healthy Participants

Purpose: To compare and quantify with ultrasound imaging (USI) the inter-recti distance (IRD), rectus abdominis (RA), external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), and multifidus thickness and the RA and multifidus cross-sectional area (CSA) between individuals with and without chronic mid-portion Achilles tendinopathy (AT). Methods: A cross-sectional study. A sample of 143 patients were recruited and divided into two groups: A group comprised of chronic mid-portion AT (n = 71) and B group composed of healthy subjects (n = 72). The IRD, RA, EO, IO, TrAb, and multifidus thickness, as well as RA and multifidus CSA, were measured by USI. Results: USI measurements for the EO (p = 0.001), IO (p = 0.001), TrAb (p = 0.041) and RA (p = 0.001) thickness were decreased as well as IRD (p = 0.001) and multifidus thickness (p = 0.001) and CSA (p = 0.001) were increased for the tendinopathy group with respect the healthy group. Linear regression prediction models (R² = 0.260 − 0.494; p < 0.05) for the IRD, RA, EO, and IO thickness (R² = 0.494), as well as multifidus CSA and thickness were determined by weight, height, BMI and AT presence. Conclusions: EO, IO, TrAb, and RA thickness was reduced and IRD, multifidus thickness and CSA were increased in patients with AT.

The Back College for nurses - an evaluation of intermediate effects

BACKGROUND

Nursing staff and care workers run an increased risk of work related musculoskeletal disorders such as low back pain. The Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) offers its insured persons the opportunity to participate in a three-week Back College with the aim of preventing them having to abandon their profession due to back problems. The aim of the study was to record the effectiveness and sustainability of the Back College on an intermediate basis (6 months).

METHODS

As part of a single-group pre-post measurement on three survey dates - at the start (T0) and end (T1) of rehabilitation and 6 months later (T2) - in 2013 all participants in the Back College at three locations were surveyed using a standard questionnaire. Wilcoxon signed-rank tests were performed to evaluate statistically significant changes.

RESULTS

For measurement dates T0 to T2 we had 570 complete datasets (response rate 70.81%). There was a significant decrease in reported back pain and the general state of health and quality of life index improved. Participants' emotional strain decreased and they showed an improved understanding of illness as well as of having acquired knowledge-based abilities and skills for dealing with the disease. After training, they recorded back-friendly behaviour in everyday life and opportunities to relieve strain on the spinal column were utilised at work more often. Participants' subjective assessment of their ability to work (Work Ability Index) improved.

CONCLUSION

The present study proved the intermediate effectiveness of the Back College curriculum. Whether these effects remain stable in the long term will be tested on the subsequent measurement date (T3, after 24 months).