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Rosenstein B, Burdick J, Roussac A, Rye M, Naghdi N, Valentin S, Licka T, Sean M, Tétreault P, Elliott J, Fortin M. The assessment of paraspinal muscle epimuscular fat in participants with and without low back pain: A case-control study. J Biomech 2024; 163:111928. [PMID: 38280825 DOI: 10.1016/j.jbiomech.2024.111928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/29/2024]
Abstract
It remains unclear whether paraspinal muscle fatty infiltration in low back pain (LBP) is i) solely intramuscular, ii) is lying outside the epimysium between the muscle and fascial plane (epimuscular) or iii) or combination of both, as imaging studies often use different segmentation protocols that are not thoroughly described. Epimuscular fat possibly disturbs force generation of paraspinal muscles, but is seldomly explored. This project aimed to 1) compare epimuscular fat in participants with and without chronic LBP, and 2) determine whether epimuscular fat is different across lumbar spinal levels and associated with BMI, age, sex and LBP status, duration or intensity. Fat and water lumbosacral MRIs of 50 chronic LBP participants and 41 healthy controls were used. The presence and extent of epimuscular fat for the paraspinal muscle group (erector spinae and multifidus) was assessed using a qualitative score (0-5 scale; 0 = no epimuscular fat and 5 = epimuscular fat present along the entire muscle) and quantitative manual segmentation method. Chi-squared tests evaluated associations between qualitative epimuscular fat ratings and LBP status at each lumbar level. Bivariate and partial spearman's rho correlation assessed relationships between quantitative and qualitative epimuscular fat with participants' characteristics. Epimuscular fat was more frequent at the L4-L5 (X2 = 13.781, p = 0.017) and L5-S1 level (X2 = 27.825, p < 0.001) in participants with LBP compared to controls, which was not found for the higher lumbar levels. The total qualitative score (combined from all levels) showed a significant positive correlation with BMI, age, sex (female) and LBP status (r = 0.23-0.55; p < 0.05). Similarly, the total area of epimuscular fat (quantitative measure) was significantly correlated with BMI, age and LBP status (r = 0.26-0.57; p < 0.05). No correlations were found between epimuscular fat and LBP duration or intensity. Paraspinal muscle epimuscular fat is more common in chronic LBP patients. The functional implications of epimuscular fat should be further explored.
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Affiliation(s)
- Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada
| | - Stephanie Valentin
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom.
| | - Theresia Licka
- Department of Companion Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom.
| | - Monica Sean
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Canada.
| | - Pascal Tétreault
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CHUS), Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Canada.
| | - Jim Elliott
- University of Sydney, School of Heath Science, Department of Medicine and Health, Sydney, Australia.
| | - Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Canada.
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Fortin M, Rye M, Roussac A, Montpetit C, Burdick J, Naghdi N, Rosenstein B, Bertrand C, Macedo LG, Elliott JM, Dover G, DeMont R, Weber MH, Pepin V. The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J Clin Med 2023; 12:5920. [PMID: 37762861 PMCID: PMC10532355 DOI: 10.3390/jcm12185920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.
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Affiliation(s)
- Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Chanelle Montpetit
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Cleo Bertrand
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Luciana G. Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - James M. Elliott
- Faculty of Medicine and Health, School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, NSW 2050, Australia;
- Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia
| | - Geoffrey Dover
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Richard DeMont
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Michael H. Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC H3J 1A4, Canada;
| | - Véronique Pepin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
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Masi S, Rye M, Roussac A, Naghdi N, Rosenstein B, Bailey JF, Fortin M. Comparison of paraspinal muscle composition measurements using IDEAL fat-water and T2-weighted MR images. BMC Med Imaging 2023; 23:48. [PMID: 36997912 PMCID: PMC10064674 DOI: 10.1186/s12880-023-00992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/06/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the agreement between paraspinal muscle composition measurements obtained from fat-water images using % fat-signal fraction (%FSF) in comparison to those obtained from T2-weighted magnetic resonance images (MRI) using a thresholding method. METHODS A sample of 35 subjects (19 females, 16 males; 40.26 ± 11.3 years old) was selected from a cohort of patients with chronic low back pain (LBP). Axial T2-weighted and IDEAL (Lava-Flex, 2 echo sequence) fat and water MR images were obtained using a 3.0 Tesla GE scanner. Multifidus, erector spinae, and psoas major muscle composition measurements were acquired bilaterally at L4-L5 and L5-S1 using both imaging sequences and related measurement methods. All measurements were obtained by the same rater, with a minimum of 7 days between each method. Intra-class correlation coefficients (ICCs) were calculated to assess intra-rater reliability. Pearson Correlation and Bland-Altman 95% limits of agreement were used to assess the agreement between both measurement methods. RESULTS The intra-rater reliability was excellent for all measurements with ICCs varying between 0.851 and 0.997. Strong positive correlations indicating a strong relationship between composition measurements were obtained from fat-water and T2-weighted images for bilateral multifidus and erector spinae muscles at both spinal levels and the right psoas major muscle at L4-L5, with correlation coefficient r ranging between 0.67 and 0.92. Bland-Altman plots for bilateral multifidus and erector spinae muscles at both levels revealed excellent agreement between the two methods, however, systematic differences between both methods were evident for psoas major fat measurements. CONCLUSION Our findings suggest that utilizing fat-water and T2-weighted MR images are comparable for quantifying multifidus and erector spinae muscle composition but not of the psoas major. While this suggests that both methods could be used interchangeably for the multifidus and erector spinae, further evaluation is required to expand and confirm our findings to other spinal levels.
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Affiliation(s)
- Sara Masi
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Alexa Roussac
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Neda Naghdi
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Brent Rosenstein
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada
| | - Jeannie F Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, QC, H4B 1R6, Canada.
- PERFORM Centre, Concordia University, Montreal, QC, Canada.
- Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, QC, Canada.
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Fortin M, Rye M, Roussac A, Naghdi N, Macedo LG, Dover G, Elliott JM, DeMont R, Weber MH, Pepin V. The effects of combined motor control and isolated extensor strengthening versus general exercise on paraspinal muscle morphology and function in patients with chronic low back pain: a randomised controlled trial protocol. BMC Musculoskelet Disord 2021; 22:472. [PMID: 34022854 PMCID: PMC8141240 DOI: 10.1186/s12891-021-04346-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 12/31/2022] Open
Abstract
Background Exercise is a common approach for the management of patients with chronic non-specific low back pain (LBP). However, there is no clear mechanistic evidence or consensus on what type of exercise is more effective than others. While considerable evidence suggests a link between lumbar muscle health (e.g., atrophy and fatty infiltration) with functional deficits, it is unknown whether exercises targeting the lumbar spine can lead to noticeable improvements in muscle health and functional outcomes. The primary aim of this study is to compare the effect of combined motor control and isolated strengthening lumbar exercises (MC + ILEX) versus a general exercise group (GE) on multifidus muscle morphology (size and composition). Secondary aims include assessing the effect of the interventions on overall paraspinal muscle health, pain and disability, as well as psychological factors as possible effect modifiers. Methods A total of 50 participants with chronic non-specific LBP and moderate to severe disability, aged between 18 and 60, will be recruited from the local orthopaedic clinics and university community. Participants will be randomised (1:1) to either the MC + ILEX or GE group. Participants will undergo 24 individually supervised exercise sessions over a 12-week period. The primary outcome will be multifidus morphology (atrophy) and composition (fatty infiltration). Secondary outcomes will be muscle function (e.g., % thickness change during contraction), morphology, lumbar extension strength, pain intensity and disability. Potential treatment effect modifiers including maladaptive cognitions (fear of movement, catastrophizing), anxiety, depression, physical activity, and sleep quality will also be assessed. All measurements will be obtained at baseline, 6-week and 12-week; self-reported outcomes will also be collected at 24-week. Between-subjects repeated measure analysis of variance will be used to examine the changes in paraspinal muscle morphology over the different time points. Linear mixed models will be used to assess whether baseline scores can modify the response to the exercise therapy treatment. Discussion The results of this study will help clarify which of these two common interventions promote better results in terms of overall paraspinal muscle heath, back pain, disability and psychological factors in adults with chronic LBP. Trial registration NTCT04257253, registered prospectively on February 5, 2020.
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Affiliation(s)
- Maryse Fortin
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada. .,PERFORM Centre, Concordia University, Montreal, Quebec, Canada. .,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, Quebec, Canada.
| | - Meaghan Rye
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada
| | - Alexa Roussac
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada
| | - Neda Naghdi
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada
| | - Luciana Gazzi Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Geoffrey Dover
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation (CRIR), Montreal, Quebec, Canada
| | - James M Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Northern Sydney Local Health District, The Kolling Institute and Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Richard DeMont
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada
| | - Michael H Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Véronique Pepin
- Department Health Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street W, SP-165.29, Montreal, Quebec, H4B 1R6, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada
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