Low Daily Step Count Associated with Small Erector Spinae Muscle Area and Sarcopenia in Idiopathic Pulmonary Fibrosis

Objective The daily step count is associated with mortality in idiopathic pulmonary fibrosis (IPF). However, the factors associated with this phenomenon are not yet fully understood. We therefore clarified its association with clinical parameters. Methods Fifty-nine patients with IPF with available data for daily step counts; 6-minute walk distance (6MWD); chest, abdominal, and pelvic computed tomography (CT); pulmonary function; psychological evaluations; and sarcopenia assessments were prospectively enrolled. The daily step count was measured continuously for seven consecutive days. The cross-sectional areas of the erector spinae muscles at the level of the 12th vertebra (ESMCSA) and psoas major muscle volume (PMV) obtained by CT were assessed. Results The average age of the patients was 73.3±8.1 years old, and the percent predicted forced vital capacity was 81.6%±15.8%. The median daily step count was 4,258 (2,155-6,991) steps. The average 6MWD, ESMCSA, and PMV were 413±97 m, 25.5±6.7 cm2, and 270±75.6 cm3, respectively. A linear regression analysis for daily step count showed that the ESMCSA and 6MWD were independent factors for the daily step count, whereas the PMV and skeletal muscle index were not. The daily step count, ESMCSA, and 6MWD were lower in patients with sarcopenia than in those without sarcopenia. Conclusion A lower daily step count was associated with a smaller erector spinae muscle area and sarcopenia in patients with IPF. Further studies are warranted to confirm the importance of physical therapy for muscle strengthening in patients with IPF.

Relationship between paraspinal muscle properties and bone mineral density based on QCT in patients with lumbar disc herniation

OBJECTIVE

Increasing research suggests that paraspinal muscle fat infiltration may be a potential biological marker for the assessment of osteoporosis. Our aim was to investigate the relationship between lumbar paraspinal muscle properties on MRI and volumetric bone mineral density (vBMD) based on QCT in patients with lumbar disc herniation (LDH).

METHODS

A total of 383 patients (aged 24-76 years, 193 females) with clinically and radiologically diagnosed LDH were enrolled in this retrospective study. The muscle cross-sectional area (CSA) and the proton density fat fraction (PDFF) were measured for the multifidus (MF), erector spinae (ES) and psoas major (PS) at the central level of L3/4, L4/5 and L5/S1 on lumbar MRI. QCT was used to measure the vBMD of two vertebral bodies at L1 and L2 levels. Patients were divided into three groups based on their vBMD values: normal bone density group (> 120 mg/cm3), osteopenia group (80 to 120 mg/cm3) and osteoporosis group (< 80 mg/cm3). The differences in paraspinal muscle properties among three vBMD groups were tested by one-way ANOVA with post hoc analysis. The relationships between paraspinal muscle properties and vBMD were analyzed using Pearson correlation coefficients. Furthermore, the association between vBMD and paraspinal muscle properties was further evaluated using multiple linear regression analysis, with age and sex also included as predictors.

RESULTS

Among the 383 LDH patients, 191 had normal bone density, 129 had osteopenia and 63 had osteoporosis. In LDH patients, compared to normal and osteopenia group, paraspinal muscle PDFF was significantly greater in osteoporosis group, while paraspinal muscle CSA was lower (p < 0.001). After adjusting for age and sex, it was found that MF PDFF and PS CSA were found to be independent factors influencing vBMD (p < 0.05).

CONCLUSION

In patients with LDH, paraspinal muscle properties measured by IDEAL-IQ sequence and lumbar MR scan were found to be related to vBMD. There was a correlation between the degree of paraspinal muscle PDFF and decreasing vBMD, as well as a decrease paraspinal muscle CSA with decreasing vBMD. These findings suggest that clinical management should consider offering tailored treatment options for patients with LDH based on these associations.

Effects of high-frequency hyperthermia on the elastic modulus of the lumbar muscle in female athletes with low back pain: A randomized crossover trial

OBJECTIVE

To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in female athletes with low back pain (LBP) and a history of LBP.

DESIGN

Randomized crossover trial.

SETTING

Academic institution.

PARTICIPANTS

Twenty female university athletes with LBP or a history of LBP were included.

INTERVENTIONS

All participants received CRMF, hotpack, and sham (CRMF without power) in a random order on the right side of the lumbar region. More than 2 days were allocated between the experiments to eliminate any residual effects.

MAIN OUTCOME MEASURES

The shear elastic moduli of the right multifidus and erector spinae were evaluated in the prone (rest) position while sitting with 35° trunk flexion (stretched) using shear wave ultrasound imaging equipment. The moduli were measured before, immediately after, and 30 minutes after the intervention.

RESULTS

Repeated-measures 2-way analysis of variance and post hoc analysis showed that the moduli of the CRMF group were significantly lower than those of the sham group in the stretched position immediately after intervention (P = .045). This difference diminished 30 minutes after the intervention (P = .920).

CONCLUSIONS

CRMF can be used to reduce the shear elastic modulus of the multifidus muscle in the short term. Further studies are warranted to determine how to provide longer effects.

TRIAL REGISTRATION

None.

Lumbopelvic postural differences in adolescent idiopathic scoliosis: A pilot study

BACKGROUND

A primary etiology of adolescent idiopathic scoliosis (AIS) is currently unknown, but poor postural control of the spinal extensor musculature has been identified as an AIS risk factor. Identifiable postural differences would aid in advancing the precise postural behaviors that should be modified during Physiotherapy Scoliosis Specific Exercise (PSSE) to help limit the progression of AIS.

RESEARCH QUESTION

Are there any determinable differences in lumbopelvic posture or range of motion between subjects with AIS and controls?

METHODS

This prospective cohort pilot study consisted of 53 subjects (27 AIS and 26 control) aged 11-17 years. Subjects had their lumbopelvic posture assessed and monitored using the ViMove DorsaVi sensor package. All subjects underwent a live assessment to obtain initial lumbopelvic (LP) range of motion (ROM) measurements. Subjects were then monitored while continuing with normal activities of daily living (ADLs) for 12 h. With an alpha level of 0.05, nonparametric analyses were performed for each variable via a Mann-Whitney U-test.

RESULTS

During the live assessment, controls exhibited a significantly greater anterior pelvic tilt ROM in the sitting position than the AIS group (p = 0.0433). When compared to female controls, females with AIS had a sitting pelvic tilt ROM that was significantly more retroverted (p = 0.0232) and less anteverted (p = 0.0010). During ADLs, female controls exhibited a higher total number of extension events than their female with AIS (p = 0.0263). These associations did not strengthen with greater spinal deformity.

SIGNIFICANCE

This work demonstrates postural differences between patients with AIS and controls. Further study is necessary to determine why patients with AIS adopt these postures, and if PSSEs can be utilized to limit the progression of AIS.

COVID-19 and Myositis: What We Know So Far

PURPOSE

Myositis as a rare manifestation of COVID-19 is only recently being reported. This review examines the current literature on COVID-19-induced myositis focusing on etiopathogenesis, clinical presentations, diagnostic practices, and therapeutic challenges with immunosuppression, and the difficulties experienced by rheumatologists in established myositis in the COVID-19 era.

RECENT FINDINGS

COVID-19 is associated with a viral myositis attributable to direct myocyte invasion or induction of autoimmunity. COVID-19-induced myositis may be varied in presentation, from typical dermatomyositis to rhabdomyolysis, and a paraspinal affliction with back pain. It may or may not present with acute exponential elevations of enzyme markers such as creatine kinase (CK). Virus-mediated muscle inflammation is attributed to ACE2 (angiotensin-converting enzyme) receptor-mediated direct entry and affliction of muscle fibers, leading on to innate and adaptive immune activation. A greater recognition of the stark similarity between anti-MDA5-positive myositis with COVID-19 has thrown researchers into the alley of exploration - finding common etiopathogenic basis as well as therapeutic strategies. For patients with established myositis, chronic care was disrupted during the pandemic with several logistic challenges and treatment dilemmas leading to high flare rates. Teleconsultation bridged the gap while ushering in an era of patient-led care with the digital transition to tools of remote disease assessment. COVID-19 has brought along greater insight into unique manifestations of COVID-19-related myositis, ranging from direct virus-induced muscle disease to triggered autoimmunity and other etiopathogenic links to explore. A remarkable shift in the means of delivering chronic care has led patients and caregivers worldwide to embrace a virtual shift with teleconsultation and opened doorways to a new era of patient-led care.

The effects of core stability training in nurses with nonspecific low back pain

To investigate the effect of core stability training on nonspecific low back pain (NSLBP) in nurses.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. A total of 40 nurses with NSLBP were included and divided into observation group and control group. Each group were given routine health education for NSLBP. Core stability training was performed in observation group for 4 weeks. Surface electromyography (sEMG) evaluation of erector spine and multifidus muscle, pain Numeric Rating Scale (NRS) and Japanese Orthopaedic Association (JOA) scores were evaluated and analyzed before and 4 weeks after intervention.There was no significant difference of NRS score and JOA score between two groups before intervention (P > .05, respectively). The NRS and JOA scores were significantly improved in both two groups after 4 weeks of intervention (P < .05, respectively). Moreover, the improvement of NRS and JOA scores in the observation group were better than those of the control group (P < .05, respectively). No significant difference of average electromyography (AEMG) or median frequency (MF) were noted between the healthy side and the affected side in both groups before or after intervention (P > .05, respectively). After 4 weeks of intervention, the AEMG of the healthy and the affected side of the two groups showed an improved trend without significant difference (P > .05, respectively). The MF of affected side was significantly higher 4 weeks after intervention than those before treatment in the observation and control group (P < .05, respectively).Core stability training can alleviate pain, improve the fatigue resistance of the core muscles and the balance of the functions of bilateral multifidus muscles in nurses with NSLBP.

Muscle network topology analysis for the classification of chronic neck pain based on EMG biomarkers extracted during walking

Neuromuscular impairments are frequently observed in patients with chronic neck pain (CNP). This study uniquely investigates whether changes in neck muscle synergies detected during gait are sensitive enough to differentiate between people with and without CNP. Surface electromyography (EMG) was recorded from the sternocleidomastoid, splenius capitis, and upper trapezius muscles bilaterally from 20 asymptomatic individuals and 20 people with CNP as they performed rectilinear and curvilinear gait. Intermuscular coherence was computed to generate the functional inter-muscle connectivity network, the topology of which is quantified based on a set of graph measures. Besides the functional network, spectrotemporal analysis of each EMG was used to form the feature set. With the use of Neighbourhood Component Analysis (NCA), we identified the most significant features and muscles for the classification/differentiation task conducted using K-Nearest Neighbourhood (K-NN), Support Vector Machine (SVM), and Linear Discriminant Analysis (LDA) algorithms. The NCA algorithm selected features from muscle network topology as one of the most relevant feature sets, which further emphasize the presence of major differences in muscle network topology between people with and without CNP. Curvilinear gait achieved the best classification performance through NCA-SVM based on only 16 features (accuracy: 85.00%, specificity: 81.81%, and sensitivity: 88.88%). Intermuscular muscle networks can be considered as a new sensitive tool for the classification of people with CNP. These findings further our understanding of how fundamental muscle networks are altered in people with CNP.

Immediate changes in trunk muscle activation patterns during a lifting task following an abdominal drawing-in exercise in subjects with recurrent low back pain

BACKGROUND

The abdominal drawing-in exercise could help improve delayed transversus abdominis (TrA) activation during limb movement in subjects with recurrent low back pain (rLBP). However, little is known about whether the same effect is observed during lifting tasks in subjects with rLBP.

OBJECTIVE

This study aimed to clarify whether a single session of abdominal drawing-in exercise could correct the altered trunk muscle activation patterns during a lifting task in subjects with rLBP.

METHODS

Fifteen subjects with rLBP performed lifting tasks before and immediately after three sets of 10 repetitions of isolated TrA voluntary contractions. The time of onset and activation amplitude during the lifting tasks were measured by surface electromyography (EMG) and compared between the trials before and immediately after exercise.

RESULTS

During lifting, the onset of internal abdominal oblique/TrA (IO/TrA) and multifidus activation occurred earlier, the EMG amplitude of IO/TrA increased, and the EMG amplitude of erector spinae and multifidus decreased, compared with the pre-exercise data.

CONCLUSIONS

These results suggest a possibility that the abdominal drawing-in exercise might be effective in improving the muscle recruitment pattern in people with rLBP.

Cervical Paraspinal Muscle Fatty Degeneration Is Not Associated with Muscle Cross-sectional Area: Qualitative Assessment Is Preferable for Cervical Sarcopenia

BACKGROUND

Sarcopenia, defined as decreased skeletal mass, is an independent marker of frailty that is not accounted for by other risk-stratification methods. Recent studies have demonstrated a clear association between paraspinal sarcopenia and worse patient-reported outcomes and complications after spine surgery. Currently, sarcopenia is characterized according to either a quantitative assessment of the paraspinal cross-sectional area or a qualitative analysis of paraspinal fatty infiltration on MRI. No studies have investigated whether the cervical paraspinal cross-sectional area correlates with fatty infiltration of the cervical paraspinal muscles on advanced imaging.

QUESTION/PURPOSE

Do patients undergoing anterior cervical discectomy and fusion (ACDF) with increasing paraspinal fatty degeneration on advanced imaging also demonstrate decreased cervical paraspinal cross-sectional area?

METHODS

Between 2011 and 2017, 98 patients were prospectively enrolled in a database of patients undergoing one- to three-level ACDF for degenerative conditions at a single institution. To be eligible for this prospective study, patients were required to undergo an MRI before surgery, be older than 18 years, and have no previous history of cervical spine surgery. Two independent reviewers, both surgeons not involved in the patients' care and who were blinded to the clinical outcomes, retrospectively assessed the paraspinal cross-sectional area and Goutallier classification of the right-sided paraspinal muscle complex. We then compared the patients' Goutallier grades with their paraspinal cross-sectional area measurements. We identified 98 patients for inclusion. Using the Fuchs modification of the Goutallier classification, we classified the fatty degeneration of 41 patients as normal (Goutallier Grades 0 to 1), that of 47 patients as moderate (Grade 2), and that of 10 patients as severe (Grades 3 to 4). We used ANOVA to compare all means between groups.

RESULTS

There was no difference in the mean paraspinal cross-sectional area of the obliquus capitus inferior (normal 295 ± 81 mm2; moderate 317 ± 104 mm2; severe 300 ± 79 mm2; p = 0.51), multifidus (normal 146 ± 59 mm2; moderate 170 ± 70 mm2; severe 192 ± 107 mm2; p = 0.11), or sternocleidomastoid (normal 483 ± 150 mm2; moderate 468 ± 149 mm2; severe 458 ± 183 mm2; p = 0.85) among patients with mild, moderate, and severe fatty infiltration based on Goutallier grading. There was a slightly greater longus colli cross-sectional area in the moderate and severe fatty infiltration groups (74 ± 22 mm2 and 66 ± 18 mm2, respectively) than in the normal group (63 ± 15 mm2; p = 0.03).

CONCLUSION

Because our study demonstrates minimal association between paraspinal cross-sectional area and fatty infiltration of the cervical paraspinals, we recommend that physicians use the proven qualitative assessment of paraspinal fatty infiltration during preoperative evaluation of patients who are candidates for ACDF. Future studies investigating the relationship between cervical paraspinal cross-sectional area and patient-reported outcomes after ACDF are necessary to lend greater strength to this recommendation.

LEVEL OF EVIDENCE

Level III, diagnostic study.

Combined abnormal muscle activity and pain-related factors affect disability in patients with chronic low back pain: An association rule analysis

Objectives

In patients with chronic low back pain (CLBP), reduced lumbar flexion-relaxation and reduced variability of muscle activity distribution are reported as abnormal muscle activity. It is not known how abnormal muscle activity and pain-related factors are related to CLBP-based disability. Here, we performed an association rule analysis to investigated how CLBP disability, muscle activity, and pain-related factors in CLBP patients are related.

Methods

Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae muscle with four-channel electrodes from 24 CLBP patients while they performed a trunk flexion re-extension task. We calculated the average value of muscle activities of all channels and then calculated the flexion relaxation ratio (FRR) and the spatial variability of muscle activities. We also assessed the pain-related factors and CLBP disability by a questionnaire method. A clustering association rules analysis was performed to determine the relationships among pain-related factors, the FRR, and the variability of muscle activity distribution.

Results

The association rules of severe CLBP disability were divisible into five classes, including ‘low FRR-related rules.’ The rules of the mild CLBP disability were divisible into four classes, including ‘high FRR-related rules’ and ‘high muscle variability-related rules.’ When we combined pain-related factors with the FRR and muscle variability, the relationship between abnormal FRR/muscle variability and CLBP disability became stronger.

Discussion

Our findings thus highlight the importance of focusing on not only the patients’ pain-related factors but also the abnormal motor control associated with CLBP, which causes CLBP disability.

Reversible Splenial Lesion Syndrome with Some Novel Causes and Clinical Manifestations

Objective Reversible splenial lesion syndrome (RESLES) is a clinical radiological syndrome characterized by a reversible lesion of the splenium of the corpus callosum with a decreased apparent diffusion coefficient (ADC) value. The clinical manifestations of RESLES are diverse. Methods Fifteen cases of adult RESLES patients (10 males and 5 females) were retrospectively selected from the radiology system using the key word "corpus callosum" at a university-affiliated tertiary care hospital between May 1, 2015 and December 31, 2019. The possible precipitating factors, clinicoradiological findings and modified Rankin Scale (mRS) on follow-up were then analyzed. Results The patient ages ranged from 22 to 53 years old. The mean age was 34 years old. The most common neurological symptoms included headache (3/15), dizziness (3/15), first onset of seizure (3/15), paroxysmal blurred vision (2/15), vertigo (2/15), amnesia (2/15), and confused consciousness without seizure (2/15), followed by drowsiness (1/15), paresthesia (1/15), dysmetria (1/15) and dysarthria (1/15). The precipitating factors included infection, seizure, anti-epileptic treatment with levetiracetam, carbamazepine, valproate, hyperglycemia, hypoglycemia, cerebral venous sinus thrombosis, and rabies vaccine injection prior to the onset of RESLES. All cases were carefully followed up and had excellent prognoses. Conclusion RESLES manifests as variety of symptoms with less specificity and precipitating factors. Paroxysmal blurred vision may be a relatively specific symptom of RESLES. Levetiracetam, carbamazepine or valproate could be the cause of RESLES, exposure to the rabies vaccine could be another predisposing factors for RESLES as well. RESLES type 1 was therefore found to be highly "reversible" with an excellent prognosis.

Relationship between straight leg-raising test measurements and area of fat infiltration in multifidus muscles in patients with lumbar disc hernation

BACKGROUND

A few studies have noted that paraspinal muscle training is important to reduce pain for patients with lumbar disc herniation (LDH). However, little is known about the exact signs for necessary training of lumbar multifidus muscles (LMM).

OBJECTIVE

The study aimed to analyze the relationship between the straight leg-raising test (SLR) and the area of fat infiltration in LMM for patients with LDH.

METHOD

One hundred and fourteen LDH patients were involved in this study. Clinical data were collected from a medical record system. On the MRI images, the cross-sectional areas (CSA) of bilateral fat infiltration in LMM were measured by picture archiving and communication system (PACS).

RESULT

For 61 patients with inclusive LDH, the positive side of SLR was positively correlated with the side of the larger total CSA of fat infiltration in LMM of L2-S1 (r= 0.75, p⁢ï⁢¼⁢ 0.01), and the CSA of fat infiltration on the side of SLR with a positive result was significantly larger than that on the side of SLR with a negative result only at L3-4 and L4-5 levels (p⁢ï⁢¼⁢ 0.01).

CONCLUSION

SLR may be used as an important sign for dysfunction of LMM and can identify the more severe side.

Sharp lower back pain • left-side paraspinal tenderness • anterior thigh sensory loss • Dx?

► Acute-onset, sharp nonradiating lower back pain ► Left-side paraspinal tenderness ► Anterior thigh sensory loss.

A study on the paraspinal muscle surface electromyography in acute nonspecific lower back pain

Aim of this study was to determine if surface electromyography (sEMG) could provide objective data in monitoring the alteration of signal amplitude of myoelectric activity of the paraspinal muscles in the patients with acute nonspecific lower back pain (ANLBP), and to explore the correlation between sEMG data and symptom relief in the ANLBP patients before and after massage therapy.Forty-five ANLBP patients and 20 healthy subjects were enrolled into this study. Patients were given massage therapy for 1 week. The average electromyography (AEMG), visual analogue scale (VAS), and distance of finger to floor (DFTF) were measured before and after treatment.AEMG at flexion and maintained flexion positions were significantly higher in the ANLBP group compared to that in the control group. At extension position, in contrast, AEMG was significantly lower in the ANLBP patients than that of control group, and there was no significant difference between the 2 groups at upright position. After massage therapy for the ANLBP patients, AEMG was significantly reduced at flexion and maintained flexion positions, but significantly increased at extension position than that before treatment. VAS and DFTF were also significantly reduced after treatment. In addition, AEMG alteration at maintained flexion position was significantly correlated with improvement of VAS or DFTF.Myoelectric activity of the paraspinal muscles in the ANLBP patients was different from that of healthy subjects. Massage therapy not only relived patients' symptoms, but also normalized myoelectric activity of the paraspinal muscles in the ANLBP patients.

The erector spinae plane block for effective analgesia after lung lobectomy: Three cases report

RATIONALE

The thoracic epidural block and thoracic paravertebral block are widely used techniques for multimodal analgesia after thoracic surgery. However, they have several adverse effects, and are not technically easy. Recently, the erector spinae plane block (ESPB), an injected local anesthetic deep to the erector spinae muscle, is a relatively simple and safe technique.

PATIENT CONCERNS

Three patients were scheduled for video assisted thoracoscopic lobectomy with mediastinal lymph node dissection. All the patients denied any past medical history to be noted.

DIAGNOSES

They were diagnosed with primary adenocarcinoma requiring lobectomy of lung.

INTERVENTIONS

The continuous ESPB was performed at the level of the T5 transverse process. The patient was received the multimodal analgesia consisted of oral celecoxib 200 mg twice daily, intravenous patient-controlled analgesia (Fentanyl 700 mcg, ketorolac 180 mg, total volume 100 ml), and local anesthetic (0.375% ropivacaine 30 ml with epinephrine 1:200000) injection via indwelling catheter every 12 hours for 5 days. Additionally, we injected a mixture of ropivacaine and contrast through the indwelling catheter for verifying effect of ESPB and performed Computed tomography 30 minutes later.

OUTCOMES

The pain score was maintained below 3 points for postoperative 5 days, and no additional rescue analgesics were administered during this period. In the computed tomography, the contrast spread laterally from T2-T12 deep to the erector spinae muscle. On coronal view, the contrast spread to the costotransverse ligament connecting the rib and the transverse process. In the 3D reconstruction, the contrast spread from T6-T10 to the costotransverse foramen.

LESSONS

Our contrast imaging data provides valuable information about mechanism of ESPB from a living patient, and our report shows that ESPB can be a good option as a multimodal analgesia after lung lobectomy.

The relationship between cross-sectional area of multifidus muscle and disability index in patients with chronic non-specific low back pain

BACKGROUND

Nonspecific low back pain (NSLBP) is a common problem that may have an effect on the level of functional ability. Imaging techniques indicated the degeneration of multifidus muscles in patients with low back pain. But its relationship with disability in NSLBP is unclear.

OBJECTIVE

To assess the relationship between changes in multifidus muscle morphology in MRI as paraclinical data with changes in the level of disability as clinical data in patients with CNLBP, whose MRI studies are normal. Moreover, the relationship between multifidus CSA and its thickness was determined.

DESIGN

Cross-sectional study.

METHODS

A total of 45 subjects with CNLBP participated in this study. Multifidus muscle thickness and cross-sectional area (CSA) for both sides in L4-L5 and L5-S1 levels were measured with MRI and Image J software. Level of disability was assessed with Roland-Morris disability index.

RESULTS

There was no significant relationship between multifidus muscle's CSA or thickness variations among the L4-L5 and L5-S1 levels and disability index score. Furthermore, Pearson's test showed significant positive relationship between thickness and CSA of muscles (p˂0.05).

CONCLUSION

The relationship between lumbar multifidus Thickness and disability in CNLBP with normal MRI study, is not proven in this study. Multifidus muscle thickness in L4-L5 or L5-S1 level can be representative of its CSA in patients with CNLBP and normal MRI.

Shear wave elastography investigation of multifidus stiffness in individuals with low back pain

The purpose of this study was to investigate differences in passive muscular stiffness between the superficial multifidus (SM) and deep multifidus (DM), and to compare their passive and active stiffness in individuals with low back pain (LBP) and asymptomatic individuals. Fifteen LBP individuals and 15 asymptomatic individuals were recruited. Passive stiffness of the SM and DM was measured bilaterally using shear wave elastography (SWE) with participants lying prone. Active stiffness was measured for the SM during trunk extension, and the contraction ratio was calculated. DM displayed higher passive muscular stiffness than SM in both the asymptomatic and LBP groups (14.41 ± 2.62 and 15.40 ± 2.77 kPa respectively; p < 0.001). Individuals with LBP exhibited higher passive muscular stiffness of SM (LBP: 10.15 ± 4.21, asymptomatic: 6.84 ± 1.69 kPa; p < 0.005) and a lower contraction ratio (LBP: 1.54 ± 0.47, asymptomatic: 2.65 ± 1.36 kPa; p < 0.003) compared to the asymptomatic group. The findings support a differentiation in passive muscular stiffness between SM and DM and provide evidence for an alteration in muscular stiffness at rest in individuals with LBP. The lower increase of muscular stiffness with contraction observed for those with LBP may reflect a deficit in activation of the multifidus.

Proposal of a new exercise protocol for idiopathic scoliosis: A preliminary study

In clinical practice, we found a unilateral instability in patients with right thoracic scoliosis during asymmetric spinal stabilization exercise (ASSE), which can be an important clue to identify the pathophysiology of idiopathic scoliosis (IS).We investigated the relationship between unilateral postural instability and weakness of paraspinal muscles according to curve pattern. And finally, we propose the new exercise method based on the curve pattern.Combined use of prospective and retrospective clinical trials.Fifteen participants without IS and 10 patients with IS in 1 tertiary referral hospital.In 15 participants without IS, surface electromyography (sEMG) was used to evaluate the muscular activation patterns in the bilateral erector spinae (ES), rectus abdominis (RA), and external oblique (EO) muscles during ASSE. In addition, to assess the clinical effect of ASSE, Cobb angle and rotation grade were measured from 10 patients with IS.The most significant findings from the sEMG data were the increased activities of ipsilateral 7th thoracic ES during hand-up motion, ipsilateral 3rd lumbar ES during leg-up motion, and 12th thoracic and 3rd lumbar ES during side-bridging. In a radiographic analysis, specific components of ASSE that activates the concave side muscles were found to be effective for IS.The paraspinal muscle strengthening of the concave side using ASSE can improve the severity of scoliosis. Based on this research, we could propose a new exercise protocol that can be personalized according to the curve pattern.

Ultrasound guided erector spinae plane block as a cause of unintended motor block

Erector spinae plane block (ESPB) as postoperative analgesia method has been successfully carried out in several surgical interventions. Postoperative pain treatment for cesarean section is considered one of the important challenges for anesthesiologists due to the risk of chronic pain development and even pospartum depression. Regional anesthesia techniques were effectively used to prevent the pain together with multimodal analgesia regimes in cesarean section. Formerly, successful erector spinae plane block was documented as postoperative analgesia treatment for cesarean section; however, no motor weakness was recorded as a side effect. In this case report, we present an unexpected motor weakness as a side effect of the erector spinae plane block after cesarean delivery operation in a 29 year old patient. To our knowledge, this is the first report of motor weakness related to the ESPB.

Armrests and back support reduced biomechanical loading in the neck and upper extremities during mobile phone use

Mobile phone use is known to be associated with musculoskeletal pain in the neck and upper extremities because of related physical risk factors, including awkward postures. A chair that provides adequate support (armrests and back support) may reduce biomechanical loading in the neck and shoulder regions. Therefore, we conducted a repeated-measures laboratory study with 20 participants (23 ± 1.9 years; 10 males) to determine whether armrests and back support during mobile phone use reduced head/neck flexion, gravitational moment, and muscle activity in the neck and shoulder regions. The results showed that the chair support (armrests and back support) reduced head/neck flexion (p < 0.001), gravitational moment (p < 0.001), and muscle activity (p < 0.01) in the neck and shoulder regions significantly compared to no chair support. These results indicate that a chair with adequate support can be an effective intervention to reduce the biomechanical exposures and associated muscular pain in the neck and shoulders during mobile phone use.

Difference of the thickness and activation of trunk muscles during static stoop lift at different loads between subjects with and without low back pain

BACKGROUND

Patients suffering from low back pain (LBP) have been reported to alter muscle contraction strategies.

OBJECTIVE

To compare activity and thickness of the trunk muscles (external oblique (EO), internal oblique (IO), transversus abdominis (TrA), and lumbar multifidus (LM)) during static stoop lift at different lifting loads between the subjects with and without LBP.

METHODS

Twenty eight subjects with LBP and twenty eight healthy subjects were recruited. The stoop lifting was performed in three conditions in 0%, 10%, and 20% of body weight.

RESULTS

The activity of EO (F= 9.513) and IO (F= 7.781) was significantly increased with increasing lifting loads in subjects with LBP (p< 0.05) but not significantly in subjects without LBP. The activity of the LM (F= 124.980) was significantly increased in response to lifting loads in both groups (p< 0.05). The percent change of TrA (F= 8.797) and LM (F= 48.170) muscles thickness was significantly increased with increasing lifting loads in both groups (p< 0.05). The percent change of TrA (F= 3.780) and LM (F= 16.314) muscles thickness in subjects without LBP was greater than those in subjects with LBP at all three lifting loads (p< 0.05).

CONCLUSIONS

The results of this study suggest that more activation of EO in subjects with LBP may contribute to increase the compressive force on the lumbar spine during stoop lift. Also, less activation of TrA and LM in subjects with LBP may contribute to decrease the lumbar stabilization during stoop lift.

Physical Therapy Management of Congenital Muscular Torticollis: A 2018 Evidence-Based Clinical Practice Guideline From the APTA Academy of Pediatric Physical Therapy

BACKGROUND

Congenital muscular torticollis (CMT) is a postural deformity evident shortly after birth, typically characterized by lateral flexion/side bending of the head to one side and cervical rotation/head turning to the opposite side due to unilateral shortening of the sternocleidomastoid muscle; it may be accompanied by other neurological or musculoskeletal conditions. Infants with CMT should be referred to physical therapists to treat these postural asymmetries as soon as they are identified.

PURPOSE

This update of the 2013 CMT clinical practice guideline (CPG) informs clinicians and families as to whom to monitor, treat, and/or refer and when and what to treat. It links 17 action statements with explicit levels of critically appraised evidence and expert opinion with recommendations on implementation of the CMT CPG into practice.

RESULTS/CONCLUSIONS

The CPG addresses the following: education for prevention; referral; screening; examination and evaluation; prognosis; first-choice and supplemental interventions; consultation; discontinuation from direct intervention; reassessment and discharge; implementation and compliance audits; and research recommendations. Flow sheets for referral paths and classification of CMT severity have been updated.

Shoulder muscular activity in individuals with low back pain and spinal cord injury during seated manual load transfer tasks

This study aimed to compare the activity of four shoulder muscles in individuals with low back pain (LBP), spinal cord injuries (SCI) and a control group, during one-handed load transfer trials. Nine individuals with minimum one-year of LBP, eleven with thoracic/lumbar SCI and nine healthy controls participated in this study. The activations of anterior deltoid, upper trapezius, infraspinatus and pectoralis major were recorded by surface EMG during one-handed transferring of a cylinder from a home shelve to six spatially distributed target shelves. The integrated EMG values were compared using repeated measure ANOVA. Both LBPs and SCIs had higher anterior deltoid activation and LBPs required more upper trapezius activation than controls (p < 0.05). The spatial position of the targets also significantly influenced demands for these two muscles. The anterior deltoid and upper trapezius in LBP and SCI individuals are under higher demand during occupational load transfer tasks. Practitioner Summary: This study aimed to compare the activation of four shoulder muscles in individuals with low back pain, spinal cord injuries and healthy condition. EMG analysis showed that the injured groups required more upper trapezius and anterior deltoid activation during load transfer tasks, which may predispose them to muscle overexertion.

Pisa syndrome in Parkinson's disease: electromyographic quantification of paraspinal and non-paraspinal muscle activity

Patients with Parkinson's disease (PD) and Pisa syndrome (PS) may present tonic dystonic or compensatory (i.e. acting against gravity) hyperactivity in the paraspinal and non-paraspinal muscles. Electromyographic (EMG) activity was measured in nine patients with PD and PS, three with PD without PS, and five healthy controls. Fine-wire intramuscular electrodes were inserted bilaterally into the iliocostalis lumborum (ICL), iliocostalis thoracis (ICT), gluteus medius (GM), and external oblique (EO) muscles. The root mean square (RMS) of the EMG signal was calculated and normalized for each muscle. In stance condition, side-to-side muscle activity comparisons showed a higher RMS only for the contralateral ICL in PD patients with PS (p=0.028). Moreover, with increasing degrees of lateral flexion, the activity of the EO and the ICL muscles progressively increased and decreased, respectively. The present data suggest that contralateral paraspinal muscle activity plays a crucial compensatory role and can be dysfunctional in PD patients with PS.

Association between spectral characteristics of paraspinal muscles and functional disability in patients with low back pain: a cohort study

OBJECTIVES

Characteristics of muscle activity, represented by surface electromyography (EMG), have revealed differences between patients with low back pain (LBP) and healthy adults; how they relate to functional and clinical parameters remains unclear. The purpose of the current study was to examine the correlation between frequency characteristics of EMG (analysed using continuous wavelet transform (CWT) analysis) and patients' self-rated score of disability.

DESIGN AND SETTING

This is a case-control study with 15 patients with mechanical LBP without radicular symptoms. Patients were recruited from the orthopaedic clinic at Charing Cross Hospital. Ten healthy adults were recruited from the staff working in the hospital and associated university. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and bilateral EMG activity was obtained from erector spinae at vertebral levels L4 and T12. Subjects performed three brief maximal voluntary isometric contractions (MVICs) of the back extensors and the torque was measured using a dynamometer. CWT was applied to the EMG signals of each muscle in a 200 ms window centred around the peak torque obtained during the MVICs. The ratio (low/high frequencies) of the energy, the peak power and the frequency of the peak power were calculated for each recording site, averaged and correlated with the individual's RMDQ score.

RESULTS

Patients had lower peak power (T12 and L4) and lower frequency of the peak power (at T12) than the healthy adults. Additionally, RMDQ positively correlated to the average ratio of energy at T12 (r=0.63; p=0.012), that is, greater self-rated disability corresponded to a dominant distribution of energy in the lower frequencies.

CONCLUSION

The current findings reveal alterations in EMG profile and its association with self-related back pain disability, suggesting that spectral characteristics of EMG reflect muscle function.

Electromyographic activity of the erector spinae: The short-effect of one workday for welders with nonspecific chronic low back pain, an observational study

OBJECTIVE

This study aimed to evaluate the effect of one workday on pain and perceived exertion, muscular strength, and electromyographic activity of the erector spinae muscles in welders with and without low back pain. This is an observational cohort study.

PARTICIPANTS

Twenty-two welders, metallurgical shipbuilding, were equally divided into 2 groups: low back pain and no low back pain. Pain and perceived exertion. Muscular strength by maximal voluntary contractions and electromyographic activity of right and left erector spinae muscles during maximal voluntary contractions and in the 3 welding positions for 2 periods of the workday (in the morning and at the end of the workday).

RESULTS

At the end of workday, the pain increased significantly for the low back pain group (t(22) = 2.448; P= 0.023). The perceived exertion also increased significantly for both groups at the end of workday groups (F(1,22) = 8.570, P= 0.000) and periods (F(1,22) = 8.142, P= 0.000). There were no significant differences between groups and workday periods for muscular strength and electromyographic activity during maximal voluntary contractions of the erector spinae. There was no significance difference for electromyographic activity between groups and workday period and in the 3 welding positions.

CONCLUSION

Although the pain and perceived exertion increased at the end of the workday, these results did not interfere in muscular strength and electromyographic activity of right and left erector spinae muscles. Thus, we can conclude that welders with chronic low back pain had a good physical capacity (muscular strength) and that muscle performance was maintained.

An investigation into four different sit-stand workstation use schedules

Twelve office workers participated in a study investigating effects of four sit/stand schedules (90-min sit/30-min stand, 80/40, 105/15, and 60/60) via several objective and subjective measures (muscle fatigue, foot swelling, spinal shrinkage, and self-reported discomfort). Results showed that there were no significant differences in shoulder and low back static muscle activities between sitting and standing. Muscle fatigue was developed during workday under all schedules. The longest standing schedule seemed to have a tendency of reducing muscle fatigue. None of the schedules helped or worsened foot swelling and spinal shrinkage. More active break-time activities seemed reducing muscle fatigue and foot swelling. While the self-reported bodily discomfort levels were generally low, the preferred schedules among the participants were varied, although the least standing schedule was the least preferred. We may conclude that effects of using sit-stand workstation to improve musculoskeletal health may be limited but promoting more active break-time activities can help. Practitioner Summary: Sit-stand workstations are used to reduce work-related musculoskeletal disorders. This study shows that office workers prefer sit/stand durations in the range between 1:1 and 3:1. Longer standing may have the potential to reduce muscle fatigue. However, active break-time activities may be more effective in reducing muscle fatigue and foot swelling.

Analysis of correlation between degeneration of lower lumbar paraspinal muscles and spinopelvic alignment in patients with osteoporotic vertebral compression fracture

BACKGROUND

A few studies have pointed that trunk extensors may affect the spinopelvic alignment; however, little is known about the exact association between degeneration of lower lumbar paraspinal muscles and spinopelvic parameters.

OBJECTIVE

The study aimed to analyze the relationship between degeneration of lower lumbar paraspinal muscles and spinopelvic alignment in patients with osteoporotic vertebral compression fracture (OVCF).

METHODS

Thirty-nine OVCF patients were involved in this study. All patients underwent a standing lateral radiographs of the entire spine and pelvis 6 months after kyphoplasty. Pelvic incidence, pelvic tilt, lower lumbar lordosis (LLL) were measured. On the MRI images, the cross-sectional areas of the erector spinae (ES), multifidus (MF), vertebral body and the signal intensity of ES, MF, subcutaneous fat were measured. Pearson's correlation coefficients was applied to analyze the correlation between the muscular degeneration degree (muscular atrophy and fatty infiltration) and spinopelvic parameters.

RESULTS

The fatty change degree of ES at L4 inferior endplate level was positively correlated with pelvis retroversion (r= 0.480, p< 0.05). The grade of fat infiltration of ES plus MF at L5 level was negatively related to LLL (r=-0.446, p< 0.05). The fatty change of ES at L5 level, atrophy of ES at L4 and L5 level did not correlate with pelvis back tilt. The fat infiltration of ES plus MF at L4 level, the atrophy degree of ES plus MF at L4 and L5 level had no correlation with LLL.

CONCLUSIONS

With the increase of fatty infiltration of the erector spinae, the degree of pelvis retroversion increases; the lower lumbar lordosis decreases with the increase of intramuscular adipose tissue of the erector spinae plus multifidus. The atrophy degree of the erector spinae and multifidus is not correlated with pelvis back tilt and lower lumbar lordosis.

Conservative treatment for lumbar compartment syndrome shows efficacy over 2-year follow-up: a case report and literature review

BACKGROUND

Since in all studies of conservative treatment of lumbar compartment syndrome the follow-up duration was less than 6 months, it is difficult to draw firm conclusions.

PURPOSE

To report a patient with lumbar paraspinal compartment syndrome who was treated conservatively over a follow-up period of 2 years.

STUDY DESIGN

This is a case report of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively.

METHODS

We report a case of a 23-year-old male college student with lumbar paraspinal compartment syndrome who was treated conservatively. We repeatedly checked his physical examination, laboratory tests, lumbar compartment pressures, and magnetic resonance imaging, and surgical teams were readily prepared to operate should the patient's condition worsen. To prevent complications of rhabdomyolysis, hydration and alkalization were performed. We followed him up to 2 years after discharge.

RESULT

Although the temporal changes on MRI up to the 1-year point, the patient continued to have no symptoms.

CONCLUSIONS

Conservative therapy can be recommended if rhabdomyolysis is under control.

Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross-sectional study

BACKGROUND CONTEXT

Heterogeneity exists within the low back pain (LBP) population. Some patients recover after every pain episode, whereas others suffer daily from LBP complaints. Until now, studies rarely make a distinction between recurrent low back pain (RLBP) and chronic low back pain (CLBP), although both are characterized by a different clinical picture. Clinical experiences also indicate that heterogeneity exists within the CLBP population. Muscle degeneration, like atrophy, fat infiltration, alterations in muscle fiber type, and altered muscle activity, compromises proper biomechanics and motion of the spinal units in LBP patients. The amount of alterations in muscle structure and muscle function of the paraspinal muscles might be related to the recurrence or chronicity of LBP.

PURPOSE

The aim of this experimental study is to evaluate differences in muscle structure (cross-sectional area and lean muscle fat index) and muscle activity of the multifidus (MF) and erector spinae (ES) during trunk extension, in patients with RLBP, non-continuous CLBP, and continuous CLBP.

STUDY DESIGN AND SETTING

This cross-sectional study took place in the university hospital of Ghent, Belgium. Muscle structure characteristics and muscle activity were assessed by magnetic resonance imaging (MRI).

PATIENT SAMPLE

Fifty-five adults with non-specific LBP (24 RLBP in remission, 15 non-continuous CLBP, 16 continuous CLBP) participated in this study.

OUTCOME MEASURES

Total cross-sectional area, muscle cross-sectional area, fat cross-sectional area, lean muscle fat index, T2-rest and T2-shift were assessed.

METHODS

A T1-weighted Dixon MRI scan was used to evaluate spinal muscle cross-sectional area and fat infiltration in the lumbar MF and ES. Muscle functional MRI was used to evaluate the muscle activity of the lumbar MF and ES during a lumbar extension exercise. Before and after the exercise, a pain assessment was performed. This study was supported by grants from the Special Research Fund of Ghent University (DEF12/AOP/022) without potential conflict of interest-associated biases in the text of the paper.

RESULTS

Fat cross-sectional area and lean muscle fat index were significantly higher in MF and ES in continuous CLBP compared with non-continuous CLBP and RLBP (p<.05). No differencesbetween groups were found for total cross-sectional area and muscle cross-sectional area in MF or ES (p>.05). Also, no significant differences between groups for T2-rest were established. T2-shift, however, was significantly lower in MF and ES in RLBP compared with, respectively, non-continuous CLBP and continuous CLBP (p<.05).

CONCLUSIONS

These results indicate a higher amount of fat infiltration in the lumbar muscles, in the absence of clear atrophy, in continuous CLBP compared with RLBP. A lower metabolic activity of the lumbar muscles was seen in RLBP replicating a relative lower intensity in contractions performed by the lumbar muscles in RLBP compared with non-continuous and continuous CLBP. In conclusion, RLBP differs from continuous CLBP for both muscle structure and muscle function, whereas non-continuous CLBP seems comparable with RLBP for lumbar muscle structure and with continuous CLBP for lumbar muscle function. These results underline the differences in muscle structure and muscle function between different LBP populations.

[Needle electromyography features and values of paraspinal muscle parameters in assessment of respiratory function of patients with amyotrophic lateral sclerosis]

Objective: To analyze the features of needle electromyography (EMG) in patients with amyotrophic lateral sclerosis (ALS), and explore the correlation between EMG parameters of the tenth thoracic paraspinal muscle and disease duration, rate of disease progression, forced vital capacity (FVC) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R). Methods: Standard EMG was recorded from unilateral sternocleidomastoid muscle and/or tongue muscles, upper and lower limbs muscles and the tenth thoracic paraspinal muscle in 112 patients with definite ALS between March 2012 and June 2013 in the Department of Neurology at Chinese PLA General Hospital. Parameters studies included spontaneous potentials, duration and amplitude of motor unit potentials (MUP), pattern of recruitment. Results: EMG revealed diffuse neurogenic changes in each case. Fibrillation potential or positive sharp waves were found in some muscles in all of patients, and both of them were found in most of the cases. Fasciculation potentials (FPs) were found in 8 patients and accompanied with fibrillation potential and positive sharp waves in 5 of them. Complex repetitive discharges (CRDs) were found in only 1 patient. Duration and amplitude of MUP was prolonged and increased in ALS patients, and the rate of high amplitude and decreased recruitment pattern were 35.71% and 72.32%, respectively. Logistic regression analysis revealed an association of the FVC loss with the drop of ALSFRS-R and peak amplitude of the tenth thoracic paraspinal muscle. Conclusions: The abnormal spontaneous activity with high frequency are fibrillation potentials and/or positive sharp waves. However, FPs is observed in a small number of patients and CRDs is rarely seen in ALS. The ALSFRS-R and peak amplitude of thetenth thoracic paraspinal muscle may be of certain clinical value in estimating the severity of disease especially the respiratory dysfunction in ALS patients.

[Relationship between lumbosacral multifidus muscle and lumbar disc herniation]

As a common disease in clinical, the treatment of lumbar disc herniation (LDH) focused on local intervertebral disc, such as surgery and other interventional therapy treatment, but postoperative complications and recurrence rate has been a difficult problem in the field of profession. With the development of spine biomechanics and anatomy, researches on lumbar herniation also increased. Researchers discovered that the incidence and prognosis of LDH were inseparable with local muscle and soft tissue. As the deep paraspinal muscles, multifidus muscle plays an important role to make lumbar stability. Its abnormal function could reduce the stable of lumbar spine, and the chronic lumbar disease could also lead to multifidus muscle atrophy.

Seated maximum flexion: An alternative to standing maximum flexion for determining presence of flexion-relaxation?

BACKGROUND

The flexion-relaxation phenomenon (FRP) in standing is a specific and sensitive diagnostic tool for low back pain. Seated flexion as an alternative could be beneficial for certain populations, yet the behavior of the trunk extensors during seated maximum flexion compared to standing flexion remains unclear.

OBJECTIVE

Compare FRP occurrences and spine angles between seated and standing flexion postures in three levels of the erector spinae muscles.

METHODS

Thirty-one participants free of back pain performed seated and standing maximum trunk flexion. Electromyographical signals were recorded from the bilateral lumbar (L3), lower-thoracic (T9), and upper-thoracic (T4) erector spinae and assessed for the occurrence of FRP. Spine angles corresponding to FRP onset and cessation were determined, and FRP occurrences and angles were compared between posture and muscle.

RESULTS

FRP occurrence was similar in standing and seated maximum flexion across all muscles, with the lumbar muscles showing the greatest consistency. Standing FRP onset and cessation angles were consistently greater than the corresponding seated FRP angles.

CONCLUSION

Considering the similar number of FRP occurrences, seated maximum flexion may constitute an objective criterion for low back pain diagnosis. Future work should seek to confirm the utility of this test in individuals with low back pain.

[Comparison of paravertebral soft tissue tension changes in patients with chronic lower back pain treated by sliver needle and traditional Chinese medicine fumigation]

OBJECTIVE

To evaluate clinical significance of waist soft tissue tension detection in treating chronic nonspecific low back pain.

METHODS

From August 2011 to March 2012,60 patients with chronic nonspecific low back pain were divided into two groups (sliver needle group and TCM fumigation group) according to propotion of 1:1. In sliver needle group, there were 17 males and 13 females aged from 28 to 55 years old with an average age of (45.70 +/- 4.15), treated with sliver needle; In TCM fumigation group,there were 19 males and 11 females aged from 27 to 55 years old with an average age of (43.03 +/- 5.86), treated with TCM fumigation. Changes of force-displacement distance (FDD), specific absorption rate (S) of two groups were observed before treatment, 1 week and 3 months after treatment respectively, VAS scoring and Roland-Morris disability questionnaire (RMDQ) were used to access clinical effects.

RESULTS

(1) VAS score of silver needle group was 4.77 +/- 0.78, 1.99 +/- 1.08 and 2.55 +/- 0.94, respectively before treatment, at 1 week and 3 months after treatment,while VAS score in TCM fumigation group were 4.43 +/- 0.61, 2.48 +/- 0.71 and 3.05 +/- 0.86, respectively. VAS score of two groups after treatment were sigificant decrease than that of before treatment (P < 0.05). There was no sigificant differences between two groups before treatment, but sliver needle group performed well in analgesia than TCM fumigation group, and had obvious differences (P < 0.05). RMDQ score of silver needle group was 13.63 +/- 1.96, 5.87 +/- 2.33 and 6.53 +/- 2.89, respectively before treatment, at 1 week and 3 months after treatment, while RMDQ score in TCM fumigation group were 13.40 +/- 2.01, 6.90 +/- 2.31, 9.23 +/- 2.87, respectively. There was no significant differences between two groups before treatment and 1 week after treatment (P > 0.05), and had obvious differences between two groups at 3 months after treatment (P < 0.01). Both groups could obvious improve dysfunction caused by chronic low back pain, and curative effect of sliver needle groups was more endurable. (2) Following-up at 3 months after treatment, FDD of multifidus, erector spinae of effected side and multifidus of healthy in sliver needle group were obvious increased (P < 0.05); In TCM fumigation group, FDD of multifidus and erector spinae on both side were increased at 1 week after treatment (P < 0.05), but had no significant meaning at 3 months after treatment on health side (P>0.05). There was no significant meaning before treatment (P > 0.05), FDD of multifidus, erector spinae of effected side in sliver needle group were obvious increased at 1 week after treatment (P < 0.05); but no obvious meaning on health side. FDD of both side in sliver needle group were obvious increased at 3 months after treatment. (3) There was correlation among differences of FDD in multifidus and erector spinae, VAS score and differences of RMDQ, and Spearman correlation coefficient R was 0.517, 0.811, 0.746 and 0.625; There was correlation between items of soft tissue tension and sympotoms, function and life quality. Conclusion:Soft tissue tension detection can effectively manifest degree of pain and dysfunction of low back, and improve objectivity of therapeutic evaluation for chronic low back pain.

Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series

A retrospective case series of three patients with chronic low back pain who received baseline MRI scans revealing multifidus muscle atrophy with fatty replacement is provided. Each patient received spinal manipulative therapy, and two were compliant with low back exercises targeting the multifidus. A follow-up scan performed >1 year later was compared to the baseline scan revealing a decrease in atrophy with fatty replacement in the two patients who performed multifidus-focused low back exercises (15% and 39% on the left and 7% and 32% on the right respectively), and an increase in the patient who underwent spinal manipulation alone (41% and 53%). Interestingly, the decrease in atrophy in the two patients that performed the exercises correlated to functional improvements. Though limited, these results highlight the utility of MRI in quantifying positive and negative long-term changes in multifidus atrophy, which may be an indicator of recovery in chronic low back pain patients.

The effect of a backrest and seatpan inclination on sitting discomfort and trunk muscle activation in subjects with extension-related low back pain

Few studies have demonstrated that seating modifications reduce low back pain (LBP). One recent study found that a forward-inclined seatpan reduced low back discomfort (LBD), however this was only examined in people with flexion-related LBP. No study has yet investigated its effectiveness among people with extension-related LBP. This crossover study examined 12 subjects with extension-related LBP. Sitting discomfort and surface electromyography of three trunk muscles were recorded during a 10-minute typing task while sitting with two different seatpan inclinations, both with and without a backrest. LBD (p < 0.001) and overall body discomfort (OBD) (p = 0.016) were significantly greater on the forward-inclined seatpan. The backrest did not alter trunk muscle activation or sitting discomfort. The results demonstrate that in a specific subgroup of people with extension-related LBP, increasing forward seatpan inclination significantly increased LBD and OBD. Future research should consider matching ergonomics prescriptions according to the individual presentation of people with LBP.

[Stiff person syndrome--case report]

Stiff person syndrome (SPS) is the rare disease and cause great inefficient. It is characterized by progressive stiffness muscles of trunk and the limbs on which the cramps of muscles overlap. In the electrophysiological investigation of the patients the involuntary discharge of motor unit potentials find and also simultaneous contraction agonistic and antagonistic muscles. SPS is presented with insulin-dependent diabetes mellitus often or is the symptom of the paraneoplastic syndrome. It is commonly associated with high anti-glutamic acid decarboxylaze (GAD) antibody titters in the serum of the blood of patients. Establishing the diagnosis can cause difficulties. We observed the patient in the last period about the atypical course the disease. The diagnosis was confirmed occurrences of the high titters of antibodies anti-GAD, the discharge of motor unit potential in paraspinal muscles in the rest and good response the treatment with diazepamem.

Specific flexion-related low back pain and sitting: comparison of seated discomfort on two different chairs

No study has examined the effectiveness of prescribing seating modifications according to the individual clinical presentation of people with low back pain (LBP). A dynamic, forward-inclined chair ('Back App') can reduce seated paraspinal muscle activation among pain-free participants. This study examined 21 participants whose LBP was specifically aggravated by prolonged sitting and was eased by standing. Low back discomfort (LBD) and overall body discomfort (OBD) were assessed every 15 min while participants sat for 1 h on both the dynamic, forward-inclined chair and a standard office chair. LBD increased significantly more (p = 0.005) on the standard office chair, with no significant difference (p = 0.178) in OBD between the chairs. The results demonstrate that, in a specific flexion-related subgroup of people with LBP, increased LBD during sitting can be minimised through modifying chair design. Mechanisms that minimise seated discomfort may be of relevance in LBP management, as part of a biopsychosocial management plan.

PRACTITIONER SUMMARY

This study examined low back discomfort (LBD) during a typing task among people with low back pain (LBP). Sitting on a dynamic, forward-inclined chair resulted in less seated LBD than sitting on a standard office chair. Further research is required to examine the long-term effectiveness of ergonomics interventions in LBP.