The relationship between the endurance of the lumbar paraspinal muscles and morphological changes needs to be clarified. In this context, the importance can be revealed of increasing the endurance level of the paraspinal muscles in the prevention and treatment of low back diseases.
OBJECTIVE:
The aim of this study was to examine the relationship between the clinical evaluation results of the cross-sectional area (CSA) and fat infiltration of the lumbar deep paraspinal muscles.
METHODS:
The study included 37 patients with mechanical low back pain (mechanical), 41 patients with lumbar hernia without root compression (discopathy) and 36 healthy individuals as a control group. The functional status of the lumbar deep paraspinal muscles was evaluated clinically with muscle endurance tests. The fat infiltration and CSA of the muscles were evaluated on axial MRI sections at the L3-S1 level.
RESULTS:
The mean values of the prone bridge, Biering-Sorenson, and trunk flexion tests were seen to be highest in the control group and lowest in the discopathy group ( 0.001). In all tests, the longest test period was obtained at 10% fat infiltration and the shortest at 50% fat infiltration. It was observed that as the amount of fat infiltration of the muscles increased, the test times were shortened. There was no significant relationship between the endurance level and the CSA of the groups.
CONCLUSION:
The study results demonstrated that the endurance of the paraspinal muscles is associated with the fat infiltration of the muscles. In patients with chronic low back pain, information about muscle morphology and degeneration can be obtained with simple endurance tests without the need for further measurements. On clinical examination, a weak endurance level of the paraspinal muscles indicates the presence of a low back problem and an increase in the amount of fat infiltration.
MiddleditchAOliverJ. Functional Anatomy of the Spine. Edinburgh: Elsevier Butterworth-Heinemann, 2005.
2.
HodgesPWDanneelsL. Changes in structure and function of the back muscles in low back pain: Different time points, observations, and mechanisms. J Orthop Sports Phys Ther.2019; 49(6): 464-476.
3.
ZwambagDPBrownSHM. Experimental validation of a novel spine model demonstrates the large contribution of passive muscle to the flexion relaxation phenomenon. J Biomech.2020; 102: 109431.
4.
CallaghanJPPatlaAEMcGillSM. Low back three dimensional joint forces, kinematics, kinetics during walking. Clin Biomech.1999; 14(3): 230-236.
5.
LindthM. Biomechanics of the Lumbal Spine. Basic Biomechanics of the Musculoskeletal System, Second Edition, USA, 1989: 183-337.
6.
NoonanAMBrownSHM. Paraspinal muscle pathophysiology associated with low back pain and spine degenerative disorders. JOR Spine.2021; 4(3): e1171.
7.
DanneelsLAVanderstraetenGGCambierDCWitvrouwEEDe CuyperHJ. CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects. Eur Spine J.2000; 9(4): 266-272.
8.
MinJHChoiHSIhl RheeWLeeJI. Association between radiculopathy and lumbar multifidus atrophy in magnetic resonance imaging. J Back Musculoskelet Rehabil.2013; 26: 175-181.
9.
KaderDFWardlawDSmithFW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol.2000; 55: 145-9.
10.
FortinMGibbonsLEVidemanTBattiéMC. Do variations in paraspinal muscle morphology and composition predict low back pain in men? Scand J Med Sci Sports.2015; 25(6): 880-7.
11.
HidesJGilmoreCStantonWBohlscheidE. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther.2008; 13(1): 43-49.
12.
LeeHJLimWHParkJWKwonBSRyuKHLeeJHParkYG. The relationship between cross sectional area and strength of back muscles in patients with chronic low back pain. Ann Rehabil Med.2012; 36(2): 173-181.
13.
HodgesPWJamesGBlomsterLHallLSchmidAShuC, et al. Multifidus muscle changes after back injury are characterized by structural remodeling of muscle, adipose and connective tissue, but not muscle atrophy: Molecular and morphological evidence. Spine (Phila Pa 1976).2015; 40: 1057-1071.
14.
JamesGSlukaKABlomsterLHallLSchmidAShuC, et al. Macrophage polarization contributes to local inflam-mation and structural change in the multifidus muscle after intervertebral disc injury. Eur Spine J.2018; 27: 1744-1756.
15.
UpadhyayBTomsAP. CT and MRI evaluation of paraspinal muscle degeneration. Europen Society of Radiology. 2015; C-2114. doi: 10.1594/ecr2015/C-2114.
16.
KjaerPBendixTSorensenJKorsholmLLeboeuf-YdeC. Are MR defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med.2007; 5(2).
17.
MengiardiBSchmidMRBoosNPfirrmannCWBrunnerFElferingA, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: Quantification with MR spectroscopy. Radiology.2006; 240: 786-92.
18.
ParkkolaRKormanoM. Lumbar disc and back muscle degeneration on MRI: Correlation to age and body mass. J Spinal Disord.1992; 5(1): 86-92.
19.
TeichtahlAJUrquhartDMWangYWlukaAEWijethilakePO’SullivanRCicuttiniFM. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J.2015; 15(7): 1593-601.
20.
SuriPFryALGellhornAC. Do muscle characteristics on lumbar spine magnetic resonance imaging or computed tomography predict future low back pain, physical function, or performance? A systematic review. PM R.2015; 7: 1269-81.
21.
BeneckGJKuligK. Multifidus atrophy is localized and bilateral in active persons with chronic unilateral low back pain. Arch Phys Med Rehabil.2012; 93: 300-306.
22.
KamazMKiresiDOguzHEmlikDLevendogluF. CT measurement of trunk muscle areas in patients with chronic low back pain. Diagn Interv Radiol.2007; 13(3): 144-148.
23.
KalichmanLHodgesPLiLGuermaziAHunterDJ. Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study. Eur Spine J.2010; 19(7): 1136-44.
24.
FortinMVidemanTGibbonsLEBattieMC. Paraspinal muscle morphology and composition: A 15-yr longitudinal magnetic resonance imaging study. Med Sci Sports Exerc.2014; 46: 893-901.
25.
DickxNCagnieBAchtenEVandemaelePParlevlietTDanneelsL. Differentiation between deep and superficial fibers of the lumbar multifidus by magnetic resonance imaging. Eur Spine J.2010; 19: 122-128.
26.
WallworkTLStantonWRFrekeMHidesJA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther.2009; 14: 496-500.
27.
McLoughlinRFD’ArcyEMBrittainMMFitzgeraldOMastersonJB. The significance of fat and muscle areas in the lumbar paraspinal space: A CT study. J Comput Assisted Tomogr.1994; 18(2): 275-278.
28.
PloumisAMichailidisNChristodoulouPKalaitzoglouIGouvasGBerisA. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol.2011; 84(1004): 709-713.
29.
GibbonsLEVidemanTBattieMCKaprioJ. Determinantsof paraspinal muscle cross-sectional area in male monozygotic twins. Phys Ther.1998; 78(6): 602-12.
30.
BattieMCNiemelainenRGibbonsLEDhillonS. Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology? Spine J.2012; 12(10): 932-939.
31.
GoubertDDe PauwRMeeusMWillemsTCagnieBSchouppeS, et al. Lumbar muscle structure and function in chronic ver-sus recurrent low back pain: A cross-sectional study. Spine J.2017; 17: 1285-1296.
32.
HultmanGNordinMSarasteHOhlsènH. Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain. J Spinal Disord.1993; 6(2): 114-23.
33.
FortinMMacedoL. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: A systematic review with a focus on blinding. Phys Ther.2013; 93(7): 873-888.
34.
DulorJPCambonBVigneronPReyneYNouguesJCasteillaL, et al. Expression of specific white adipose tissue genes in denervation-induced skeletal muscle fatty degeneration. FEBS Lett.1998; 439: 89-92.
35.
YoshiharaKShiraiYNakayamaYUesakaS. Histochemical changes in the multifidus muscle in patients with lumbar intervertebral disc herniation. Spine (Phila Pa 1976).2001; 26(6): 622-6.
36.
GutinBManosTStrongW. Defining health and fitness: First step toward establishing childrens fitness standards. Res Q Exerc Sport.1992; 63(2): 128-132.
ProperKIBeekAJHildebrandtVHTwiskJWRMechelenW. Short term effect of feedback on fitness and health measurements on self reported appraisal of the stage of change. Br J Sports Med.2003; 37: 529-534.
39.
GrutherWWickFPaulBLeitnerCPoschMMatznerMCrevennaREbenbichlerG. Diagnostic accuracy and reliability of muscle strength and endurance measurements in patients with chronic low back pain. J Rehabil Med.2009; 41(8): 613-9.
40.
ReidSHazardRGFenwickJW. Isokinetic trunk-strength deficits in people with and without low back pain: A comparative study with consideration of effort. J Spinal Disord.1991; 4: 68-72.
41.
ParkkolaRRytökoskiUKormanoM. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine.1993; 18(7): 830-836.
42.
HodgesPWRichardsonCA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976).1996; 21: 2640-2650.
43.
MacDonaldDMoseleyGLHodgesPW. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain.2009; 142: 183-188.
44.
CagnieBDhoogeFSchumacherCDe MeulemeesterKPetrovicMvan OosterwijckJ, et al. Fiber typing of the erector spinae and multifidus muscles in healthy controls and back pain patients: A systematic literature review. J Manipulative Physiol Ther.2015; 38(9): 653-663.
45.
HasueMFujiwaraMKikuchiS. A new method of quantitative measurement of abdominal and back muscle strength. Spine.1980; 5: 143-148.
46.
NewtonMThowMSomervilleDHendersonIWaddellG. Trunk strength testing with iso-machines. Part 2: Experimental evaluation of the Cybex II Back Testing System in normal subjects and patients with chronic low back pain. Spine (Phila Pa 1976).1993; 18(7): 812-24.
47.
MoffroidMReidSHenrySMHaughLDRicamatoA. Some endurance measures in persons with chronic low back pain. J Orthop Sports Phys Ther.1994; 20(2): 81-7.
48.
SteeleJBruce-LowSSmithD. A review of the clinical value of isolated lumbar extension resistance training for chronic low back pain. PM R.2014; 7: 169-187.
49.
ChoKHBeomJWLeeTSLimJHLeeTHYukJH. Trunk muscles strength as a risk factor for nonspecific low back pain: A pilot study. Ann Rehabil Med.2014; 38: 234-240.
50.
LeeJHHoshinoYNakamuraKKariyaYSaitaKItoK. Trunk muscle weakness as a risk factor for low back pain. A 5-year prospective study. Spine.1999; 24: 54-57.
51.
MacDonaldDAMoseleyGLHodgesPW. The lumbar multifidus: does the evidence support clinical beliefs? Man Ther.2006; 11: 254-263.
52.
DanneelsLACoorevitsPLCoolsAMVanderstraetenGGCambierDCWitvrouwEE, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Eur Spine J.2002; 11(1): 13-9.
53.
O’LearySJullGVan WykLPedlerAElliottJ. Morphological changes in the cervical muscles of women with chronic whiplash can be modified with exercise – a pilot study. Muscle Nerve.2015; 52: 772-779.
54.
McGillSGrenierSBluhmMPreussRBrownSRussellC. Previous history of LBP with work loss is related to lingering deficits in biomechanical, physiological, personal, psychosocial and motor control characteristics. Ergonomics.2003; 46: 731-746.
55.
Batti’eMCBigosSJFisherLDHanssonTHJonesMEWortleyMD. Isometric lifting strength as a predictor of industrial back pain reports. Spine (Phila Pa 1976).1989 Aug; 14(8): 851-6.
56.
LarivièreCGagnonDLoiselP. The comparison of trunk muscles EMG activation between subjects with and without chronic low back pain during flexion-extension and lateral bending tasks. J Electromyogr Kinesiol.2000; 10: 79-91.
57.
LisińskiP. Surface EMG in chronic low back pain. Eur Spine J.2000; 9: 559-562.
58.
MysliwiecLWCholewickiJWinkelpleckMDEisGP. MSU classification for herniated lumbar discs on MRI: Toward developing objective criteria for surgical selection. Eur Spine J.2010; 19(7): 1087-93.
59.
PanjabiMM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol.2003; 13(4): 371-9.
60.
FardonDF. Nomenclature and classification of lumbar disc pathology. Spine.2001; 26: 461-462.
61.
Solgaard SorensenJKjaerPJensenSTAndersenP. Low-field magnetic resonance imaging of the lumbar spine: Relia-bility of qualitative evaluation of disc and muscle parameters. Acta Radiol.2006; 47: 947-53.
62.
KalichmanLCarmeliEBeenE. The association between imaging parameters of the paraspinal muscles, spinal degeneration, and low back pain. Biomed Res Int. 2017; 2562957.
63.
Biering-SorensenF. Physical measurements as risk indicators for low-back trouble over a one-year period. Spine.1984; 9: 106-19.
64.
Mc GillSMChildsALiebensonC. Endurance times for low back stabilization exercises: Clinical targets for testing and training from a normal database. Arch Phys Med Rehabil.1999; (80): 941-944.
65.
DurallCJGreenePFKernozekTW. A comparison of two isometric tests of trunk flexor endurance. J Strength Cond Res.2012; 26: 1939-1944.
66.
SprietLLDyckDJ. The glucose-fatty acid cycle in skeletal muscle at rest and during exercise. Biochemistry of exercise. Human Kinetics Publishers İnc. 2003: 127-56.
67.
MiuraTSakurabaK. Properties of force output and spectral EMG in young patients with nonspecific low back pain during isometric trunk extension. J Phys Ther Sci.2014; 26(3): 323-9.
68.
OddssonLIDe LucaCJ. Activation imbalances in lumbar spine muscles in the presence of chronic low back pain. J Appl Physiol.2003; 94: 1410-1420.
69.
ElfvingBDederingANemethG. Lumbar muscle fatigue and recovery in patients with long-term low-back trouble-electromyography and health-related factors. Clin Biomech (Bristol, Avon), 2003; 18: 619-630.
70.
LarivièreCArsenaultABGravelDGagnonDLoiselP. Surface electromyography assessment of back muscle intrinsic properties. J Electromyogr Kinesiol.2003; 13(4): 305-18.
71.
BiedermannHJShanksGLForrestWJInglisJ. Power spectrum analyses of electromyographic activity. Discriminators in the differential assessment of patients with chronic low-back pain. Spine (Phila Pa 1976).1991; 16(10): 1179-84.
72.
GibbonsLELatikkaPVidemanTManninenHBat-tiéMC. Th e association of trunk muscle cross-section-al area and magnetic resonance image parameters with isokinetic and psychophysical lifting strength and static back muscle endurance in men. J Spinal Disord.1997; 10: 398-403.
73.
SungPSLammersARDanialP. Different parts of erector spinae muscle fatigability in subjects with and without low back pain. Spine J.2009; 9(2): 115-20.
74.
LewisJSHewittJSBillingtonLColeSByngJKarayiannisS. A randomized clinical trial comparing two physiotherapy interventions for chronic low back pain. Spine (Phila Pa 1976).2005; 30(7): 711-21.
75.
NiemistöLLahtinen-SuopankiTRissanenPLindgrenKASarnaSHurriH. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine (Phila Pa 1976).2003; 28(19): 2185-91.
76.
KimSKimHChungJ. Effects of Spinal Stabilization Exercise on the Cross-sectional Areas of the Lumbar Multifidus and Psoas Major Muscles, Pain Intensity, and Lumbar Muscle Strength of Patients with Degenerative Disc Disease J Phys Ther Sci. 2014; 26: 579-582.
77.
KellerABroxJIGundersonRHolmIFriisAReikeråsO. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine (Phila Pa 1976).2004; 29(1): 3-8.
78.
HidesJAStantonWRMcMahonSSimsKRichardsonCA. Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. J Orthop Sports Phys Ther.2008; 38(3): 101-8.
79.
CholewickiJBreenAPopovichJM JrReevesNPSahrmannSAvan DillenLR, et al. Can biomechanics research lead to more effective treatment of low back pain? A point-counterpoint debate. J Orthop Sports Phys Ther.2019; 49(6): 425-436.
80.
HlaingSSPuntumetakulRKhineEEBoucautR. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: A randomized controlled trial. BMC Musculoskelet Disord.2021; 22(1): 998.
81.
HodgesPWvan DieënJHCholewickiJ. Time to reflect on the role of motor control in low back pain. J Orthop Sports Phys Ther.2019; 49(6): 367-369.
82.
van DieënJHReevesNPKawchukGvan DillenLRHodgesPW. Analysis of motor control in patients with low back pain: A key to personalized care? J Orthop Sports Phys Ther.2019; 49(6): 380-388.
83.
van DieënJHReevesNPKawchukGvan DillenLRHodgesPW. Motor control changes in low back pain: Divergence in presentations and mechanisms. J Orthop Sports Phys Ther.2019; 49(6): 370-379.
84.
HodgesPWBarbeMFLoggiaMLNijsJStoneLS. Diverse role of biological plasticity in low back pain and its impact on sensorimotor control of the spine. J Orthop Sports Phys Ther.2019; 49(6): 389-401.
