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      The Evaluation of Chronic Low Back Pain by Determining the Ratio of the Lumbar Multifidus Muscle Cross-sectional Areas of the Unaffected and Affected Sides

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          Abstract

          [Purpose] The primary purpose of this study was to evaluate chronic low back pain by determining the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides at the L5 level using the ultrasound imaging. [Subjects and Methods] The subjects were 24 young people (10 males, 14 females) with chronic low back pain lasting for more than 6 months on one side. The visual analog scale (VAS) value of pain was assessed and the cross-sectional areas of the bilateral multifidus muscle were measured with the subjects in a supine position in a resting state using ultrasound imaging. Correlation and linear regression analysis were performed on the VAS and the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides. [Results] The VAS and the ratio of the cross-sectional areas of the lumbar multifidus were linearly correlated. [Conclusion] The results of this research indicate that when the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides increases, the symptom of chronic low back pain deteriorates.

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          Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain.

          G Jull, George B. Richardson, J Hides (1996)
          A clinical study was conducted on 39 patients with acute, first-episode, unilateral low back pain and unilateral, segmental inhibition of the multifidus muscle. Patients were allocated randomly to a control or treatment group. To document the natural course of lumber multifidus recovery and to evaluate the effectiveness of specific, localized, exercise therapy on muscle recovery. Acute low back pain usually resolves spontaneously, but the recurrence rate is high. Inhibition of multifidus occurs with acute, first-episode, low back pain, and pathologic changes in this muscle have been linked with poor outcome and recurrence of symptoms. Patients in group 1 received medical treatment only. Patients in group 2 received medical treatment and specific, localized, exercise therapy. Outcome measures for both groups included 4 weekly assessments of pain, disability, range of motion, and size of the multifidus cross-sectional area. Independent examiners were blinded to group allocation. Patients were reassessed at a 10-week follow-up examination. Multifidus muscle recovery was not spontaneous on remission of painful symptoms in patients in group 1. Muscle recovery was more rapid and more complete in patients in group 2 who received exercise therapy (P = 0.0001). Other outcome measurements were similar for the two groups at the 4-week examination. Although they resumed normal levels of activity, patients in group 1 still had decreased multifidus muscle size at the 10-week follow-up examination. Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.
          Article 0 comments Cited 162 times – based on 0 reviews     Review now
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            The Intervention Effects of Different Treatment for Chronic Low Back Pain as Assessed by the Cross-sectional Area of the Multifidus Muscle

            Qiuchen Huang, Desheng Li, Noriyo Yokotsuka … (2013)
            [Purpose] The purpose of this this study was to examine the immediate effects of intervention of proprioceptive neuromuscular facilitation (PNF), neuromuscular joint facilitation (NJF) and NJF+pelvic floor muscle (PFM) exercise. [Subjects] Thirteen young people (5 males, 8 females) who had chronic low back pain on one side for more than 6 months. [Methods] Subjects were asked to lie on their sides with the painful side uppremost. The subjects received PNF, and NJF, NJF+PFM exercise treatments. The changes in the cross-sectional area of the multifidusmuscle were measured using ultrasonography. [Results] The cross-sectional area of the multifidus muscle of NJF+PFM group showed the largest increases on both the sides with and without pain. [Conclusion] Our results show that chronic low back pain can be improved by a combination of PFM exercise and the NJF pattern.
            Article 0 comments Cited 13 times – based on 0 reviews     Review now
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              A revised anatomical model of the abdominal musculature for torso flexion efforts.

              Stuart McGill (1996)
              Models of the abdominal musculature, which used single slice MRI or CT scans to reconstruct the anatomy, were unable to explain magnitudes of abdominal flexion moment which exceed 100 Nm in living subjects. For example, the muscle areas and corresponding flexor moment arms measured from a transverse scan at L4-L5 predict maximum moments less than 50 Nm. The architecture of rectus abdominis, external and internal obliques, and transverse abdominis was examined from cadaveric specimens, from which the geometric details were incorporated into a revised model. Scaling of the muscles to obtain physiological cross-sectional areas were obtained using two methods: serial MRI slices; and from several locations of ultrasound measurement. The two major anatomically justified improvements that had dramatic effects on flexor moment production were: the increase in flexor moment arms of muscles (approximately 30%) measured in a standing posture when compared to the supine posture for MRI examination; reinterpretation of the line of action of the obliques which transmit their flexor forces through the linea semilunaris (increasing their effective flexor moment arm) to eventual skeletal attachment at the pelvis.
              Article 0 comments Cited 10 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Phys Ther Sci
                Journal ID (iso-abbrev): J Phys Ther Sci
                Journal ID (publisher-id): JPTS
                Title: Journal of Physical Therapy Science
                Publisher: The Society of Physical Therapy Science
                ISSN (Print): 0915-5287
                ISSN (Electronic): 2187-5626
                Publication date (Electronic): 28 October 2014
                Publication date (Print): October 2014
                Volume: 26
                Issue: 10
                Pages: 1613-1614
                Affiliations
                [1) ] Department of Physical Therapy, International University of Health and Welfare, Japan
                [2) ] Department of Physical Therapy, China Rehabilitation Center, China
                [3) ] School of Rehabilitation Medicine, Capital Medical University, China
                [4) ] Himeji Dokkyo University, Japan
                Author notes
                [* ]Corresponding author. Qiuchen Huang, Department of Physical Therapy, International University of Health and Welfare: 2600-1 Kitakanemaru, Ohtawara City, Tochigi 324-8501, Japan. (E-mail: qiuchen_1984@ 123456126.com )
                Article
                Publisher ID: jpts-2014-155
                DOI: 10.1589/jpts.26.1613
                PMC ID: 4210411
                PubMed ID: 25364126
                SO-VID: fe29df74-be65-4883-b8a1-bfbe16ab48d4
                Copyright © 2014©by the Society of Physical Therapy Science
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License.

                History
                Date received : 10 March 2014
                Date accepted : 21 April 2014
                Categories
                Subject: Original Article

                Keywords: multifidus,chronic low back pain,ultrasound imaging
                Data availability:
                Keywords: multifidus, chronic low back pain, ultrasound imaging

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