Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which may restore normal LMM morphology and reduce LBP. However, its effects on LMM morphology have not been summarized. This review aimed to summarize evidence regarding the (1) effectiveness of MCE in altering LMM morphometry and decreasing LBP; and (2) relations between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, EMBASE and SPORTDiscus were searched from inception to 30 September 2020 to identify relevant randomized controlled trials. Two reviewers independently screened articles, extracted data, and evaluated risk of bias and quality of evidence. Four hundred and fifty-one participants across 9 trials were included in the review. Very low-quality evidence supported that 36 sessions of MCE were better than general physiotherapy in causing minimal detectable increases in LMM cross-sectional areas of patients with chronic LBP. Very low- to low-quality evidence suggested that MCE was similar to other interventions in increasing resting LMM thickness in patients with chronic LBP. Low-quality evidence substantiated that MCE was significantly better than McKenzie exercise or analgesics in increasing contracted LMM thickness in patients with chronic LBP. Low-quality evidence corroborated that MCE was not significantly better than other exercises in treating people with acute/chronic LBP. Low-quality evidence suggested no relation between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Collectively, while MCE may increase LMM dimensions in patients with chronic LBP, such changes may be unrelated to clinical outcomes. This raises the question regarding the role of LMM in LBP development/progression.
IntroductionLumbar multifidus muscle (LMM) dysfunction is thought to be related to pain and/or disability in people with chronic low back pain (CLBP). Although psychosocial factors play a major role in pain/disability, they are seldom considered as confounders in analyzing the association between LMM and CLBP.ObjectivesThis study aimed to determine: (1) differences in psychological factors, insomnia, and LMM characteristics between people with and without CLBP; (2) associations between psychological factors, insomnia, or LMM characteristics and low back pain (LBP) intensity or LBP-related disability in people with CLBP; and (3) whether LMM characteristics are related to LBP symptoms in people with CLBP after considering confounders.MethodsSeventy-eight volunteers with CLBP and 73 without CLBP provided sociodemographic information, filled the 11-point numeric pain rating scale and Roland-Morris disability questionnaire (RMDQ). They completed the Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), Fear Avoidance Belief Questionnaire (FAB), and Insomnia Severity Index Scale (ISI). Resting and contracted thickness of LMM at L4-S1 levels were measured from brightness-mode ultrasound images. Percent thickness changes of LMM at L4-S1 levels during contraction were calculated. Resting LMM stiffness at L4-S1 was measured by shear wave elastography. Associations among LMM, psychosocial or insomnia parameters and clinical outcomes were analyzed by univariate and multivariate analyses.ResultsPeople with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCS-helplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBP-intensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP.ConclusionMore fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.
Objectives: Sleep disturbance is prevalent among patients with chronic low back pain (CLBP). This systematic review aimed to summarize the evidence regarding the: (1) temporal relations between changes in sleep quality/quantity and the corresponding changes in pain and/or disability; and (2) role of baseline sleep quality/quantity in predicting future pain and/or disability in patients with CLBP.Methods: Four databases were searched from their inception to February 2021. Two reviewers independently screened the abstract and full text, extracted data, assessed the methodological quality of the included studies, and evaluated the quality of evidence of the findings using the Grading of Recommendations Assessment Development and Evaluation (GRADE).Results: Of 1995 identified references, 6 articles involving 1641 participants with CLBP were included. Moderate-quality evidence substantiated that improvements in self-reported sleep quality and total sleep time were significantly correlated with the corresponding LBP reduction. Low-quality evidence showed that self-reported improvements in sleep quality were related to the corresponding improvements in CLBP-related disability. There was conflicting evidence regarding the relation between baseline sleep quality/ quantity and future pain/disability in patients with CLBP.Discussion: This is the first systematic review to accentuate that improved self-reported sleep quality/quantity may be associated with improved pain/disability, although it remains unclear whether baseline sleep quality/quantity is a prognostic factor for CLBP. These findings highlight the importance of understanding the mechanisms underlying the relation between sleep and CLBP, which may inform the necessity of assessing or treating sleep disturbance in people with CLBP.
Introduction: While young adults with chronic low back pain (CLBP) exhibit impaired lumbar proprioception, it remains unclear if the same phenomenon is observed in middle-aged adults with CLBP.Objectives: This study aimed to investigate whether young or middle-aged adults with CLBP displayed different proprioception ability as compared to age-matched asymptomatic controls.Methods: Sixty-four young adults with [median age:34 [interquartile range (IQR): 29–37] years] and without [median age:29 (IQR; 23–34) years] CLBP, and 87 middle-aged adults with [median age:53 (IQR: 49–58) years] and without [median age: 54 (IQR: 45–64) years] CLBP underwent postural sway tests on a force-plate with (unstable surface) and without a foam (stable surface), while bilateral L5/S1 multifidi and triceps-surae were vibrated separately. An individual's proprioception reweighting ability was estimated by relative proprioceptive reweighting (RPW). Higher RPW values indicate less reliance on lumbar multifidus proprioceptive signals for balance. Participants also underwent lumbar repositioning tests in sitting to determine repositioning errors in reproducing target lumbar flexion/extension positions.Results: Young adults with CLBP demonstrated significantly higher median RPW values than age-matched asymptomatic controls for maintaining standing balance [stable surface: CLBP: 0.9 (IQR: 0.7–0.9), asymptomatic: 0.7 (IQR: 0.6–0.8), p < 0.05; unstable surface: CLBP: 0.6 (IQR: 0.4–0.8), asymptomatic: 0.5 (IQR: 0.3–0.7), p < 0.05]. No significant differences in repositioning error were noted between young or middle-aged adults with and without CLBP (p > 0.05). RPW values were unrelated to repositioning errors in all groups (p > 0.05).Conclusion: Young adults with CLBP, and middle-aged adults with and without CLBP had inferior proprioceptive reweighting capability. This finding may indicate potential age-related deterioration in central and peripheral processing of lumbar proprioceptive signals. Future studies should use advanced imaging and/or electroencephalogram to determine mechanisms underlying changes in proprioceptive reweighting in middle-aged adults.
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