Investigation of physiological stress shielding within lumbar spinal tissue as a contributor to unilateral low back pain: A finite element study

Newell, Emily; Driscoll, Mark

doi:10.1016/j.compbiomed.2021.104351

Cited by 11 publications

(17 citation statements)

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“…In accordance with the anatomical connectivity of the thoracolumbar fascia to the various spinal protrusions as well as past suggestions, such as Gracovetsky et al [ 22 ] and Fairbank et al [ 23 ], who suggested that forces may be transmitted between the transverse and axial directions to form of an extensor moment, a prior model [ 11 , 24 ] was further expanded to a 3D model in order to explore the out-of-plane effects of the Thoracolumbar Fascia in collaboration with the abdominal pressure. Specifically, this study seeks to investigate the axial force across the TLF using different boundary conditions or simulated patient positions.…”

Section: Introductionsupporting

confidence: 75%

“…This notion will be further studied in subsequent studies. Interestingly, one may contrast another study in which not only positional loading, as observed herein, impacted fascia or TLF loading, and the geometry and mechanical properties impact what load it undertakes in the spine [ 24 , 32 ].…”

Section: Discussionmentioning

confidence: 88%

“…Simulations were selectively and sequentially performed, as detailed below, to allow for relative insight to be gained from the parameter controlled in silico environments building on prior validated models [ 11 , 12 , 24 ]. The following tasks were simulated: A FE simulation was conducted by utilizing upright inputs, comprising 3.4 mmHg intra-abdominal pressure (IAP) and 18mmHg intra-muscular pressure (ICP) without any follower load, and compared the forces at the L3 level; A FE simulation was performed utilizing (a) upright, (b) squatting with 20 kg weight, and (c) kyphotic back with 20 kg weight with a follower load of 800 N, 2350 N, and 3185 N. Extra validations of the disc stresses were performed.…”

Section: Methodsmentioning

confidence: 99%

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Investigation of Reaction Forces in the Thoracolumbar Fascia during Different Activities: A Mechanistic Numerical Study

El-Monajjed

Driscoll

2021

Life

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Spinal instability remains a complex phenomenon to study while the cause of low back pain continues to challenge researchers. The role of fascia in biomechanics adds to the complexity of spine biomechanics but offers a new window from which to investigate our spines. Specifically, the thoracolumbar fascia may have an important role in spine biomechanics, and thus the purpose of this study was to access the mechanical influence of the thoracolumbar fascia on spine biomechanics during different simulated activities. A numerical finite element model of the lumbar spine inclusive of the intra-abdominal and intra-muscular regions as well as the thoracolumbar fascia was constructed and validated. Four different loading scenarios were simulated while deformation, stress, pressure, and reaction forces between the thoracolumbar fascia and spine were measured. Model validation was accomplished through comparison to in vivo and ex vivo published studies. Force transmission between the thoracolumbar fascia and the spine increased 40% comparing kyphotic and squatting lifting patterns. Further, the importance of reciprocating paraspinal and intra-abdominal pressures was demonstrated. It was also found that tension in the thoracolumbar fascia remains even in a simulated prone position. This numerical analysis allowed for an objective interpretation of the loads conveyed through the thoracolumbar fascia in different positional or lifting scenarios. Based on validation studies, it would appear to be a viable experimental platform from which insight can be derived. The loads in the thoracolumbar fascia vary considerably based on simulated tasks and are linked to the pressures in the paraspinal and intra-abdominal regions.

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Section: Introductionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

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Investigation of Reaction Forces in the Thoracolumbar Fascia during Different Activities: A Mechanistic Numerical Study

El-Monajjed

Driscoll

2021

Life

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“…Additionally, the onset of changes to lumbar soft tissues' mechanical properties, eventually leading to a load allocation bias and stress shielding, may be a contributing factor to the onset of LBP. Such a sequence of cyclical stress shielding has also been hypothesized to occur within musculoskeletal systems depicting unilateral LBP [32]. Future studies will be required to further investigate stress shielding's role in the pathomechanism of LBP.…”

Section: Discussionmentioning

confidence: 97%

The examination of stress shielding in a finite element lumbar spine inclusive of the thoracolumbar fascia

Newell

Driscoll

2021

Med Biol Eng Comput

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“…If so, aerobic exercises may help, as this is the case for MFI (Tuñón-Suárez et al, 2021). From a mechanical perspective, having fatty infiltration of the TLF may alter its elastic modulus, or ability to extend under a certain load, and thus have an important role in local load allocation (Newell & Driscoll, 2021a;Newell & Driscoll, 2021b) (Delitto et al, 1995) and more specifically, with patients thought to have movement coordination impairment, segmental hypermobility or clinical lumbar instability (Cook et al, 2006;Delitto et al, 2012;Rabin et al, 2013). Aberrant movements are associated with decreased control of lumbar segment mobility in the mid-range portion of the lumbar ROM, as demonstrated by a fluoroscopic study of flexion and extension movements in the sagittal plane (Teyhen et al, 2007).…”

Section: Thoracolumbar Fascia Thicknessmentioning

confidence: 99%

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study

et al. 2022

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Patients with chronic low back pain (CLBP) exhibit remodelling of the lumbar soft tissues such as muscle fatty infiltrations (MFI) and fibrosis of the lumbar multifidus (LuM) muscles, thickness changes of the thoracolumbar fascia (TLF) and perimuscular connective tissues (PMCT) surrounding the abdominal lateral wall muscles. Rehabilitative ultrasound imaging (RUSI) parameters such as thickness and echogenicity are sensitive to this remodelling. This experimental laboratory study aimed to explore whether these RUSI parameters (LuM echogenicity and fascia thicknesses), hereafter called dependent variables (DV) were linked to independent variables (IV) such as (1) other RUSI parameters (trunk muscle thickness and activation) and (2) physical and psychological measures. RUSI measures, as well as a clinical examination comprising physical tests and psychological questionnaires, were collected from 70 participants with LBP. The following RUSI dependent variables (RUSI‐DV), measures of passive tissues were performed bilaterally: (1) LuM echogenicity (MFI/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1); (2) TLF posterior layer thickness, and (3) PMCT thickness of the fasciae between subcutaneous tissue thickness (STT) and external oblique (PMCTSTT/EO), between external and internal oblique (PMCTEO/IO), between IO and transversus abdominis (PMCTIO/TrA) and between TrA and intra‐abdominal content (PMCTTrA/IA). RUSI measures of trunk muscle's function (thickness and activation), also called measures of active muscle tissues, were considered as independent variables (RUSI‐IV), along with physical tests related to lumbar stability (n = 6), motor control deficits (n = 7), trunk muscle endurance (n = 4), physical performance (n = 4), lumbar posture (n = 2), and range of motion (ROM) tests (n = 6). Psychosocial measures included pain catastrophizing, fear‐avoidance beliefs, psychological distress, illness perceptions and concepts related to adherence to a home‐based exercise programme (physical activity level, self‐efficacy, social support, outcome expectations). Six multivariate regression models (forward stepwise selection) were generated, using RUSI‐DV measures as dependent variables and RUSI‐IV/physical/psychosocial measures as independent variables (predictors). The six multivariate models included three to five predictors, explaining 63% of total LuM echogenicity variance, between 41% and 46% of trunk superficial fasciae variance (TLF, PMCTSTT/EO) and between 28% and 37% of deeper abdominal wall fasciae variance (PMCTEO/IO, PMCTIO/TrA and PMCTTrA/IA). These variables were from RUSI‐IV (LuM thickness at rest, activation of IO and TrA), body composition (percent fat) and clinical physical examination (lumbar and pelvis flexion ROM, aberrant movements, passive and active straight‐leg raise, loaded‐reach test) from the biological domain, as well as from the lifestyle (physical activity level during sports), psychological (psychological distress—cognitive subscale, fear‐avoidance beliefs during physical ac...

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Investigation of physiological stress shielding within lumbar spinal tissue as a contributor to unilateral low back pain: A finite element study

Cited by 11 publications

References 50 publications

Investigation of Reaction Forces in the Thoracolumbar Fascia during Different Activities: A Mechanistic Numerical Study

Investigation of Reaction Forces in the Thoracolumbar Fascia during Different Activities: A Mechanistic Numerical Study

The examination of stress shielding in a finite element lumbar spine inclusive of the thoracolumbar fascia

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study

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