Multifidus Atrophy Is Localized and Bilateral in Active Persons With Chronic Unilateral Low Back Pain

Beneck, George J.; Kulig, Kornelia

doi:10.1016/j.apmr.2011.09.017

Cited by 134 publications

(109 citation statements)

References 52 publications

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“…This atrophy can be seen easily and reliably 26 on MRI. Atrophy may be seen unilaterally or bilaterally, and bilateral atrophy is frequently seen in patients who complain of unilateral pain 25, 27. MF changes are apparent in chronic LBP 28, 29, in proportion to the duration of symptoms 30, and are not due to a change in muscle fiber type 31.…”

Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

130

129

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ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

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Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

130

129

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“…4,11 Changes in other muscles have been identified. The CSA of the psoas muscle has been shown to be reduced bilaterally in people with chronic LBP, 40 and this decrease in CSA has been associated with increased symptom duration on the painful side in individuals with unilateral LBP.…”

mentioning

confidence: 99%

“…1 A possible sequela of these spinal loads may be low back pain (LBP), which is consistently reported to be one of the most prevalent chronic injuries in professional ballet dancers. 2,9,14,25 In nondancers, LBP is associated with musculoskeletal changes, including alteration in muscle size, symmetry, 3,4,11,22 and fat content. 37 These changes include reduced cross-sectional area (CSA) of the multifidus in patients with acute, subacute, 22 and chronic LBP.…”

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confidence: 99%

Size and Symmetry of Trunk Muscles in Ballet Dancers With and Without Low Back Pain

Gildea¹,

Hides²,

Hodges³

2013

J Orthop Sports Phys Ther

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[ research report ] C lassical ballet dancers are a unique combination of athlete and artist who perform complex movement patterns requiring both muscle strength and control. Ballet places particularly high demands on the trunk due to the requirement for extreme range of motion and tolerance of high compressive forces.1 A possible sequela of these spinal loads may be low back pain (LBP), which is consistently reported to be one of the most prevalent chronic injuries in professional ballet dancers. 2,9,14,25 In nondancers, LBP is associated with musculoskeletal changes, including alteration in muscle size, symmetry, 3,4,11,22 and fat content. 37 These changes include reduced cross-sectional area (CSA) of the multifidus in patients with acute, subacute, 22 and chronic LBP. 3,11 Two investigations found that people with unilateral LBP had a smaller multifidus on the side 3,22 and at the spinal level of pain.22 These changes were associated with longer symptom duration.3 Another study found that people with unilateral LBP had decreased CSA of the multifidus bilaterally and symmetrically.4 By contrast, when the CSA of the erector spinae has been differentiated from the multifidus, changes in CSA have not been demonstrated in active people with chronic LBP. 4,11 Changes in other muscles have been identified. The CSA of the psoas muscle has been shown to be reduced bilaterally in people with chronic LBP, 40 and this decrease in CSA has been associated with increased symptom duration on the painful side in individuals with unilateral LBP.3,10 In cricketers with LBP, when compared with pain-free cricketers, the T T STUDY DESIGN: Cross-sectional, observational study. T T OBJECTIVES:To investigate the cross-sectional area (CSA) of trunk muscles in professional ballet dancers with and without low back pain (LBP). T T BACKGROUND:LBP is the most prevalent chronic injury in classical ballet dancers. Research on nondancers has found changes in trunk muscle size and symmetry to be associated with LBP. There are no studies that examine these changes in ballet dancers. T T METHODS:Magnetic resonance imaging was performed in 14 male and 17 female dancers. The CSAs of 4 muscles (multifidus, lumbar erector spinae, psoas, and quadratus lumborum) were measured and compared among 3 groups of dancers: those without LBP or hip pain (n = 8), those with LBP only (n = 13), and those with both hip-region pain and LBP (n = 10). T T RESULTS:Dancers with no pain had larger multifidus muscles compared to those with LBP at L3-5 (P<.024) and those with both hip-region pain and LBP at L3 and L4 on the right side (P<.027). Multifidus CSA was larger on the left side at L4 and L5 in dancers with hip-region pain and LBP compared to those with LBP only (P<.033). Changes in CSA were not related to the side of pain (all, P>.05). The CSAs of the other muscles did not differ between groups. The psoas (P<.0001) and quadratus lumborum (P<.01) muscles were larger in male dancers compared to female dancers. There was a positive correlation between the size of th...

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“…Numerous studies with MRI have shown morphological changes of the multifidus muscle in patients with low back pain and disc herniation (25)(26)(27)(28)(29)(30)(31)(32). Woodham et al (25) have described fatty replacement and atrophy in lumbar multifidus muscle in patients with chronic low back pain and disc herniation.…”

Section: Discussionmentioning

confidence: 99%