Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms

Langevin, Hélène M.; Sherman, Karen J.

doi:10.1016/j.mehy.2006.06.033

Cited by 231 publications

(184 citation statements)

References 56 publications

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“…Although PMCT has been hypothesized to play a role in the pathogenesis of chronic LBP, 30 the authors identified only 1 other investigation in the literature that [ research report ]…”

Section: Discussionmentioning

confidence: 99%

“…As connective tissues are known to remodel in response to mechanical stress, 53 it is possible that abnormal movement patterns resulting from altered motor control may contribute to physiological changes in these tissues. 30,31 The foundations for this hypothesis are histology investigations showing that connective tissue fibrosis occurs as a result of microtrauma and inflammation resulting from increased load, 11,35 or due to atrophy, architectural disorganization, and adhesions caused by an absence of load. 42,59 When the findings of the current investigation (thinner RA, thicker PMCT, and increased IRD in the LPP cohort) are considered simultaneously, an explanation consistent with adaptive connective tissue changes emerges.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain

Whittaker¹,

Warner²,

Stokes³

2013

Journal of Orthopaedic & Sports Physical Therapy

138

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Study Design Cross-sectional, case-control study. Objectives To measure and compare the resting thickness of the 4 abdominal wall muscles, their associated perimuscular connective tissue (PMCT), and interrecti distance (IRD) in persons with and without lumbopelvic pain (LPP), using ultrasound imaging. Background The muscles and PMCT of the abdominal wall assist in controlling the spine. Functional deficits of the abdominal wall muscles have been detected in populations with LPP. Investigations of the abdominal wall in those with LPP are primarily concerned with muscle, most commonly the transversus abdominis (TrA) and internal oblique (IO). Because the abdominal wall functions as a unit, all 4 abdominal muscles and their associated connective tissues should be considered concurrently. Methods B-mode ultrasound imaging was used to measure the resting thickness of the rectus abdominis (RA), external oblique, IO, and TrA muscles; the PMCT planes; and IRD in 50 male and female subjects, 25 with and 25 without LPP (mean ± SD age, 36.3 ± 9.4 and 46.6 ± 8.0 years, respectively). Univariate correlation analysis was used to identify covariates. Analyses of covariance (ANCOVAs) and the Kruskal-Wallis test (IRD) were used to compare cohorts (α = .05). Results The LPP cohort had less total abdominal muscle thickness (LPP mean ± SD, 18.9 ± 3.0 mm; control, 20.3 ± 3.0 mm; ANCOVA adjusted for body mass index, P = .03), thicker PMCT (LPP, 5.5 ± 0.2 mm; control, 4.3 ± 0.2 mm; ANCOVA adjusted for body mass index, P = .007), and wider IRD (LPP, 11.5 ± 2.0 mm; control, 8.4 ± 1.8 mm; Kruskal-Wallis, P = .005). Analysis of individual muscle thickness revealed no difference in the external oblique, IO, and TrA, but a thinner RA in the LPP cohort (LPP mean ± SD, 7.8 ± 1.5 mm; control, 9.1 ± 1.2 mm; ANCOVA adjusted for body mass index, P<.001). Conclusion To our knowledge, this is the first study to investigate the morphological characteristics of all 4 abdominal muscles and PMCT in individuals with LPP. The results suggest that there may be altered loading of the PMCT and linea alba secondary to an altered motor control strategy involving a reduced contribution of the RA. Further, the change in RA and connective tissue morphology may be more evident than changes in external oblique, IO, and TrA thickness in persons with LPP. The causes and functional implications of these changes warrant further investigation, as does the role of the RA muscle in the development and persistence of LPP. J Orthop Sports Phys Ther 2013;43(1):11–19. Epub 16 November 2012. doi:10.2519/jospt.2013.4450

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“…Although PMCT has been hypothesized to play a role in the pathogenesis of chronic LBP, 30 the authors identified only 1 other investigation in the literature that [ research report ]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain

Whittaker¹,

Warner²,

Stokes³

2013

Journal of Orthopaedic & Sports Physical Therapy

138

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“…Possible mechanisms leading to therapeutic effects include changes in matrix composition and biomechanical properties leading to modulation of sensory afferent input from connective tissue. 16 Further studies will be needed to examine these potential responses to acupuncture needling ex vivo and in vivo.…”

Section: Discussionmentioning

confidence: 99%

Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect of Bidirectional Needle Rotation

Langevin

Bouffard

Churchill

et al. 2007

The Journal of Alternative and Complementary Medicine

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121

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“…(Van Dillen et al 2001;Van Dillen et al 2003a) A number of factors have been theorized to contribute to the movement and alignment patterns that people with LBP display. (Langevin & Sherman 2007;Panjabi 1992;Sahrmann 2002) The two types of factors most often noted are (1) neural control factors, and (2) biomechanical factors. Neural control factors include the timing or magnitude of trunk muscle activity either during activities that require movement of the trunk or during activities that require the trunk to remain stable.…”

Section: Introductionmentioning

confidence: 99%

“…Understanding the passive characteristics of the lumbar region in people with LBP is important because alterations in passive structures secondary to acute injury, (Zhao et al 2005) degenerative changes, (Burton et al 1996;Gay et al 2006) repeated lumbar movements, (Zhao et al 2005) or sustained lumbar positions, could result in changes in the load-bearing and stabilizing capacity of these structures. (Langevin & Sherman 2007;Panjabi 1992) Changes in the load-bearing and stabilizing capacity of passive structures may contribute to alterations in movement patterns and loading of the spine, and potentially a LBP problem. (Mueller & Maluf 2002;Sahrmann 2002) Specifically, asymmetry of passive tissue characteristics may be especially important to examine in people with LBP.…”

Section: Introductionmentioning

confidence: 99%

Differences in symmetry of lumbar region passive tissue characteristics between people with and people without low back pain

Gombatto

Norton

Scholtes

et al. 2008

Clinical Biomechanics

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Background-Several investigators have suggested that passive tissue characteristics of the lumbar region may be altered in people with low back pain. Passive stiffness of the lumbar region has been examined during physiological movements in healthy individuals and intersegmental spine mobility and stiffness have been examined in people with and people without low back pain. However, no investigators have examined differences in passive tissue characteristics of the lumbar region during a physiological movement between people with and people without low back pain.

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Pathophysiological model for chronic low back pain integrating connective tissue and nervous system mechanisms

Cited by 231 publications

References 56 publications

Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain

Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain

Connective Tissue Fibroblast Response to Acupuncture: Dose-Dependent Effect of Bidirectional Needle Rotation

Differences in symmetry of lumbar region passive tissue characteristics between people with and people without low back pain

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