The effects of exposure to microgravity and reconditioning of the lumbar multifidus and anterolateral abdominal muscles: implications for people with LBP

Hides, Julie; Lambrecht, Gunda; Sexton, Christopher; Pruett, Casey J.; Petersen, Nora; Jaekel, Patrick; Rosenberger, André; Weerts, Guillaume

doi:10.1016/j.spinee.2020.09.006

Cited by 20 publications

(21 citation statements)

References 52 publications

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“…However, by recovery, nearly all of the changes we found between pre-and postflight had resolved and the muscle was no longer significantly different from its preflight values. Prior work using various imaging modalities, including ultrasound and CT, documents similar results for multifidus changes immediately following spaceflight along with recovery to preflight values [14,25]. In agreement with our results along with other studies on astronauts and bed-rest [25,26], studies exploring multifidus atrophy in relation to low back pain in a terrestrial clinical context often report most striking effects in the lower lumbar spine [27].…”

Section: Discussionsupporting

confidence: 91%

“…Prior work using various imaging modalities, including ultrasound and CT, documents similar results for multifidus changes immediately following spaceflight along with recovery to preflight values [14,25]. In agreement with our results along with other studies on astronauts and bed-rest [25,26], studies exploring multifidus atrophy in relation to low back pain in a terrestrial clinical context often report most striking effects in the lower lumbar spine [27]. This may be due to the relatively larger size and a greater amount of Type 2 fibers in the multifidus at the lower lumbar spine, possibly reflecting greater mobility and less stability of this spinal region [28,29].…”

Section: Discussionmentioning

confidence: 66%

“…Our results suggest preexisting end plate pathology is a risk factor for postflight spinal stiffness which we found to affect the upper lumbar spine primarily. Recent work from Hides et al similarly shows compromised biomechanical function of the upper lumbar spine segments via decreased multifidus contraction activation at L2L3 and L3L4 following spaceflight [25].…”

Section: Discussionmentioning

confidence: 93%

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Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

et al. 2022

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BACKGROUND CONTEXT: For chronic low back pain, the causal mechanisms between pathological features from imaging and patient symptoms are unclear. For instance, disc herniations can often be present without symptoms. There remains a need for improved knowledge of the pathophysiological mechanisms that explore spinal tissue damage and clinical manifestations of pain and disability. Spaceflight and astronaut health provides a rare opportunity to study potential low back pain mechanisms longitudinally. Spaceflight disrupts diurnal loading on the spine and several lines of evidence indicate that astronauts are at a heightened risk for low back pain and disc herniation following spaceflight. PURPOSE: To examine the relationship between prolonged exposure to microgravity and the elevated incidence of postflight disc herniation, we conducted a longitudinal study to track the spinal health of twelve NASA astronauts before and after approximately 6-months in space. We hypothesize that the incidence of postflight disc herniation and low back complaints associates with spaceflight-included muscle atrophy and pre-existing spinal pathology. STUDY DESIGN: This is a prospective longitudinal study. PATIENT SAMPLE: Our sample included a cohort of twelve astronaut crewmembers. OUTCOME MEASURES: From 3T MRI, we quantified disc water content (ms), disc degeneration (Pfirrmann grade), vertebral end plate irregularities, facet arthropathy and/ fluid, high intensity zones, disc herniation, multifidus total cross-sectional area (cm 2 ), multifidus lean muscle cross-sectional area (cm 2 ), and muscle quality/composition (%). From quantitative fluoroscopy we quantified, maximum flexion-extension ROM (˚), maximum lateral bending ROM (˚), and maximum translation (%). Lastly, patient outcomes and clinical notes were used for identifying postflight symptoms associated with disc herniations from 3T MRI. METHODS: Advanced imaging data from 3T MRI were collected at three separate time points in relation to spending 6-months in space: (1) within a year before launch ("pre-flight"), (2) within a FDA device/drug status: Not applicable.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 93%

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Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

et al. 2022

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“…Exposure to microgravity during spaceflight provokes rapid adaptation in lumbar spine morphology (for review, see (24)). Increased spinal length, loss of lumbar lordosis, vertebral osteopenia, and atrophy of the lumbar multifidus (LM) at L4 and L5 vertebral levels have been observed following space missions (4,11,30). Recently, using computed tomography (CT), attenuation values in the LM, lumbar erector spinae (LES), and quadratus lumborum (QL) have been described in astronauts after 6-month of spaceflight (9,51).…”

Section: Introductionmentioning

confidence: 99%

Lumbar muscle atrophy and increased relative intramuscular lipid concentration are not mitigated by daily artificial gravity after 60-day head-down tilt bed rest

Martino

Hides

Elliott

et al. 2021

Journal of Applied Physiology

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Exposure to axial unloading induces adaptations in paraspinal muscles, as shown after spaceflights. This study investigated whether daily exposure to artificial gravity (AG) mitigated lumbar spine flattening and muscle atrophy associated with 60-day head-down tilt (HDT) bed rest (Earth-based space analogue). Twenty-four healthy individuals participated in the study: Eight received 30 minutes continuous AG; eight received 6x5 minutes AG, interspersed with rest periods; eight received no AG exposure (control group). Magnetic Resonance Imaging (MRI) of the lumbopelvic region was conducted at baseline (BDC) and at day 59 of HDT (HDT59). T1-weighted images were used to assess morphology of the lumbar spine (spinal length, intervertebral disc angles, disc area) and volumes of the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum (QL), and psoas major (PM) muscles from L1/L2 to L5/S1 vertebral levels. A chemical shift-based 2‐point lipid/water Dixon sequence was used to evaluate muscle composition. Results showed that: spinal length and disc area increased (P<0.05); intervertebral disc angles (P<0.05) and muscle volumes of LM, LES, and QL reduced (P<0.01); and fat/water ratio for the LM and LES muscles increased (P<0.01) after HDT59 in all groups. Neither of the AG protocols mitigated the lumbar spinal deconditioning induced by HDT bed rest. The increase in lipid/water ratio in LM and LES muscles indicates an increased relative intramuscular lipid concentration. Altered muscle composition in atrophied muscles may impair lumbar spine function after body unloading, which could increase injury risk to vulnerable soft tissues. This relationship needs further investigation.

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“…The consequence of the delayed onset of muscle activation implies that control of the spine is reduced after a period of bed rest, and this might compromise spine tissues. Importantly, increases of IVD height due to hyperhydration have been observed following bed rest studies and spaceflights (4,35), as well as atrophy of the LM (2,23). Taken together, changes in the intervertebral disc morphology and chemical proprieties, atrophy of the lumbar paraspinal muscles, and delayed onset of the lumbar and abdominal muscles after prolonged gravitation unloading may have clinical consequences.…”

Section: Operational Relevance and Recommendations For Future Planetary Surface Explorationsmentioning

confidence: 98%

Intermittent short-arm centrifugation is a partially effective countermeasure against upright balance deterioration following 60-day head-down tilt bed rest

Martino

Salomoni

Hodges

et al. 2021

Journal of Applied Physiology

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This study investigated whether artificial gravity (AG), induced by short-radius centrifugation, mitigated deterioration in standing balance and anticipatory postural adjustments (APAs) of trunk muscles following 60-day head-down tilt bed rest. Twenty-four participants were allocated to one of three groups: control group (N=8); 30 minutes continuous AG daily (N=8); intermittent 6x5 minutes AG daily (N=8). Before and immediately after bed rest, standing balance was assessed in four conditions: eyes open and closed on both stable and foam surfaces. Measures including sway path, root-mean-square, and peak sway velocity, sway area, sway frequency power, and sway density curve were extracted from the centre of pressure displacement. APAs were assessed during rapid arm movements using intramuscular or surface electromyography electrodes of the rectus abdominis, obliquus externus and internus abdominis, transversus abdominis, erector spinae at L1, L2, L3, and L4 vertebral levels, and deep lumbar multifidus muscles. The relative latency between the EMG onset of the deltoid and each of the trunk muscles was calculated. All three groups had poorer balance performance in most of the parameters (all P<0.05) and delayed APAs of the trunk muscles following bed rest (all P<0.05). Sway path and sway velocity were deteriorated, and sway frequency power was less in those who received intermittent AG than in the control group (all P<0.05), particularly in conditions with reduced proprioceptive feedback. These data highlight the potential of intermittent AG to mitigate deterioration of some aspects of postural control induced by gravitational unloading, but no protective effects on trunk muscle responses were observed.

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The effects of exposure to microgravity and reconditioning of the lumbar multifidus and anterolateral abdominal muscles: implications for people with LBP

Cited by 20 publications

References 52 publications

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

Biomechanical changes in the lumbar spine following spaceflight and factors associated with postspaceflight disc herniation

Lumbar muscle atrophy and increased relative intramuscular lipid concentration are not mitigated by daily artificial gravity after 60-day head-down tilt bed rest

Intermittent short-arm centrifugation is a partially effective countermeasure against upright balance deterioration following 60-day head-down tilt bed rest

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