Individuals with Recurrent Low Back Pain Exhibit Significant Changes of Paraspinal Muscle Performance after Lumbar Multifidus Intramuscular Fine Wire Electrode Insertion

STUDY DESIGN: Case control study. BACKGROUND: Recurrent low back pain (RLBP) is associated with paraspinal muscle dysfunction. Intramuscular electromyography (EMG) is a common tool for studying activation of the deep lumbar paraspinal muscles such as multifidi muscles, but it is currently currently unclear how muscle performance and activation are affected by the pain and micro-injury associated with intramuscular fine-wire electrode (IFWE) insertion and how it interacts with the presence of RLBP. OBJECTIVES: The purpose of this study was to examine how IFWE insertion into the lumbar multifidus affects paraspinal muscle strength and endurance in subjects with and without RLBP. METHODS: Forty subjects aged 18 - 40 were recruited; 20 subjects with a history of RLBP were compared with a group of 20 age-matched controls with no RLBP. Paraspinal extensor strength and endurance were measured under three conditions over three testing days. On Day 1, the baseline condition (BL), we obtained preliminary measures of discomfort, force production, endurance, and muscle activation. On Days 2 and 3, the participants randomly alternated between the two experimental conditions: (i) a wire-in condition (WI) in which the IFWE was inserted and remained within the muscle and (ii) a wire-out condition (WO) in which the IFWE was inserted and immediately removed. Participants were blinded to the order of the fine-wire conditions. Subjective pain levels were recorded via the Visual Analog Scale at specific time points throughout the testing protocol. RESULTS: Individuals with RLBP showed a significant decrease in strength in both conditions that involved IFWE insertion. Controls showed no significant difference in strength across conditions. Both groups exhibited similar performance in the endurance test. CONCLUSION: Our findings indicate IFWE insertion into lumbar multifidus may lead to reduced peak spinal extensor muscle force production in individuals with a history of RLBP compared to healthy controls

Understanding spinal loading in persons with traumatic lower limb amputations

Recent conflicts in Afghanistan and Iraq have led to nearly 300 lower limb amputations in the British military alone. A number of complications are associated with limb loss including low back pain (LBP) which is commonly reported as a secondary disability of amputation. Despite much published literature into LBP amongst those with lower limb amputations, few have focused on the traumatic aetiology, especially from within the military, who tend to be younger and fitter than those with amputations due to vascular or diabetic reasons, and thus have a higher level of functioning. Whilst the association between amputation and LBP is agreed, it is the causality that is less clear. The focus of this thesis is to gain a deeper understanding of the mechanics behind LBP in persons with traumatic amputations by studying the kinematics and kinetics of the lumbar spine and lower limbs amongst these persons during activities of daily living. Insights into possible mechanisms has the potential to inform care, management and the longer term rehabilitation process to improve quality of life in those with lower limb loss. Following suggestions in published literature that fatigue is a significant factor in the propagation of LBP in this cohort, this study focused on analysing the gait performance before, during and after a six minute walk test (6MWT). Motion analysis was used to understand the spatiotemporal characteristics, kinematics and kinetics of veterans who had experienced traumatic lower limb loss. The results indicated the importance of including all classifications of lower limb amputations in research studies involving those with amputations. There were differences in the 6MWT, spatiotemporal, kinematic and kinetic results between the different groups. It was observed that inducing muscle fatigue in the cohorts highlighted some of the compensation mechanisms, which otherwise may have gone unnoticed. Although individuals may display similar ankle, knee or hip mechanisms, the variations in the lower lumbar and upper lumbar joints are very different and may be unique to individual participant. This emphasises the need for subject specific mathematical models that are able to factor in the individual amputation characteristics. The work in this thesis gives a solid foundation for understanding compensatory mechanisms in those with amputations, which can lead to individual rehabilitation or re-education programmes to ultimately prevent long-term musculoskeletal problems and improve quality of life in persons with traumatic lower limb amputations.Open Acces

Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review

Spine disorders are becoming more prevalent in today's ageing society. Motion abnormalities have been linked to the prevalence and recurrence of these disorders. Various protocols exist to measure thoracolumbar spine motion, but a standard multi-segmental approach is still missing. This study aims to systematically evaluate the literature on stereophotogrammetric motion analysis approaches to quantify thoracolumbar spine kinematics in terms of measurement reliability, suitability of protocols for clinical application and clinical significance of the resulting functional assessment

The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function

Peer reviewedPublisher PD

Countermeasure Development for Lumbopelvic Deconditioning in Space

Physical inactivity and lumbopelvic deconditioning have been linked to increased incidence of non-specific low back pain (LBP) and spinal injury in those who are exposed to microgravity (e.g. astronauts and individuals on long-duration bed rest) and in the general population. Astronauts have an increased risk of experiencing moderate to severe LBP during microgravity exposure and herniated intervertebral discs within 1 year following spaceflight. Atrophy and reduced motor control of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles resulting from periods of deconditioning are linked to non-specific LBP and spinal injury risk in both post-flight astronauts and general populations. However, voluntary recruitment of these two key muscles is difficult and presents a rehabilitation challenge. This chapter reviews the concept of spinal stability as it relates to microgravity, discusses how existing exercise countermeasures used in space do not successfully maintain lumbopelvic muscle size, and introduces the functional readaptive exercise device (FRED) that shows potential to activate the LM and TrA muscles automatically and in a tonic fashion, which has relevance to rehabilitation of both astronaut and terrestrial populations

Developing, testing and refining a physiotherapy model of care for acute low back pain

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis is concerned with the physiotherapy management of acute low back pain. Various national guidelines contain conflicting views regarding the role of physiotherapy in the management of acute low back pain. The discrepancies involve primarily the content and timing of physiotherapy intervention. There is a need to place the physiotherapy management of acute low back pain on a more firm research base. A comprehensive literature review was undertaken to develop a best practice model of care for acute low back pain. This model was tested in a randomised controlled trial. Subjects involved in the treatment model demonstrated significantly better short-term outcomes than subjects given advice only. Furthermore, subjects treated early demonstrated significantly better long-term outcome than subjects who waited six weeks for their treatment. Changes in pain and physical function were found to be the factors most closely associated with good outcome in the short-term. Good outcome in the long term was associated with improvement in a number of physical and psychological variables. It is recommended that changes be made to the treatment model to facilitate improvement in pain relief and maintenance of physical and social function to further enhance treatment effectiveness.This study was funded by a grant from the NHS R&D committee