11 research outputs found

    The use of technology in measuring low back function and morphology in low back pain patients

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    Low back pain (LBP) is a very common symptom experienced by people worldwide. In most cases, however, it is hard to choose the most efficient intervention for the physiotherapist in primary care. Physiological and psychosocial components can play a role in LBP symptoms. In this thesis, the main question was if technology can be used in monitoring/diagnostics for patients with LBP in primary care physiotherapy. The focus was on the physiological components, especially the lumbar multifidus (LM). First, we found that the presentation of the anatomy of LM was inconsistent in literature and anatomical atlases. Second, we presented the LM with a 3D-model of two cadavers and ultrasound images. Third, we tried to measure muscle activity of low back muscles by using surface electromyography. This is a technology that is applied by physiotherapists in primary care. This research showed that this technology made no distinction between muscle activity from several low back muscles. Finally, technologies are used to measure differences between healthy volunteers and patients with LBP. This last research showed that muscle thickness measured by ultrasound, and trunk range of motion measured by a 3D sensor can be used by physiotherapists to monitor patients with LBP. Overall, this thesis contributed to new insights in low back muscles anatomy and technology that can be applied in monitoring biological components in patients with LBP in primary care physiotherapy

    Inconsistent descriptions of lumbar multifidus morphology:A scoping review

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    Background Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature. Methods Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system. Results In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings - particularly for levels L4-S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases. Discussion Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas. Conclusions We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology

    A guide for standardized interpretation of lumbar multifidus ultrasonography:an observational study

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    BACKGROUND: Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography. METHODS: An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 ÎĽm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1. RESULTS: Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images. CONCLUSION: The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback

    Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care

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    Background: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to nonspecific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. Objectives: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. Design: Multicenter case control study. Method: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, pvalues< 0.05, with Tukey’s HSD post-hoc test were considered significant. Results: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11–0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10–0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). Conclusions: Trunk ROM and LM thickness show differences between LBP patients and healthy controls

    Intramuscular EMG versus Surface EMG of Lumbar Multifidus and Erector Spinae in Healthy Participants

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    Study Design: Cross-sectional design. Objective: The aim of this study was to investigate the correlation between intramuscular EMG (iEMG) and surface EMG (sEMG) from lumbar multifidus and erector spinae muscles during (submaximal) voluntary contraction tests in healthy participants. Summary of Background Data: Low back muscle function is a key component in the stability of the lumbar spine in which an important role is attributed to the lumbar multifidus (LM). Impairments in this stabilization system are held responsible for (chronic) low back pain. LM function can be measured by iEMG and sEMG; however, in earlier studies, results from iEMG and sEMG were inconsistent. Methods: Fifteen healthy adults were included. The intervention consisted of five clinical tests: resting, submaximal contraction tests of the lower back, abdominal contraction, and a biofeedback test in which LM and erector spinae (ES) activities were compared by iEMG and sEMG. Correlations were calculated with regard to original signal, co-contraction ratio, and cross-talk ratio. Correlation coefficients for each combination of iEMG and sEMG signals were calculated, to identify original signal (i.e., activity of only the targeted muscle) and possible cross-talk. Correlations >0.75 were considered as good concurrent validity. Results: The original signals of LM showed fair to high correlation coefficients (r: 0.3–0.8). Co-contraction of LM and ES was observed during all tests, but iEMG shows more variation in the correlations (r: 0.1–0.8) compared to sEMG (r: 0.3–0.8). Significant cross-talk was observed in all tests, particularly during the biofeedback test of iEMGESversus sEMGLM and iEMGLMversus sEMGES (r = 0.8). Conclusion: Surface EMG of ES and LM are no adequate representation of LM and ES activity measured by iEMG because of moderate/high cross-talk and co-contractions. Clinical tests that aim to assess LM activity do not represent isolated LM activity. This should be taken into account in future clinical studies

    Inconsistent descriptions of lumbar multifidus morphology: A scoping review

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    https://doi.org/10.1186/s12891-020-03257-7 &nbsp; Background: Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature.Methods: Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system.Results: In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings &ndash; particularly for levels L4&ndash;S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases.Discussion: Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas.Conclusions: We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology

    Corrigendum to “Reliability and validity of the Microgate Gyko for measuring range of motion o the low back” [Muscoskel. Sci. Pract. 45 (2020) 102091] (Musculoskeletal Science and Practice (2020) 45, (S2468781219302814), (10.1016/j.msksp.2019.102091))

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    The authors regret to inform that de-anonymisation of the study has failed in the publication. Section 2.2 of the methods section should be corrected with the following text. Line 1: Subjects were recruited based on convenience sampling from networks at Saxion University of Applied Sciences in the Eastern part of The Netherlands. Line 4 of section 2.2 should be corrected to: the study was part of regular education of Saxion University of Applied Sciences. The authors would like to apologise for any inconvenience caused

    A guide for standardized interpretation of lumbar multifidus ultrasonography; an observational study

    No full text
    Background Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography. Methods An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 µm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1. Results Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images. Conclusion The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback

    Reliability and validity of the Microgate Gyko for measuring range of motion of the low back

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    Background: The aim of this study was to test the inter- and intrarater reliability and the concurrent validity of the Gyko Microgate for the assessment of lumbar range of motion. Methods: A cross-sectional study was carried out with two groups of healthy participants. The first group, consisting of 91 subjects, was tested to determine the inter- and intrarater reliability. Concurrent validity was assessed with comparisons with an optical motion system (Vicon) in a second group of 20 subjects. Lumbar range of motion in flexion, extension, left and right lateral flexion were performed. Intraclass correlation coefficient (ICC) was calculated for both analyses. Measurement error was calculated with standard error of the measurement (SEM), smallest detectable change (SDC) and Limits of Agreement (LoA). ICCs were considered good when ICC ≥0.80 and excellent with ICC ≥0.90. Results: Interrater reliability was good to excellent with ICCs ranging from 0.82 to 0.94. Intrarater reliability was good to excellent with ICCs ranging from 0.84 to 0.95. Concurrent validity was excellent with ICCs varying from 0.90 to 0.95. LoA were highest in interrater reliability and smallest in concurrent validity. SEM ranged from 2.2 to 4.0° in lateral flexion left and flexion respectively. SDC varied from 6.1 to 11.1°. Conclusion: Gyko has good inter- and intrarater reliability and excellent concurrent validity compared to the optical motion system for lumbar range of motion. Gyko may be considered as objective measure to measure range of motion for clinical purposes, however trials with patients are currently lacking
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