Associations between Deformation of the Thoracolumbar Fascia and Activation of the Erector Spinae and Multifidus Muscle in Patients with Acute Low Back Pain and Healthy Controls: A Matched Pair Case-Control Study

Brandl, Andreas; Egner, Christoph; Reer, Rüdiger; Schmidt, Tobias; Schleip, Robert

doi:10.3390/life12111735

Cited by 14 publications

(17 citation statements)

References 54 publications

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“…Some studies suggest that the ability of the TLF to deform (in terms of stretching and relaxing) and slide on the epimysium of the erector spinae is a critical feature that distinguishes healthy individuals from low back pain patients ( 13–15 ). This group of patients has 13.8% less shear strain ( 13 ) and 28% less TLF deformability ( 15 ) than healthy controls.…”

Section: Introductionmentioning

confidence: 84%

“…All participants were aged between 18 and 60 years. Further inclusion criteria for UaLBP were: acute lumbar back pain as defined by the European guidelines for the management of acute low back pain ( 16 ); minimum score of 10 on the Oswestry Disability Questionnaire [ODQ-D; ( 15 )]; minimum score of 3 on the visual analog scale (VAS) for pain intensity; <6 weeks pain duration. Participants were eligible for TF if they qualified at least once for the German championships in the last 2 years, were active athletes of the southern German TF base, and had a 1 repetition maximum (1RM) of no more than 130 kg.…”

Section: Methodsmentioning

confidence: 99%

“…The movement is completed by bringing the spine into a fully upright, natural position. Participants were given further information on how to perform a defined trunk extension task (TET) from a 60° flexed hip position, as described in a previous study ( 15 ). Briefly, participants seated on a treatment table first performed a 60-degree thoracolumbar flexion which was controlled using a digital goniometer.…”

Section: Methodsmentioning

confidence: 99%

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Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain

et al. 2023

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BackgroundAlterations in posture, lumbopelvic kinematics, and movement patterns are commonly seen in patients with low back pain. Therefore, strengthening the posterior muscle chain has been shown to result in significant improvement in pain and disability status. Recent studies suggest that thoracolumbar fascia (TLF) has a major impact on the maintenance of spinal stability and paraspinal muscle activity, and thus is likely to have an equal impact on deadlift performance.ObjectiveAim of the study was to evaluate the role of thoracolumbar fascia deformation (TFLD) during spinal movement in track and field athletes (TF) as well as individuals with and without acute low back pain (aLBP).MethodsA case–control study was performed with n = 16 aLBP patients (cases) and two control groups: untrained healthy individuals (UH, n = 16) and TF (n = 16). Participants performed a trunk extension task (TET) and a deadlift, being assessed for erector spinae muscle thickness (EST) and TLFD using high-resolution ultrasound imaging. Mean deadlift velocity (VEL) and deviation of barbell path (DEV) were measured by means of a three-axis gyroscope. Group differences for TLFD during the TET were examined using ANOVA. Partial Spearman rank correlations were calculated between TLFD and VEL adjusting for baseline covariates, EST, and DEV. TLFD during deadlifting was compared between groups using ANCOVA adjusting for EST, DEV, and VEL.ResultsTLFD during the TET differed significantly between groups. TF had the largest TLFD (−37.6%), followed by UH (−26.4%), while aLBP patients had almost no TLFD (−2.7%). There was a strong negative correlation between TLFD and deadlift VEL in all groups (r = −0.65 to −0.89) which was highest for TF (r = −0.89). TLFD during deadlift, corrected for VEL, also differed significantly between groups. TF exhibited the smallest TLFD (−11.9%), followed by aLBP patients (−21.4%), and UH (−31.9%).ConclusionTFLD maybe a suitable parameter to distinguish LBP patients and healthy individuals during lifting tasks. The cause-effect triangle between spinal movement, TFLD and movement velocity needs to be further clarified.Clinical trial registrationhttps://drks.de/register/de/trial/DRKS00027074/, German Clinical Trials Register DRKS00027074.

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Section: Introductionmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain

et al. 2023

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“…Based on our current knowledge, this study may be stated as the first study detailing the TLF thickness at the L3 level of the lumbar spine in chronic non-specific LBP patients compared with healthy volunteers. As has been reported by other studies examining the TLF, the TLF was easily visualized in the longitudinal and transverse axes, appearing with multilayer, linear, and hyperechogenic layers below the subcutaneous tissue [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 52%

Ultrasound Imaging of Thoracolumbar Fascia Thickness: Chronic Non-Specific Lower Back Pain versus Healthy Subjects; A Sign of a “Frozen Back”?

Pirri

Guidolin

et al. 2023

Diagnostics

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The thoracolumbar fascia (TLF) plays an important role in lower back pain (LBP). Recent studies have revealed an association between increases in TLF thickness and reduced TLF gliding in patients with LBP. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the TLF at the bilateral L3 level of the lumbar spine in the longitudinal and transverse axes in chronic non-specific LBP and in healthy subjects. A cross-sectional study was performed using US imaging to measure the longitudinal and transverse axes with a new protocol in a sample of 92 subjects: 46 chronic non-specific LBP patients and 46 healthy participants. The findings for TLF thickness revealed statistically significant differences (p < 0.05) in the longitudinal and transverse axes between the two groups. Moreover, in the healthy group, a statistically significant difference was found between the longitudinal and transverse axes (p = 0.001 for left and p = 0.02 for right), which was not evident in the LBP patients. These findings suggest that the LBP patients lost anisotropy of the TLF, with it becoming homogeneously thicker and losing adaptability in the transversal direction. The US imaging evaluation suggests that TLF thickness behavior points out altered fascial remodelling compared to healthy subjects, a sort of “frozen back”.

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“…The TLF is rhombically pervaded by this dense nerve network [ 7 ]. The deformation of the TLF and altered morphology probably also affect blood vessels as well as free nerve endings and could lead to changes in muscle tone, fluid delivery, and other neurological effects that were probably positively influenced by the intervention in this study [ 25 , 26 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Immediate Effects of Myofascial Release Treatment on Lumbar Microcirculation: A Randomized, Placebo-Controlled Trial

Brandl

Egner

Reer

et al. 2023

JCM

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(1) Background: Inflammatory processes in the thoracolumbar fascia (TLF) lead to thickening, compaction, and fibrosis and are thought to contribute to the development of nonspecific low back pain (nLBP). The blood flow (BF) of fascial tissue may play a critical role in this process, as it may promote hypoxia-induced inflammation. The primary objective of the study was to examine the immediate effects of a set of myofascial release (MFR) techniques on the BF of lumbar myofascial tissue. The secondary objectives were to evaluate the influence of TLF morphology (TLFM), physical activity (PA), and body mass index (BMI) on these parameters and their correlations with each other. (2) Methods: This study was a single-blind, randomized, placebo-controlled trial. Thirty pain-free subjects (40.5 ± 14.1 years) were randomly assigned to two groups treated with MFR or a placebo intervention. Correlations between PA, BMI, and TLFM were calculated at baseline. The effects of MFR and TLFM on BF (measured with white light and laser Doppler spectroscopy) were determined. (3) Results: The MFR group had a significant increase in BF after treatment (31.6%) and at follow-up (48.7%) compared with the placebo group. BF was significantly different between disorganized and organized TLFM (p < 0.0001). There were strong correlations between PA (r = −0.648), PA (d = 0.681), BMI (r = −0.798), and TLFM. (4) Conclusions: Impaired blood flow could lead to hypoxia-induced inflammation, possibly resulting in pain and impaired proprioceptive function, thereby likely contributing to the development of nLBP. Fascial restrictions of blood vessels and free nerve endings, which are likely associated with TLFM, could be positively affected by the intervention in this study.

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Associations between Deformation of the Thoracolumbar Fascia and Activation of the Erector Spinae and Multifidus Muscle in Patients with Acute Low Back Pain and Healthy Controls: A Matched Pair Case-Control Study

Cited by 14 publications

References 54 publications

Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain

Thoracolumbar fascia deformation during deadlifting and trunk extension in individuals with and without back pain

Ultrasound Imaging of Thoracolumbar Fascia Thickness: Chronic Non-Specific Lower Back Pain versus Healthy Subjects; A Sign of a “Frozen Back”?

Immediate Effects of Myofascial Release Treatment on Lumbar Microcirculation: A Randomized, Placebo-Controlled Trial

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