Paraspinal muscle cross-sectional area predicts low back disability but not pain intensity

Abstract

Background and context: The lumbar paraspinal muscles, including the erector spinae and multifidus, play an important role in movement and control of the spine. However, our understanding of their contribution to low back pain and disability is unclear. Systematic reviews have reported conflicting evidence for an association between paraspinal muscle size and low back pain, and a paucity of data examining muscle cross-sectional area and low back disability. Purpose: To investigate the relationship between paraspinal muscle cross-sectional area and both low back pain intensity and disability. Study design/ setting: 1-year longitudinal cohort study Patient sample: Participants were selected from the SpineData Registry (Denmark), which enrolls people with low back pain of 2 to 12 months duration without radiculopathy and a satisfactory response to primary intervention. Outcome measures: Current, typical and worst pain in the prior 2 weeks were assessed by 11-point numeric rating scales and an average pain score was calculated, and disability was measured using the 23-item Roland-Morris Disability Questionnaire. Cross-sectional area (CSA, cm 2) of the lumbar paraspinal muscles was measured at levels L3 to L5 from magnetic resonance images (MRI). Methods: Participants completed the study questionnaires and underwent the lumbar spine MRI at baseline and were followed up 12 months later to repeat the questionnaires. Statistical analyses involved multivariable linear regression (cross-sectional analysis) and linear mixed-models (longitudinal analysis) with adjustment for confounders. Multiple imputation was conducted to account for missing data. Sources of Funding: (Author 1) is the recipient of an Australian Government Research Training Program Scholarship. (Author 2) is the recipient of a (funding body) Career Development Fellowship.

State-of-the-Art Exercise Concepts for Lumbopelvic and Spinal Muscles – Transferability to Microgravity

“…The multifidus muscle at L5/S1 has been shown to be affected more than other vertebral levels in response to de-loading (Hides et al, 2007; Belavy et al, 2011), acute and chronic LBP (Hides et al, 1996, 2011) and in response to exercise interventions (Hides et al, 2008, 2012; Welch et al, 2015). The observation that size of the multifidus muscles at L4 and L5 predicts disability associated with LBP, reinforces the premise that these lower levels require special attention when prescribing exercise (Ranger et al, 2018). The position of the lumbo-sacral junction has been monitored closely in astronaut reconditioning to allow progression to weightlifting and endurance training for astronauts (Petersen et al, 2017).…”

“…Results were conflicting for the other muscles (Ranger et al, 2017). CSA of the multifidus muscles was predictive of LBP for up to 12 months in men (Ranger et al, 2017) and CSA of the multifidus and erector spinae muscles at the L4 and L5 vertebral levels predicted low back disability (Ranger et al, 2018). Fatty infiltration of paraspinal muscles may result in loss of muscle function and impaired strength (Lang et al, 2010).…”

Longitudinal Analysis of Paraspinal Muscle Cross-Sectional Area During Early Adulthood – A 10-Year Follow-Up MRI Study

“…Paraspinal muscle morphology and size have been of particular interest in studies investigating low back pain (LBP). Still, how lumbar muscle characteristics is an explaining factor for LBP is far from explicit 1,2,37–42 . A great need for longitudinal studies has been addressed to evaluate causality in this matter 1,39 .…”

“…Recent studies have suggested that a small cross-sectional area (CSA) of paraspinal muscles predicts low back pain and disability 1,2 . Age-related structural changes in the lumbar spine, including CSA, morphology and composition, have been widely examined in cross sectional studies 1–7 , but longitudinal studies in this area are scarce 1,8,9 . The need for long-term cohort studies on this matter has been addressed 1 .…”

“…Age-related structural changes in the lumbar spine, including CSA, morphology and composition, have been widely examined in cross sectional studies 1–7 , but longitudinal studies in this area are scarce 1,8,9 . The need for long-term cohort studies on this matter has been addressed 1 . Previous studies have shown that muscle mass decreases with age 10,11 .…”