Rapid Atrophy of the Lumbar Multifidus Follows Experimental Disc or Nerve Root Injury

Hodges, Paul W.; Holm, Allison Kaigle; Hansson, Tommy; Holm, Sture

doi:10.1097/01.brs.0000248453.51165.0b

Cited by 344 publications

(291 citation statements)

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“…Although we were only able to identify a significant relationship between multifidus density and spondylolisthesis when we used the summative measure from the principle component analysis, when data were considered separately for each level we identified an association between muscle density of multifidus and/or erector spinae at a specific lumbar level and FJOA, disc narrowing, and spondylolisthesis and related levels. This is consistent with data of Hides [16], and Hodges [17] following acute pain/ injury and Danneels [6] in chronic LBP, L4 multifidus density was reduced in association with FJOA or spondylolisthesis at L4-5. As multifidus fibers arising from L4 arise from the caudal border of the spinous process and adjacent lamina [38], their bulk lies adjacent to L5.…”

Section: Discussionsupporting

confidence: 92%

“…They proposed that the wasting was not likely to be due to disuse atrophy because of the rapidity of onset and localized distribution. Animal studies have shown atrophy to develop rapidly after experimental injury to an intervertebral disc [17]. Again these changes were localized to the level of injury and were associated with rapid changes in intra-muscular fat.…”

Section: Discussionmentioning

confidence: 99%

“…Current evidence suggests that the paraspinal muscles are smaller in patients with chronic LBP [4,6,40,50] than in healthy individuals of similar age. Reduced size of multifidus has also been reported in acute LBP [16] and recent animal work has shown rapid changes in CSA in the multifidus muscle following discrete injury to an intervertebral disc [17]. In several imaging studies, chronic LBP was found to be associated with CT-evaluated muscle density (measured in Hounsfield units) [14,19,28].…”

Section: Introductionmentioning

confidence: 88%

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Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

et al. 2009

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The objectives of the study were to evaluate the association between lumbar paraspinal muscle density, evaluated on computed tomography (CT) and age, sex and BMI; and to evaluate the association of those changes with low back pain (LBP) and spinal degeneration features in a community-based sample. This study was an ancillary project to the Framingham Study. A sample of 3,529 participants aged 40-80 years had a CT scan performed to assess aortic calcification. 187 individuals were randomly enrolled in this study. LBP in the last 12 months was evaluated using self-report questionnaire. Density (in Hounsfield units) of multifidus and erector spinae was evaluated on CT. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA), spondylolysis, spondylolisthesis and spinal stenosis were also evaluated. We used linear regression models to examine the association of paraspinal muscles density with age, sex, BMI, LBP, and spinal degeneration features. The results show that in our study, men have higher density of paraspinal muscles than women, younger individuals have higher density than older ones and individuals with lower weight have higher muscle density than overweight. No differences between individuals with and without LBP were found. Significant association was found between L4 multifidus/erector spinae density and FJOA at L4-L5; between multifidus at L4 and spondylolisthesis at L4-5; and between erector spinae at L4 and L5 with disc narrowing at L4-5 and L5-S1, respectively. We conclude that the paraspinal muscle density decreases with age, and increases BMI. It is associated with at some levels FJOA, spondylolisthesis and disc narrowing at the same level, but not associated with occurrence of LBP.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

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Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

et al. 2009

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“…There is evidence from humans and animal models, including ovine 58, porcine 59, 60, and feline 61 that induced local injury compromises neural drive to the MF, seen as changes in electrical activity on MF electromyography. Experimentally induced intervertebral disc degeneration in the cat induces pathophysiologic changes to the MF 62.…”

Section: Introductionmentioning

confidence: 99%

Muscle Control and Non-specific Chronic Low Back Pain

Russo¹,

Deckers

Eldabe

et al. 2018

Neuromodulation: Technology at the Neural Interface

144

129

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ObjectivesChronic low back pain (CLBP) is the most prevalent of the painful musculoskeletal conditions. CLBP is a heterogeneous condition with many causes and diagnoses, but there are few established therapies with strong evidence of effectiveness (or cost effectiveness). CLBP for which it is not possible to identify any specific cause is often referred to as non‐specific chronic LBP (NSCLBP). One type of NSCLBP is continuing and recurrent primarily nociceptive CLBP due to vertebral joint overload subsequent to functional instability of the lumbar spine. This condition may occur due to disruption of the motor control system to the key stabilizing muscles in the lumbar spine, particularly the lumbar multifidus muscle (MF).MethodsThis review presents the evidence for MF involvement in CLBP, mechanisms of action of disruption of control of the MF, and options for restoring control of the MF as a treatment for NSCLBP.ResultsImaging assessment of motor control dysfunction of the MF in individual patients is fraught with difficulty. MRI or ultrasound imaging techniques, while reliable, have limited diagnostic or predictive utility. For some patients, restoration of motor control to the MF with specific exercises can be effective, but population results are not persuasive since most patients are unable to voluntarily contract the MF and may be inhibited from doing so due to arthrogenic muscle inhibition.ConclusionsTargeting MF control with restorative neurostimulation promises a new treatment option.

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“…However, changes in spinal mechanics have been reported as a common element (Panjabi, 2006). Altered spinal mechanics and LBP have been linked with atrophy (Hides et al, 2008a;Danneels et al, 2000;Hodges et al, 2006;Hodges & Richardson, 1996;Ferriera et al, 2004) and altered motor control (Hodges & Richardson, 1996) of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles. Atrophy of LM and TrA has also been associated with loss of lordosis, development of back pain and spinal injury, and following periods of low activity and disuse of spinal muscles (Buckey, 2006;Hides et al, 2011;Sayson & Hargens, 2008).…”

Section: Introductionmentioning

confidence: 99%

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

Winnard

Debuse

Wilkinson

et al. 2017

Musculoskeletal Science and Practice

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BackgroundDysfunction of the lumbar multifidus (LM) and transversus abdominis (TrA) muscles is associated with low back pain (LBP). The Functional Re-adaptive Exercise Device (FRED) has shown potential as a non-specific LBP intervention by automatically recruiting LM and TrA. Loss or lordosis and altered lumbopelvic positioning has also been linked to LBP and is often trained within LM and TrA interventions. The effect that FRED exercise has on lumbopelvic positioning and lumbar lordosis is unknown. ObjectivesTo assess the effect of FRED exercise on lumbopelvic kinematics and alignment to establish whether FRED exercise promotes a favourable lumbopelvic posture for training LM and TrA. DesignWithin and between-group comparison study MethodOne hundred and thirty participants, 74 experiencing LBP, had lumbopelvic kinematic data measured during over-ground walking and FRED exercise.Magnitude-based inferences were used to compare walking with FRED exercise within participants and between the asymptomatic and LBP groups, to establish the effects of FRED exercise on lumbopelvic kinematics, compared to walking, in each group. ResultsFRED exercise promotes an immediate change in anterior pelvic tilt by 8.7 degrees compared to walking in the no-LBP and LBP groups. Sagittal-plane spinal extension increased during FRED exercise at all spinal levels by 0.9 degrees in the no-LBP group, and by 1.2 degrees in the LBP group. ConclusionsFRED exercise promotes a lumbopelvic position more conducive to LM and TrA training than walking in both asymptomatic people and those with LBP. Highlights A posture conducive to LM and TrA training was promoted. The posture appears to occur automatically in people with and without LBP. Exercise on the FRED may be effective for LM and TrA training.

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Rapid Atrophy of the Lumbar Multifidus Follows Experimental Disc or Nerve Root Injury

Abstract: These data resolve the controversy that the multifidus cross-sectional area reduces rapidly after lumbar injury. Changes after disc lesion affect 1 level with a different distribution to denervation. Such changes may be due to disuse following reflex inhibitory mechanisms.

Cited by 344 publications

References 61 publications

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

Changes in paraspinal muscles and their association with low back pain and spinal degeneration: CT study

Muscle Control and Non-specific Chronic Low Back Pain

The immediate effects of exercise using the Functional Re-adaptive Exercise Device on lumbopelvic kinematics in people with and without low back pain

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