Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

Abstract

BackgroundAlthough the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.MethodsIn each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.ResultsThere were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had ~25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p < 0.01 and p < 0.001 respectively).ConclusionThis is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.

Comparison of the Sonographic Features of the Abdominal Wall Muscles and Connective Tissues in Individuals With and Without Lumbopelvic Pain

“…1,38,54 With respect to the abdominal connective tissue, no studies could be identified that assessed changes in these tissues in persons with LPP. However, Langevin et al, 31 using ultrasound imaging (USI), reported the presence of thicker and more disorganized lumbar perimuscular connective tissue (PMCT) at the L2-3 vertebral level in individuals with longstanding low back pain (LBP).…”

Ultrasound Imaging and Muscle Function

“…44 To date, the most common use of USI in studies by physical therapists has been measurement of the architectural characteristics of muscle, which usually involves measuring parameters such as thickness, 59,60,65 width, 8,65 and cross-sectional area (CSA), 8,43,65 and comparing changes or differences in these parameters between groups of individuals 19,70 or over time-before and after some event (eg, injury) 8 or intervention (eg, training).…”

“…22,23 As a decrease in muscle size has been linked to various pathologies and impairments, 16,19 the use of the technology has continued to expand to include investigation of muscles such as the supraspinatus and infraspinatus, 35 rectus femoris, 13 biceps brachii, 2 transversus abdominis (TrA) and internal oblique (IO), 20 rectus abdominis, 8 cervical multifidus, 45 trapezius, 56 rectus femoris, sartorius, and iliopsoas. 53 Other aspects of muscle morphology and function that have been explored with USI include composition, 44,61,66 changes in internal architecture (pennation angles), 48,80 force generation, 13 and muscle activity (ie, electrical activity recorded by electromyography [EMG]). 6,28,34,36,52 While physical therapists are familiar with therapeutic ultrasound and the underlying physics, they often lack training regarding the principles and instrumentation underlying USI.…”

Episacral Lipoma: A Treatable Cause of Low Back Pain (Case Report)

“…[1] Episakral lipoma, torakodorsal fasyadaki bir yırtık sonucu fıtıklaşmış subfasiyal yağ dokusudur. Çeşitli çalışmalar ile episakral lipomanın akut ve kronik bel ağrısının önemli nedenlerinden biri olduğu ve ciddi bel ağrısına ve sakatlanmaya yol açabileceği gösteril-miştir.…”