Sonography Evaluation of Stabilization Muscles of Lumbar Spine in Vertebrogenic Patients
Authors:
M. Holinka 1,2
; J. Gallo 2; J. Zapletalová 3
Authors place of work:
Ortopedické oddělení, Karvinská hornická nemocnice, a. s.
prim. MUDr. R. Pavličný
1; Ortopedická klinika, Fakultní nemocnice Olomouc, Univerzita Palackého v Olomouci
prof. MUDr. J. Gallo, Ph. D.
2; Ústav lékařské biofyziky, Lékařská fakulta, Univerzita Palackého v Olomouci
prof. RNDr. H. Kolářová, CSc.
3
Published in the journal:
Rehabil. fyz. Lék., 23, 2016, No. 2, pp. 64-73.
Category:
Original Papers
Summary
Introduction:
Degenerative changes of lumbar spine with accompanying backache belong to the most frequent complaints encountered in clinical practice. A wide spectrum of potential causes is associated with extensive changes in muscular stabilizers of the spine. The objective of this work was to evaluate the thickness of selected stabilization muscles by means of sonography examination in patients with chronic impairment of lumbar spine and to compare the results with a control group of healthy individuals.
Methodical procedure:
The study included 63 patients on the whole, 22 of them being men (34.9%) and 41 women (65.1%) at the age of 21 to 83 years. Forty eight patients (76.2%) with chronic backache formed the group of patients and 15 patients (23.8%) represented young and healthy individuals within the framework of the control group. Each patient underwent clinical examination and assessed intensity of the presently perceived pain on the basis of a visual analogous scale (VAS). At the same time all patients filled out the OSWESTRY questionnaire, which is considered as a “gold standard” in determination of subjective measure of limitation in ordinary daily activities.
Results:
In patients with chronic pains in lumbar spine (VAS 1 – 100 mm), the mean thickness of musculus obliquus abdominis internus, transversus abdominis and multifidus were always less than in the control group of healthy individuals. In the case of musculus multifidus we always determined linearly decreasing dependence of the thickness of stabilization muscles in comparison with the increasing intensity of the backache. In the subgroups of patients divided according to a subjective measure of limitation in ordinary daily activities on the basis of the OSWESTRY questionnaire (OSWESTRY 1 – 20 %, 21 – 40 %, 41 – 100 %), we observed even in this case there were lower mean thicknesses in musculus obliquus abdominis internus, transversus abdominis and multifidus than in the control group of healthy individuals. In the case of musculus obliquus abdominis internus were observed a linearly decreasing dependence in the muscle thickness as compared with the increasing limitation according to the OSWESTRY questionnaire. The sonography examination also revealed high individual variability of the measured muscle in resting muscles as well as after a load in both groups investigated. This kind of variability was particularly noticeable in musculus multifidus in the group of patients with chronic backache, where the observed difference in the muscle thickness at rest and after the load proved to be 39mm and 47mm, respectively.
Conclusion:
In patients with different type and degree of chronic disease of lumbar spine the authors determined lower thickness of the selected stabilization muscles as compared with the healthy control group. Sonography examination also revealed high individual variability of the measured muscles. A higher intensity of backache and greater limitation in ordinary daily activities (VAS pain, OSWESTRY questionnaire) correlated in some cases with the decreasing thickness of the muscles measured.
Keywords:
sonography, stabilization muscles of lumbar spine, muscle thickness, visual analogous scale, OSWESTRY questionnaire
Zdroje
1. AINSCOUGH-POTTS, A. M., MORRISSEY, M. C., CRITCHLEY, D.: The response of the transverse abdominis and internal oblique muscles to different postures. Man. Ther., 11, 2006, 1, s. 54-60.
2. ARAB, A. M., RASOULI, O., AMIRI, M., TAHAN, N.: Reliability of ultrasound measurement of automatic activity of the abdominal muscle in participants with and without chronic low back pain. Chiropr. Man. Therap., 21, 2013, 1, s. 37-43.
3. BARNETT, F., GILLEARD, W.: The use of lumbar spinal stabilization techniques during the performance of abdominal strengthening exercise variations. J. Sports. Med. Phys. Fitness., 45, 2005, 1, s. 38-43.
4. BEAZELL, J. R., GRINDSTAFF, T. L., MAGRUM, E. M., CULLATY, M., HART, J. M., SHEN, F. H.: Comparison of clinical test and real time ultrasound evaluation of muscle contraction in normals and patients with low back pain. J. Man. Manip. Ther., 14, 2006, 3, s. 168-169.
5. COSTA, L. O., MAHER, C. G., LATIMER, J., SMEETS, R. J.: Reproducibility of rehabilitative ultrasound imaging for the measurement of abdominal muscle activity: A systematic review. Phys. Ther., 89, 2009, 8, s. 756-769.
6. COSTA, L. O., MAHER, C. G., LATIMER, J., HODGES, P. W., SHIRLEY, D.: An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain. Eur. Spine. J., 18, 2009, 7, s. 1059-1065.
7. DAVIDSON, M., KEATING, J. L.: A Comparison of five low back disability questionnaires: Reliability and responsiveness. Phys. Ther., 82, 2002, 1, s. 8-24.
8. Dynasit [online]. Dynasit: ©2015 [cit. 29. 9. 2015]. Dostupné z: http://www.dynasit.com/.
9. FAIRBANK, J. C. T., PYNSET, P. B.: The Oswestry Disability Index. Spine, 25, 2000, 22, s. 2940-2953.
10. FERREIRA, P. H., FERREIRA, M. L. , MAHER, CH. G., HERBERT, R. D., REFSHAUGE, K.: Specific stabilisation exercise for spinal and pelvic pain: A systematic review. Aust. J. Physiother., 52, 2006, 2, s. 79-88.
11. HIDES, J. A., RICHARDSON, C. A., JULL, G. A.: Magnetic resonance imaging and ultrasonography of the lumbar multifidus muscle: Comparison of two different modalities. Spine, 20, 1995, 1, s. 54-58.
12. HODGES, P. W., RICHARDSON, C. A.: Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch. Phys. Med. Rehabil., 80, 1999, 9, s. 1005-1012.
13. HODGES, P. W., RICHARDSON, C. A.: Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J. Spinal. Disord., 11, 1998, 1, s. 46-56.
14. CHEUNG, K. M., KARPPINEN, J., CHAN, D., HO, D. W., SONG, Y. Q., SHAM, P., CHEAH, K. S., LEONG, J. C., LUK, K. D.: Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine, 34, 2009, 9, s. 934-940.
15. CHOU, R., QASSEM, A ., SNOW, V., CASEY, D., CROSS, J. T., SHEKELLE, P., OWENS, D. K.: Diagnosis and treatment of low back pain: a joint clinical practice guideline from the american college of physicians and the american pain society. Ann. Intern. Med., 147, 2007, 7, s. 478-491.
16. KELLY, A. M.: The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg. Med. J., 18, 2001, 3, s. 205-207.
17. KIESEL, K. B., UHL, T., UNDERWOOD, F. B., NITZ, A. J.: Rehabilitative ultrasound measurement of select trunk muscle activation during induced pain. Man. Ther., 13, 2008, 2, s. 132-138.
18. KIM, K. H., CHO S.H., GOO, B. O., BAEK, I. H.: Differences in transversus abdominis muscle function between chronic low back pain patients and healthy subjects at maximum expiration: measurement with real-time ultrasonography. J. Phys. Ther. Sci., 25, 2013, 7, s. 861-863.
19. KIM, S. G., YONG, M. S., NA, S. S.: The effect of trunk stabilization exercises with a swiss ball on core muscle activation in the elderly. J. Phys. Ther. Sci., 26, 2014, 9, s. 1473-1474.
20. KOH, H. W., CHO, S. H., KIM, C. Y.: Comparison of the effects of hollowing and bracing exercises on cross-sectional areas of abdominal muscles in middle-aged women. J. Phys. Ther. Sci., 26, 2014, 2, s. 295-299.
21. KOLÁŘ, P., LEWIT, K., DYRHONOVÁ, O., BITNAR, P.: Vyšetřovací postupy zaměřené na funkci pohybové soustavy. In: Rehabilitace v klinické praxi. Praha, Galén, 2009. Kapitola 1., s. 25-32.
22. KOLÁŘ, P.: Vertebrogenní obtíže a stabilizační funkce svalů - diagnostika. Rehabil. Fyz. Lek., 13, 2006, 4, s. 155-170.
23. LIEBENSON, C.: Spinal stabilization training: the therapeutic alternative to weight training. J. Bodyw. Mov. Ther., 1, 1997, 2, s. 87-90.
24. MACEDO, L. G., MAHER, C. G., LATIMER, J., MCAULEY, J. H.: Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys. Ther., 89, 2008, 1, s. 9-25.
25. MANNION, A. F., PULKOVSKI, N., GUBLER, D., GORELICK, M., O’RIORDAN, D., LOUPAS, T., SCHENK, P., GERBER, H., SPROTT, H.: Muscle thickness changes during abdominal hollowing: an assessment of between-day measurement error in controls and patients with chronic low back pain. Eur. Spine, 17, 2008, 4, s. 494-501.
26. MCGILL, S. M., KARPOWICZ, A.: Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Arch. Phys. Med. Rehabil., 90, 2009, 1, s. 118-126.
27. MIN, J. H., CHOI, H. S., IHL RHEE, W., LEE, J. I.: Association between radiculopathy and lumbar multifidus atrophy in magnetic resonance imaging. J. Back. Musculoskelet. Rehabil., 26, 2013, 2, s. 175-181.
28. MOON, J. H., HONG, S. M. , KIM, C. W., SHIN, Y. A.: Comparison of deep and superficial abdominal muscle activity between experienced pilates and resistance exercise instructors and controls during stabilization exercise. J. Exerc. Rehabil., 11, 2015, 3, s. 161-168.
29. MÜLLER, O., GÜNTHER, M., KRAUΒ, I., HORSTMANN, T.: Physical characterization of the therapeutic device Posturomed as a measuring device--presentation of a procedure to characterize balancing ability. Biomed. Tech., 49, 2004, 3, s. 56-60.
30. O‘SULLIVAN, P. B.: Lumbar segmental ‘instability’: clinical presentation and specific stabilizing exercise management. Man. Ther., 5, 2000, 1, s. 2-12.
31. PETERSEN, T., LARSEN, K., JACOBSEN, S.: One-year follow-up comparison of the effectiveness of McKenzie treatment and strengthening training for patients with chronic low back pain: outcome and prognostic factors. Spine, 32, 2007, 26, s. 2948-2956.
32. RANTANEN, J., HURME, M., FALCK, B., ALARANTA, H., NYKVIST, F., LEHTO, M., EINOLA, S., KALIMO, H.: The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Spine (Phila Pa 1976), 18, 1993, 5, s. 568-574.
33. Redcord [online]. Redcord: ©2011 [cit. 29. 9. 2015]. Dostupné z: http://www.redcord.com/.
34. RICHARDSON, C., HODGES, P. W. , HIDES, J., RICHARDSON, C.: Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. 2nd ed. New York: Churchill Livingstone, 2004, 271 s.
35. RISSANEN, A., KALIMO, H., ALARANTA, H.: Effect of intensive training on the isokinetic strength and structure of lumbar muscles in patients with chronic low back pain. Spine (Phila Pa 1976), 20, 1995, 3, s. 333-340.
36. SALIBA, S. A., CROY, T., GUTHRIE, R., GROOMS, D., WELTMAN, A., GRINDSTAFF, T. L.: Differences in transverse abdominis activation with stable and unstable bridging exercises in individuals with low back pain. N. Am. J. Sports. Phys. Ther., 5, 2010, 2, s. 63-73.
37. SKIKIĆ, E. M., SUAD, T.: The effects of McKenzie exercise for patients with low back pain, our experience. Bosn. J. Basic. Med. Sci., 3, 2003, 4, s. 70-75.
38. STEVENS, V. K., BOUCHE, K. G., MAHIEU, N. N. , COOREVITS, P. L., VANDERSTRAETEN, G. G., DANNEELS, L. A.: Trunk muscle activity in healthy subjects during bridging stabilization exercises. BMC Musculoskelet. Disord., 7, 2006, 1, s. 75.
39. STOLZENBERG, N., BELAVÝ, D. L. , RAWER, R., FELSEN-BERG, D.: Whole-body vibration versus proprioceptive training on postural control in post-menopausal osteopenic women. Gait Posture, 38, 2013, 3, s. 416-420.
40. ŠPRINGROVÁ, I.: Funkce - diagnostika - terapie hlubokého stabilizačního systému. 2. vyd., Česko, REHASPRING centrum, s.r.o., s. 12-14.
41. TEYHEN, D. S., MILTENBERGER, C. E., DEITERS, H. M., DEL TORO, Y. M., PULLIAM, J. N., CHILDS, J. D., BOYLES, R. E., FLYNN, T. W.: The use of ultrasound imaging of the abdominal drawing-in maneuver in subjects with low back pain. J. Orthop. Sports Phys. Ther., 35, 2005, 6, s. 346-355.
42. TRX [online]. Fitness Anywhere: ©2005 – 2015 [cit. 29. 9. 2015]. Dostupné z: https://www.trxtraining.com/.
43. WALLERSTEIN, S. L.: Scaling clinical pain and pain relief. In: BROMM, B.: Pain measurement in man: neurophysiological correlates of pain. New York, Elsevier, 1984, 511 s.
44. WOODHAM, M., WOODHAM, A., SKEATE, J. G., FREEMAN, M.: Long-term lumbar multifidus muscle atrophy changes documented with magnetic resonance imaging: a case series. J. Radiol. Case. Rep., 8, 2014, 5, s. 27-34.
45. WU, W. W., HU, Z. J., FAN, S. W., XU, W. B., FANG, X. Q., ZHAO, F. D.: Influencing of chronic low back pain on multifidus muscle atrophy. Zhongguo Gu Shang., 27, 2014, 3, s. 207-212.
46. YOON, J. S., LEE, J. H., KIM, J. S.: The effect of swiss ball stabilization exercise on pain and bone mineral density of patients with chronic low back pain. J. Phys. Ther. Sci., 25, 2013, 8, s. 953-956.
47. ZHAO, W. P., KAWAGUCHI, Y., MATSUI, H., KANAMORI, M., KIMURA, T.: Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine, 25, 2000, 17, s. 2191-2199.
Štítky
Physiotherapist, university degree Rehabilitation Sports medicineČlánok vyšiel v časopise
Rehabilitation and Physical Medicine
2016 Číslo 2
- Hope Awakens with Early Diagnosis of Parkinson's Disease Based on Skin Odor
- Deep stimulation of the globus pallidus improved clinical symptoms in a patient with refractory parkinsonism and genetic mutation
Najčítanejšie v tomto čísle
- Sacralization of Vertebra L5
- Positioning Chronically Immobile and Terminally-Ill Patients
- Options of Physiotherapy for Patients with Kidney Disease, on Dialysis and after Kidney Transplantation - Overview from Past to Present
- Spectrum, Trends and Approaches in Contemporary Neurorehabilitation