• Clin J Pain · Mar 2013

    Comparative Study

    Lumbar muscle dysfunction during remission of unilateral recurrent nonspecific low-back pain: evaluation with muscle functional MRI.

    • Roseline D'hooge, Barbara Cagnie, Geert Crombez, Guy Vanderstraeten, Eric Achten, and Lieven Danneels.
    • Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium. roseline.dhooge@ugent.be
    • Clin J Pain. 2013 Mar 1;29(3):187-94.

    ObjectivesAfter cessation of a low-back pain (LBP) episode, alterations in trunk muscle behavior, despite recovery from pain, have been hypothesized to play a pathogenic role in the recurrence of LBP. This study aimed to identify the presence of lumbar muscle dysfunction during the remission of recurrent LBP, while performing a low-load trunk-extension movement.MethodsThirteen participants with unilateral recurrent LBP were tested at least 1 month after cessation of the previous LBP episode and were compared with a healthy control group without any history of LBP (n=13). Also, differences between previously painful and nonpainful sides were examined. Muscle functional magnetic resonance imaging, based on quantitative T2-imaging, was used to examine muscle tissue characteristics (T2 rest) and muscle recruitment (T2 shift) during prone trunk extension. The lumbar multifidus, erector spinae, quadratus lumborum, and psoas were bilaterally visualized on 2 lumbar levels using a T2-weighted (spin-echo multicontrast) magnetic resonance imaging sequence.ResultsLinear mixed model analysis revealed a significantly lower T2 rest (P=0.044) and a significantly higher T2 shift (P=0.034) solely for the multifidus in the LBP group compared with the control group. No significant differences between pain sides were found.DiscussionLower T2-rest values have been suggested to correlate with a conversion of the multifidus' fiber typing toward the glycolytic muscle spectrum. Elevated T2 shifts correspond with increased levels of metabolic activity in the multifidus in the LBP group, for which several hypotheses can be put forward. Taken together, these findings provide evidence of concurrent alterations in the multifidus structure and activity in individuals with unilateral recurrent LBP, despite being pain free and functionally recovered.

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