Quantitative Ultrasound Imaging Differences in Multifidus and Thoracolumbar Fasciae between Athletes with and without Chronic Lumbopelvic Pain: A Case-Control Study

Jaime Almazán-Polo, Daniel López-López, Carlos Romero-Morales, David Rodríguez-Sanz, Ricardo Becerro-de-Bengoa-Vallejo, Marta Elena Losa-Iglesias, María Bravo-Aguilar, César Calvo-Lobo, Jaime Almazán-Polo, Daniel López-López, Carlos Romero-Morales, David Rodríguez-Sanz, Ricardo Becerro-de-Bengoa-Vallejo, Marta Elena Losa-Iglesias, María Bravo-Aguilar, César Calvo-Lobo

Abstract

New trends in ultrasound imaging are focused on exploration of morphology and muscle quality. The main goal of the study was to evaluate the first-order descriptor and echostructure of lumbar multifidus at the L4 vertebral level in athletes with and without chronic lumbopelvic pain (CLPP). A case-control study was performed in 15 semiprofessional athletes with CLPP and 15 without (healthy athletes). Lumbar multifidus echointensity and echovariation were measured for muscle quality assessment. Echostructure was used to evaluate lumbar multifidus cross-sectional area (CSA) at resting and during muscle contraction, respective differences during both phases (CSADif.), activation patterns, and thoracolumbar fasciae morphology and thickness. Significant differences with a large effect size were observed in quantitative data from CLPP and healthy athletes for left lumbar multifidus CSADif. and thoracolumbar fasciae morphology. Categorical data showed statistically significant differences with a small-to-moderate effect size for lumbar multifidus activation pattern and thoracolumbar fasciae morphology. Athletes with CLPP showed a reduced CSA difference between lumbar multifidus contraction and at resting and higher disorganization of thoracolumbar fasciae morphology compared to healthy athletes. These findings suggest the importance of dynamic exploration of the lumbar region and connective tissue in sports performance and injury prevention.

Keywords: athletes; cross-sectional area; grayscale analysis; lower back pain; lumbar multifidus; quantitative ultrasound imaging; ultrasonography.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Ultrasonographic evaluation of the lumbar region. (A) Probe location for longitudinal assessment of lumbar multifidus at L4 vertebral level (yellow dotted line). (B) Longitudinal scanning view of LM (yellow arrow), and L4/5 (orange asterisk) and L5/S1 (white asterisk) facet joints visualization. (C) Probe location for transverse scanning of lumbar multifidus at L4 vertebral level (yellow dotted line). (D) Transverse scanning view of the lumbar multifidus, and visualization of the L4 spinous process (SP), the laminae (LA) and L4/5 facet joint as measurement landmark, and CSA of LM; (E), CSA of lumbar multifidus at resting (LM) and borders delimitation with lumbar longissimus muscle (LG), as well as the white enhancement of the L4 spinous process (SP), the laminae (LA), and facet joint of L4/5 (orange asterisk). (F) CSA of lumbar multifidus (LM) during muscle contraction (CAL test) and borders delimitation with lumbar longissimus muscle (LG). Abbreviations: CAL, contralateral arm lift test; CSA, cross-sectional area; LA, laminae; LG, lumbar longissimus muscle; LM, lumbar multifidus; SP, spinous process.
Figure 2
Figure 2
ImageJ measurements of echostructure and first-order descriptors of the lumbar multifidus (LM) and the thoracolumbar fasciae (TLF). (A) Representation of the measurement protocol using ImageJ: Central line (1. Central line, magenta), Thoracolumbar fasciae distance reference (2. TLF-Distance, green), thickness (TH) of the thoracolumbar fasciae (3. TLF-TH, blue), cross-sectional area (CSA) of the lumbar multifidus at resting (4. CSA of LM red), width of the lumbar multifidus (5. LM width, yellow), region of interest (ROI) of lumbar multifidus at midpoint (6. ROI 145 × 145 pixels, orange), and vertical line reference for ROI adjustment (7. Vertical reference, cyan). (B) CSA of LM histogram displayed. (C) ROI of LM histogram displayed.
Figure 3
Figure 3
Ultrasound imaging assessment of thoracolumbar fasciae morphology and categorization based on Likert-scale type which considers fascial lines delimitation and organization, echogenicity and the ability to draw a rectangular box around the hyperechoic fascial layers (organized). The figure shows sample homologous images of a “very organized” ((A,B); Group = 4, Likert-scale type score = 9), “somewhat organized” ((C,D); Group = 3, Likert-scale type score = 7) and “somewhat disorganized” ((E,F); Group = 3, Likert-scale type score = 5) thoracolumbar fasciae. Abbreviations: SP, spinous process; TLF, thoracolumbar fasciae.

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