Lumbar muscles biomechanical characteristics in young people with chronic spinal pain

Wai Leung Ambrose Lo, Qiuhua Yu, Yurong Mao, Wenfeng Li, Chengpeng Hu, Le Li, Wai Leung Ambrose Lo, Qiuhua Yu, Yurong Mao, Wenfeng Li, Chengpeng Hu, Le Li

Abstract

Background: The prevalence of low back pain is rising among the young adult population. Altered lumbar muscle tone was suggested to be associated with underlying pathologies and symptoms. To date, there is minimum information available on the repeatability of lumbar spine muscle mechanical properties in the young adults who experienced low back pain. This study aimed to assess the reproducibility of mechanical properties of lumbar spinal muscle in young adults with spinal pain by myotonometer and explored the difference in reproducibility when different number of indentations was used.

Methods: Participants who aged between 18 to 25 and reported chronic LBP were recruited. Lumbar muscle tone (Hz) and stiffness (N/m) were assessed by myotonometer on one occasion by two assessors. Parameters were recorded by triple scans and 5-scans mode. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD), Bland and Altman analysis were used to assess agreement between two measurements. The relationship between muscle mechanical properties and pain score and disability level were assessed by Spearman's rank correlation coefficient.

Results: The results of ICCs indicated excellent repeatability in triple scans and 5-scans mode for each lumbar level bilaterally (ICC > 0.75). SEM and SRD were smaller in triple scans than 5-scans mode for most levels. Bland and Altman analysis revealed no systematic bias. Spearman's rank correlation analysis indicated significant high correlations between muscle tone and disability level (r = 0.80, p < 0.05), and between muscle stiffness and disability level (r = 0.81, p < 0.05).

Conclusions: This study found that lumbar spinal muscle tone and stiffness were repeatable parameters when measured by myotonometer. The reproducibility of muscle mechanical parameters did not appear to differ between the two scanning modes with different number of indentations. Muscle tone and stiffness measured by myotonometer may therefore be reliable as outcome measures to assess intervention induced changes. The lack of significant association between intensity of pain and mechanical properties of paraspinal muscles may suggest that muscle properties measured at rest might not be related to pain level at rest but more related to pain elicited during movement.

Keywords: Low back pain; Muscle stiffness; Muscle tone; Myotonometer; Paraspinal muscle.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. DALYs GBD, Collaborators H Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1603–1658. doi: 10.1016/S0140-6736(16)31460-X.
    1. Ganesan S, Acharya AS, Chauhan R, Acharya S. Prevalence and risk factors for low Back pain in 1,355 young adults: a Cross-sectional study. Asian Spine J. 2017;11(4):610–617. doi: 10.4184/asj.2017.11.4.610.
    1. Haladaj R, Topol M. Multiple impulse therapy in the assessment of Paraspinal muscle tone in patients with low Back pain. Ortop Traumatol Rehabil. 2016;18(6):537–547. doi: 10.5604/15093492.1230520.
    1. Nair K, Masi AT, Andonian BJ, Barry AJ, Coates BA, Dougherty J, et al. Stiffness of resting lumbar myofascia in healthy young subjects quantified using a handheld myotonometer and concurrently with surface electromyography monitoring. J Bodyw Mov Ther. 2016;20(2):388–396. doi: 10.1016/j.jbmt.2015.12.005.
    1. Kawchuk GN, Kaigle AM, Holm SH, Rod Fauvel O, Ekstrom L, Hansson T. The diagnostic performance of vertebral displacement measurements derived from ultrasonic indentation in an in vivo model of degenerative disc disease. Spine (Phila Pa 1976) 2001;26(12):1348–1355. doi: 10.1097/00007632-200106150-00018.
    1. Van Deun B, Hobbelen JS, Cagnie B, Van Eetvelde B, Van Den Noortgate N, Cambier D. Reproducible measurements of muscle characteristics using the MyotonPRO device: comparison between individuals with and without Paratonia. J Geriatr Phys Ther. 2018;41(4):194–203.
    1. van Dieen JH, Selen LP, Cholewicki J. Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol. 2003;13(4):333–351. doi: 10.1016/S1050-6411(03)00041-5.
    1. Roland MO. A critical review of the evidence for a pain-spasm-pain cycle in spinal disorders. Clin Biomech (Bristol, Avon) 1986;1(2):102–109. doi: 10.1016/0268-0033(86)90085-9.
    1. Simons DG, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998;75(1):1–17. doi: 10.1016/S0304-3959(97)00102-4.
    1. Mense S, Masi AT. Increased Muscle Tone as a Cause of Muscle Pain. In: Mense S, Gerwin RD, editors. Muscle Pain: Understanding the Mechanisms. Berlin: Springer Berlin Heidelberg; 2010. pp. 207–249.
    1. Abbott JH, Flynn TW, Fritz JM, Hing WA, Reid D, Whitman JM. Manual physical assessment of spinal segmental motion: intent and validity. Man Ther. 2009;14(1):36–44. doi: 10.1016/j.math.2007.09.011.
    1. Masaki M, Aoyama T, Murakami T, Yanase K, Ji X, Tateuchi H, et al. Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers. Clin Biomech (Bristol, Avon) 2017;49:128–133. doi: 10.1016/j.clinbiomech.2017.09.008.
    1. Schoenrock B, Zander V, Dern S, Limper U, Mulder E, Veraksitš A, et al. Bed Rest, Exercise Countermeasure and Reconditioning Effects on the Human Resting Muscle Tone System. Front Physiol. 2018;9:810. doi: 10.3389/fphys.2018.00810.
    1. Jonsson A, Rasmussen-Barr E. Intra- and inter-rater reliability of movement and palpation tests in patients with neck pain: a systematic review. Physiother Theory Pract. 2018;34(3):165–180. doi: 10.1080/09593985.2017.1390806.
    1. Seffinger MA, Najm WI, Mishra SI, Adams A, Dickerson VM, Murphy LS, et al. Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature. Spine (Phila Pa 1976) 2004;29(19):E413–E425. doi: 10.1097/01.brs.0000141178.98157.8e.
    1. Lehman G. Kinesiological research: the use of surface electromyography for assessing the effects of spinal manipulation. J Electromyogr Kinesiol. 2012;22(5):692–696. doi: 10.1016/j.jelekin.2012.02.010.
    1. Creze M, Nordez A, Soubeyrand M, Rocher L, Maitre X, Bellin MF. Shear wave sonoelastography of skeletal muscle: basic principles, biomechanical concepts, clinical applications, and future perspectives. Skelet Radiol. 2018;47(4):457–471. doi: 10.1007/s00256-017-2843-y.
    1. Feng YN, Li YP, Liu CL, Zhang ZJ. Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci Rep. 2018;8(1):17064. doi: 10.1038/s41598-018-34719-7.
    1. Fischer AA. Tissue compliance meter for objective, quantitative documentation of soft tissue consistency and pathology. Arch Phys Med Rehabil. 1987;68(2):122–125.
    1. Chuang LL, Wu CY, Lin KC. Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with stroke. Arch Phys Med Rehabil. 2012;93(3):532–540. doi: 10.1016/j.apmr.2011.09.014.
    1. Frohlich-Zwahlen AK, Casartelli NC, Item-Glatthorn JF, Maffiuletti NA. Validity of resting myotonometric assessment of lower extremity muscles in chronic stroke patients with limited hypertonia: a preliminary study. J Electromyogr Kinesiol. 2014;24(5):762–769. doi: 10.1016/j.jelekin.2014.06.007.
    1. Li X, Shin H, Li S, Zhou P. Assessing muscle spasticity with Myotonometric and passive stretch measurements: validity of the Myotonometer. Sci Rep. 2017;7:44022. doi: 10.1038/srep44022.
    1. Andonian BJ, Masi AT, Aldag JC, Barry AJ, Coates BA, Emrich K, et al. Greater resting lumbar extensor Myofascial stiffness in younger Ankylosing spondylitis patients than age-comparable healthy volunteers quantified by Myotonometry. Arch Phys Med Rehabil. 2015;96(11):2041–2047. doi: 10.1016/j.apmr.2015.07.014.
    1. Chuang LL, Wu CY, Lin KC, Lur SY. Quantitative mechanical properties of the relaxed biceps and triceps brachii muscles in patients with subacute stroke: a reliability study of the myoton-3 myometer. Stroke Res Treat. 2012;2012:617694.
    1. Kelly JP, Koppenhaver SL, Michener LA, Proulx L, Bisagni F, Cleland JA. Characterization of tissue stiffness of the infraspinatus, erector spinae, and gastrocnemius muscle using ultrasound shear wave elastography and superficial mechanical deformation. J Electromyogr Kinesiol. 2018;38:73–80. doi: 10.1016/j.jelekin.2017.11.001.
    1. Oliva-Pascual-Vaca Á, Heredia-Rizo AM, Barbosa-Romero A, Oliva-Pascual-Vaca J, Rodríguez-Blanco C, Tejero-García S. Assessment of Paraspinal muscle hardness in subjects with a mild single scoliosis curve: a preliminary Myotonometer study. J Manip Physiol Ther. 2014;37(5):326–333. doi: 10.1016/j.jmpt.2014.03.001.
    1. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther. 2005;10(4):242–255. doi: 10.1016/j.math.2005.07.001.
    1. Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr, Shekelle P, et al. 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. 2007;147(7):478–491. doi: 10.7326/0003-4819-147-7-200710020-00006.
    1. Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: a randomized placebo controlled crossover study. N Am J Med Sci. 2011;3(10):456–461. doi: 10.4297/najms.2011.3456..
    1. Joseph LH, Hancharoenkul B, Sitilertpisan P, Pirunsan U, Paungmali A. Effects of massage as a combination therapy with Lumbopelvic stability exercises as compared to standard massage therapy in low Back pain: a randomized Cross-over study. Int J Ther Massage Bodywork. 2018;11(4):16–22.
    1. Sasaki T, Yoshimura N, Hashizume H, Yamada H, Oka H, Matsudaira K, et al. MRI-defined paraspinal muscle morphology in Japanese population: the Wakayama spine study. PLoS One. 2017;12(11):e0187765. doi: 10.1371/journal.pone.0187765.
    1. Gapeyeva H, Vain A. Methodological guide: principles of applying Myoton in physical medicine and rehabilitation. Tartu: Muomeetria Ltd; 2008.
    1. Bailey L, Samuel D, Warner MB, Stokes M. Parameters representing muscle tone, elasticity and stiffness of biceps brachii in healthy older males: symmetry and within-session reliability using the MyotonPRO. J Neuro Disord. 2013;1(1):1–7. doi: 10.4172/2329-6895.1000116.
    1. Lo WLA, Zhao JL, Li L, Mao YR, Huang DF. Relative and absolute Interrater reliabilities of a hand-held Myotonometer to quantify mechanical muscle properties in patients with acute stroke in an inpatient Ward. Biomed Res Int. 2017;2017:4294028. doi: 10.1155/2017/4294028.
    1. Portney L, Watkins M. Foundations of clinical research: applications to practice. New Jeresey: Prentice-Hall Inc.; 2000.
    1. Hopkins WG. Measures of reliability in sports medicine and science. Sports Med. 2000;30(1):1–15. doi: 10.2165/00007256-200030010-00001.
    1. Rankin G, Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil. 1998;12(3):187–199. doi: 10.1191/026921598672178340.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327(8476):307–310. doi: 10.1016/S0140-6736(86)90837-8.
    1. Eriksson EM, Mokhtari M, Pourmotamed L, Holmdahl L, Eriksson H. Inter-rater reliability in a resource-oriented physiotherapeutic examination. Physiother Pract. 2009;16(2):95–103. doi: 10.1080/095939800407286.
    1. Bruton A, Conway JH, Holgate ST. Reliability: what is it, and how is it measured? Physiotherapy. 2000;86(2):94–99. doi: 10.1016/S0031-9406(05)61211-4.
    1. Ko CY, Choi HJ, Ryu J, Kim G. Between-day reliability of MyotonPRO for the non-invasive measurement of muscle material properties in the lower extremities of patients with a chronic spinal cord injury. J Biomech. 2018;73:60–65. doi: 10.1016/j.jbiomech.2018.03.026.
    1. Aird L, Samuel D, Stokes M. Quadriceps muscle tone, elasticity and stiffness in older males: reliability and symmetry using the MyotonPRO. Arch Gerontol Geriatr. 2012;55(2):e31–ee9. doi: 10.1016/j.archger.2012.03.005.
    1. Lothe LR, Raven TJL, Sandbaek G, Eken T. Single-motor-unit discharge characteristics in lumbar multifidus muscle of acute low back pain patients. J Neurophysiol. 2019;122(4):1373–1385. doi: 10.1152/jn.00004.2019.
    1. Wattananon P, Silfies SP, Tretriluxana J, Jalayondeja W. Lumbar Multifidus and erector Spinae muscle synergies in patients with nonspecific low Back pain during prone hip extension: a Cross-sectional study. PM R. 2019;11(7):694–702. doi: 10.1002/pmrj.12002.
    1. Murillo C, Falla D, Rushton A, Sanderson A, Heneghan NR. Shear wave elastography investigation of multifidus stiffness in individuals with low back pain. J Electromyogr Kinesiol. 2019;47:19–24. doi: 10.1016/j.jelekin.2019.05.004.

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