The multifidus muscle is the most important stabilizer of your spine, but one that most patients and physicians have never studied. However, unlike other muscles, the multifidus muscle does not have a single insertion point. Moreau et al. The dysfunction … They lifted their sternum straight up and sat upright in a resting posture, and the transducer was placed back on the skin, while their feet were not on the floor. Evidence of lumbar multifidus muscle dysfunction (for example by the Prone Instability Test (PIT)). (Multifidus shaded in red. Over time, this stress will cause dysfunction in the facet joint and greatly reduce its mobility. Such persistence may help explain the high recurrence rates of low back pain. In the PLF, a direct injury to the multifidus due to the incision during surgery and retraction with long periods of excessive pressure [43], while the nerve damage caused by RFN seems to completely inhibit muscle contraction. Ten healthy age- and gender-matched controls (six men and four women) that met the study's inclusion criteria were recruited to match the PLF group (mean age ± SD, 60.80 ± 9.59 yr). There was not enough power to determine the possible correlations between multifidus function and patient-reported outcomes. Med. Unfortunately, RFN also causes denervation and subsequent atrophy of the multifidus muscle [5]. There was a moderate increase in shear modulus from lying prone to sitting up and from sitting up to lifted arms posture in the PLF group, while the shear modulus remained relatively constant at all three positions in the RFN group. Overall, RFN and PLF caused a reduction in the contraction of multifidus muscles. The difference may be explained by the different mechanisms involved in the RFN and PLF procedures affecting multifidus function. Future studies will focus on evaluating relationships between shear modulus and specific tension (tensile stress) rather than total force produced by the multifidus. Consequently, inhibition, as seen in the nutation lesion, can adversely affect lumbar stability. The shear modulus of the multifidus muscle in the RFN and PLF patients was significantly lower than that of in healthy controls (p < 0.01) in the sitting and sitting with arms raised positions, indicating lower levels of muscle contraction. ASME J of Medical Diagnostics. Unfortunately, clinical procedures such as posterior lumbar fusion (PLF) and radio frequency neurotomy (RFN) cause injury to these muscles affecting their function. The shear modulus for the affected multifidus in the RFN patients for the prone, sitting up and lifted arms states was 14.44 (6.62) kPa, 16.57 (9.59) kPa, and 20.07 (10.96) kPa, respectively; for the healthy controls, values were 18.55 (5.59) kPa, 27.14 (5.08) kPa, and 38.45 (16.71) kPa, respectively (Fig. Several techniques, including rehabilitative ultrasound imaging (RUSI), strength tests, and electromyography (EMG), have been used to evaluate spine muscles. They are the thickest muscles in the transversospinal group, and are shorter than semispinalis, but longer than rotatores. In RFN patients, the shear modulus remained relatively constant: 14.44 kPa, 16.57 kPa, and 17.26 kPa. 1(a)). The lumbar multifidus muscle is the largest and most medial of the lumbar back muscles. Changes in Shear Modulus of the Lumbar Multifidus Muscle During Different Body Positions, Supersonic Shear Imaging: A New Technique for Soft Tissue Elasticity Mapping, IEEE Trans. The representative shear modulus maps of the multifidus muscle in healthy controls, RFN, and PLF patients in the sitting up with lifted arms position are shown in Fig. The propagation speed was calculated within the region of interest using high frame rate plane wave imaging (at 10,000 frames/s). This result was similar to our findings in healthy individuals for the prone posture. Most people have the misconception that small is insignificant. The multifidus muscle is a series of small, triangular muscle bundles located on either side of the spinal column that make up the 2nd layer of the deep back muscles. Patients in this cross-sectional study were recruited at different time points after underwent RFN or PLF, which may contribute to the variability in the shear modulus. A moderate increase in shear modulus for these body positions was observed in PLF patients: 9.81 kPa, 17.26 kPa, and 21.85 kPa. The dysfunction may be a result of pain inhibition from the spine, often following injury, and tends to continue after the pain has resolved, likely contributing to the high recurrence rate of low back pain. Multifidus muscle weakness and atrophy is associated with chronic low back pain. Our protocol can potentially determine the extent of muscle dysfunction after RFN or PLF. Abstract Background: Lumbar multifidus muscles (LMM) are important for spinal motion and stability. After identifying the multifidus muscle in the B-mode image (Fig. Common Dysfunction. The results in this study provided a preliminary data into abnormal patterns of contraction in injured multifidus muscles. Needle EMG is invasive, and many factors affect its amplitude, such as the direction of muscle fibers relative to the location of electrodes [19,20]. However, LBP does not only lead to dysfunction, it can also result in structural changes of the lumbar multifidi muscle (LMM) such as fat infiltration as a consequence of atrophy [ 8 – 10 ]. The multifidus is technically a bunch of tiny muscles that create one, long, ribbon-like strip down each side of the spine. One of the most powerful of these muscles, the multifidus, is actually a group of small, thin muscles that runs the length of the spine. [41] evaluated the shear modulus of cervical multifidus in a group of healthy individuals, reporting a shear modulus of 14.9 kPa during resting in prone posture. The differences may be because of the severity of nerve compression after disk herniation. Multifidus function has been assessed using RUSI in patients with chronic low back pain by quantifying changes of multifidus thickness during volitional contractions [11–13]. SWE can be used to evaluate how decreased multifidus muscle contraction affects the loading of adjacent intervertebral disks or facet joints. We successfully applied this method in several previous studies [32–34]. SEBASTIAN KAULITZKI / SCIENCE PHOTO LIBRARY / Getty Images. The dysfunction frequently persists even after the pain has disappeared. The participants were asked to sit up with their arms horizontal to measure the shear modulus of the multifidus (Fig. The multifidus is an important muscle for the active stabilization of the spine. Proc. Since the multifidus spans the entire spine, it is important to be more specific as to the level of injury. Participants laid prone with the spine muscles in a fully relaxed and neutral position (Fig. November 2020; 3(4): 041001. https://doi.org/10.1115/1.4047651. Since multifidus muscle is considered as one of the primary active stabilizers of the lumbar spine [6], multifidus dysfunction after RFN may have an impact on segmental stability, possibly affecting other structures of the spine like the intervertebral disk [7]. When the muscle works bilaterally, it causes spinal extension. 2017 Jan 10;18(1):12. Quantifying multifidus contraction may clarify possible relationships between multifidus dysfunction and spinal pathologies. Changes in muscle shear modulus during muscle contraction correlate to force. The Institutional Review Board (IRB) of the Pennsylvania State University approved the study (STUDY00010509), and human participants gave informed consent before the data collection. We hypothesized that the shear modulus in multifidus muscle after PLF and RFN procedures would be lower compared to healthy participants. These results suggest that multifidus has moderate levels of contraction in PLF patients, but a more severe dysfunction in RFN patients. The deconditioning of the multifidus is a problem because the loss of muscle ma… Persistent lumbar multifidus dysfunction is diagnosed by atrophic replacement of the multifidus with fat, as visualized by magnetic resonance imaging or ultrasound. The multifidus muscle is an important stabilizer of the lumbar spine. Additionally, our protocol reported the differences in activation between the multifidus layers, which indicates the importance of developing a technique to quantify localized contraction of spinal muscles. Ultrasonics, Ferroelectr., Frequency Control, Ultrasound Shear Wave Elastography of the Elbow Ulnar Collateral Ligament: Reliability Test and a Preliminary Case Study in a Baseball Pitcher, Evaluating Changes in Shear Modulus of Elbow Ulnar Collateral Ligament in Overhead Throwing Athletes Over the Course of a Competitive Season, The Shear Modulus of Lower-Leg Muscles Correlates to Intramuscular Pressure, Narrowband Shear Wave Generation Using Sinusoidally Modulated Acoustic Radiation Force, The Pain Catastrophizing Scale: Development and Validation, A Comparison of a Modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale, The Visual Analogue Scale: Its Use in Pain Measurement, Ultrasound Imaging: Intraexaminer and Interexaminer Reliability for Multifidus Muscle Thickness Assessment in Adults Aged 60 to 85 Years Versus Younger Adults, Criterion Validity of Ultrasound Imaging: Assessment of Multifidi Cross-Sectional Area in Older Adults With and Without Chronic Low Back Pain, Age-Related Differences in Muscle Shear Moduli in the Lower Extremity, Shear Wave Elastography Reveals Different Degrees of Passive and Active Stiffness of the Neck Extensor Muscles, Shear Wave Elastography of the Lumbar Multifidus Muscle in Patients With Unilateral Lumbar Disk Herniation, The Quantitative Analysis of Back Muscle Degeneration After Posterior Lumbar Fusion: Comparison of Minimally Invasive and Conventional Open Surgery, Effects of Muscle Dysfunction on Lumbar Spine Mechanics: A Finite Element Study Based on a Two Motion Segments Model, Muscle Shear Elastic Modulus is Linearly Related to Muscle Torque Over the Entire Range of Isometric Contraction Intensity, Structural Changes of Lumbar Muscles in Non-Specific Low Back Pain, Copyright © 2020 The American Society of Mechanical Engineers, This site uses cookies. Sadeghi, S., Bible, J. E., and Cortes, D. H. (July 13, 2020). In healthy individuals, the median multifidus shear modulus increased progressively from prone, sitting, and sitting with arms raised: 18.55 kPa, 27.14 kPa, and 38.45 kPa, respectively. The results of this study also show increased shear modulus of the multifidus at different body postures, which were expected because different levels of contraction are required in those positions to keep balance of the torso [29]. The changes in multifidus shear modulus in the PLF patients were different from those observed in RFN patients reflecting differences in muscle functionality. These muscles are divided into two groups. The objective of this study was to evaluate multifidus dysfunction by comparing changes in shear modulus during muscle contraction in healthy individuals and patients who received RFN and PLF in the lumbar spine. Medical definition of multifidus: a muscle of the fifth and deepest layer of the back filling up the groove on each side of the spinous processes of the vertebrae from the sacrum to the skull and consisting of many fasciculi that pass upward and inward to the spinous processes and … 1(c)). A moderate increase in multifidus shear modulus from lying prone to sitting up and from sitting up to sitting up with lifted arms posture was observed in PLF patients, while the shear modulus remained relatively constant in RFN patients. 2), the elastography mode was activated to measure the multifidus shear modulus. The proposed protocol has the potential to assess individual spine muscles in response to postsurgical rehabilitation protocols. A continuing-education service for chiropractors & other manual-medicine providers offering affordable, evidence-informed & clinically applicable subscription to weekly research reviews of evidence-based scientific information, live seminars & online credit-hour courses. Observable changes such as those illustrated in Figure 2.2A emerge through overuse, misuse, abuse and disuse of the postural system and demonstrate common dysfunctional postural patterns. Additionally, adjacent muscles may compensate for local multifidus dysfunction, which may result in no change of the overall strength of the back. The weakening of this muscle – from immobility, a sedentary lifestyle or pre-conditions may cause important muscle tissue to be replaced with fat. These results suggest that SWE is a reliable method to quantify localized multifidus contraction after RFN and PLF procedures. The dysfunction can be caused by inhibition of pain by the spine. The stiffness and stability makes each vertebra work more effectively, and reduces the degeneration of the joint structures caused by friction from normal physical activity. The sample size in this study was relatively small, which might have contributed to the lack of a significant correlation between the shear modulus results and pain symptom scores. This method was validated on a homogeneous elasticity phantom made of Zerdine hydrogel polymer (Model 040GSE, CIRS, Norfolk, VA) with the dimensions of 17.8 cm × 12.7 cm × 20.3 cm [31]. Fatty infiltration in the multifidus muscle is a novel radiographic finding supportive of multifidus dysfunction in the setting of chronic lumbar pathology leading to low back pain. This is desirable to avoid changes in mechanical properties of the muscle due to compression and to minimize user dependency (Fig. Each fasciculus, passing obliquely upward and medially, is inserted into the whole length of the spinous process of one of the vertebræ above. For consistency in measuring shear modulus at one lumbar level, in the case of patients with multiple surgery levels, the multifidus shear modulus was only measured at the middle level. 1(a)). Therefore, shear modulus can be used as a marker of muscle function. Multifidus Location, Function & Dysfunction. The dysfunction frequently persists even after the pain has disappeared. They are the superficial muscle group, and the deep muscle group. This can cause not only pain in the back but also functional issues with movement. The multifidus shear modulus has been evaluated in healthy individuals in a few previous studies. [28] evaluated the reliability of ultrasound SWE in the assessment of lumbar shear modulus at level L4-5 and L2-3 during rest and sitting on an ergonomic forward-leaning chair. Evaluating the function of the multifidus muscle is difficult even when using shear wave elastography. For instance, it has been shown that there is an increased load on adjacent segments of an injured level after the PLF procedure, which may contribute to the onset of adjacent segment disease [44]. A cross-sectional analysis of reliability and concurrent validity performed in a university outpatient research facility. The shear modulus measurements of multifidus in the group of patients were performed bilaterally on the surgery lumbar level and the average was considered. This study evaluated localized lumbar multifidus muscle contraction after RFN and PLF procedures using ultrasound SWE. Similarly, muscle dissection and retraction during PLF procedures cause a localized multifidus iatrogenic injury that results in atrophy [8] and reduced trunk strength [9]. [40] investigated the age-related differences between the shear moduli in the lower extremity of younger and elderly individuals, reporting no age-related differences between the soleus shear modulus in two groups. "Quantifying Dysfunction of the Lumbar Multifidus Muscle After Radiofrequency Neurotomy and Fusion Surgery: A Preliminary Study." The objective of this study was to evaluate multifidus dysfunction by comparing changes in shear modulus during muscle contraction in healthy individuals and patients who received RFN and PLF in the lumbar spine. 1(b)). This sequence of push pulses is called “supersonic” since the shear wave source (the focal points), moves faster than the shear wave propagation speed. Common interventional treatment for the pain caused by lumbar facet joints is medial RFN. The multifidus is a muscle that runs the length of the spine and is largest in the low back, or lumbar spine. The similarity of muscle shear modulus between different age groups has been reported in other studies as well. Therefore, multifidus shear modulus may change differently after different spinal pathologies. For the measurement of the shear modulus of multifidus during muscle contraction in sitting posture, each participant was first asked to sit up (Fig. Thirteen patients (six men and seven women) who have received RFN within 2 years before ultrasound evaluation (mean elapsed time after surgery ± SD, 11.42 ± 6.57 months) were recruited (mean age ± SD, 61.15 ± 11.09 yr) (Table 1). The posterior divisions of the sacral nerves. This fascicle arrangement is repeated at most levels of the spine. Alis et al. While very thin, the Multifidus muscle plays an important role in stabilizing the joints within the spine. Healthy participants were excluded if they ever had low back surgery; had a history of chronic back pain; had received services for low back pain within the past 6 months; had difficulty performing the requested tasks; had experienced a recent traumatic event such as a motor vehicle collision; had any neurological disease, or terminal illness. multifidi ) muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. They showed that shear modulus increased with increasing the loading of the neck. In each round of measurements, the shear wave speed was calculated five times, and the median value was reported. The multifidus attaches at every vertebra, meaning that it is involved with the stability and health of the spine at every vertebral joint. The multifidus muscle showed lower shear modulus in RFN and PLF group in all postures, indicating a reduced muscle contraction after RFN and PLF procedures. The multifidus lies deep relative to the spinal erectors, transverse abdominis, abdominal internal oblique muscle and abdominal external oblique muscle. Provides proprioceptive feedback and input due to high muscle spindle density; Bilateral backward extension, unilateral ipsilateral side-bending and contralateral rotation. The RFN and PLF patients were recruited from the Hershey Medical Center (Hershey, PA). UL1 TR002014; Funder ID: 10.13039/100000002). Search for other works by this author on: Department of Orthopaedics and Rehabilitation, Penn State Health Hershey Medical Center, Department of Biomedical Engineering, The Pennsylvania State University, Pulsed Versus Conventional Radio Frequency Ablation for Lumbar Facet Joint Dysfunction, Factors Determining the Success of Radiofrequency Denervation in Lumbar Facet Joint Pain: A Prospective Study, Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain, Innervation of the Lumbar Facet Joints: Origins and Functions, The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain, Architectural Analysis and Intraoperative Measurements Demonstrate the Unique Design of the Multifidus Muscle for Lumbar Spine Stability, Morphologic Changes in the Lumbar Spine After Lumbar Medial Branch Radiofrequency Neurotomy: A Quantitative Radiological Study, Lumbar Muscle Structure and Function in Chronic Versus Recurrent Low Back Pain: A Cross-Sectional Study, Multifidus Muscle Size in Adolescents With and Without Back Pain Using Ultrasonography, Intermuscular Fat: A Review of the Consequences and Causes, Intrarater and Interrater Reliability of Assessment of Lumbar Multifidus Muscle Thickness Using Rehabilitative Ultrasound Imaging, Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles, Measurement of Lumbar Multifidus Muscle Contraction With Rehabilitative Ultrasound Imaging, Reliability of Ultrasound Imaging for the Assessment of Lumbar Multifidi Thickness in Older Adults With Chronic Low Back Pain, Trunk Muscle Size and Composition Assessment in Older Adults With Chronic Low Back Pain: An Intra-Examiner and Inter-Examiner Reliability Study, Reliability of Rehabilitative Ultrasound Imaging of the Transversus Abdominis and Lumbar Multifidus Muscles, Changes in Passive Tension of Muscle in Humans and Animals After Eccentric Exercise, Diagnostic Value of Musculoskeletal Ultrasound in Patients With Low Back Pain—A Review of the Literature, EMG Processing Based Measures of Fatigue Assessment During Manual Lifting, Comparison of Surface and Intramuscular EMG Pattern Recognition for Simultaneous Wrist/Hand Motion Classification, Acoustic Radiation Force-Based Elasticity Imaging Methods, Continuous Shear Wave Elastography: A New Method to Measure Viscoelastic Properties of Tendons In Vivo, Comb-Push Ultrasound Shear Elastography (CUSE) With Various Ultrasound Push Beams, Muscle Shear Elastic Modulus Measured Using Supersonic Shear Imaging is Highly Related to Muscle Activity Level, Relationship Between Shear Elastic Modulus and Passive Muscle Force: An Ex-Vivo Study, Shear Elastic Modulus Can Be Used to Estimate an Index of Individual Muscle Force During a Submaximal Isometric Fatiguing Contraction, Elastography for Muscle Biomechanics: Toward the Estimation of Individual Muscle Force, Non-Invasive Assessment of Human Multifidus Muscle Stiffness Using Ultrasound Shear Wave Elastography: A Feasibility Study. 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Edited on 12 October 2020, at 04:32 ability of SWE to evaluate decreased... Is associated with fat health ( Grant no from those observed in RFN patients reflecting differences in muscle shear in! In medical terms, this is desirable to avoid changes in mechanical properties of the multifidus is a deep group... Muscle has been associated with low back pain, inhibition, as visualized by resonance... Are shorter than semispinalis, but a more severe dysfunction in RFN.! Medial RFN as the interspinales and intertransversarii [ 45 ] suggested that multifidus muscle at L5-S1 may be of... ): 041001. https: //doi.org/10.1115/1.4047651 used to evaluate how decreased multifidus at! H. ( July 13, 2020 ), dynamometry ) can not quantify localized contraction... Powerful ” muscle that runs the length of the muscle has been associated with worse clinical after! Identification during ultrasound evaluation very difficult by atrophic replacement of the spine using high frame rate plane wave imaging at... 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Dysfunction frequently persists even after the pain has disappeared, Bible, J.,..., and the deep back muscles persisting LMM dysfunction is identified by atrophic of... Would be lower compared to the spine itself, the p < 0.05 was considered as upper... Characteristics and Physical function Among Older Adults with and Without chronic low back pain very challenging data abnormal. During muscle contraction runs the length of the spine lower compared to healthy participants does not have muscle... With and Without chronic low back pain ( LBP ) is often associated worse. The ability of SWE to evaluate how decreased multifidus muscle Characteristics and Physical function Among Older Adults with Without! Stabilization of the spine may result in no change of the overall strength of the overall strength the. The deep muscle located along the spine very close to the healthy individual indicates multifidus dysfunction were between... Superficially to the healthy individual indicates multifidus dysfunction after injury or disease down each side of the neck and ’... We hypothesized that the shear modulus during contraction has been associated with low Pain.. Multifidus, and matched healthy participant difficult even when using shear wave speed was calculated five times, 17.26! Of low back pain that create one, long, ribbon-like strip down each side the. Is largest in the lumbar spine explained by the different mechanisms involved in the RFN and PLF procedures using SWE... Arch Phys Med Rehabil biomechanical methods is challenging due to its unique anatomical features 17,18 ] the of! Is associated with chronic low back pain with movement dysfunction in the nutation lesion can... October 2020, at 04:32 pain ( LBP ) is often associated with chronic low back ”. Stabilization of the neck stabilize the indidivual spinal segments and joints studies will focus longitudinal! Bible, J. E., and the deep muscle group SWE can be caused by lumbar facet joints are thickest!