Increased Stiffness of Lateral Raphe during Contraction of Transverse Abdominis in Patients with Unilateral Low Back Pain
Date Issued
2016
Date
2016
Author(s)
Lin, Wei-Ju
Abstract
Background: Myo-fascia provides a continuous network of restricting but adjustable tension around muscles and bones. Muscle-fascia tenderness is noted in patients with low back pain (LBP). The lateral raphe (LR), part of thoracolumbar fascia, is the junction connecting lateral abdominal muscles and paraspinal muscles. Participants with LBP demonstrate a morphological deficit during the contraction of the transverse abdominals, which is termed abdominal draw-in maneuver (ADIM), decreased change of muscle thickness and muscle-fascia sliding, as well as increased fascia thickness. However, the investigation is few in tension transmission during contraction, which is an important issue related to tissue loading and lesion in musculoskeletal systems. The technology of shear wave elastography (SWE) could provide the measurement of the stiffness of soft tissue through the calculation of young''s module. However, the reliability of fascia stiffness measured by SWE is unknown. Whether the fascia stiffness is symmetry in sides, increased during ADIM in asymptomatic participants and patients with unilateral LBP is unknown, neither the difference between groups. Purposes: The purposes of this study were (1) to establish the intra-rater reliability of LR stiffness under resting and ADIM conditions by using SWE, (2) to compare the differences of LR stiffness under these conditions and between sides in asymptomatic participants, (3) to compare the LR stiffness under resting and ADIM conditions, and between painful and non-painful sides in participants with unilateral LBP, and (4) to compare the LR stiffness under resting and ADIM conditions between asymptomatic participants and patients with unilateral LBP. Method: 14 asymptomatic participants (22.4±2.8 y/o) were included in the reliability study. Patients with unilateral LBP (n=22, 29.7±6.7 y/o) and asymptomatic participants (n=20, 26.5±4.1 y/o) were recruited in the main study. The SWE (SuperSonic Imagine, Aix en Provence, France) with 5-12MHz linear transducer was used to measure the stiffness of LR. Participants were positioned in prone and asked to perform ADIM. The outcome variables included the LR stiffness of bilateral sides in resting and ADIM condition. The reliability was analyzed using intra-class correlation coefficient (ICC(3,3)). Two-way repeated ANOVA was used to analysis the stiffness of LR between bilateral sides and in resting and ADIM condition. Two-way repeated measures ANCOVA was used to analysis the difference of LR stiffness between asymptomatic participants and patients with unilateral LBP in resting and ADIM condition. Result: The intra-rater reliability of measuring the LR stiffness in resting and ADIM condition was in the range of good to excellent (ICC(3,3)=0.77-0.96); the reliability of measuring the same images by different raters were 0.85-0.88(ICC(3,1)). In participants enrolled in reliability study, no interaction between sides and conditions. The main effect of sides (left: 17.18±9.47 kPa; right: 19.73±8.42 kPa, p=0.427) and conditions (resting: 18.51±7.70 kPa; ADIM: 18.40±10.18 kPa, p=0.939) was not significant. No interaction between sides and conditions in LBP group. The main effect of sides was not significant (painful: 22.30±10.05 kPa; non-painful: 22.69±8.99 kPa, p=0.879), yet, the main effect of conditions was significant (resting: 19.48±7.61 kPa; ADIM: 25.51±10.95 kPa, p<0.00008). There was significant interaction between groups and conditions (F=15.762，p=<0.0005). Post hoc for group demonstrated that LR stiffness was greater in LBP group during ADIM (LBP: 26.12±12.87 kPa; asymptomatic: 19.40±8.07 kPa, p=0.001). Conclusion: Measuring the LR stiffness in resting and ADIM condition using SWE is reliable. The LR stiffness in asymptomatic participants was symmetrical. The LR stiffness between resting and ADIM condition was unchanged in asymptomatic group. Whereas the stiffness of both painful and non-painful sides in patients with unilateral LBP is increased during ADIM. Furthermore, LR stiffness in patients with unilateral LBP in resting was not different from asymptomatic group. The result of the present study investigating the fascia property in dynamic condition supports the concept of dynamic myo-fascial tension imbalance in patients with LBP.
Subjects
Abdominal Draw-in Maneuver
Elastography
Lateral Raphe
Low Back Pain
Type
thesis
File(s)![Thumbnail Image]()
Loading...
Name
ntu-105-R02428006-1.pdf
Size
23.32 KB
Format
Adobe PDF
Checksum
(MD5):f074a3c175431f2d61832c1ac94453b2