Psoas Major Thickness Changes during a Lumbar Lordosis Maneuver in Persons with and without Unilateral Low Back Pain— an Ultrasonography Study
Date Issued
2016
Date
2016
Author(s)
Fu, Yu-Lin
Abstract
Background Psoas major (PM) is the only muscle that attaches to both lumbar spine and hip joint. Anatomical and biomechanical studies revealed that PM contraction could increase segmental compressive force that leads to an increase in lumbar stability and also controls lumbar lordosis. Patients with low back pain (LBP) had different lumbar curvatures and neuromuscular recruitment strategies in sitting positions. Several studies indicated that patients with unilateral LBP showed significant reductions in PM cross-sectional areas at their symptomatic sides of their backs but most of them are static MRI approaches. Therefore, it is warranted to investigate whether PM thickness changes differently during dynamic lumbar lordosis maneuver between patients with unilateral LBP and healthy populations using a dynamic imaging approach. Purpose There are two purposes of this study. First, to investigate whether the neuromuscular control of PM and erector spinae muscle during lumbar lordosis maneuver are different between unilateral LBP and healthy individuals. Second, to investigate whether the neuromuscular control of PM and erector spinae during lumbar lordosis maneuver are different between painful side and non-painful side in the LBP population. Methods Both LBP patients and healthy subjects were recruited in this study, and patients with unilateral LBP were recruited from National Taiwan University hospital. Besides recording basic data, PM and erector spinae muscle were measured by ultrasonography and surface electromyography respectively during lumbar lordosis maneuver simultaneously in different contraction levels for each subjects. Data were analyzed using SPSS18.0 version, and were presented as means ± standard deviations and percentages. Mann-whitney u test were used to analyze the ratios of thickness changes in PM, erector spinae EMG magnitudes between groups (unilateral LBP, healthy) and Wilcoxon Signed Rank test were used to analyze outcome measures between sides (painful side, non-painful side) during different contraction levels. The significance level was set at α< 0.05. Results: A total of twenty-three participants enrolled in this study. (Healthy:13; LBP:10) Significant group differences in age (Healthy: 21.4 ± 2.5 y/o; LBP: 25.4 ± 4.1 y/o) and BMI (Healthy: 21.3 ± 0.5 Kg/m2; LBP: 23.5 ± 1.1 Kg/m2) were detected. Mann-Whitney U test revealed that there were significant group differences in ratios of PM thickness changes in higher contraction levels (40-25mmHg: Healthy: 23.2± 14.6 %; LBP:11.1 ± 4.1 %, p=0.006; 40-20mmHg: Healthy: 29.2 ± 15.7 %; LBP:12.2 ± 6.5 %, p=0.001). There were no significant group differences in erector spinae muscle activities in all contraction levels. Within unilateral LBP group, there were no side to side differences in ratios of PM thickness changes and erector spinae muscle activities in all contraction levels. Conclusion: There was a significant reduction in ratios of PM thickness changes during dynamic lumbar lordosis maneuver in persons with unilateral LBP when compared to healthy controls. Furthermore, ultrasound can be a feasible tool in clinical practice to examine PM thickness changes in a non-invasive, dynamic approach.
Subjects
Ultrasonography
Psoas major
Lordosis
Unilateral low back pain
Muscle thickness changes
Type
thesis
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