Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2015

Open Access 01-12-2015 | Research

Reliability of diagnostic ultrasound in measuring the multifidus muscle

Authors: Eirik Johan Skeie, Jan Arve Borge, Charlotte Leboeuf-Yde, Jenni Bolton, Niels Wedderkopp

Published in: Chiropractic & Manual Therapies | Issue 1/2015

Login to get access

Abstract

Background

Ultrasound is frequently used to measure activity in the lumbar multifidus muscle (LMM). However previous reliability studies on diagnostic ultrasound and LMM have included a limited number of subjects and few have used Bland-Altman’s Limits of Agreement (LOA). Further one does not know if activity affects the subjects’ ability to contract the LMM.

Methods

From January 2012 to December 2012 an inter- and intra-examiner reliability study was carried out in a clinical setting. It consisted of a total of four experiments with 30 subjects in each study. Two experienced examiners performed all measurements. Ultrasound measurements were made of: 1. the LMM in the resting state, 2. during a contracted state, 3. on subsequent days, and, before and after walking. Reliability and agreement was tested for 1. resting LMM, 2. contracted LMM, and 3. thickness change in the LMM. Mean values of three measurements were used for statistical analysis for each spinal level. The intra-class correlation coefficient (ICC) 3.1 and 3.2 was used to test for reliability, and Bland-Altman’s LOA method to test for agreement.

Results

All of the studies indicate high levels of reliability, but as the LMM thickness increased (increasing contraction) the agreement between examiners was poorer than for low levels of contraction.

Conclusions

The use of diagnostic ultrasound to measure the LMM seems to be reliable in subjects who have little or no change in thickness of the LMM with contraction.
Literature
1.
Donelson R, McIntosh G, Hall H. Is it time to rethink the typical course of low back pain? PMR. 2012;4(6):394–401.CrossRef
2.
Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2. doi:10.1186/1741-7015-5-2.CrossRefPubMedCentralPubMed
3.
Zhao WP, Kawaguchi Y, Matsui H, Kanamori M, Kimura T. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine. 2000;25(17):2191–9.CrossRefPubMed
4.
Yoshihara K, Nakayama Y, Fujii N, Aoki T, Ito H. Atrophy of the multifidus muscle in patients with lumbar disk herniation: histochemical and electromyographic study. Orthopedics. 2003;26(5):493–5.PubMed
5.
Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145–9.CrossRefPubMed
6.
Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2008;13(1):43–9.CrossRefPubMed
7.
Danneels L, Coorevits P, Cools A, Vanderstraeten G, Cambier D, Witvrouw E, et al. Differences in electromyographic activity in the multifidus muscle and the iliocostalis lumborum between healthy subjects and patients with sub-acute and chronic low back pain. Eur Spine J. 2002;11(1):13–9.CrossRefPubMedCentralPubMed
8.
Parkkola RR, Rytökoski UU, Kormano MM. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine. 1993;18(7):830–6.CrossRefPubMed
9.
Wallwork TL, Stanton WR, Freke M, Hides JA. The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther. 2008;14(5):496–500.CrossRefPubMed
10.
Lee HI, Song J, Lee HS, Kang JY, Kim M, Ryu JS. Association between cross-sectional areas of lumbar muscles on magnetic resonance imaging and chronicity of low back pain. Ann Rehabil Med. 2011;35(6):852–9.CrossRefPubMedCentralPubMed
11.
Heydari A, Nargol AVF, Jones APC, Humphrey AR, Greenough CG. EMG analysis of lumbar paraspinal muscles as a predictor of the risk of low-back pain. Eur Spine J. 2010;19(7):1145–52.CrossRefPubMedCentralPubMed
12.
Wong AYL, Parent EC, Funabashi M, Stanton TR, Kawchuk GN. Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in non-specific low back pain? A systematic review. Pain. 2013;154(12):2589–602.CrossRefPubMed
13.
Zielinski KA, Henry SM, Ouellette-Morton RH, DeSarno MJ. Lumbar multifidus muscle thickness does not predict patients with low back pain who improve with trunk stabilization exercises. Arch Phys Med Rehabil. 2013;94(6):1132–8.CrossRefPubMedCentralPubMed
14.
Danneels L, Vanderstraeten G, Cambier D, Witvrouw E, Bourgois J, Dankaerts W, et al. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Br J Sports Med. 2001;35(3):186–91.CrossRefPubMedCentralPubMed
15.
Weber BRB, Grob DD, Dvorák JJ, Müntener MM. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine. 1997;22(15):1765–72.CrossRefPubMed
16.
Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine. 2001;26(11):E243–8.CrossRefPubMed
17.
Macdonald D, Moseley GL, Hodges PW. Why do some patients keep hurting their back? Evidence of ongoing back muscle dysfunction during remission from recurrent back pain. Pain. 2009;142(3):183–8.CrossRefPubMed
18.
Kiesel KB, Uhl T, Underwood FB, Nitz AJ. Rehabilitative ultrasound measurement of select trunk muscle activation during induced pain. Man Ther. 2008;13(2):132–8.CrossRefPubMed
19.
Hodges PW, Pengel LHM, Herbert RD, Gandevia SC. Measurement of muscle contraction with ultrasound imaging. Muscle Nerve. 2003;27(6):682–92.CrossRefPubMed
20.
Kiesel KB, Uhl TL, Underwood FB, Rodd DW, Nitz AJ. Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging. Man Ther. 2007;12(2):161–6.CrossRefPubMed
21.
Hebert JJ, Koppenhaver SL, Parent EC, Fritz JM. A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine. 2009;34(23):E848–56.CrossRefPubMed
22.
Koppenhaver SL, Parent EC, Teyhen DS, Hebert JJ, Fritz JM. The effect of averaging multiple trials on measurement error during ultrasound imaging of transversus abdominis and lumbar multifidus muscles in individuals with low back pain. J Orthop Sports Phys Ther. 2009;39(8):604–11.CrossRefPubMed
23.
Larivière C, Gagnon D, De Oliveira E, Henry SM, Mecheri H, Dumas J-P. Ultrasound measures of the lumbar multifidus: effect of task and transducer position on reliability. PMR. 2013;5(8):678–87.CrossRef
24.
Wallwork TL, Hides JA, Stanton WR. Intrarater and interrater reliability of assessment of lumbar multifidus muscle thickness using rehabilitative ultrasound imaging. J Orthop Sports Phys Ther. 2007;37(10):608–12.CrossRefPubMed
25.
Van K, Hides JA, Richardson CA. The use of real-time ultrasound imaging for biofeedback of lumbar multifidus muscle contraction in healthy subjects. J Orthop Sports Phys Ther. 2006;36(12):920–5.CrossRefPubMed
26.
Koppenhaver SL, Hebert JJ, Fritz JM, Parent EC, Teyhen DS, Magel JS. Reliability of rehabilitative ultrasound imaging of the transversus abdominis and lumbar multifidus muscles. Arch Phys Med Rehabil. 2009;90(1):87–94.CrossRefPubMed
27.
Wong AYL, Parent EC, Kawchuk GN. Reliability of two ultrasonic imaging analysis methods in quantifying lumbar multifidus thickness. J Orthop Sports Phys Ther. 2012;43(4):251–62.CrossRefPubMed
28.
Gracovetsky S. An hypothesis for the role of the spine in human locomotion: a challenge to current thinking. J Biomed Eng. 1985;7(3):205–16.CrossRefPubMed
29.
Saunders SW, Schache A, Rath D, Hodges PW. Changes in three dimensional lumbo-pelvic kinematics and trunk muscle activity with speed and mode of locomotion. Clin Biomech. 2005;20(8):784–93.CrossRef
30.
Zaki R, Bulgiba A, Ismail R, Ismail NA. Statistical methods used to test for agreement of medical instruments measuring continuous variables in method comparison studies: a systematic review. PLoS One. 2011;7(5):e37908. doi:10.1371/journal.pone.0037908.CrossRef
31.
Hanneman SK. Design, analysis, and interpretation of method-comparison studies. Adv Crit Care. 2008;19(2):223–34.CrossRef
32.
Bland JMJ, Altman DGD. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307–10.CrossRefPubMed
33.
Kottner JJ, Audige LL, Brorson SS, Donner AA, Gajewski BJB, Hróbjartsson AA, et al. Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. Int J Nurs Stud. 2011;48(6):661–71.CrossRefPubMed
34.
Rankin G, Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil. 1998;12(3):187–99.CrossRefPubMed
35.
Shrout PE. Measurement reliability and agreement in psychiatry. Stat Methods Med Res. 1998;7(3):301–17.CrossRefPubMed
36.
Teyhen DS, Childs JD, Stokes MJ, Wright AC, Dugan JL, George SZ. Abdominal and lumbar multifidus muscle size and symmetry at rest and during contracted states normative reference ranges. J Ultrasound Med. 2012;31(7):1099–110.PubMed
Metadata
Title
Reliability of diagnostic ultrasound in measuring the multifidus muscle
Authors
Eirik Johan Skeie
Jan Arve Borge
Charlotte Leboeuf-Yde
Jenni Bolton
Niels Wedderkopp
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2015
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-015-0059-6

Other articles of this Issue 1/2015

Chiropractic & Manual Therapies 1/2015 Go to the issue

Research

Chiropractic identity, role and future: a survey of North American chiropractic students

Systematic review

Is back pain during childhood or adolescence associated with muscle strength, muscle endurance or aerobic capacity: three systematic literature reviews with one meta-analysis

Commentary

Helping address the national research and research capacity needs of Australian chiropractic: introducing the Australian Chiropractic Research Network (ACORN) project

Methodology

Could the clinical interpretability of subgroups detected using clustering methods be improved by using a novel two-stage approach?

Research

Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise: a subgroup analysis of a randomised controlled trial

Research

Attitudes and beliefs of Australian chiropractors’ about managing back pain: a cross-sectional study