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Osteopathic Medicine and Primary Care
Published in: Osteopathic Medicine and Primary Care 1/2009

Open Access 01-12-2009 | Research

Muscle functional magnetic resonance imaging and acute low back pain: a pilot study to characterize lumbar muscle activity asymmetries and examine the effects of osteopathic manipulative treatment

Authors: Brian C Clark, Stevan Walkowski, Robert R Conatser, David C Eland, John N Howell

Published in: Osteopathic Medicine and Primary Care | Issue 1/2009

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Abstract

Background

Muscle functional magnetic resonance imaging (mfMRI) measures transverse relaxation time (T2), and allows for determination of the spatial pattern of muscle activation. The purposes of this pilot study were to examine whether MRI-derived T2 or side-to-side differences in T2 (asymmetries) differ in low back muscles between subjects with acute low back pain (LBP) compared to asymptomatic controls, and to determine if a single osteopathic manipulative treatment (OMT) session alters these T2 properties immediately and 48-hours after treatment.

Methods

Subjects with non-specific acute LBP (mean score on 1-10 visual analog score = 3.02 ± 2.81) and asymptomatic controls (n = 9/group) underwent an MRI, and subsequently the LBP subjects received OMT and then underwent another MRI. The LBP subjects reported back for an additional MRI 48-hours following their initial visit. T2 and T2 asymmetry were calculated from regions of interest for the psoas, quadratus lumborum (QL), multifidus, and iliocostalis lumborum/longissimus thoracis (IL/LT) muscles.

Results

No differences were observed between the groups when T2 was averaged for the left and right side muscles. However, the QL displayed a significantly greater T2 asymmetry in LBP subjects when compared to controls (29.1 ± 4.3 vs. 15.9 ± 4.1%; p = 0.05). The psoas muscle also displayed a relatively large, albeit non-significant, mean difference (22.7 ± 6.9 vs. 9.5 ± 2.8%; p = 0.11). In the subjects with LBP, psoas T2 asymmetry was significantly reduced immediately following OMT (25.3 ± 6.9 to 6.1 ± 1.8%, p = 0.05), and the change in LBP immediately following OMT was correlated with the change in psoas T2 asymmetry (r = 0.75, p = 0.02).

Conclusion

Collectively, this pilot work demonstrates the feasibility of mfMRI for quantification and localization of muscle abnormalities in patients with acute low back pain. Additionally, this pilot work provides insight into the mechanistic actions of OMT during acute LBP, as it suggests that it may attenuate muscle activity asymmetries of some of the intrinsic low back muscles.
Appendix
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Literature
1.
The Burden of Musculoskeletal Disease in the United States: Prevalence, Societal and Economic Cost. Joint project by the United States Bone and Joint Decade. 2008, Rosemont, IL: American Academy of Orthopaedic Surgeons
2.
Sherman RA: Relationships between strength of low back muscle contraction and reported intensity of chronic low back pain. Am J Phys Med. 1985, 64 (4): 190-200.CrossRefPubMed
3.
Cohen MJ, Swanson GA, Naliboff BD, Schandler SL, McArthur DL: Comparison of electromyographic response patterns during posture and stress tasks in chronic low back pain patterns and control. J Psychosom Res. 1986, 30 (2): 135-141. 10.1016/0022-3999(86)90042-5.CrossRefPubMed
4.
Miller DJ: Comparison of electromyographic activity in the lumbar paraspinal muscles of subjects with and without chronic low back pain. Phys Ther. 1985, 65 (9): 1347-1354.PubMed
5.
Nouwen A, Van Akkerveeken PF, Versloot JM: Patterns of muscular activity during movement in patients with chronic low-back pain. Spine (Phila Pa 1976). 1987, 12 (8): 777-782.CrossRef
6.
Lehman GJ: Clinical considerations in the use of surface electromyography: three experimental studies. J Manipulative Physiol Ther. 2002, 25 (5): 293-299. 10.1067/mmt.2002.124423.CrossRefPubMed
7.
Finneran MT, Mazanec D, Marsolais ME, Marsolais EB, Pease WS: Large-array surface electromyography in low back pain: a pilot study. Spine. 2003, 28 (13): 1447-1454. 10.1097/00007632-200307010-00016.PubMed
8.
Thelen DG, Ashton-Miller JA, Schultz AB: Lumbar muscle activities in rapid three-dimensional pulling tasks. Spine. 1996, 21 (5): 605-613. 10.1097/00007632-199603010-00014.CrossRefPubMed
9.
Farina D, Merletti R, Enoka RM: The extraction of neural strategies from the surface EMG. J Appl Physiol. 2004, 96 (4): 1486-1495. 10.1152/japplphysiol.01070.2003.CrossRefPubMed
10.
11.
Meyer RA, Prior BM: Functional magnetic resonance imaging of muscle. Exerc Sport Sci Rev. 2000, 28 (2): 89-92.PubMed
12.
Patten C, Meyer RA, Fleckenstein JL: T2 mapping of muscle. Semin Musculoskelet Radiol. 2003, 7 (4): 297-305. 10.1055/s-2004-815677.CrossRefPubMed
13.
Yue G, Alexander AL, Laidlaw DH, Gmitro AF, Unger EC, Enoka RM: Sensitivity of muscle proton spin-spin relaxation time as an index of muscle activation. J Appl Physiol. 1994, 77 (1): 84-92.PubMed
14.
Adams GR, Harris RT, Woodard D, Dudley GA: Mapping of electrical muscle stimulation using MRI. J Appl Physiol. 1993, 74 (2): 532-537.PubMed
15.
Barnes PM, Bloom B, Nahin RL: Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report. 2009, 1-23. 12
16.
Licciardone JC, Brimhall AK, King LN: Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2005, 6: 43-10.1186/1471-2474-6-43.PubMedCentralCrossRefPubMed
17.
National Institutes of Health Funding Opportunity Announcement: Biology of Manual Therapies (PA-07-393). Released by the Department of Health and Human Services. 2007
18.
Mayer JM, Graves JE, Clark BC, Formikell M, Ploutz-Snyder LL: The use of magnetic resonance imaging to evaluate lumbar muscle activity during trunk extension exercise at varying intensities. Spine. 2005, 30 (22): 2556-2563. 10.1097/01.brs.0000186321.24370.4b.CrossRefPubMed
19.
Ploutz-Snyder LL, Clark BC, Logan L, Turk M: Evaluation of spastic muscle in stroke survivors using magnetic resonance imaging and resistance to passive motion. Arch Phys Med Rehabil. 2006, 87 (12): 1636-1642. 10.1016/j.apmr.2006.09.013.CrossRefPubMed
20.
Fisher MJ, Meyer RA, Adams GR, Foley JM, Potchen EJ: Direct relationship between proton T2 and exercise intensity in skeletal muscle MR images. Invest Radiol. 1990, 25 (5): 480-485. 10.1097/00004424-199005000-00003.CrossRefPubMed
21.
Glossary of osteopathic terminology. Foundations for Osteopathic Medicine. Edited by: Ward R. 2003, Philadelphia, PA: Lippincott, Williams & Wilkins, 1229-1253. 2
22.
McAtee RE, Charland J: Facilitated Stretching. 2007, Champaign, IL: Human Kinetics
23.
Finden SG, Enochs WS, Rao VM: Pathologic changes of the lateral pterygoid muscle in patients with derangement of the temporomandibular joint disk: objective measures at MR imaging. AJNR Am J Neuroradiol. 2007, 28 (8): 1537-1539. 10.3174/ajnr.A0590.CrossRefPubMed
24.
Sihvonen T, Partanen J, Hanninen O: Averaged (rms) surface EMG in testing back function. Electromyogr Clin Neurophysiol. 1988, 28 (6): 335-339.PubMed
25.
Zedka M, Kumar S, Narayan Y: Comparison of surface EMG signals between electrode types, interelectrode distances and electrode orientations in isometric exercise of the erector spinae muscle. Electromyogr Clin Neurophysiol. 1997, 37 (7): 439-447.PubMed
26.
Thelen DG, Schultz AB, Ashton-Miller JA: Co-contraction of lumbar muscles during the development of time-varying triaxial moments. J Orthop Res. 1995, 13 (3): 390-398. 10.1002/jor.1100130313.CrossRefPubMed
27.
Howell JN, Cabell KS, Chila AG, Eland DC: Stretch reflex and Hoffmann reflex responses to osteopathic manipulative treatment in subjects with Achilles tendinitis. J Am Osteopath Assoc. 2006, 106 (9): 537-545.PubMed
28.
Korr IM: Proprioceptors and somatic dysfunction. J Am Osteopath Assoc. 1975, 74 (7): 638-650.PubMed
29.
Ellestad SM, Nagle RV, Boesler DR, Kilmore MA: Electromyographic and skin resistance responses to osteopathic manipulative treatment for low-back pain. J Am Osteopath Assoc. 1988, 88 (8): 991-997.PubMed
30.
Lehman GJ, McGill SM: Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech (Bristol, Avon). 2001, 16 (4): 293-299. 10.1016/S0268-0033(00)00085-1.CrossRef
31.
Hides J, Gilmore C, Stanton W, Bohlscheid E: Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2008, 13 (1): 43-49. 10.1016/j.math.2006.07.017.CrossRefPubMed
32.
Manini TM, Clark BC, Nalls MA, Goodpaster BH, Ploutz-Snyder LL, Harris TB: Reduced physical activity increases intermuscular adipose tissue in healthy young adults. Am J Clin Nutr. 2007, 85 (2): 377-384.PubMed
33.
Elder CP, Apple DF, Bickel CS, Meyer RA, Dudley GA: Intramuscular fat and glucose tolerance after spinal cord injury - a cross-sectional study. Spinal Cord. 2004, 42 (12): 711-716. 10.1038/sj.sc.3101652.CrossRefPubMed
34.
Meyer CA, Kransdorf MJ, Jelinek JS, Moser RP: MR and CT appearance of nodular fasciitis. J Comput Assist Tomogr. 1991, 15 (2): 276-279. 10.1097/00004728-199103000-00017.CrossRefPubMed
35.
De Smet AA, Norris MA, Fisher DR: Magnetic resonance imaging of myositis ossificans: analysis of seven cases. Skeletal Radiol. 1992, 21 (8): 503-507.CrossRefPubMed
36.
Prior BM, Ploutz-Snyder LL, Cooper TG, Meyer RA: Fiber type and metabolic dependence of T2 increases in stimulated rat muscles. J Appl Physiol. 2001, 90 (2): 615-623.PubMed
37.
Kim SW, Choi JH: Myositis ossificans in psoas muscle after lumbar spine fracture. Spine. 2009, 34 (10): E367-370. 10.1097/BRS.0b013e31819b30bf.CrossRefPubMed
38.
Hurley MV, Jones DW, Newham DJ: Arthrogenic quadriceps inhibition and rehabilitation of patients with extensive traumatic knee injuries. Clin Sci (Lond). 1994, 86 (3): 305-310.CrossRef
Metadata
Title
Muscle functional magnetic resonance imaging and acute low back pain: a pilot study to characterize lumbar muscle activity asymmetries and examine the effects of osteopathic manipulative treatment
Authors
Brian C Clark
Stevan Walkowski
Robert R Conatser
David C Eland
John N Howell
Publication date
01-12-2009
Publisher
BioMed Central
Published in
Osteopathic Medicine and Primary Care / Issue 1/2009
Electronic ISSN: 1750-4732
DOI
https://doi.org/10.1186/1750-4732-3-7

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