Top

Chiropractic & Manual Therapies

Published in:

Open Access 01-12-2019 | Magnetic Resonance Imaging | Research

Fear-avoidance beliefs are associated with a high fat content in the erector spinae: a 1.5 tesla magnetic resonance imaging study

Authors: Eddo Wesselink, Edwin de Raaij, Philip Pevenage, Nick van der Kaay, Jan Pool

Published in: Chiropractic & Manual Therapies | Issue 1/2019

Abstract

Background

Intramuscular adipose tissue (IMAT) is a feature of degenerative muscle composition and is a common feature in populations with chronic low back pain (CLBP). Avoidance behavior is a possible cause of morphological muscle composition due to disuse of the paraspinal muscles. Therefore it is of clinical interest to determine the association between fear-avoidance beliefs and IMAT of the paraspinal muscles in populations with CLBP.

Methods

In this cross-sectional study, we examined twenty-four adults, featuring a mean age of 48.63 years (SD ± 14.73), with CLBP. Axial T2-weighted Magnetic Resonance Imaging (MRI) images were selected on the same level as the intervertebral disc of segments L4-L5 and L5-S1. After determine the region of interest, the amount of IMAT was measured by an automatic-threshold method to distinguish fat from muscle tissue. Fear-avoidance beliefs were measured with the Fear-Avoidance Beliefs Questionnaire, with regard to Physical Activity (FABQ-PA). Bivariate correlation and multiple regression analysis were used to determine the association between IMAT of the paraspinal muscles and fear-avoidance beliefs.

Results

There is a significant bivariate association between the FABQ-PA and ES IMAT (r = 0.484, P = 0.017), but not for LMM (r = 0.228, P = 0.284). The association between the FABQ-PA and ES IMAT remained moderate after adjusting for covariates (β = 0.381, P = 0.028).

Conclusion

Fear-avoidance beliefs are moderately associated with ES IMAT and poorly associated with LMM IMAT in a population with CLBP. Results should be interpreted with caution due to a small and selected study population.

Becker A, Held H, Redaelli M, Strauch K, Chenot JF, Leonhardt C, Keller S, Baum E, Pfingsten M, Hildebrandt J, Basler HD, Kochen MM, Donner-Banzhoff N. Low back pain in primary care: costs of care and prediction of future health care utilization. Spine (Phila Pa 1976). 2010;35:1714–20.CrossRef

Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur. Spine J. 2003;12:149–65. https://doi.org/10.1007/s00586-002-0508-5. CrossRef

O’ Sullivan P, Caneiro JP, O’Keeffe M, O’Sullivan K. Unraveling the complexity of low back pain. J Orthop Sports Phys Ther. 2016;46(11):932–7. https://doi.org/10.2519/jospt.2016.0609.CrossRef

Fortin M, Lazary A, Varga PP, McCall I, Battié MC. Paraspinal muscle asymmetry and fat infiltration in patients with symptomatic disc herniation. Eur Spine J. 2016;25(5):1452–9. https://doi.org/10.1007/s00586-016-4503-7.CrossRefPubMed

Ploumis A, Michailidis N, Christodoulou P, Kalatizoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. Br J Radiol. 2011;84(1004):709–13. https://doi.org/10.1259/bjr/58136533.CrossRefPubMedPubMedCentral

Goubert D, Oosterwijck JV, Meeus M, Danneels L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician. 2016;19(7):985–1000.

Sions JM, Coyle PC, Velasco TO, Elliot JM, Hicks GE. Multifidi muscle characteristics and physical function among older adults with and without chronic low back pain. Arch Phys Med Rehabil. 2017;98(1):51–7. https://doi.org/10.1016/j.apmr.2016.07.027.CrossRefPubMed

Sions JM, Elliot JM, Pohlig RT, Hicks GE. Trunk muscle characteristics of the multifidi, erector spinae, psoas and Quadratus Lumborum in older adults with and without chronic low back pain. J Orthop Sports Phys Ther. 2017;47(3):173–9. https://doi.org/10.2519/jospt.2017.7002.CrossRefPubMed

Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 1994;19(2):165–72.CrossRef

10.

Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic low back pain and healthy asymptomatic subjects. Man Ther. 2008;13(1):43–9. https://doi.org/10.1016/j.math.2006.07.017.CrossRefPubMed

11.

Hodges PW, James G, Blomster L, Hall L, Schmid A, Shu C, Little C, Melrose J. Multifidus muscle changes after back injury are characterized by structural remodeling of muscle, adipose and connective tissue, but not muscle atrophy: molecular and morphological evidence. Spine (Phila Pa 1976). 2015;40(14):1057–71. https://doi.org/10.1097/BRS.0000000000000972. CrossRef

12.

D’hooge R, Cagnie B, Crombez G, Vanderstraeten G, Dolphens M, Danneels L. Increased intramuscular fatty infiltration without differences in lumbar muscle cross-sectional area during remission of unilateral recurrent low back pain. Man Ther. 2012;17(6):584–8. https://doi.org/10.1016/j.math.2012.06.007.CrossRefPubMed

13.

D’hooge R, Cagnie B, Crombez G, Vanderstraeten G, Achten E, Danneels L. Lumbar muscle dysfunction during remission of unilateral recurrent nonspecific low-back pain: evaluation with muscle function MRI. Clin J Pain. 2013;29(3):187–94. https://doi.org/10.1097/AJP.0b013e31824ed170.CrossRefPubMed

14.

Shahidi B, Hubbard JC, Gibbons MC, Ruoss S, Zlomislic V, Allen RT, Garfin SR, et al. Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology. J Orthop Res. 2017;35(12):2700–6. https://doi.org/10.1002/jor.23597.CrossRefPubMedPubMedCentral

15.

Mengiardi B, Schmid MR, Boos N, Pfirrmann CWA, Brunner F, Elfering A, et al. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240(3):786–92. https://doi.org/10.1148/radiol.2403050820.CrossRefPubMed

16.

Wan Q, Lin C, Li X, Zeng W, Ma C. MRI assessment of paraspinal muscles in patients with acute and chronic unilateral low back pain. Br J Radiol. 2015;88(1053). https://doi.org/10.1259/bjr.20140546.

17.

Ross GB, Sheahan PJ, Mahoney B, Gurd BJ, Hodges PW, Graham RB. Pain catastrophizing moderates changes in spinal control in response to noxiously induced low back pain. Biomechanics. 2017;14(58):64–70. https://doi.org/10.1016/j.jbiomech.2017.04.010.CrossRef

18.

Goubert D, de Pauw R, Meeus M, Willems T, Cagnie B, Schouppe S, van Oosterwijck J, Dhondt E, Danneels L. Lumbar muscle structure and function in chronic versus recurrent low back pain: a cross sectional study. Spine J. 2017;17(9):1285–96. https://doi.org/10.1016/j.spinee.2017.04.025.CrossRefPubMed

19.

Ryall JG, Schertzer JD, Lynch GS. Cellular and molecular mechanisms underlying age-related skeletal muscle wasting and weakness. Biogerontology. 2008;9(4):213–28. https://doi.org/10.1007/s10522-008-9131-0.CrossRefPubMed

20.

Rivas DA, Mc Donald DJ, Rice NP, Haran PH, Dolnikowski GG, Fielding RA. Diminished anabolic signaling response to insulin induced by intramuscular lipid accumulation is associated with inflammation in aging, but not obesity. Am J Physiol Regul Integr Comp Physiol. 2016;310(7):561–9. https://doi.org/10.1152/ajpregu.00198.2015.CrossRef

21.

Agley CC, Rowlerson AM, Velloso CP, Lazarus NR, Harridge SD. Human skeletal muscle fibroblasts, but not myogenic cells, readily undergo adipogenic differentiation. J Cell Sci. 2013;126:5610–25. https://doi.org/10.1242/jcs.132563.CrossRefPubMed

22.

Farup J, Madaro L, Puri PL, Mikkelsen UR. Interactions between muscle stem cells, mesenchymal-derived cells and immune cells in muscle homeostasis, regeneration and disease. Cell Death Dis. 2015;6:1830. https://doi.org/10.1038/cddis.2015.198.CrossRef

23.

Vettor R, Milan G, Franzin C, et al. The origin of intermuscular adipose tissue and its pathophysiological implications. Am J Physiol Endocrinol Metab. 2009;297:987–98. https://doi.org/10.1152/ajpendo.00229.2009.CrossRef

24.

Verbunt JA, Seelen HA, Vlaeyen JW, Bousema EJ, van der Heijden GJ, Heuts PH, Knottnerus JA. Pain-related factors contributing to muscle inhibition in patients with chronic low back pain: an experimental investigation based on superimposed electrical stimulation. Clin J Pain. 2005;21(3):232–40.CrossRef

25.

Bunzli S, Smith A, Schütze R, Lin L, O’Sullivan P. Making sense of low Back pain and pain-related fear. J Orthop Sports Phys Ther. 2017;47(9):628–36. https://doi.org/10.2519/jospt.2017.7434.CrossRefPubMed

26.

Hodges PW, Smeets RJ. Interaction between pain, movement, and physical activity: short-term benefits, long-term consequences, and targets for treatment. Clin J Pain. 2015;31(2):97–107. https://doi.org/10.1097/AJP.0000000000000098.CrossRefPubMed

27.

Wertli MM, Rasmussen- Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs - a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658–78. https://doi.org/10.1016/j.spinee.2014.02.033.CrossRefPubMed

28.

Colado JC, Pablos C, Chulvi-Medrano I, Garcia-Masso X, Flandez J, Behm DG. The progression of paraspinal muscle recruitment intensity in localized an global strength training exercises is not based on instability alone. Arch Phys Med Rehabil. 2011;92(11):1875–83. https://doi.org/10.1016/j.apmr.2011.05.015.CrossRefPubMed

29.

Haddad F, Adams GR, Bodell PW, Baldwin KM. Isometric resistance exercise fails to counteract skeletal muscle atrophy processes during the initial stages of unloading. J Appl Physiol (1985). 2006;100(2):433–41. https://doi.org/10.1152/japplphysiol.01203.2005. CrossRef

30.

Crawford RJ, Cornwall J, Abbott R, Elliott JM. Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference. BMC Musculoskeletal Disord. 2017;18(1):25. https://doi.org/10.1186/s12891-016-1378-z.CrossRef

31.

Ranson CA, Burnett AF, Kerslake R, Batt ME. O’ Sullivan PB. An investigation into the use of MR imaging to determine the functional cross sectional area of lumbar paraspinal muscles. Eur Spine J. 2006;15(6):764–73. https://doi.org/10.1007/s00586-005-0909-3.CrossRefPubMed

32.

Berry DB, Padwal J, Johnson S, Parra CL, Ward SR, Shahidi B. Methodologic considerations in region of interest definitions for paraspinal muscles in axial MRIs of the lumbar spine. BMC Musculoskeletal Disord. 2018;19(1):135. https://doi.org/10.1186/s12891-018-2059-x.CrossRef

33.

Gold GE, Han E, Stainsby J, Wright G, Brittain J, Beaulieu C. Musculoskeletal MRI at 3.0T: relaxation times and image contrast. AJR Am J Roentgenol. 2004;183:343–51. https://doi.org/10.2214/ajr.183.2.1830343.CrossRefPubMed

34.

George SZ, Valencia C, Beneciuk JM. A psychometric investigation of fear-avoidance model measures in patients with chronic low back pain. J Orthop Sports Phys Ther. 2010;(4):197–205. https://doi.org/10.2519/jospt.2010.3298.

35.

Teichtahl AJ, Urquhart DM, Wang Y, Wluka Y, O’Sullivan R, Jones G, Cicuttini FM. Lumbar disc degeneration is associated with modic change and high paraspinal fat content – a 3. 0T magnetic resonance imaging study BMC Musculoskeletal Disorders. 2016;17(1):439. https://doi.org/10.1186/s12891-016-1297-z. CrossRefPubMed

36.

Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, O’Sullivan R, Jones G, Cicuttini FM. Physical inactivity is associated with narrower lumbar intervertebral discs, high fat content of paraspinal muscles and low back pain and disability. Arthritis Res Ther. 2015;17:114. https://doi.org/10.1186/s13075-015-0629-y.CrossRefPubMedPubMedCentral

37.

Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O’Sullivan R, Cicuttini FM. Fat infiltration of paraspinal muscles is associated with low back pain, disability and structural abnormalities in community-based adults. Spine J. 2015;15(7):1593–601. https://doi.org/10.1016/j.spinee.2015.03.039.CrossRefPubMed

38.

Crawford R, Filli L, Elliot J, Nanz D, Fischer M, Marcon M, Ulbrich E. Age and level-dependence of fatty infiltration in lumbar paravertebral muscles of healthy volunteers. Am J Neuroradiol. 2016;37(4):742–6. https://doi.org/10.3174/ajnr.A4596.CrossRefPubMed

39.

Shahidi B, Parra CL, Berry DB, Hubbard JC, Gombatto S, Zlomisclic V, Allen RT, Hughes-Austin J, Garfin S, Ward SR. Contribution of lumbar spine pathology and age to paraspinal muscle size and fatty infiltration. Spine (Phila Pa 1976). 2016;42(8):616–23. https://doi.org/10.1097/BRS.0000000000001848. CrossRef

40.

Parkkola R, Kormano M. Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass. J Spinal Disord. 1992;5(1):86–92.CrossRef

41.

Le Cara EC, Marcus RL, Dempsey AR, Hoffman MD, Hebert JJ. Morphology versus function: the relationship between lumbar multifidus intramuscular adipose tissue and muscle function among patients with low back pain. Arch Phys Med Rehabil. 2014;95(10):1846–52. https://doi.org/10.1016/j.apmr.2014.04.019.CrossRefPubMed

42.

Jensen MP, Turner Ja. Romano JM, fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain 1999;83(2):157–162.

43.

Pfirrmann CW, Metzdorf A, Zanetti M. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26(17):1873–8.CrossRef

44.

Griffith JF, Wang JYX, Antonio GE, Choi KC, Yu A, Ahuja AT, Leung PC. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine. 2007;(24):708–12. https://doi.org/10.1097/BRS.0b013e31815a59a0.

45.

Vetter TR. Fundamentals of research data and variables: the devil is in the details. Anasth Analg. 2017;125(4):1375–80. https://doi.org/10.1213/ANE.0000000000002370.CrossRef

46.

Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaption to pain. Pain. 2011;152(3):90–8. https://doi.org/10.1016/j.pain.2010.10.020. CrossRef

47.

van Dieen JH, Flor H, Hodges PW. Low-back pain patients learn to adapt motor behavior with adverse secondary consequences. Exerc Sports Sci Rev. 2017;45(4):223–9. https://doi.org/10.1249/JES.0000000000000121.CrossRef

48.

Elfving B, Andersson T, Grooten WJ. Low levels of physical activity in back pain patients are associated with high levels of fear-avoidance beliefs and pain catastrophizing. Physiother Res Int. 2007;12(1):14–24.CrossRef

49.

Bierry G, Kremer S, Kellner F, Abu Eid M, Bogorin A, Dietemann JL. Disorders of paravertebral lumbar muscles: from pathology to cross-sectional imaging. Skelet Radiol. 2008;37(11):967–77. https://doi.org/10.1007/s00256-008-0494-8.CrossRef

50.

Hodges P, Holm AK, Hansson T, Holms S. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury. Spine (Phila Pa 1976). 2006;31(25):2926–33. https://doi.org/10.1097/01.brs.0000248453.51165.0b. CrossRef

51.

Freeman MD, Woodham M, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. PM&R Journal. 2010;2:142–6. https://doi.org/10.1016/j.pmrj.2009.11.006.CrossRef

52.

Tsao H, Danneels LA, Hodges PW. ISSL prize winner: smudging the motor brain in young adults with recurrent low back pain. Spine (Phila Pa 1976). 2011;36(11):1721–7. https://doi.org/10.1097/BRS.0b013e31821c4267. CrossRef

53.

Schabrun SM, Elgueta-Cancino EL, Hodges PW. Smudging of the motor cortex is related to the severity of low back pain. Spine (Phila Pa 1976). 2017;42(15):1172–8. https://doi.org/10.1097/BRS.0000000000000938. CrossRef

54.

Tsao H, Druitt TR, Schollum TM, Hodges PW. Motor training of the lumbar paraspinal muscles induces immediate changes in motor coordination in patients with recurrent low back pain. J Pain. 2010;11(11):1120–8. https://doi.org/10.1016/j.jpain.2010.02.004.CrossRefPubMed

55.

Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–22.

56.

Malfliet A, Kregel J, Coppetiers I, de Pauw R, Meeus M, Roussel N, Cagnie B, Danneels L, Nijs J. Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain. Jama Neurol. 2018:E1–E11. https://doi.org/10.1001/jamaneurol.2018.0492

57.

Hebert JJ, Kjaer P, Fritz JM, Walker BF. The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain: a 9-year population-based prospective cohort study. Spine. 2014;39(17):1417–25. https://doi.org/10.1097/BRS.0000000000000424.CrossRefPubMed

58.

Rossi A, Zoico E, Goodpaster BH, Sepe A, Di Francesco V, Fantin F. Quantification of intermuscular adipose tissue in the erector spinae muscle by MRI: agreement with histological evaluation. Obesity. 2010;18(12):2379–84. https://doi.org/10.1038/oby.2010.48.CrossRefPubMed

59.

Kan HE, Scheenen TW, Wohlgemuth M, Klomp DW, Van Loosbroek-Wagenmans I. Quantitative MR imaging of individual muscle involvement in facioscapulohumeral muscular dystrophy. Neuromuscul Disord. 2009;19:357–62. https://doi.org/10.1371/journal.pone.0132717. CrossRefPubMed

60.

Maillard SM, Jones R, Owens C, Pilkington C, Woo P, Wedderburn LR, Murray KJ. Quantitative assessment of MRI T2 relaxation time of thigh muscles in juvenile dermatomyositis. Rheumatology. 2004;43(5):603–8. https://doi.org/10.1093/rheumatology/keh130.CrossRefPubMed

61.

Dixon WT. Simple proton spectroscopic imaging. Radiology. 1984;153(1):189–94.CrossRef

62.

Ma J. Dixon techniques for water and fat imaging. J Magn Reson Imaging. 2008;28(3):543–58. https://doi.org/10.1002/jmri.21492. CrossRefPubMed

63.

Reeder SB, Hu HH, Sirlin CB. Proton density fat-fraction: a standardized MR-based biomarker of tissue fat concentration. J Magn Reson Imaging. 2012;36(5):1011–4. https://doi.org/10.1002/jmri.23741.CrossRefPubMedPubMedCentral

64.

Moons KG, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: what, why and how. BMJ. 2009;338:375. https://doi.org/10.1136/bmj.b375.CrossRef

Title: Fear-avoidance beliefs are associated with a high fat content in the erector spinae: a 1.5 tesla magnetic resonance imaging study
Authors: Eddo Wesselink
Edwin de Raaij
Philip Pevenage
Nick van der Kaay
Jan Pool
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Anxiety
Back Pain
Back Pain
Back Pain
Published in: Chiropractic & Manual Therapies / Issue 1/2019
Electronic ISSN: 2045-709X
DOI: https://doi.org/10.1186/s12998-019-0234-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Fear-avoidance beliefs are associated with a high fat content in the erector spinae: a 1.5 tesla magnetic resonance imaging study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

If I was more informed about what exactly they do: perceptions of Botswana district hospital healthcare providers about World Spine Care

A perspective on Chiropractic Councils on Education accreditation standards and processes from the inside: a narrative description of expert opinion, part 1: Themes

Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial

Where do patients with MRI-confirmed single-level radiculopathy experience pain, and what is the clinical interpretability of these pain patterns? A cross-sectional diagnostic accuracy study

Contrasting real time quantitative measures (weekly SMS) to patients’ retrospective appraisal of their one-year’s course of low back pain; a probing mixed-methods study

The impact on anatomical landmark identification after an ultrasound-guided palpation intervention: a pilot study