Spinal muscle evaluation in healthy individuals and low-back-pain patients: a literature review.

This article reviews available techniques for spinal muscle investigation, as well as data on spinal muscles in healthy individuals and in patients with low back pain. In patients with chronic low back pain, medical imaging studies show paraspinal muscle wasting with reductions in cross-sectional surface area and fiber density. In healthy individuals, the paraspinal muscles contain a high proportion of slow-twitch fibers (Type I), reflecting their role in maintaining posture. The proportion of Type I fibers is higher in females, leading to better adaptation to aerobic exertion compared to males. Abnormalities seen in paraspinal muscles from patients with chronic low back pain include marked Type II fiber atrophy, conversion of Type I to Type II fibers, and an increased number of nonspecific abnormalities. Limited data are available from magnetic resonance spectroscopy used to investigate muscle metabolism and from near infrared spectroscopy used to measure oxygen uptake by the paraspinal muscles. Surface electromyography in patients with chronic low back pain shows increased paraspinal muscle fatigability, often with abolition of the flexion-relaxation phenomenon.

[1]  M. Parnianpour,et al.  Relationship between muscle fiber composition and functional capacity of back muscles in healthy subjects and patients with back pain. , 1998, The Journal of orthopaedic and sports physical therapy.

[2]  T. Mayer,et al.  Quantifying the Lumbar Flexion–Relaxation Phenomenon: Theory, Normative Data, and Clinical Applications , 2003, Spine.

[3]  P. Watson,et al.  Chronic Low Back Pain-Associated Paraspinal Muscle Dysfunction is not the Result of a Constitutionally Determined “Adverse” Fiber-type Composition , 2004, Spine.

[4]  Large-Array Surface Electromyography in Low Back Pain: A Pilot Study , 2003, Spine.

[5]  M Nordin,et al.  Body composition, endurance, strength, cross-sectional area, and density of MM erector spinae in men with and without low back pain. , 1993, Journal of spinal disorders.

[6]  Denis Gravel,et al.  Surface electromyography assessment of back muscle intrinsic properties. , 2003, Journal of Electromyography & Kinesiology.

[7]  A. Mannion,et al.  The Influence of Muscle Fiber Size and Type Distribution on Electromyographic Measures of Back Muscle Fatigability , 1998, Spine.

[8]  C. Richardson,et al.  Reliability of electromyographic power spectral analysis of back muscle endurance in healthy subjects. , 1996, Archives of physical medicine and rehabilitation.

[9]  C. Demoulin,et al.  Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature. , 2006, Joint, bone, spine : revue du rhumatisme.

[10]  R Grassme,et al.  Simultaneous surface electromyography (SEMG) and 31 P -MR spectroscopy measurements of the lumbar back muscle during isometric exercise , 2004, Journal of Neuroscience Methods.

[11]  Anne Keller,et al.  Reliability of Computed Tomography Measurements of Paraspinal Muscle Cross-Sectional Area and Density in Patients With Chronic Low Back Pain , 2003, Spine.

[12]  P. Carlier,et al.  A comparison of voluntary and electrically induced contractions by interleaved 1H- and 31P-NMRS in humans. , 2003, Journal of applied physiology.

[13]  G. Vanderstraeten,et al.  CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects , 2000, European Spine Journal.

[14]  Y. Bhambhani,et al.  Reliability of erector spinae oxygenation and blood volume responses using near-infrared spectroscopy in healthy males , 2004, European Journal of Applied Physiology.

[15]  G. Vanderstraeten,et al.  Intra-operator and inter-operator reliability of surface electromyography in the clinical evaluation of back muscles. , 2001, Manual therapy.

[16]  Localized oxygen use of healthy and low back pain individuals during controlled trunk movements. , 2001, Journal of spinal disorders.

[17]  Y. Itai,et al.  Relationships between Fiber Composition and NMR Measurements in Human Skeletal Muscle , 1996, NMR in biomedicine.

[18]  C. Richardson,et al.  Magnetic Resonance Imaging and Ultrasonography of the Lumbar Multifidus Muscle: Comparison of Two Different Modalities , 1995, Spine.

[19]  A Thorstensson,et al.  EMG activities of the quadratus lumborum and erector spinae muscles during flexion-relaxation and other motor tasks. , 1996, Clinical biomechanics.

[20]  D. Goodin,et al.  Ovid: Pullman: Neurology, Volume 55(2).July 25, 2000.171-177 , 2006 .

[21]  A Gupta,et al.  Analyses of myo-electrical silence of erectors spinae. , 2001, Journal of biomechanics.

[22]  M Kormano,et al.  Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass. , 1992, Journal of spinal disorders.

[23]  S M McGill,et al.  Lumbar erector spinae oxygenation during prolonged contractions: implications for prolonged work , 2000, Ergonomics.

[24]  P. Dolan,et al.  The use of surface EMG power spectral analysis in the evaluation of back muscle function. , 1997, Journal of rehabilitation research and development.

[25]  R. Cooper,et al.  Between-days reliability of electromyographic measures of paraspinal muscle fatigue at 40, 50 and 60% levels of maximal voluntary contractile force , 2002, Clinical rehabilitation.

[26]  B Chance,et al.  Noninvasive detection of skeletal muscle underperfusion with near-infrared spectroscopy in patients with heart failure. , 1989, Circulation.

[27]  S. McGill,et al.  Appropriately placed surface EMG electrodes reflect deep muscle activity (psoas, quadratus lumborum, abdominal wall) in the lumbar spine. , 1996, Journal of biomechanics.

[28]  B. Chance,et al.  Wrist flexor muscles of elite rowers measured with magnetic resonance spectroscopy. , 1989, Journal of applied physiology.

[29]  A. Mannion,et al.  Influence of age and duration of symptoms on fibre type distribution and size of the back muscles in chronic low back pain patients , 2000, European Spine Journal.

[30]  K Jørgensen,et al.  Human trunk extensor muscles physiology and ergonomics. , 1997, Acta physiologica Scandinavica. Supplementum.

[31]  J. Troup,et al.  The Journal of Bone and Joint Surgery Myosin Atpase Activity in Multifidus Muscle from Cases of Lumbar Spinal Derangement , 2022 .

[32]  C. D. De Luca,et al.  Spectral electromyographic assessment of back muscles in patients with low back pain undergoing rehabilitation. , 1995, Spine.

[33]  M. Battié,et al.  Isokinetic and psychophysical lifting strength, static back muscle endurance, and magnetic resonance imaging of the paraspinal muscles as predictors of low back pain in men. , 1997, Scandinavian journal of rehabilitation medicine.

[34]  S M McGill,et al.  The importance of normalization in the interpretation of surface electromyography: a proof of principle. , 1999, Journal of manipulative and physiological therapeutics.

[35]  W. Floyd,et al.  Function of erectores spinae in flexion of the trunk. , 1951, Lancet.

[36]  P J Watson,et al.  Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio. , 1997, Clinical biomechanics.

[37]  G. Vanderstraeten,et al.  The effects of three different training modalities on the cross‐sectional area of the paravertebral muscles , 2001, Scandinavian journal of medicine & science in sports.

[38]  H. Alaranta,et al.  Effect of Intensive Training on the Isokinetic Strength and Structure of Lumbar Muscles in Patients With Chronic Low Back Pain , 1995, Spine.

[39]  Sharon M Henry,et al.  Surface EMG electrodes do not accurately record from lumbar multifidus muscles. , 2003, Clinical biomechanics.

[40]  M. Suckfüll,et al.  Tissue oxygen measurement and31P magnetic resonance spectroscopy in patients with muscle tension and fibromyalgia , 2005, Rheumatology International.

[41]  Paolo Bonato,et al.  Reliability of EMG time-frequency measures of fatigue during repetitive lifting. , 2002, Medicine and science in sports and exercise.

[42]  K. Häkkinen,et al.  Neuromuscular and hormonal adaptations during strength and power training. A review. , 1989, The Journal of sports medicine and physical fitness.

[43]  G C Elder,et al.  Variability of fiber type distributions within human muscles. , 1982, Journal of applied physiology: respiratory, environmental and exercise physiology.

[44]  Inger Holm,et al.  The Effect of Comprehensive Group Training on Cross-sectional Area, Density, and Strength of Paraspinal Muscles in Patients Sick-Listed for Subacute Low Back Pain , 2003, Journal of spinal disorders & techniques.

[45]  J. Brox,et al.  Predictors of isokinetic back muscle strength in patients with low back pain. , 1999, Spine.

[46]  E. Potchen,et al.  Direct relationship between proton T2 and exercise intensity in skeletal muscle MR images. , 1990, Investigative radiology.

[47]  S M McGill,et al.  Transfer of Loads Between Lumbar Tissues During the Flexion‐Relaxation Phenomenon , 1994, Spine.

[48]  D. Resnick,et al.  Relationships between myoelectric activity, strength, and MRI of lumbar extensor muscles in back pain patients and normal subjects. , 1997, Journal of spinal disorders.

[49]  Serge H. Roy,et al.  Lumbar Muscle Fatigue and Chronic Lower Back Pain , 1989, Spine.

[50]  A. Mannion,et al.  Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: normal values and sex differences , 1997, Journal of anatomy.

[51]  D. Grob,et al.  Posterior Surgical Approach to the Lumbar Spine and Its Effect on the Multifidus Muscle , 1997, Spine.

[52]  Ronald M. Peshock,et al.  Lumbar Muscle Usage in Chronic Low Back Pain: Magnetic Resonance Image Evaluation , 1993, Spine.

[53]  A. Mannion,et al.  Fibre type characteristics of the lumbar paraspinal muscles in normal healthy subjects and in patients with low back pain , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[54]  T. Häggmark,et al.  Muscle fiber type changes in human skeletal muscle after injuries and immobilization. , 1986, Orthopedics.

[55]  D. Laaksonen,et al.  Age, sex, and body mass index as determinants of back and hip extensor fatigue in the isometric Sørensen back endurance test. , 1998, Archives of physical medicine and rehabilitation.

[56]  A Sirca,et al.  The fibre type composition of thoracic and lumbar paravertebral muscles in man. , 1985, Journal of anatomy.

[57]  Carlo J. De Luca,et al.  Use of the surface EMG signal for performance evaluation of back muscles , 1993 .

[58]  N. Roberts,et al.  The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males , 2005, European Spine Journal.

[59]  M. Johnson,et al.  Data on fibre size in thirty-six human muscles. An autopsy study. , 1973, Journal of the neurological sciences.

[60]  J Dvorak,et al.  Active Therapy for Chronic Low Back Pain: Part 2. Effects on Paraspinal Muscle Cross-Sectional Area, Fiber Type Size, and Distribution , 2001, Spine.