Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?

BackgroundBecause training of the lumbar muscles is a commonly recommended intervention in low back pain (LBP), it is important to clarify whether lumbar muscle atrophy is related to LBP. Fat infiltration seems to be a late stage of muscular degeneration, and can be measured in a non-invasive manner using magnetic resonance imaging. The purpose of this study was to investigate if fat infiltration in the lumbar multifidus muscles (LMM) is associated with LBP in adults and adolescents.MethodsIn total, 412 adults (40-year-olds) and 442 adolescents (13-year-olds) from the general Danish population participated in this cross-sectional cohort study. People with LBP were identified through questionnaires. Using MRI, fat infiltration of the LMM was visually graded as none, slight or severe. Odds ratios were calculated for both age groups, taking into account sex, body composition and leisure time physical activity for both groups, and physical workload (in adults only) or daily bicycling (in adolescents only).ResultsFat infiltration was noted in 81% of the adults but only 14% of the adolescents. In the adults, severe fat infiltration was strongly associated with ever having had LBP (OR 9.2; 95% CI 2.0–43.2), and with having LBP in the past year (OR 4.1; 1.5–11.2), but there was no such association in adolescents. None of the investigated moderating factors had an obvious effect on the OR in the adults.ConclusionFat infiltration in the LMM is strongly associated with LBP in adults only. However, it will be necessary to quantify these measurements objectively and to investigate the direction of this link longitudinally in order to determine if the abnormal muscle is the cause of LBP or vice versa.

[1]  Evaluation of two questionnaires to determine exposure to risk factors for non-specific low back pain in Mallorcan schoolchildren and their parents , 1999 .

[2]  R. Mcloughlin,et al.  The Significance of Fat and Muscle Areas in the Lumbar Paraspinal Space: A CT Study , 1994, Journal of computer assisted tomography.

[3]  P. Hodges,et al.  Pain and motor control of the lumbopelvic region: effect and possible mechanisms. , 2003, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[4]  M Kormano,et al.  Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. , 1993, Spine.

[5]  P. Kjaer,et al.  Low-field magnetic resonance imaging of the lumbar spine: reliability of qualitative evaluation of disc and muscle parameters , 2006, Acta radiologica.

[6]  T. Helliwell,et al.  Objective quantification of muscle and fat in human dystrophic muscle by magnetic resonance image analysis , 1996, Muscle & nerve.

[7]  Gabrielle Rankin MSc Mcsp Mmacp.  Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain , 2000 .

[8]  T. Lauritzen,et al.  The Association Between Physical Workload and Low Back Pain Clouded by the “Healthy Worker” Effect: Population-Based Cross-Sectional and 5-Year Prospective Questionnaire Study , 2001, Spine.

[9]  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.

[10]  J. Salminen,et al.  Development of degenerative changes in the lumbar intervertebral disk: results of a prospective MR imaging study in adolescents with and without low-back pain. , 1995, Radiology.

[11]  C. Leboeuf‐Yde,et al.  An Epidemiologic Study of MRI and Low Back Pain in 13-Year-Old Children , 2005, Spine.

[12]  F W Smith,et al.  Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. , 2000, Clinical radiology.

[13]  Y. Shirai,et al.  Histochemical Changes in the Multifidus Muscle in Patients With Lumbar Intervertebral Disc Herniation , 2001, Spine.

[14]  S. Mottram,et al.  Movement and stability dysfunction--contemporary developments. , 2001, Manual therapy.

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

[16]  B. Jonsson,et al.  Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. , 1987, Applied ergonomics.

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

[18]  Garry T. Allison,et al.  Evaluation of Specific Stabilizing Exercise in the Treatment of Chronic Low Back Pain With Radiologic Diagnosis of Spondylolysis or Spondylolisthesis , 1997, Spine.

[19]  N. Vøllestad,et al.  The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain After Pregnancy: A Two-Year Follow-up of a Randomized Clinical Trial , 2004, Spine.

[20]  Christine Klein,et al.  BMC Medicine , 2006 .

[21]  R. Jinkins.  Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration , 2002, European Radiology.

[22]  Per Kjaer,et al.  Magnetic Resonance Imaging and Low Back Pain in Adults: A Diagnostic Imaging Study of 40-Year-Old Men and Women , 2005, Spine.

[23]  S B Heymsfield,et al.  Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. , 1998, Journal of applied physiology.

[24]  I. Holm,et al.  Trunk Muscle Strength, Cross-sectional Area, and Density in Patients With Chronic Low Back Pain Randomized to Lumbar Fusion or Cognitive Intervention and Exercises , 2004, Spine.

[25]  K. Kyvik,et al.  At What Age Does Low Back Pain Become a Common Problem?: A Study of 29,424 Individuals Aged 12‐41 Years , 1998, Spine.

[26]  Erik Larsen,et al.  Risk factors for low back pain in a cohort of 1389 Danish school children: an epidemiologic study , 1999, European Spine Journal.

[27]  J. Hilden,et al.  Reproducibility of the History of Low-Back Trouble , 1984, Spine.

[28]  S. Mottram,et al.  Functional stability re-training: principles and strategies for managing mechanical dysfunction. , 2001, Manual therapy.

[29]  N. Vøllestad,et al.  The Efficacy of a Treatment Program Focusing on Specific Stabilizing Exercises for Pelvic Girdle Pain After Pregnancy: A Randomized Controlled Trial , 2004, Spine.

[30]  A. Newman,et al.  Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[31]  O. Naesh,et al.  Changes in Cross‐Sectional Area of Psoas Major Muscle in Unilateral Sciatica Caused by Disc Herniation , 1998, Spine.

[32]  C. Richardson,et al.  Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain , 2001, Spine.

[33]  S. Sahrmann.  Diagnosis and Treatment of Movement Impairment Syndromes , 2001 .

[34]  M. Battié,et al.  The association of trunk muscle cross-sectional area and magnetic resonance image parameters with isokinetic and psychophysical lifting strength and static back muscle endurance in men. , 1997, Journal of spinal disorders.

[35]  J. Le Huec,et al.  Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up. , 2005, The Orthopedic clinics of North America.

[36]  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.

[37]  K. Barker,et al.  Changes in the Cross-Sectional Area of Multifidus and Psoas in Patients With Unilateral Back Pain: The Relationship to Pain and Disability , 2004, Spine.

[38]  W. Campbell,et al.  Focal atrophy of the multifidus muscle in lumbosacral radiculopathy , 1998, Muscle & nerve.

[39]  U. Kujala,et al.  Back extensor and psoas muscle cross-sectional area, prior physical training, and trunk muscle strength – a longitudinal study in adolescent girls , 1997, European Journal of Applied Physiology and Occupational Physiology.

[40]  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.

[41]  M. Stokes,et al.  Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. , 1994, Spine.

[42]  A. Mannion.  Fibre type characteristics and function of the human paraspinal muscles: normal values and changes in association with low back pain. , 1999, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[43]  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.

[44]  R. Parkkola,et al.  MR relaxation times and fiber type predominance of the psoas and multifidus muscle. An autopsy study. , 1993, Acta radiologica.

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

[46]  T Videman,et al.  Magnetic Resonance Imaging Findings and Their Relationships in the Thoracic and Lumbar Spine: Insights Into the Etiopathogenesis of Spinal Degeneration , 1995, Spine.

[47]  Karsten Froberg,et al.  Back Pain Reporting Pattern in a Danish Population-Based Sample of Children and Adolescents , 2001, Spine.

[48]  T. Cole,et al.  Establishing a standard definition for child overweight and obesity worldwide: international survey , 2000, BMJ : British Medical Journal.

[49]  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.