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

The effect of exercise on back muscle cross-sectional area (CSA), density, and strength was evaluated in patients sick-listed for subacute low back pain. Twenty-four patients were randomized into an exercise (n = 11) or a control (n = 13) group. Patients in the exercise group followed a biweekly exercise protocol for 15 weeks. Control patients received usual care. Muscle CSA and density were measured by computed tomography before and after intervention. Isokinetic test of back extensors was conducted simultaneously. Results showed a tendency to increased muscle CSA and density in patients in the exercise group, a significant decrease in muscle CSA at L4–L5 in control group patients, and a significant difference in change between groups in muscle CSA at L4–L5. Back extension strength increased in patients in the exercise group, but the improvement was not significant compared with control group patients. In conclusion, there was a tendency for reversal of muscle atrophy after exercise.

[1]  F. Shellock,et al.  Muscle physiology and pathophysiology: magnetic resonance imaging evaluation. , 2000, Seminars in musculoskeletal radiology.

[2]  M. Panjabi.  The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. , 1992, Journal of spinal disorders.

[3]  I. Holm,et al.  Intensive group training versus cognitive intervention in sub-acute low back pain: short-term results of a single-blind randomized controlled trial. , 2003, Journal of rehabilitation medicine.

[4]  M. Battié,et al.  Determinants of Isokinetic and Psychophysical Lifting Strength and Static Back Muscle Endurance: A Study of Male Monozygotic Twins , 1997, Spine.

[5]  J. Kaprio,et al.  Determinants of paraspinal muscle cross-sectional area in male monozygotic twins. , 1998, Physical therapy.

[6]  S. Smith,et al.  Quantification of Lumbar Function: Part 2: Sagittal Plane Trunk Strength in Chronic Low-Back Pain Patients , 1985, Spine.

[7]  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.

[8]  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.

[9]  J. Després,et al.  American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. , 1998, Medicine and science in sports and exercise.

[10]  B. Falck,et al.  The Lumbar Multifidus Muscle Five Years After Surgery for a Lumbar Intervertebral Disc Herniation , 1993, Spine.

[11]  K. Härkäpää,et al.  A controlled study on the outcome of inpatient and outpatient treatment of low back pain. Part II. Effects on physical measurements three months after treatment. , 2020, Scandinavian journal of rehabilitation medicine.

[12]  N Bogduk,et al.  The morphology of the human lumbar multifidus. , 1986, Clinical biomechanics.

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

[14]  M. H. Pope,et al.  European Spine Society —The Acromed Prize for Spinal Research 1995 Unexpected load and asymmetric posture as etiologic factors in low back pain , 2004, European Spine Journal.

[15]  M. Panjabi.  The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. , 1992, Journal of spinal disorders.

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

[17]  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.

[18]  M J Pearcy,et al.  A Universal Model of the Lumbar Back Muscles in the Upright Position , 1992, Spine.

[19]  The Effect of Intensive Group Exercise in Patients with Chronic Low Back Pain , 2000 .

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

[21]  H. Vanharanta,et al.  Anthropometric Variables, Self‐efficacy Beliefs, and Pain and Disability Ratings on the Isokinetic Performance of Low Back Pain Patients , 1994, Spine.

[22]  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.

[23]  O. Rutherford,et al.  Physiological changes in skeletal muscle as a result of strength training. , 1989, Quarterly journal of experimental physiology.

[24]  P. Dolan,et al.  Electromyographic Median Frequency Changes During Isometric Contraction of the Back Extensors to Fatigue , 1994, Spine.

[25]  Carol Ewing Garber,et al.  ACSM Position Stand: The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults , 1998 .

[26]  J. Cholewicki,et al.  Muscle Response Pattern to Sudden Trunk Loading in Healthy Individuals and in Patients with Chronic Low Back Pain , 2000, Spine.

[27]  E. Laasonen.  Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain , 2004, Neuroradiology.

[28]  Gordon Waddell,et al.  The Back Pain Revolution , 1998 .

[29]  I. Holme,et al.  Single blind, randomised controlled trial of pelvic floor exercises, electrical stimulation, vaginal cones, and no treatment in management of genuine stress incontinence in women , 1999, BMJ.

[30]  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.

[31]  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.

[32]  G. Waddell,et al.  A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability , 1993, Pain.

[33]  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.

[34]  C. Davies,et al.  Adaptive response of mammalian skeletal muscle to exercise with high loads , 1984, European Journal of Applied Physiology and Occupational Physiology.

[35]  I. Holme,et al.  The Oslo study. Cardiovascular disease in middle-aged and young Oslo men. , 1975, Acta medica Scandinavica. Supplementum.

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

[37]  R. Parkkola,et al.  Response of the trunk muscles to training assessed by magnetic resonance imaging and muscle strength , 2004, European Journal of Applied Physiology and Occupational Physiology.

[38]  Robert Gringmuth,et al.  Therapeutic Exercise For Spinal Segmental Stabilization in Low Back Pain: Scientific Basis and Clinical Approach. , 2000 .

[39]  H. Matsui,et al.  Histochemistry and Morphology of the Multifidus Muscle in Lumbar Disc Herniation: Comparative Study Between Diseased and Normal Sides , 2000, Spine.

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

[41]  A. Keller,et al.  Reliability of the Isokinetic Trunk Extensor Test, Biering-Sørensen Test, and Åstrand Bicycle Test: Assessment of Intraclass Correlation Coefficient and Critical Difference in Patients With Chronic Low Back Pain and Healthy Individuals , 2001, Spine.

[42]  T. Mayer,et al.  Physical progress and residual impairment quantification after functional restoration. Part II: Isokinetic trunk strength. , 1994, Spine.

[43]  Y. Koryak.  Effect of 120 days of bed-rest with and without countermeasures on the mechanical properties of the triceps surae muscle in young women , 1998, European Journal of Applied Physiology and Occupational Physiology.

[44]  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.

[45]  J. Partanen,et al.  Local Denervation Atrophy of Paraspinal Muscles in Postoperative Failed Back Syndrome , 1993, Spine.

[46]  Xiaolin Zhu,et al.  Histochemistry and Morphology of Erector Spinae Muscle in Lumbar Disc Herniation , 1989, Spine.

[47]  M. Jayson,et al.  Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. , 1992, British journal of rheumatology.

[48]  E. Mälkiä,et al.  Muscular performance after a 3 month progressive physical exercise program and 9 month follow‐up in subjects with low back pain. A controlled study , 1996, Scandinavian journal of medicine & science in sports.

[49]  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.

[50]  S. May.  Re: Exercise therapy for low back pain. A systematic review within the framework of the Cochrane Collaboration Back review Group. Spine 2000;25:2784--96. , 2001, Spine.

[51]  M. Pollock,et al.  Lumbar Strengthening in Chronic Low Back Pain Patients|Physiologic and Psychological Benefits , 1993, Spine.

[52]  J. Fairbank,et al.  Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain , 1995, BMJ.

[53]  S. Koskinen,et al.  Associations of isometric and isoinertial trunk muscle strength measurements and lumbar paraspinal muscle cross-sectional areas. , 1999, Journal of spinal disorders.

[54]  V. Goel,et al.  CT-based geometric data of human spine musculature. Part I. Japanese patients with chronic low back pain. , 1992, Journal of spinal disorders.

[55]  T. Mayer,et al.  Comparison of CT Scan Muscle Measurements and Isokinetic Trunk Strength in Postoperative Patients , 1989, Spine.

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

[57]  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.

[58]  O. Madsen.  Trunk Extensor and Flexor Strength Measured by the Cybex 6000 Dynamometer: Assessment of Short‐Term and Long‐Term Reproducibility of Several Strength Variables , 1996, Spine.

[59]  K. Jørgensen,et al.  Trunk strength, back muscle endurance and low-back trouble. , 2020, Scandinavian journal of rehabilitation medicine.

[60]  U. Moritz,et al.  Trunk muscle strength and back muscle endurance in construction workers with and without low back disorders. , 2020, Scandinavian journal of rehabilitation medicine.

[61]  M. Simmonds,et al.  Psychometric Characteristics and Clinical Usefulness of Physical Performance Tests in Patients With Low Back Pain , 1998, Spine.

[62]  Robert S. Piascik,et al.  Effects of K max on Fatigue Crack Growth Threshold in Aluminum Alloys , 2000 .

[63]  G. Waddell,et al.  Trunk strength testing with iso-machines. Part 2: Experimental evaluation of the Cybex II Back Testing System in normal subjects and patients with chronic low back pain. , 1993, Spine.

[64]  G. Vanderstraeten,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 , 2001, British journal of sports medicine.

[65]  M Rosen,et al.  The reliability of a linear analogue for evaluating pain , 1976, Anaesthesia.

[66]  Eva Lundberg,et al.  CLINICAL TRIAL OF INTENSIVE MUSCLE TRAINING FOR CHRONIC LOW BACK PAIN , 1988, The Lancet.

[67]  C. Richardson,et al.  Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First‐Episode Low Back Pain , 1996, Spine.

[68]  M. Järvinen,et al.  The Multifidus Muscle in Patients with Lumbar Disc Herniation: A Histochemical and Morphometric Analysis of Intraoperative Biopsies , 1986, Spine.

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

[70]  B. Koes,et al.  Exercise Therapy for Low Back Pain: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group , 2000, Spine.

[71]  M. Morrissey,et al.  A review of the literature related to trunk muscle performance. , 1988, Spine.

[72]  W. Mechelen,et al.  Return-to-Work Interventions for Low Back Pain , 2002, Sports medicine.

[73]  A Nouwen,et al.  Patterns of Muscular Activity during Movement in Patients with Chronic Low-back Pain , 1987, Spine.

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

[75]  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.

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

[77]  T. Hansson,et al.  Muscular and kinematic behavior of the lumbar spine during flexion-extension. , 1998, Journal of spinal disorders.