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Clinical Trial
. 2012 Oct;22(5):724-31.
doi: 10.1016/j.jelekin.2012.03.004. Epub 2012 Apr 18.

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

Shane L Koppenhaver  1 , Julie M Fritz, Jeffrey J Hebert, Greg N Kawchuk, Eric C Parent, Norman W Gill, John D Childs, Deydre S Teyhen
Affiliations
Clinical Trial

Association between history and physical examination factors and change in lumbar multifidus muscle thickness after spinal manipulation in patients with low back pain

Shane L Koppenhaver et al. J Electromyogr Kinesiol. 2012 Oct.

Abstract

Understanding the clinical characteristics of patients with low back pain (LBP) who display improved lumbar multifidus (LM) muscle function after spinal manipulative therapy (SMT) may provide insight into a potentially synergistic interaction between SMT and exercise. Therefore, the purpose of this study was to identify the baseline historical and physical examination factors associated with increased contracted LM muscle thickness one week after SMT. Eighty-one participants with LBP underwent a baseline physical examination and ultrasound imaging assessment of the LM muscle during submaximal contraction before and one week after SMT. The relationship between baseline examination variables and 1-week change in contracted LM thickness was assessed using correlation analysis and hierarchical multiple linear regression. Four variables best predicted the magnitude of increases in contracted LM muscle thickness after SMT. When combined, these variables suggest that patients with LBP, (1) that are fairly acute, (2) have at least a moderately good prognosis without focal and irritable symptoms, and (3) exhibit signs of spinal instability, may be the best candidates for a combined SMT and lumbar stabilization exercise (LSE) treatment approach.

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Figures

Fig. 1
Fig. 1
Imaging of the lumbar multifidus (LM) muscle was performed during a contralateral arm raise using one of 3 possible hand weight selected based on the participants body weight.
Fig. 2
Fig. 2
Parasagital ultrasound image of the lumbar multifidus (LM) muscle. Measurements were taken between the posterior-most portion of the L4/L5 facet joint and the fascial plane between the muscle and subcutaneous tissue.
Fig. 3
Fig. 3
Spinal manipulation technique. The participant was maximally side-bent away and then rotated toward the examiner. A high-velocity low-amplitude thrust was then given to the participant’s anterior superior iliac spine (ASIS) in a posterior and inferior direction.
Fig. 4
Fig. 4
One-week change in contracted lumbar multifidus (LM) thickness for each study participant. Bars represent change in LM thickness as a percentage of baseline.
See this image and copyright information in PMC

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