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. 2021 Nov 4;6(3):261-270.
doi: 10.22603/ssrr.2021-0103. eCollection 2022.

The Relationship between Exercise-Induced Low Back Pain, the Fat Infiltration Rate of Paraspinal Muscles, and Lumbar Sagittal Balance

Masataka Nakamura  1 , Koji Otani  1 , Yota Kaneko  1 , Miho Sekiguchi  1 , Shin-Ichi Konno  1
Affiliations

The Relationship between Exercise-Induced Low Back Pain, the Fat Infiltration Rate of Paraspinal Muscles, and Lumbar Sagittal Balance

Masataka Nakamura et al. Spine Surg Relat Res. .

Abstract

Introduction: Exercise-induced low back pain (EILBP) is induced during anterior trunk tilting when walking or prolonged standing. In some elderly with chronic LBP, the pain is induced by EILBP. The paraspinal muscles play an important role in supporting the spine; therefore, a dysfunction of back muscles and kyphotic alignment are considered to be associated with EILBP. However, few reports are showing the relationship between EILBP and degenerative muscle changes. This study aimed to clarify the relationship between EILBP, degenerative changes of paraspinal muscles, and spinal alignment in an epidemiological study.

Methods: A total of 324 subjects were included in the analysis. The presence of EILBP was determined through a medical interview and physical examination. The subjects underwent lumbar spine magnetic resonance image (MRI) and X-ray. The fat infiltration rate (FIR) of the multifidus, erector spinae, and psoas major were analyzed using MRI. For lumbar sagittal balance, L1 axis S1 distance (LASD) was measured using X-ray images. Multivariate logistic regression analysis was used to analyze the association between the presence of EILBP and FIR or LASD.

Results: The prevalence of EILBP was 21% and it increased with age. The subjects with EILBP had statistically higher FIR of the multifidus, erector spinae, and psoas major than those without EILBP. There was a significant association between the presence of EILBP and higher FIR of the erector spinae at L1-2 and L5-S1 (p<0.05). However, there were no significant associations between EILBP and LASD.

Conclusions: According to the results in this study, EILBP is not rare and the FIR of the erector spinae is associated with the presence of EILBP.

Keywords: exercise-induced low back pain; fat infiltration rate; low back pain; lumbar sagittal balance; paraspinal muscle.

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Association with postural change and pain in EILBP. Anterior trunk tilting posture while walking and prolonged standing is the cause of pain. The pain is relieved by lumbar extension. Abbreviations: LBP, low back pain; EILBP, exercise-induced low back pain
Figure 2.
Figure 2.
Measurement for fat infiltration rate and cross-sectional area of paraspinal muscles and L1 axis S1 distance. This figure shows the L3-4 intervertebral disc level as the example. a; The area surrounded by the yellow line was the cross-sectional area of each muscle. b; The region of red color represents high intensity area, and it was defined as the fatty infiltration area. (1, 2, multifidus; 3, 4, erector spinae; 5, 6, psoas major). c; This figure shows the lumbar lateral radiographs. L1 axis S1 distance is the horizontal distance from the plumb line of the center in the L1 lumbar vertebral to the back corner of the S1 vertebral body. Abbreviations: LASD, L1 axis S1 distance
Figure 3.
Figure 3.
Prevalence of subjects with EILBP. The prevalence of subjects with EILBP increased with age. Abbreviations: EILBP, exercise-induced low back pain *p<0.05
Figure 4.
Figure 4.
FIR of paraspinal muscles. Abbreviations: FIR, fat infiltration rate; Mf, multifidus; ES, erector spinae; PM, psoas major *p<0.05
Figure 5.
Figure 5.
ROC curves of EILBP and the FIR of erector spinae. The AUC of the ROC curve was acceptable for L1-2, while L5-S1 was poorly discriminated. Abbreviations: ROC, receiver operating characteristic; EILBP, exercise-induced low back pain; FIR, fat infiltration rate; AUC, area under the curve; ES, erector spinae
Figure 6.
Figure 6.
The hypothesis of pathogenesis for EILBP. Paraspinal muscle degeneration causes anterior trunk tilting posture while walking and standing. It causes chronic compartment syndrome, and chronic compartment syndrome causes LBP. And chronic compartment syndrome can cause further fat degeneration of the paraspinal muscles. In other words, it can lead a vicious cycle. Abbreviations: EILBP, exercise-induced low back pain; IMP, intramuscular pressure; IMBF, intramuscular blood flow
See this image and copyright information in PMC

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