The results of this study also show increased shear modulus of the multifidus at different body postures, which were expected because different levels of contraction are required in those positions to keep balance of the torso . Inst. The Institutional Review Board (IRB) of the Pennsylvania State University approved the study (STUDY00010509), and human participants gave informed consent before the data collection. Additionally, our protocol reported the differences in activation between the multifidus layers, which indicates the importance of developing a technique to quantify localized contraction of spinal muscles. When the muscle works bilaterally, it causes spinal extension. Dysfunction and atrophy of the muscle has been linked to lower back pain. 4(a)). While very thin, the Multifidus muscle plays an important role in stabilizing the joints within the spine. Sadeghi et al. The limitation of these techniques has made the evaluation of the role of multifidus function on back pain very challenging. Search for other works by this author on: Department of Orthopaedics and Rehabilitation, Penn State Health Hershey Medical Center, Department of Biomedical Engineering, The Pennsylvania State University, Pulsed Versus Conventional Radio Frequency Ablation for Lumbar Facet Joint Dysfunction, Factors Determining the Success of Radiofrequency Denervation in Lumbar Facet Joint Pain: A Prospective Study, Pathogenesis, Diagnosis, and Treatment of Lumbar Zygapophysial (Facet) Joint Pain, Innervation of the Lumbar Facet Joints: Origins and Functions, The Significance of Multifidus Atrophy After Successful Radiofrequency Neurotomy for Low Back Pain, Architectural Analysis and Intraoperative Measurements Demonstrate the Unique Design of the Multifidus Muscle for Lumbar Spine Stability, Morphologic Changes in the Lumbar Spine After Lumbar Medial Branch Radiofrequency Neurotomy: A Quantitative Radiological Study, Lumbar Muscle Structure and Function in Chronic Versus Recurrent Low Back Pain: A Cross-Sectional Study, Multifidus Muscle Size in Adolescents With and Without Back Pain Using Ultrasonography, Intermuscular Fat: A Review of the Consequences and Causes, Intrarater and Interrater Reliability of Assessment of Lumbar Multifidus Muscle Thickness Using Rehabilitative Ultrasound Imaging, Rehabilitative Ultrasound Imaging of the Posterior Paraspinal Muscles, Measurement of Lumbar Multifidus Muscle Contraction With Rehabilitative Ultrasound Imaging, Reliability of Ultrasound Imaging for the Assessment of Lumbar Multifidi Thickness in Older Adults With Chronic Low Back Pain, Trunk Muscle Size and Composition Assessment in Older Adults With Chronic Low Back Pain: An Intra-Examiner and Inter-Examiner Reliability Study, Reliability of Rehabilitative Ultrasound Imaging of the Transversus Abdominis and Lumbar Multifidus Muscles, Changes in Passive Tension of Muscle in Humans and Animals After Eccentric Exercise, Diagnostic Value of Musculoskeletal Ultrasound in Patients With Low Back Pain—A Review of the Literature, EMG Processing Based Measures of Fatigue Assessment During Manual Lifting, Comparison of Surface and Intramuscular EMG Pattern Recognition for Simultaneous Wrist/Hand Motion Classification, Acoustic Radiation Force-Based Elasticity Imaging Methods, Continuous Shear Wave Elastography: A New Method to Measure Viscoelastic Properties of Tendons In Vivo, Comb-Push Ultrasound Shear Elastography (CUSE) With Various Ultrasound Push Beams, Muscle Shear Elastic Modulus Measured Using Supersonic Shear Imaging is Highly Related to Muscle Activity Level, Relationship Between Shear Elastic Modulus and Passive Muscle Force: An Ex-Vivo Study, Shear Elastic Modulus Can Be Used to Estimate an Index of Individual Muscle Force During a Submaximal Isometric Fatiguing Contraction, Elastography for Muscle Biomechanics: Toward the Estimation of Individual Muscle Force, Non-Invasive Assessment of Human Multifidus Muscle Stiffness Using Ultrasound Shear Wave Elastography: A Feasibility Study. Therefore, evaluating multifidus dysfunction is important to understand and improve the long-term outcomes of these treatments. From the normality test, it was determined that the shear modulus data from the prone position measurements in the RFN group as well as data from the sitting position in the control groups were not normally distributed (data from the other positions passed the normality test). The RFN and PLF patients were recruited from the Hershey Medical Center (Hershey, PA). In conclusion, this study showed the quantification of localized lumbar multifidus muscle dysfunction after RFN and PLF procedures using ultrasound SWE. ASME. Multifidus muscle (musculi multifidi) Multifidus is a group of short, triangular muscles that along with the semispinalis and rotatores comprises the transversospinal group of deep back muscles. Moreau et al. However, the contraction of multifidus muscle slightly increased during multifidus activation in PLF patients, while it did not change in RFN patients. Such persistence may help explain the high recurrence rates of low back pain. Any exercise that extends the lumbar spine or stabilizes the lumbar spine will activate multifidus to some degree. The stiffness and stability makes each vertebra work more effectively, and reduces the degeneration of the joint structures caused by friction from normal physical activity. The participants were asked to sit up with their arms horizontal to measure the shear modulus of the multifidus (Fig. The multifidus lies deep relative to the spinal erectors, transverse abdominis, abdominal internal oblique muscle and abdominal external oblique muscle. SEBASTIAN KAULITZKI / SCIENCE PHOTO LIBRARY / Getty Images. This is desirable to avoid changes in mechanical properties of the muscle due to compression and to minimize user dependency (Fig. These results suggest that SWE is a reliable method to quantify localized multifidus contraction after RFN and PLF procedures. This study has several limitations. Overall, RFN and PLF caused a reduction in the contraction of multifidus muscles. Dieterich et al. However, the sample size did not compromise the linear mixed effects model results showing differences between patients and healthy controls (p < 0.01). Persistent lumbar multifidus dysfunction is diagnosed by atrophic replacement of the multifidus with fat, as visualized by magnetic resonance imaging or ultrasound. The content is solely the responsibility of the authors and does not necessarily represent the official vies of the NIH. The low load multifidus activation exercise, developed by Richardson et al 7 and used by O'Sullivan and colleagues, 8 is to be performed as a co-contraction with the transversus abdominis muscle, and is intended to correct a neurologically mediated loss of normal multifidus muscle volume, not unlike that seen in the vastus medialis following trauma or surgery involving the knee joint. However, it is not the case when it comes to this particular muscle. The dysfunction can be caused by inhibition of pain by the spine. They showed that shear modulus increased with increasing the loading of the neck. Several techniques, including rehabilitative ultrasound imaging (RUSI), strength tests, and electromyography (EMG), have been used to evaluate spine muscles. The similarity of the shear modulus between these two groups with different age groups (average age: 35 versus 60 yr old) suggests that age may not have a significant effect in the multifidus muscle shear modulus. It is also attached to the spinal column. Healthy participants were excluded if they ever had low back surgery; had a history of chronic back pain; had received services for low back pain within the past 6 months; had difficulty performing the requested tasks; had experienced a recent traumatic event such as a motor vehicle collision; had any neurological disease, or terminal illness. Surface EMG also has some limitations, such as maintaining robust contact of the electrode with skin and crosstalk for evaluating localized multifidus muscle independent of neighboring muscles. The multifidus muscles are considered deep muscles, but in this course you will learn that they are medial muscles and this makes all the difference in palpation and treatment. Participants were asked to fill out the pain catastrophizing scale (PCS) , modified Oswestry low back pain disability questionnaire (ODQ) , and visual analog scale (VAS) pain intensity rating questionnaire  to assess their pain intensity and perceived disability. The change in median shear modulus from lying prone to sitting up and from sitting up to sitting up with the lifted arms was more significant in the healthy participants compared to changes in the other groups. Lumbar multifidus muscles are important for providing segmental stability and they function as dynamic stabilizers of the lumbar spine. These fasciculi vary in length: the most superficial, the longest, pass from one vertebra to the third or fourth above; those next in order run from one vertebra to the second or third above; while the deepest connect two adjacent vertebrae. Unfortunately, RFN also causes denervation and subsequent atrophy of the multifidus muscle . The multifidus muscle provides stiffness, stability, and support to the spinal column. Multifidus muscle weakness and atrophy is associated with chronic low back pain. These preliminary measurements suggest that the proposed protocol using SWE can provide important information about the function of individual spine muscles to guide the design and evaluation of postsurgical rehabilitation protocols. They are the thickest muscles in the transversospinal group, and are shorter than semispinalis, but longer than rotatores. The shear modulus measurements of multifidus in the group of patients were performed bilaterally on the surgery lumbar level and the average was considered. Our protocol can potentially determine the extent of muscle dysfunction after RFN or PLF. During lifting arms in healthy controls, the higher multifidus shear modulus indicates increased contraction in multifidus muscle to keep the balance of the torso. The objective of this study was to evaluate multifidus dysfunction by comparing changes in shear modulus during muscle contraction in healthy individuals and patients who received RFN and PLF in the lumbar spine. For the measurement of the shear modulus of multifidus during muscle contraction in sitting posture, each participant was first asked to sit up (Fig.  evaluated the shear modulus of cervical multifidus in a group of healthy individuals, reporting a shear modulus of 14.9 kPa during resting in prone posture. Dysfunction in the lumbar multifidus muscles is strongly associated with low back pain. Future studies will focus on evaluating relationships between shear modulus and specific tension (tensile stress) rather than total force produced by the multifidus. (Multifidus shaded in red. It is a very deep muscle that runs along both sides of the spine and can be grouped into the Cervical Multifidus, the Thoracic Multifidus, and the Lumbar Multifidus. 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