A customized supersonic SWE method [30] was implemented to quantify the shear modulus of multifidus muscle using a Verasonic ultrasound system (Verasonic, Inc., Redmond, WA) with an ATL C5-2 transducer (128 elements, beamwidth = 2–5 MHz, center frequency = 3.1025 MHz) [29]. The Multifidus Muscle as It Relates to Function. The muscle is activated during spinal extension primarily. A linear mixed effects model followed by Sidak's multiple comparison tests was used to find significant differences between multifidus shear modulus between patients (RFN or PLF) and matched controls for each of the body positions (lying down, sitting up, and sitting up with the arms lifted). The shear modulus of the multifidus muscle in the RFN and PLF patients was significantly lower than that of in healthy controls (p < 0.01) in the sitting and sitting with arms raised positions, indicating lower levels of muscle contraction. The differences may be because of the severity of nerve compression after disk herniation. The deconditioning of the multifidus is a problem because the loss of muscle ma… Biomechanical Considerations: Tension in the multifidus muscles, and in the other deep paraspinal muscles, can produce mechanical stress on the joints that connect one vertebrae to another (the spinal facet joints). Figure 2 shows the representative B-mode image of the multifidus in an RFN, PLF, and matched healthy participant. ASME J of Medical Diagnostics. 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. 3. The multifidus shear modulus has been evaluated in healthy individuals in a few previous studies. [40] investigated the age-related differences between the shear moduli in the lower extremity of younger and elderly individuals, reporting no age-related differences between the soleus shear modulus in two groups. Common Dysfunction. The multifidus muscles (labeled left) as seen in a posterior view of the neck. As with many spinal muscles, when the multifidus works unilaterally, it causes lateral flexion and rotation to the opposite side as the working muscle. The multifidus muscle gained notoriety in the mid 1990's when researchers at Queensland University first demonstrated gross muscle atrophy using real-time ultrasound. In RFN patients, the shear modulus remained relatively constant: 14.44 kPa, 16.57 kPa, and 17.26 kPa. SWE can be used to evaluate how decreased multifidus muscle contraction affects the loading of adjacent intervertebral disks or facet joints. Our proposed protocol may also help clinicians evaluate the health status and monitor the recovery process of the muscle after interventions are applied to mitigate the severity of its dysfunction. The results in this study provided a preliminary data into abnormal patterns of contraction in injured multifidus muscles. Fascicles of the multifidus originate in the mammillary process of lumbar vertebrae and insert in the spinous process of the following three vertebrae above its origin [47]. The multifidusis a thin muscle that plays a crucial role in the stability of the spine. multifidi ) muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. This fascicle arrangement is repeated at most levels of the spine. Ultrasound shear wave elastography (SWE) is a reliable and noninvasive method that can potentially quantify the shear modulus of the tissues [21–23]. The changes in multifidus shear modulus in the PLF patients were different from those observed in RFN patients reflecting differences in muscle functionality. The representative shear modulus maps of the multifidus muscle in healthy controls, RFN, and PLF patients in the sitting up with lifted arms position are shown in Fig. 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. 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They lifted their sternum straight up and sat upright in a resting posture, and the transducer was placed back on the skin, while their feet were not on the floor. Inst. The change in muscle shear modulus during contraction has been corrected to force generation for several skeletal muscles. RFN and PLF participants were excluded if they had previous spinal surgeries other than RFN or PLF; had a history of scoliosis; were pregnant, or had any neurological disease. The shear modulus for the affected multifidus in the RFN patients for the prone, sitting up and lifted arms states was 14.44 (6.62) kPa, 16.57 (9.59) kPa, and 20.07 (10.96) kPa, respectively; for the healthy controls, values were 18.55 (5.59) kPa, 27.14 (5.08) kPa, and 38.45 (16.71) kPa, respectively (Fig. ASME. However, the contraction of multifidus muscle slightly increased during multifidus activation in PLF patients, while it did not change in RFN patients. Therefore, the change in shear modulus can be used to quantify muscle contraction. The Institutional Review Board (IRB) of the Pennsylvania State University approved the study (STUDY00010509), and human participants gave informed consent before the data collection. The ability of SWE to evaluate function from individual muscles can also be exploited to understand interactions between back muscles. Common interventional treatment for the pain caused by lumbar facet joints is medial RFN. The multifidus muscle is an important stabilizer of the lumbar spine. The presence of lumbar disk herniation compresses the adjacent nerve root, which may cause a change in multifidus function depending on the compression severity. Wilke showed that the multifidus has the strongest influence, of all back muscles, on lumbar segmental stability. Multifidus muscle weakness and atrophy is associated with chronic low back pain. In the PLF, a direct injury to the multifidus due to the incision during surgery and retraction with long periods of excessive pressure [43], while the nerve damage caused by RFN seems to completely inhibit muscle contraction. The multifidus (multifidus spinae : pl. Thirteen patients (six men and seven women) who have received RFN within 2 years before ultrasound evaluation (mean elapsed time after surgery ± SD, 11.42 ± 6.57 months) were recruited (mean age ± SD, 61.15 ± 11.09 yr) (Table 1). 1(c)). Lumbar multifidus muscles are important for providing segmental stability and they function as dynamic stabilizers of the lumbar spine. In all analyses, the p < 0.05 was considered as the level of statistical significance. Since there is not a single insertion point or a single moment arm, measuring force production of the multifidus through changes in shear modulus is nearly impossible. 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. 4(b)). SPSS statistics software (v24, IBM) was used for all statistical analyses. Shapiro–Wilks test was used to analyze the normality of data distribution. An essential advantage of using SWE for quantifying multifidus muscle contraction is that this is a localized method that can quantify multifidus function in the specific injured lumbar level independent of the neighboring muscles. There was not enough power to determine the possible correlations between multifidus function and patient-reported outcomes. This can cause not only pain in the back but also functional issues with movement. The limitation of these techniques has made the evaluation of the role of multifidus function on back pain very challenging. Since multifidus muscle is considered as one of the primary active stabilizers of the lumbar spine [6], multifidus dysfunction after RFN may have an impact on segmental stability, possibly affecting other structures of the spine like the intervertebral disk [7]. Provides proprioceptive feedback and input due to high muscle spindle density; Bilateral backward extension, unilateral ipsilateral side-bending and contralateral rotation. These muscles are divided into two groups. The multifidus muscle is a series of muscles. 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). [Epub ahead of print] Images in Practice: Multifidus Muscle Dysfunction Characterized by Fat Infiltration in a Patient with Chronic Lumbar Back Pain. A continuing-education service for chiropractors & other manual-medicine providers offering affordable, evidence-informed & clinically applicable subscription to weekly research reviews of evidence-based scientific information, live seminars & online credit-hour courses. Persistent lumbar multifidus dysfunction is diagnosed by atrophic replacement of the multifidus with fat, as visualized by magnetic resonance imaging or ultrasound. The lumbar facet joints are the primary source of pain in approximately 10–40% of chronic low back pain patients [2–4]. Significant fatty infiltration in the multifidus muscle at L5-S1 may be correlated with poor function in patients with L4-5 single-segment DLSS. The posterior divisions of the sacral nerves. Continuing low back pain despite >90 days of medical management including: At least one attempt of physical therapy treatment for low back pain, which may optionally be accomplished over multiple episodes or flare-ups of low back pain. 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