Effects of Age and Sex on Properties of Lumbar Erector Spinae in Healthy People: Preliminary Results From a Pilot Study

Erector spinae plane block spread patterns and its analgesic effects after computed tomography-guided hepatic tumour ablation: a randomized double-blind trial

INTRODUCTION

Spread patterns of the erector spinae plane block (ESPB) in a larger cohort of living subjects remain inadequately understood. This study investigated the spread of local anaesthetics or saline with contrast in patients undergoing computed tomography-guided radiofrequency ablation of hepatic tumours.

PATIENTS AND METHODS

Thirty patients participated in a double-blinded randomized controlled trial, 14 April 2021 and 18 January 2023. These patients were randomized into two groups: the ESPB group, which received local anaesthetic with contrast, and the sham group, which received saline with contrast. The spread of the drug was assessed regarding vertebral levels and its correlation with the patient characteristics. Pain intensity and morphine consumption were also evaluated.

RESULTS

The ESPB consistently spread cranio-caudally to the dorsal erector spinae muscle in all patients, with a median (IQR) spread of 9 (8-11) vertebral levels, and to the intercostal space with a median (IQR) spread of 4 (3-6) vertebral levels. Paravertebral spread occurred in 90% of patients (27 out of 30) with a median (IQR) spread of 3 (2-5) vertebral levels, while epidural spread was observed in 36.7% of patients (11 out of 30) with a median (IQR) spread of 0 (0-2) vertebral levels. Cranio-caudal spread negatively correlated with back muscle thickness (r= -0.4; p = 0.035), and females exhibited significantly more intercostal spread levels than males (5.8 ± 1.0 vs. 4.3 ± 1.6 levels in females and males, respectively; p = 0.021). However, no significant difference was found in pain intensity and morphine consumption between the two study groups.

CONCLUSION

This study provides insights into the drug spread patterns of ESPB in living subjects. However, a unilateral ESPB did not yield sufficient analgesic effects for radiofrequency ablation of hepatic tumours.

Assessing the association between degenerative disc disease and spinal mobility

OBJECTIVE

Degenerative disc disease (DDD) is commonly associated with chronic low back pain (cLBP) and disability, yet its impact on spinal mobility remains underexplored. This study investigates the association between lumbar disc degeneration and spinal mobility to assess its functional consequences.

METHODS

In this cross-sectional study, participants were recruited from the general population. Individuals with specific LBP were excluded. Intervertebral disc degeneration was graded using the Pfirrmann classification, and an overall lumbar Pfirrmann grade (PG) was calculated. Uni- and multivariable linear regression models were performed to analyze the relationship between disc degeneration and spinal mobility, accounting for age, sex, BMI, physical activity, and pain intensity, with additional subgroup analysis by sex, cLBP status, and age.

RESULTS

909 participants (44.1% female) were included in the study; 421 (46.3%) were affected by cLBP. After accounting for confounders, a higher lumbar PG was significantly associated with reduced sagittal lumbar and rotational mobility (p < 0.001) and increased thoracic sagittal mobility (p = 0.005)in males. Subgroup analyses indicated that associations with mobility impairments were more pronounced in individuals with cLBP and older patients.

DISCUSSION

This study providesevidence linking lumbar disc degeneration to reductions in spinal mobility, particularly in individuals with chronic low back pain. The pronounced mobility loss in cLBP patients suggests that chronic pain may disrupt compensatory mechanisms. These findings validate the role of disc degeneration within the context of cLBP and highlight the need for targeted interventions.

Research on non-invasive monitoring of biomechanical and viscoelastic properties of myotendinous complex in patients with herniated disk with radiculopathy (pre- and post-surgery) in the in order to optimize the neurorehabilitation approach – a systematic literature review

Low back pain is considered to have "epidemic proportions in Western societies", so that it is obvious that discovertebral pathology, especially severe (as is the case with neurosurgical indications), which is our subject research, succita a major and constantly growing interest due to, including to the numerical pressure, which places it among public health problems. This is also reflected by the fact that, for example, in the United States, in recent decades, healthcare costs allocated to prescription drugs to combat lumbosacralgia have risen at a higher rate than in any other category of health services [1]. In our study, we consider that evaluating the viscoelastic properties of muscles provides valuable information about muscle health, function, and progress in recovery. This innovative approach involves assessing the muscle's ability to resist deformation and return to its original shape, which reflects its characteristics of elasticity and viscosity. [2] We previously conducted a systematic review of the related literature using the method of filtering and selecting profile documentary material, a widely accepted and internationally recognized approach: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Thus, we searched using contextually relevant combinations and syntaxes of search keywords in the following international databases: Elsevier, PubMed, PMC, PEDro, and articles published in English in ISI-indexed journals in Web of Knowledge/Science, from January 1, 2021, to December 31, 2023.

Comparative Impact of Kinesio Taping and Post-Isometric Muscle Relaxation on Pain and Myofascial Mechanics in Chronic Low Back Pain: A Randomized Clinical Trial

BACKGROUND This study aimed to evaluate and compare the effects of Kinesio taping (KT), with or without tension (Placebo), and post-isometric muscle relaxation (PIR) on pain intensity and the mechanical properties of myofascial tissues in chronic low back pain (LBP) patients. MATERIAL AND METHODS Study participants (n=64; females, n=34; males, n=30; mean age 41.9 years), were randomly assigned to 1 of the 3 intervention groups. The numerical rating scale (NRS) was used to assess pain intensity at rest, the Oswestry Disability Index was used to estimate the level of disability, and the MyotonPRO© device was used to measure tension, stiffness, and relaxation in the erector spinae on both sides of the lumbar spine. The examinations were performed before the intervention, after interventions, and at 7-day follow-up (RCT Id: ACTRN12624000121561). RESULTS Pain and level of disability were reduced for all groups (P<0.01). In addition, post hoc analysis of the KT group showed significant increases in tension and stiffness of the erector spinae and significantly decreased relaxation between the pre-intervention and follow-up measurements, but only on the contralateral side (P<0.01). CONCLUSIONS KT with or without tape tension and PIR had similar effects in decreasing the level of resting pain and disability. Pain reduction was not related to changes in the mechanical properties of the soft tissue. It can be concluded that the KT with or without tape tension or PIR were mainly analgesic effects, and should be used as a combined therapy in LBP patients.

Do Lumbar Paravertebral Muscle Properties Show Changes in Mothers with Moderate-Severity Low Back Pain Following a Cesarean Birth? A Case–Control Study

Background/Objectives: Cesarean birth (CB) is linked to nonspecific low back pain (NSLBP). Different properties of the muscular tissue, including contractile, biomechanical, and viscous properties, may reflect its physiological or pathological condition. This study aimed to measure these properties of lumbar paravertebral muscles (LPVMs) and their relationship with post-CB mothers with moderate-severity NSLBP and match their measurements to those of the controls. Methods: Sixty women were included in this case–control research. They were divided into two equal groups: Group (A) representing cases, consisted of 30 females who experienced CB and complained of moderate-severity NSLBP, and Group (B) representing controls, consisted of 30 healthy females who had never experienced pregnancy with no or mild-severity NSLBP. Results: The statistical analysis between the two groups yielded significant differences in the right and left LPVMs’ tone (p = 0.002 and 0.015), relaxation time (p = 0.002 and 0.022), and creep (p = 0.013 and 0.008), respectively. On the other side, there were non-significant differences in the right and left LPVMs’ stiffness (p = 0.055 and 0.367) and elasticity (p = 0.115 and 0.231), respectively. The regression analysis’s final model indicated a strong overall performance (Nagelkerke: 1.00). Conclusions: The LPVMs of post-CB mothers with moderate-severity NSLBP showed remarkable changes in both contractile and viscous properties: muscle tone notably decreased, while viscosity increased. However, biomechanical properties like stiffness and elasticity showed negligible changes. This fitted regression analysis illustrated the holistic strong effect of LPVMs’ properties as risk factors contributing to post-CB NSLBP, emphasizing their consideration in diagnosis and intervention strategies for such cases.

Do Lumbar Paravertebral Muscle Properties Show Changes in Mothers with Moderate-Severity Low Back Pain Following a Cesarean Birth? A Case-Control Study

Background/Objectives: Cesarean birth (CB) is linked to nonspecific low back pain (NSLBP). Different properties of the muscular tissue, including contractile, biomechanical, and viscous properties, may reflect its physiological or pathological condition. This study aimed to measure these properties of lumbar paravertebral muscles (LPVMs) and their relationship with post-CB mothers with moderate-severity NSLBP and match their measurements to those of the controls. Methods: Sixty women were included in this case-control research. They were divided into two equal groups: Group (A) representing cases, consisted of 30 females who experienced CB and complained of moderate-severity NSLBP, and Group (B) representing controls, consisted of 30 healthy females who had never experienced pregnancy with no or mild-severity NSLBP. Results: The statistical analysis between the two groups yielded significant differences in the right and left LPVMs' tone (p = 0.002 and 0.015), relaxation time (p = 0.002 and 0.022), and creep (p = 0.013 and 0.008), respectively. On the other side, there were non-significant differences in the right and left LPVMs' stiffness (p = 0.055 and 0.367) and elasticity (p = 0.115 and 0.231), respectively. The regression analysis's final model indicated a strong overall performance (Nagelkerke: 1.00). Conclusions: The LPVMs of post-CB mothers with moderate-severity NSLBP showed remarkable changes in both contractile and viscous properties: muscle tone notably decreased, while viscosity increased. However, biomechanical properties like stiffness and elasticity showed negligible changes. This fitted regression analysis illustrated the holistic strong effect of LPVMs' properties as risk factors contributing to post-CB NSLBP, emphasizing their consideration in diagnosis and intervention strategies for such cases.

The Differences in Parameters in Ultrasound Imaging and Biomechanical Properties of the Quadriceps Femoris with Unilateral Knee Osteoarthritis in the Elderly: A Preliminary Observational Study

Purpose

Our study aims to evaluate differences in muscle parameters of the quadriceps muscles in patients with knee osteoarthritis (KOA) in older adults.

Methods

The study included 40 patients diagnosed with unilateral knee osteoarthritis in the KOA group (KG) and 40 asymptomatic elderly individuals in the control group (CG). Muscle ultrasonic mean echo intensity and shear modulus, as well as tone and stiffness of the rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were analyzed. Additionally, clinical correlations were performed.

Results

In the KG group, there were significant differences in echo intensity, shear modulus, and tone between the affected and unaffected sides for RF (p=0.003, 0.019, 0.014), while VM showed significant differences in shear modulus and tone (p=0.006, 0.002). Additionally, VL exhibited significant differences in echo intensity, shear modulus, and stiffness (p=0.007, 0.006, 0.010). Compared to the CG group, the KG group showed significant differences in echo intensity of the affected side RF (p=0.001). VM exhibited statistically significant differences in echo intensity and shear modulus (p < 0.001, p=0.008), while VL showed statistically significant differences in echo intensity, tone, and stiffness (p < 0.001, p=0.028, p < 0.001). The correlation results showed that patients with unilateral KOA, VM, and VL echo intensity were correlated with K-L grade (r = 0.443, p=0.004; r = 0.469, p=0.002). The tone of VL was correlated with VAS and WOMAC (r = 0.327, p=0.039; r = 0.344, p=0.030).

Conclusion

The parameters of the quadriceps femoris muscle exhibit asymmetry between the affected and unaffected sides in patients with unilateral KOA, as well as a difference between the dominant side of healthy older individuals and the affected side of KOA.

Impact of Standing and Sitting Postures on Spinal Curvature and Muscle Mechanical Properties in Young Women: A Photogrammetric and MyotonPro Analysis

BACKGROUND This study aimed to evaluate the effect of standing and sitting positions on spinal curvatures evaluated using projection moire and muscle tone and stiffness using the MyotonPRO hand-held device in young women. MATERIAL AND METHODS Thirty-three healthy women, aged 21 to 23 years, volunteered in the study. We used the projection moire method to examine spinal curvatures in both positions and the MyotonPRO device to measure the tone and stiffness of muscles in 3 regions. We evaluated the effects of positions (standing vs sitting), regions (cervical, thoracic, and lumbar), and side factor (right vs left) using multivariate analysis. RESULTS The sitting position significantly decreased the lumbosacral and thoracolumbar angles (P<0.001), but had no effect on the superior thoracic angle. Muscle tension and stiffness were the highest (P<0.001) in the cervical region and did not differ between positions (P>0.05) in this region. We found significantly higher muscle tone and stiffness in the thoracic and lumbar regions during sitting than during standing (P<0.001). There was symmetry in the muscle tone and the stiffness between the right and left sides of the spine. CONCLUSIONS The sitting posture decreased lumbosacral and thoracolumbar angles but increased muscle tension and stiffness in the lumbar and thoracic regions only. The symmetry of muscle tone and transverse stiffness in both positions was the normative value. This study provides insight into the adaptive physiological changes in spinal curvature and muscle mechanical properties in young women and serves as an important reference point for clinical studies of women.

Inter-rater reliability and test-retest reliability of the foot posture index (FPI-6) for assessing static foot posture in elderly female patients with knee osteoarthritis and its association with quadriceps muscle tone and stiffness

Objective

1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA.

Methods

The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed.

Result

Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6.

Conclusion

The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.

Muscle activity and rehabilitation in spinal stenosis (MARSS) after conservative therapy and surgical decompression with or without fusion: Protocol for a partially randomized patient preference trial on rehabilitation timing

Background

Patients affected by lumbar spinal stenosis (LSS) suffer from a multifactorial degeneration of the lumbar spine resulting in narrowing of the neuroforamina and spinal canal, leading to various functional limitations. It remains unclear whether LSS patients after surgery would benefit from early post-operative rehabilitation, or if a delayed rehabilitation would be more advantageous. The purpose of this partially randomized patient preference trial is to evaluate the impact of post-operative rehabilitation timing as well as surgical intervention type on psychometric properties and functional outcomes in patients with LSS.

Methods

Data for this patient preference trial are collected before and after surgical (decompression only or decompression and fusion) and rehabilitative interventions as well as six, 12 and 24 months after completing rehabilitation. The study participants are patients diagnosed with LSS who are at least 18 years old. After a medical check-up, participants will complete patient-reported outcome measures (PAREMO-20, SIBAR, FREM-8, SF-12, SFI, ODI) and different functional assessments (functional reach test, loaded reach test, handgrip strength, standing balance control, 6-min walk test).

Ethics and dissemination

The results of this study will be published through peer-reviewed publications and scientific contributions at national and international conferences. This research has been approved by the Institutional Review Board of Martin Luther University Halle-Wittenberg (reference number: 2022-128).

Muscle stiffness indicating mission crew health in space

Muscle function is compromised by gravitational unloading in space affecting overall musculoskeletal health. Astronauts perform daily exercise programmes to mitigate these effects but knowing which muscles to target would optimise effectiveness. Accurate inflight assessment to inform exercise programmes is critical due to lack of technologies suitable for spaceflight. Changes in mechanical properties indicate muscle health status and can be measured rapidly and non-invasively using novel technology. A hand-held MyotonPRO device enabled monitoring of muscle health for the first time in spaceflight (> 180 days). Greater/maintained stiffness indicated countermeasures were effective. Tissue stiffness was preserved in the majority of muscles (neck, shoulder, back, thigh) but Tibialis Anterior (foot lever muscle) stiffness decreased inflight vs. preflight (p < 0.0001; mean difference 149 N/m) in all 12 crewmembers. The calf muscles showed opposing effects, Gastrocnemius increasing in stiffness Soleus decreasing. Selective stiffness decrements indicate lack of preservation despite daily inflight countermeasures. This calls for more targeted exercises for lower leg muscles with vital roles as ankle joint stabilizers and in gait. Muscle stiffness is a digital biomarker for risk monitoring during future planetary explorations (Moon, Mars), for healthcare management in challenging environments or clinical disorders in people on Earth, to enable effective tailored exercise programmes.

The association between different physical activity levels and flexion-relaxation phenomenon in women: a cross-sectional study

BACKGROUND

To investigate whether the flexion-relaxation phenomenon differs in women with different physical activity levels.

METHODS

Seventy-two subjects were recruited for this study. The electromyographic activity of the erector spinae and multifidus muscles was recorded during a flexion task using a surface electromyographic device. The flexion-relaxation and extension-relaxation ratios were calculated. Participants were classified into different physical activity level groups based on their responses to the International Physical Activity Questionnaire. A Welch analysis of variance was conducted to compare the flexion-relaxation ratio and extension-relaxation ratio between groups.

RESULTS

A significant difference in the flexion-relaxation and extension-relaxation ratio was observed in both the erector spinae and multifidus muscles between different levels of physical activity.

CONCLUSIONS

In this study, we observed that female participants with high levels of physical activity showed a more pronounced flexion-relaxation phenomenon compared to those with moderate and low levels of physical activity. No significant difference was found between moderate and low physical activity levels. The findings of our study highlight the association between physical activity and the mechanics of the spinal stabilising muscles.

Effect of osteopathic techniques on human resting muscle tone in healthy subjects using myotonometry: a factorial randomized trial

Musculoskeletal disorders (MSDs) are highly prevalent, burdensome, and putatively associated with an altered human resting muscle tone (HRMT). Osteopathic manipulative treatment (OMT) is commonly and effectively applied to treat MSDs and reputedly influences the HRMT. Arguably, OMT may modulate alterations in HRMT underlying MSDs. However, there is sparse evidence even for the effect of OMT on HRMT in healthy subjects. A 3 × 3 factorial randomised trial was performed to investigate the effect of myofascial release (MRT), muscle energy (MET), and soft tissue techniques (STT) on the HRMT of the corrugator supercilii (CS), superficial masseter (SM), and upper trapezius muscles (UT) in healthy subjects in Hamburg, Germany. Participants were randomised into three groups (1:1:1 allocation ratio) receiving treatment, according to different muscle-technique pairings, over the course of three sessions with one-week washout periods. We assessed the effect of osteopathic techniques on muscle tone (F), biomechanical (S, D), and viscoelastic properties (R, C) from baseline to follow-up (primary objective) and tested if specific muscle-technique pairs modulate the effect pre- to post-intervention (secondary objective) using the MyotonPRO (at rest). Ancillary, we investigate if these putative effects may differ between the sexes. Data were analysed using descriptive (mean, standard deviation, and quantiles) and inductive statistics (Bayesian ANOVA). 59 healthy participants were randomised into three groups and two subjects dropped out from one group (n = 20; n = 20; n = 19-2). The CS produced frequent measurement errors and was excluded from analysis. OMT significantly changed F (-0.163 [0.060]; p = 0.008), S (-3.060 [1.563]; p = 0.048), R (0.594 [0.141]; p < 0.001), and C (0.038 [0.017]; p = 0.028) but not D (0.011 [0.017]; p = 0.527). The effect was not significantly modulated by muscle-technique pairings (p > 0.05). Subgroup analysis revealed a significant sex-specific difference for F from baseline to follow-up. No adverse events were reported. OMT modified the HRMT in healthy subjects which may inform future research on MSDs. In detail, MRT, MET, and STT reduced the muscle tone (F), decreased biomechanical (S not D), and increased viscoelastic properties (R and C) of the SM and UT (CS was not measurable). However, the effect on HRMT was not modulated by muscle-technique interaction and showed sex-specific differences only for F.Trial registration German Clinical Trial Register (DRKS00020393).