Effects of a six-week exercise intervention on function, pain and lumbar multifidus muscle cross-sectional area in chronic low back pain: A proof-of-concept study

INTRODUCTION

Exercise with the Functional Re-adaptive Exercise Device (FRED) has previously been shown to activate the lumbar multifidus (LM) and transversus abdominis (TrA) muscles in non-symptomatic volunteers. This study aimed to determine the effects of a six-week FRED exercise intervention on pain intensity, patient-reported function and LM cross sectional area (CSA) in people with chronic non-specific low back pain (LBP).

METHODS

Thirteen participants undertook six weeks of FRED exercise for up to 15 min, three times per week. At six weeks pre-, immediately pre-, immediately post-, and six and 15 weeks post-intervention, participants completed the Numeric Pain Rating Scale, Patient-Specific Functional Scale, and ultrasound imaging was used to assess the size of the LM muscles at L5 level. Changes in outcomes were assessed using effect size, confidence intervals and minimum clinically important difference (MCID).

RESULTS

There was no improvement in pain intensity following the intervention. Patient-reported function improved by at least twice the MCID for all follow-up assessments compared to immediately pre-intervention (d = 4.20-6.58). Lumbar multifidus CSA showed a large effect size increase from immediately pre-intervention to immediately post-intervention (d = 0.8-1.1); this was maintained at six weeks post-intervention (not measured at 15 weeks post-intervention).

CONCLUSION

Six weeks of FRED exercise improved physical function in all 13 participants with chronic non-specific LBP who took part in this study and most participants' lumbar multifidus muscle CSA. On this basis, it may be an effective intervention for people with chronic LBP and should now be tested in a randomised controlled trial.

Cytoplasmic filaments in the endothelial cells of the sheathed capillary: an ultrastructural and immunocytochemical study in the pig spleen

Cytoplasmic filaments of the endothelial cells of sheathed capillaries in the pig spleen were identified and their ultrastructure was studied. Two types of cytoplasmic filaments were found: intermediate filaments (diameter: 10 nm) which filled most of the interior of the cells, and thin filaments (diameter: 5 nm) which were located just beneath the cell membrane and filled the lateral cytoplasmic processes. In immunocytochemical preparations, the intermediate filaments were positive for vimentin and desmin, and were negative for keratin. Staining of the thin filaments with heavy meromyosin resulted in arrowhead formations. These observations suggest that the intermediate filaments maintain the cytoarchitecture, possibly protecting the cell from structural alterations induced by blood pressure changes. Concurrently, thin filaments may facilitate the passage of red blood cells and blood platelets through the interendothelial fenestrae of the sheathed endothelial cell to the reticular meshwork in the capillary sheath.