Diaphragmatic Activation Correlated with Lumbar Multifidus Muscles and Thoracolumbar Fascia by B-Mode and M-Mode Ultrasonography in Subjects with and without Non-Specific Low Back Pain: A Pilot Study.

Background and Objectives: The diaphragm, the lumbar multifidus muscles, and the thoracolumbar fascia (TLF) execute an important role in the stability of the lumbar spine and their morphology has been modified in subjects with non-specific low back pain (NS-LBP). While it is true that three structures correlate anatomically, the possible functional correlation between them has not been investigated previously in healthy subjects nor in subjects with NS-LBP. The aim of the present study was to examine this functional nexus by means of a comparison based on ultrasonographic parameters of the diaphragm, the lumbar multifidus muscles, and the TLF in subjects with and without NS-LBP. Materials and Methods: A sample of 54 (23 NS-LBP and 31 healthy) subjects were included in the study. The thickness and diaphragmatic excursion at tidal volume (TV) and force volume (FV), the lumbar multifidus muscles thickness at contraction and at rest, and the TLF thickness were evaluated using rehabilitative ultrasound imaging (RUSI) by B-mode and M-mode ultrasonography. The diaphragm thickening capacity was also calculated by thickening fraction (TF) at tidal volume and force volume. Results: There were no significant differences recorded between the activation of the diaphragm and the activation of the lumbar multifidus muscles and TLF for each variable, within both groups. However, there were significant differences recorded between both groups in diaphragm thickness and diaphragm thickening capacity at tidal volume and force volume. Conclusions: Diaphragmatic activation had no functional correlation with the activation of lumbar multifidus muscles and TLF for both groups. Nevertheless, subjects with NS-LBP showed a reduced diaphragm thickness and a lower diaphragm thickening capacity at tidal volume and force volume, compared to healthy subjects.

Test-Retest Reliability of Ultrasonographic Measurements from the Rectus Femoris Muscle 1-5 Years after Anterior Cruciate Ligament Reconstruction in the Ipsilateral and Contralateral Legs: An Observational, Case-Control Study.

About 40% of traumatic injuries in sports are related to the knee. Of these, 33% require arthroscopic surgery. The rehabilitative ultrasound imaging technique is a simple method to obtain objective real-time results on the state and measurement of the musculoskeletal tissue and its use can represent an important change in the process of functional diagnosis and recovery of these injuries. The aim was to quantify the differences in the thickness, muscle contraction time, and muscle relaxation time of the rectus femoris muscle between individuals with knee arthroscopy and healthy individuals and to verify the reliability of the inter-examiner measurements in these ultrasound variables. An observational case-control study with individuals (18−60 years aged) who underwent surgery for anterior cruciate ligament through knee arthroscopy a year or more before. A total of 38 subjects were divided into 2 groups, case and control. Ultrasound measurements were taken of the following outcomes: thickness at rest and contraction, muscle contraction time, and muscle relaxation time of the rectus femoris muscle. Excellent inter-examiner reliability was obtained for all ultrasound measurements (ICC3.3 > 0.90). No significant changes were found in the rate of contraction or rest of the rectus femoris muscle. On the other hand, if significant changes in the thickness of the rectus femoris muscle were found between control and case group. Arthroscopic surgery for anterior cruciate ligament reconstruction does not appear to modify function but does modify the thickness of the rectus femoris muscle on ultrasound examination. Ultrasound appears to be a reliable tool for the study of these measurements in the rectus femoris muscle.

Abdominal and Pelvic Floor Activity Related to Respiratory Diaphragmatic Activity in Subjects with and without Non-Specific Low Back Pain.

One of the advances in physiotherapy in recent years is the exploration and treatment by ultrasound imaging. This technique makes it possible to study the relationship between the musculature of the anterolateral wall of the abdomino-pelvic cavity, the pelvic floor muscles and the diaphragm muscle, among others, and thus understand their implication in non-specific low back pain (LBP) in pathological subjects regarding healthy subjects. OBJECTIVE: To evaluate by RUSI (rehabilitative ultrasound imaging) the muscular thickness at rest of the abdominal wall, the excursion of the pelvic floor and the respiratory diaphragm, as well as to study their activity. METHODOLOGY: Two groups of 46 subjects each were established. The variables studied were: non-specific low back pain, thickness and excursion after tidal and forced breathing, pelvic floor (PF) excursion in a contraction and thickness of the external oblique (EO), internal oblique (IO) and transverse (TA) at rest. DESIGN: Cross-sectional observational study. RESULTS: Good-to-excellent reliability for measurements of diaphragm thickness at both tidal volume (TV) (inspiration: 0.763, expiration: 0.788) and expiration at forced volume (FV) (0.763), and good reliability for inspiration at FV (0.631). A correlation was found between the EO muscle and PF musculature with respect to diaphragmatic thickness at TV, inspiration and expiration, and inspiration at FV, in addition to finding significant differences in all these variables in subjects with LBP. CONCLUSION: Subjects with LBP have less thickness at rest in the OE muscle, less excursion of the pelvic diaphragm, less diaphragmatic thickness at TV, in inspiration and expiration, and in inspiration to FV.

Architectural Ultrasound Pennation Angle Measurement of Lumbar Multifidus Muscles: A Reliability Study.

The pennation angle has been shown to be a relevant parameter of muscle architecture. This parameter has not previously been measured in the lumbar multifidus musculature, and it is for this reason that it has been considered of great interest to establish an assessment protocol to generate new lines of research in the future. OBJECTIVE: The objective of this study was to establish a protocol for measuring the pennation angle of the multifidus muscles, with a study of intra-rater and interrater reliability values. DESIGN: This was a reliability study following the recommendations of the Guidelines for Reporting Reliability and Agreement Studies (GRRAS). SETTING: The study was carried out at University of Alcalá, Department of Physiotherapy. SUBJECTS: Twenty-seven subjects aged between 18 and 55 years were recruited for this study. METHODS: Different ultrasound images of the lumbar multifidus musculature were captured. Subsequently, with the help of ImageJ software, the pennation angle of this musculature was measured. Finally, a complex statistical analysis determined the intra- and interrater reliability. RESULTS: The intra-rater reliability of the pennation angle measurement protocol was excellent for observer 1 in the measurement of the left-sided superficial multifidus 0.851 (0.74, 0.923), and for observer 2 in the measurement of the right-sided superficial 0.711 (0.535, 0.843) and deep multifidus 0.886 (0.798, 0.942). Interrater reliability was moderate to poor, and correlation analysis results were high for thickness vs. pennation angle. CONCLUSIONS: The designed protocol for ultrasound measurement of the pennation angle of the lumbar multifidus musculature has excellent intra-rater reliability values, supporting the main conclusions and interpretations. Normative ranges of pennation angles are reported. High correlation between variables is described.

Correlation between Anthropometric and Ultrasound Measurement for Dry Needling of the Iliocostalis Lumborum Muscle with a Safety Protocol: A Cross-Sectional Observational Study.

INTRODUCTION: the management of musculoskeletal pain through the application of dry needling (DN) is effective. The application of this technique can carry very infrequent major risks on muscles, such as on the iliocostalis lumborum due to its proximity to the kidney and the peritoneum. It is important to establish a DN protocol based on the different anthropometric variables of the subjects. MAIN OBJECTIVE: the main objective of this study was to investigate the correlation between different anthropometric variables and the skin-kidney and skin-peritoneum distances to establish the size of the needle that could perform DN in the iliocostalis lumborum muscle without risk. DESIGN: a cross-sectional observational study was conducted. METHODOLOGY: a total of 68 healthy subjects were evaluated. Demographic and anthropometric data, such as age, gender, weight, height, body mass index (BMI), chest (xiphoid process and axilla) and abdomen circumferences, and skinfold thickness were collected. The measurements of skin-upper and lower edge of the iliocostalis lumborum muscle and the skin-peritoneum and/or kidney in the regions of L2 and L4, and on both sides, were assessed using ultrasound imaging. RESULTS: a multiple linear regression analysis was performed, confirming that, in L2 without compression, gender significantly predicted the distance, with the distance being greater in women than in men. The measurement without compression increased with age up to 50 years, and it also increased with higher measurements for the chest-triceps, iliac crest, and thigh skinfold thickness, and decreased with higher measurement for the abdominal circumference. It was verified that the measurement with compression in L2 decreased as the neutral axillary circumference and the skinfold thickness in the abdomen-iliac crest increased, while the distance increased with larger measurements obtained in the neutral abdominal circumference and in the skinfold thickness of the chest-triceps. It was also verified that the measurement with compression in L4 increased up to a body mass index of 25 and then decreased even if the index increased further, and it decreased as the skinfold thickness in the abdomen-iliac crest decreased and increased as the measurements of the neutral abdominal circumference and the skinfold thickness in the chest-triceps increased. In L4 without compression, the gender variable significantly predicted changes in the measurement, with women tending to have a smaller distance compared to men. CONCLUSIONS: the measurements of the neutral abdominal circumference, chest-triceps, and abdomen-iliac crest skinfold thickness could help clinicians predict the skin-kidney and skin-peritoneum distances for dry needling of the iliocostalis lumborum with the methodology described.