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OBJECTIVE@#To observe the effect of acupotomy on the fat infiltration degree of lumbar multifidus muscle (LMM) in patients with lumbar disc herniation after percutaneous transforaminal endoscopic discectomy (PTED).@*METHODS@#A total of 104 patients with lumbar disc herniation treated with PTED were randomly divided into an observation group (52 cases, 3 cases dropped off) and a control group (52 cases, 4 cases dropped off). Patients of both groups received rehabilitation training of two weeks 48 h after PTED treatment. The observation group was treated with acupotomy (L3-L5 Jiaji [EX-B 2]) once within 24 h after PTED. In the two groups, the fat infiltration cross sectional area (CSA) of LMM was compared before and 6 months after PTED, the visual analogue scale (VAS) score and Oswestry disability index (ODI) score were observed before and 1, 6 months after PTED. The correlation between fat infiltration CSA of LMM in each segment and VAS score was analyzed.@*RESULTS@#Six months after PTED, the fat infiltration CSA of LMM in L4/L5 and the total L3-S1 segments of the observation group was lower than that before PTED (P<0.05), and the fat infiltration CSA of LMM in L4/L5 of the observation group was lower than the control group (P<0.01). One month after PTED, the ODI and VAS scores of the two groups were lower than those before PTED (P<0.01), and those in the observation group were lower than the control group (P<0.05). Six months after PTED, the ODI and VAS scores of the two groups were lower than those before PTED and 1 month after PTED (P<0.01), and those in the observation group were lower than the control group (P<0.01). There was a positive correlation between the fat infiltration CSA of LMM in the total L3-S1 segments and VAS scores in the two groups before PTED (r = 0.64, P<0.01). Six months after PTED, there was no correlation between the fat infiltration CSA of LMM in each segment and VAS scores in the two groups (P>0.05).@*CONCLUSION@#Acupotomy can improve the fat infiltration degree of LMM, pain symptoms and activities of daily living in patients with lumbar disc herniation after PTED.
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Humans , Intervertebral Disc Displacement , Activities of Daily Living , Paraspinal Muscles , Treatment Outcome , Lumbar Vertebrae , Retrospective Studies , Endoscopy , Diskectomy , Acupuncture TherapyABSTRACT
Objective:To explore the repeatability of ultrasound shear wave elastography (SWE) in evaluating the Young′s modulus (E) of the lumbar multifidus (LM) and the difference in E of the bilateral LM, and to analyze the E′s change ratio of LM and its impact factors at upright and 90° forward bend positions.Methods:A total of 60 healthy volunteers, selected from interns, standardized training residents and refresher doctors in department of diagnostic ultrasound of Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from July to December in 2020, were examined twice by SWE to estimate the E value of LM at prone, upright and 90° flexion positions, respectively. Firstly, the intraclass correlation coefficient (ICC) was applied to test the reliability between the two repeated measurements.Secondly, the differences in E of the bilateral LM were discussed. The discrepancies in the E value of male and female volunteers at prone, upright and 90° flexion positions and the change ratio of the E value at upright and 90° forward bend positions were also discussed, respectively. Finally, Spearman correlation coefficient was utilized to evaluate the correlations of E and its change ratio with gender, age, BMI and activity level at upright and 90° forward bend positions, respectively.Results:The ICC value in LM measured by SWE was in the range of 0.691 to 0.951. No obvious change in bilateral E values of the same posture was observed for an individual(all P>0.05). The change ratios of E at upright and 90° flexion positions were approximate to 2 and 7, respectively. Moreover, at prone position, the E value exhibited negative correlation with age and activity level of self-assessment ( rs=-0.300, P=0.020; rs=-0.383, P=0.002). The E in female was higher compared with that in male. At active states the change ratio in E was positively correlated with age and activity level ( rs=0.278, P=0.031; rs=0.495, P<0.001), and the E′s change ratio in male was higher than that in female. Conclusions:SWE possesses excellent repeatability in evaluating the E value of LM with no significant difference in E of bilateral LM. The E′s change ratio in LM varies with different contraction strategies and changes with age, sex and self-reported activity level.
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OBJECTIVE: To observe the effect of electroacupuncture (EA) at "Weizhong" (BL40) on histopathological changes and expression of extracellular matrix (ECM) component Collagen Ⅰ， matrix metalloproteinases 2 (MMP2), MyoD and Pax7 proteins of lumbar muscle tissues in rats with lumbar multifidus muscle injury (LMMI), so as to explore its underlying mechanisms in improving muscular injury. METHODS: A total of 24 male SD rats were equally randomized into blank control, model and EA groups. The LMMI model was established by injection of 0.5% Bupivacaine (100 µL/ point) into bilateral multifidus muscles of lumbar 4 and 5 (4 points). EA (2 Hz/100 Hz in frequency, 1－2 mA) was applied to BL40 for 20 min, once a day for 3 days. The morphological changes of the left lumbar multifidus muscle were observed under microscope after H．E. and Masson staining, and the expression of Collagen Ⅰ， MMP2, MyoD and Pax7 of the right lumbar multifidus muscle was determined by Western blot. RESULTS: H．E. staining showed large areas of degeneration and necrosis of muscle fibers, and vacuolar structure formed by degradation of muscle fibers in the model group, and newborn juvenile muscle fibers with different diameters in the EA group. Masson staining showed a large number of morphologically damaged muscle fibers and blue stained collagen fibers in the model group, and significantly reduced collagen fibers as well as new muscle fibers with uneven diameters in the EA group. The expression levels of Collagen Ⅰ， MMP2 and MyoD proteins were significantly up-regulated (P<0.01, P<0.05), and that of Pax7 was considerably down-regulated in the model group relative to the control group (P<0.01). After EA intervention, the expression levels of Collagen Ⅰ was significantly down-regulated (P<0.01), and those of MMP2, MyoD and Pax7 proteins were obviously or further obviously up-regulated in the EA group compared with the model group (P<0.01, P<0.05). CONCLUSION: EA at BL40 can reduce the degree of skeletal muscle fibrosis to promote the regeneration of the injured multifidus at the early phase, which may be related to its effect in regulating the expression of Collagen Ⅰ and MMP2 proteins.
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Objective This work aimed to observe averaged electromyogram(AEMG)changes in surface electromyography(sEMG)of thigh muscles and lumbar multifidus muscles in different states of squat training. Then,to find out which is the most effective for squat training. Methods A total of 46 healthy volunteers were selected and divided into two groups,namely,with and without leaning against the wall.sEMG was used to record vastus lateralis muscle,vastus medialis muscle,biceps femoris muscle,and lumbar multifidus muscles at differ-ent knee flexion angles(30°,45°,60°,and 75°). AEMG was analyzed by repeated-measures analysis of vari-ance. Results Different knee flexion angles exerted significant effects on AEMG of all tested muscles(P <0.001).Whether leaning against the wall to squat had a significant impact on AEMG of biceps femoris muscle,but not on vastus lateralis muscle,vastus medialis muscle and lumbar multifidus muscles. Significant difference was detected in interactions of knee flexion angle,and the same to the factor of with and without leaning against the wall on examined AEMG of the thigh muscle,but not for lumbar multifidus muscles. Multiple comparisons showed,the AEMG level of the tested muscles was significantly increased when the knee flexion angles was 75°. Conclusions With increased knee flexion angle,muscle activation has enheanced for vastus lateralis muscle, vastus medialis muscle,biceps femoris muscle and lumbar multifidus muscles. Squatting without leaning against the wall exerts a more marked influence on activation of biceps femoris muscle,but no activation for vastus lateralis muscle,vastus medialis muscle and lumbar multifidus muscles.
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Objective To evaluate the effect of lumbar multifidus muscle training on muscle thickness.Methods The morphological changes in volunteers' lumbar multifidus muscles were observed in response to 11 kinds of training.Muscle thickness was measured at rest and during contraction using ultrasonography and two examiners.The rate of change in muscle thickness and the contraction rate were calculated.Results There was no significant difference in the contraction rates determined by the two examiners using ultrasound imaging.There was no significant difference in average contraction rate between the males and females.Pairwise,there was no significant difference among contralateral leg-raising,ipsilateral leg-raising,contralateral hand-raising,ipsilateral hand-raising and contralateral leg-lifting.Pairwise,there was no significant difference among ipsilateral leg-lifting and ipsilateral arm-lifting compared with contralateral leg-lifting,contralateral arm-lifting or contralaleral lower limb-lifting.There was no significant difference between contralateral arm-lifting and ipsilateral arm-lifting.There was no significant difference between ipsilateral arm-lifting with contralateral leg-lifting and contralateral arm-lifting with ipsilateral leg-lifting.Pairwise,there was a significant difference in lumbar multifidus muscle contraction rates among these actions.Conclusion Lumbar multifidus muscle training has various effects.Muscle thickness as measured using ultrasonography can provide a basis for formulating a rehabilitation training plan.
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OBJECTIVE: To investigate changes in lumbar multifidus (LM) and deep lumbar stabilizing abdominal muscles (transverse abdominis [TrA] and obliquus internus [OI]) during transcutaneous neuromuscular electrical stimulation (NMES) of lumbar paraspinal L4-L5 regions using real-time ultrasound imaging (RUSI). METHODS: Lumbar paraspinal regions of 20 healthy physically active male volunteers were stimulated at 20, 50, and 80 Hz. Ultrasound images of the LM, TrA, OI, and obliquus externus (OE) were captured during stimulation at each frequency. RESULTS: The thicknesses of superficial LM and deep LM as measured by RUSI were greater during NMES than at rest for all three frequencies (p<0.05). The thicknesses in TrA, OI, and OE were also significantly greater during NMES of lumbar paraspinal regions than at rest (p<0.05). CONCLUSION: The studied transcutaneous NMES of the lumbar paraspinal region significantly activated deep spinal stabilizing muscle (LM) and the abdominal lumbar stabilizing muscles TrA and OI as evidenced by RUSI. The findings of this study suggested that transcutaneous NMES might be useful for improving spinal stability and strength in patients having difficulty initiating contraction of these muscles.
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Humans , Male , Abdominal Muscles , Electric Stimulation , Muscles , Paraspinal Muscles , Ultrasonography , VolunteersABSTRACT
OBJECTIVE: To investigate the correlation of multifidus muscle atrophy on MRI findings with clinical findings in low back pain patients. METHOD: Medical records of 80 patients presenting with low back pain were retrospectively reviewed. Their MR images were visually analysed to know lumbar multifidus muscle atrophy, disc herniation, disc degeneration, spinal stenosis and nerve root compression. RESULTS: Multifidus muscle atrophy increased from the upper lumbar level to the most caudal intervertebral level. It was bilateral in the majority of the cases. Multifidus muscle atrophy was well correlated with patient's age, referred leg pain, and disc degeneration. However, duration of low back pain, disc herniation, spinal stenosis, nerve root compression, sex, weight, height and BMI had no correlation with multifidus muscle atrophy. CONCLUSION: Examination of multifidus muscle atrophy should be considered when assessing MR images of lumbar spine. It may help for further evaluation and planning the treatment modalities of low back pain.