Using neuromuscular electrical stimulation in conjunction with ultrasound imaging technique to investigate lumbar multifidus muscle activation deficit

Background and Objectives: Ultrasound echo intensity (EI) of the lumbar multifidus muscle (LMM) could offer valuable insights regarding muscle quality in people with low back pain (LBP). However, whether the rater’s experience noticeably influences the reliability and precision of LMM EI measurements has not been established. The aims of this study were to investigate the intra-rater and inter-rater reliability of LMM EI measurements, and to compare the reliability and SEM between a novice and an experienced rater. Materials and Methods: Twenty athletes (10 females, 10 males) with a history of LBP were included in this study. Transverse ultrasound images of LMM were taken at L5 in prone. LMM EI measurements were obtained bilaterally by tracing the maximum ROI representing the LMM cross-sectional area (CSA), avoiding the inclusion of bone or surrounding fascia. All measurements were performed by two novice raters and an experienced researcher. Each measurement was acquired by each rater three times for each side on three different images, and the average was used in the analyses. Raters were blinded to each other’s measurements and the participant’s clinical information. Intra-class correlation coefficients (ICCs) were obtained to assess the intra-rater and inter-rater reliability. Results: The intra-rater ICC values for the LMM measurements for the experienced rater were excellent (ICC all > 0.997). The inter-rater reliability ICC values showed moderate to excellent reliability (0.614 to 0.994) and agreement between the novice raters and the experienced rater, except for Novice 1 for the right LMM, which revealed lower ICCs and a wider 95% CI. Intra-rater and inter-rater reliability results were similar when separately looking at the right and left side of the muscle and participant gender. Conclusions: Our findings support the clinical use of ultrasound imaging for the assessment of LMM EI in individuals with LBP.

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Asymmetric muscle activation in the lumbar multifidus muscle during unilateral prone hip extension

Physiotherapy ◽

10.1016/j.physio.2015.03.1602 ◽

2015 ◽

Vol 101 ◽

pp. e1594

Author(s):

M. Wachi ◽

T. Kurihara ◽

M. Fujimoto ◽

N. Kanazawa ◽

T. Isaka

Keyword(s):

Muscle Activation ◽

Multifidus Muscle ◽

Lumbar Multifidus ◽

Hip Extension ◽

Lumbar Multifidus Muscle

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Influence of Feedback Schedule in Motor Performance and Learning of a Lumbar Multifidus Muscle Task Using Rehabilitative Ultrasound Imaging: A Randomized Clinical Trial

Physical Therapy ◽

10.2522/ptj.20060308 ◽

2008 ◽

Vol 88 (2) ◽

pp. 261-269 ◽

Cited By ~ 16

Author(s):

Wendy J Herbert ◽

Deborah Givens Heiss ◽

D Michele Basso

Keyword(s):

Ultrasound Imaging ◽

Rank Test ◽

Muscle Recruitment ◽

Multifidus Muscle ◽

Lumbar Multifidus ◽

Term Retention ◽

Signed Rank ◽

Wilcoxon Signed Rank Test ◽

Signed Rank Test ◽

Lumbar Multifidus Muscle

Background and Purpose Low back pain (LBP) may be associated with inadequate multifidus muscle function. Varying the frequency and timing of feedback may enhance acquisition and retention of multifidus muscle recruitment during exercise. Subjects Subjects without LBP (n=30) were randomly assigned to a constant (CON) or variable (VAR) feedback group. Twenty-eight subjects (mean age=28 years, SD=8.0; mean body mass index=24 kg/m2, SD=0.70) completed training, and 23 completed retention testing. Methods Eight training sessions over 4 weeks included multifidus muscle exercise with rehabilitative ultrasound imaging (RUSI) feedback. Retention was assessed at 1 week and ≥1 month. Results At the start, both groups had similar performances of multifidus muscle recruitment (Fisher exact test, P=.26). Early in training, the CON group had good success (mean=80%) that was maintained at session 8 (mean=84%), with no difference between sessions 1 and 8 (Wilcoxon signed rank test, P=.19, 95% confidence interval [CI]=−9%, 42%). The VAR group gradually increased success (Wilcoxon signed rank test, P=.002, 95% CI=17%, 59%) between sessions 1 and 8. Both groups sustained their session 8 success when tested for short-term retention at 1 week (CON group: Wilcoxon signed rank test, P=.79; VAR group: Wilcoxon signed rank test, P=.36). At the long-term retention test, the VAR group outperformed the CON group (Wilcoxon score test, P=.04), indicating superior motor learning. Discussion and Conclusion Variable feedback provided by RUSI resulted in greater success in lumbar multifidus muscle recruitment up to 3 to 4 months after training.

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