Use of Ultrasonography to Evaluate Thickness of the Erector Spinae Muscle in Maximum Flexion and Extension of the Lumbar Spine

Background Physiological motion of the lumbar spine is a subject of interest for musculoskeletal health care professionals, as abnormal motion is believed to be related to lumbar conditions and complaints. Many researchers have described ranges of motion for the lumbar spine, but only a few have mentioned specific motion patterns of each individual segment during flexion and extension. These motion patterns mostly comprise the sequence of segmental initiation in sagittal rotation. However, an adequate definition of physiological motion of the lumbar spine is still lacking. The reason for this is the reporting of different ranges of motion and sequences of segmental initiation in previous studies. Furthermore, due to insufficient fields of view, none of these papers have reported on maximum flexion and extension motion patterns of L1 to S1. In the lower cervical spine, a consistent pattern of segmental contributions was recently described. In order to understand physiological motion of the lumbar spine, it is necessary to systematically study motion patterns, including the sequence of segmental contribution, of vertebrae L1 to S1 in healthy individuals during maximum flexion and extension. Objective This study aims to define the lumbar spines’ physiological motion pattern of vertebrae L1, L2, L3, L4, L5, and S1 by determining the sequence of segmental contribution and the sequence of segmental initiation of motion in sagittal rotation of each vertebra during maximum flexion and extension. The secondary endpoint will be exploring the possibility of analyzing the intervertebral horizontal and vertical translation of each vertebra during maximum flexion and extension. Methods Cinematographic recordings will be performed on 11 healthy male participants, aged 18-25 years, without a history of spine problems. Cinematographic flexion and extension recordings will be made at two time points with a minimum 2-week interval in between. Results The study has been approved by the local institutional medical ethical committee (Medical Research Ethics Committee of Zuyderland and Zuyd University of Applied Sciences) on September 24, 2018. Inclusion of participants will be completed in 2020. Conclusions If successful, these physiological motion patterns can be compared with motion patterns of patients with lumbar conditions before or after surgery. Ultimately, researchers may be able to determine differences in biomechanics that can potentially be linked to physical complaints like low back pain. Trial Registration ClinicalTrials.gov NCT03737227; https://clinicaltrials.gov/ct2/show/NCT03737227 International Registered Report Identifier (IRRID) DERR1-10.2196/14741

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Validity of flexicurve for the assessment of spinal flexibility in asymptomatic individuals

Fisioterapia em Movimento ◽

10.1590/1980-5918.033.ao14 ◽

2020 ◽

Vol 33 ◽

Author(s):

Marja Bochehin do Valle ◽

Vinícius Hoffmann Dutra ◽

Cláudia Tarragô Candotti ◽

Juliana Adami Sedrez ◽

Edgar Santiago Wagner Neto ◽

...

Keyword(s):

Lumbar Spine ◽

Reference Value ◽

Relevant Information ◽

Neutral Position ◽

Maximum Flexion ◽

Spinal Flexibility ◽

Rms Error ◽

The Difference ◽

Asymptomatic Individuals ◽

Flexion And Extension

Abstract Introduction: Spine problems are common, and assessment of spine flexibility provides relevant information; however, alternative evaluation methods need to be validated. Objective: To evaluate the concurrent validity of the Flexicurve using 3D videogrammetry as a reference value to assess spinal flexion and extension in the lumbar and thoracic regions. Method: The consecutive sample consisted of 39 individuals aged between 18 and 50 years. Two consecutive evaluations were performed by the same rater on the same day and at the same location: (1) Flexicurve and (2) 3D videogrammetry. The assessments were performed with the spine in the neutral position, followed by maximum flexion and extension. The range of motion (ROM) in the maximum flexion and extension positions was calculated in MATLAB® and defined as the difference between the maximum flexion or extension angle and that of the neutral position. Statistical analyses used were the Pearson Product-Moment Correlation coefficient, RMS error and Bland-Altman plot (α < 0.05). Results: The ROM between instruments was similar, with high correlations for thoracic flexion (r = 0.751), extension (r = 0.814) and lumbar flexion (r = 0.853), and RMS errors under 8°. The correlation for lumbar extension was moderate (r = 0.613) and the RMS error was more than 10°. The limits of agreement varied between ± 10º and ± 21º. Conclusion: The Flexicurve is valid for assessing maximum flexion and extension of the thoracic spine, and maximum flexion of the lumbar spine. We suggest caution in evaluating the maximum extension of the lumbar spine.

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The Effect of Muscle Direction on the Predictions of Finite Element Model of Human Lumbar Spine

BioMed Research International ◽

10.1155/2018/4517471 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Rui Zhu ◽

Wen-xin Niu ◽

Zhi-peng Wang ◽

Xiao-long Pei ◽

Bin He ◽

...

Keyword(s):

Finite Element ◽

Lumbar Spine ◽

Finite Element Model ◽

Element Model ◽

Intradiscal Pressure ◽

Erector Spinae ◽

Rectus Abdominis Muscle ◽

Oblique Direction ◽

Erector Spinae Muscle ◽

Human Lumbar Spine

The normal physiological loads from muscles experienced by the spine are largely unknown due to a lack of data. The aim of this study is to investigate the effects of varying muscle directions on the outcomes predicted from finite element models of human lumbar spine. A nonlinear finite element model of L3–L5 was employed. The force of the erector spinae muscle, the force of the rectus abdominis muscle, follower loads, and upper body weight were applied. The model was fixed in a neural standing position and the direction of the force of the erector spinae muscle and rectus abdominis muscle was varied in three directions. The intradiscal pressure, reaction moments, and intervertebral rotations were calculated. The intradiscal pressure of L4-L5 was 0.56–0.57 MPa, which agrees with the in vivo pressure of 0.5 MPa from the literatures. The models with the erector spinae muscle loaded in anterior-oblique direction showed the smallest reaction moments (less than 0.6 Nm) and intervertebral rotations of L3-L4 and L4-L5 (less than 0.2 degrees). In comparison with loading in the vertical direction and posterior-oblique direction, the erector spinae muscle loaded in the anterior-oblique direction required lower external force or moment to keep the lumbar spine in the neutral position.

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Repositioning Suture of the Erector Spinae Muscle for Lumbar Spine Surgery via the Posterior Approach: A Prospective Randomized Study

Cell Biochemistry and Biophysics ◽

10.1007/s12013-013-9770-x ◽

2013 ◽

Vol 69 (1) ◽

pp. 75-80

Author(s):

Yu-Jie Wu ◽

Zhi-Yi Fu ◽

Xiao-Peng Hu ◽

Jiang Shao ◽

Xing-Zhen Liu ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Posterior Approach ◽

Randomized Study ◽

Erector Spinae ◽

Prospective Randomized Study ◽

Lumbar Spine Surgery ◽

Erector Spinae Muscle

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Comparison of MET and AIS on Erector Spinae Muscle in Low Back Pain

Case Medical Research ◽

10.31525/ct1-nct04156776 ◽

2019 ◽

Author(s):

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Erector Spinae ◽

Low Back ◽

Erector Spinae Muscle

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Preoperative Fluoroscopically Guided Regional Erector Spinae Plane Blocks Reduce Opioid Use, Increase Mobilization, and Reduce Length of Stay Following Lumbar Spine Fusion

Global Spine Journal ◽

10.1177/21925682211010740 ◽

2021 ◽

pp. 219256822110107

Author(s):

Robert J. Owen ◽

Noah Quinlan ◽

Addisyn Poduska ◽

William Ryan Spiker ◽

Nicholas T. Spina ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Lumbar Fusion ◽

Spine Fusion ◽

Erector Spinae ◽

Control Group ◽

Block Group ◽

Opioid Use ◽

Lumbar Spine Fusion ◽

Delivery Technique

Study Design: Retrospective review. Objective: To determine the effectiveness of erector spinae plane (ESP) blocks at improving perioperative pain control and function following lumbar spine fusions. Methods: A retrospective analysis was performed on patients undergoing < 3 level posterolateral lumbar fusions. Data was stratified into a control group and a block group. We collected postop MED (morphine equivalent dosages), physical therapy ambulation, and length of stay. PROMIS pain interference (PI) and physical function (PF) scores, ODI, and VAS were collected preop and at the first postop visit. Chi-square and student’s t-test ( P = .05) were used for analysis. We also validated a novel fluoroscopic technique for ESP block delivery. Results: There were 37 in the block group and 39 in the control group. There was no difference in preoperative opioid use ( P = .22). On postop day 1, MED was reduced in the block group (32 vs 51, P < .05), and more patients in the block group did not utilize any opioids (22% vs 5%, P < .05). The block group ambulated further on postop day 1 (312 ft vs 204 ft, P < .05), and had reduced length of stay (2.4 vs 3.2 days, P < .05). The block group showed better PROMIS PI scores postoperatively (58 vs 63, P < .05). The novel delivery technique was validated and successful in targeting the correct level and plane. Conclusions: ESP blocks significantly reduced postop opioid use following lumbar fusion. Block patients ambulated further with PT, had reduced length of stay, and had improved PROMIS PI postoperatively. Validation of the block demonstrated the effectiveness of a novel fluoroscopic delivery technique. ESP blocks represent an underutilized method of reducing opioid consumption, improving postoperative mobilization and reducing length of stay following lumbar spine fusion.

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Comparison among low intensity bridge exercises using suspension devices based on muscle activity and subjective difficulty

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200057 ◽

2021 ◽

pp. 1-6

Author(s):

Sang-Yeol Lee ◽

Se-Yeon Park

Keyword(s):

Inclination Angle ◽

Muscle Activity ◽

Erector Spinae ◽

Trunk Muscles ◽

Oblique Muscle ◽

Abdominal Muscles ◽

Internal Oblique Muscle ◽

Low Intensity ◽

Erector Spinae Muscle ◽

Internal Oblique

BACKGROUND: Recent clinical studies have revealed the advantages of using suspension devices. Although the supine, lateral, and forward leaning bridge exercises are low-intensity exercises with suspension devices, there is a lack of studies directly comparing exercise progression by measuring muscular activity and subjective difficulty. OBJECTIVE: To identify how the variations in the bridge exercise affects trunk muscle activity, the present study investigated changes in neuromuscular activation during low-intensity bridge exercises. We furthermore explored whether the height of the suspension point affects muscle activation and subjective difficulty. METHODS: Nineteen asymptomatic male participants were included. Three bridge exercise positions, supine bridge (SB), lateral bridge (LB), forward leaning (FL), and two exercise angles (15 and 30 degrees) were administered, thereby comparing six bridge exercise conditions with suspension devices. Surface electromyography and subjective difficulty data were collected. RESULTS: The rectus abdominis activity was significantly higher with the LB and FL exercises compared with the SB exercise (p< 0.05). The erector spinae muscle activity was significantly higher with the SB and LB exercises, compared with the FL exercise (p< 0.05). The LB exercise significantly increased the internal oblique muscle activity, compared with other exercise variations (p< 0.05). The inclination angle of the exercise only affected the internal oblique muscle and subjective difficulty, which were significantly higher at 30 degrees compared with 15 degrees (p< 0.05). CONCLUSIONS: Relatively higher inclination angle was not effective in overall activation of the trunk muscles; however, different bridge-type exercises could selectively activate the trunk muscles. The LB and SB exercises could be good options for stimulating the internal oblique abdominis, and the erector spinae muscle, while the FL exercise could minimize the erector spinae activity and activate the abdominal muscles.

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