Lumbar muscle dysfunction during remission of unilateral recurrent nonspecific low-back pain: evaluation with muscle functional MRI

Objectives: After cessation of a low back pain (LBP) episode, alterations in trunk muscle behavior despite recovery from pain have been hypothesized to play a pathogenic role in recurrence of LBP. This study aimed to identify the presence of lumbar muscle dysfunction during remission of recurrent LBP, while performing a low-load trunk extension movement. Methods: Thirteen participants with unilateral recurrent LBP were tested at least one month after cessation of the previous LBP episode and were compared to a healthy control group without any history of LBP (n=13). Also, differences between previously painful and non-painful sides were examined. Muscle functional magnetic resonance imaging (MRI), based on quantitative T2-imaging, was used to examine muscle tissue characteristics (T2-rest), and muscle recruitment (T2-shift) during prone trunk extension. The lumbar Multifidus (MF), Erector Spinae (ES), Quadratus Lumborum (QL) and Psoas (PS) were bilaterally visualized on 2 lumbar levels using a T2-weighted (spin-echo multi-contrast, SE_MC) MRI-sequence. Results: Linear Mixed Model analysis revealed a significantly lower T2-rest (p=0.044) and a significantly higher T2-shift (p=0.034) solely for the MF in the LBP group compared to the control group. No significant differences between pain-sides were found. Discussion: Lower T2-rest values have been suggested to correlate with a conversion of the MF fiber typing towards the glycolytic muscle spectrum. Elevated T2-shifts correspond with increased levels of metabolic activity in the MF in the LBP group, for which several hypotheses can be put forward. Taken together, these findings provide innovative evidence of concurrent alterations in Multifidus structure and activity in individuals with unilateral recurrent LBP, despite being pain-free and functionally recovered.Objectives: After cessation of a low back pain (LBP) episode, alterations in trunk muscle behavior despite recovery from pain have been hypothesized to play a pathogenic role in recurrence of LBP. This study aimed to identify the presence of lumbar muscle dysfunction during remission of recurrent LBP, while performing a low-load trunk extension movement. Methods: Thirteen participants with unilateral recurrent LBP were tested at least one month after cessation of the previous LBP episode and were compared to a healthy control group without any history of LBP (n=13). Also, differences between previously painful and non-painful sides were examined. Muscle functional magnetic resonance imaging (MRI), based on quantitative T2-imaging, was used to examine muscle tissue characteristics (T2-rest), and muscle recruitment (T2-shift) during prone trunk extension. The lumbar Multifidus (MF), Erector Spinae (ES), Quadratus Lumborum (QL) and Psoas (PS) were bilaterally visualized on 2 lumbar levels using a T2-weighted (spin-echo multi-contrast, SE_MC) MRI-sequence. Results: Linear Mixed Model analysis revealed a significantly lower T2-rest (p=0.044) and a significantly higher T2-shift (p=0.034) solely for the MF in the LBP group compared to the control group. No significant differences between pain-sides were found. Discussion: Lower T2-rest values have been suggested to correlate with a conversion of the MF fiber typing towards the glycolytic muscle spectrum. Elevated T2-shifts correspond with increased levels of metabolic activity in the MF in the LBP group, for which several hypotheses can be put forward. Taken together, these findings provide innovative evidence of concurrent alterations in Multifidus structure and activity in individuals with unilateral recurrent LBP, despite being pain-free and functionally recovered.A