Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

Department of Neurology, Given Building, University of Vermont, Burlington, VT 05405, USA.
BMC Musculoskeletal Disorders (Impact Factor: 1.72). 12/2009; 10(1):151. DOI: 10.1186/1471-2474-10-151
Source: PubMed


Although the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.
In each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.
There were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had approximately 25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p<0.01 and p<0.001 respectively).
This is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.

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    • "The pain radiation after fascia injection was in the typical locations of ''lumbago'' in LBP patients. The notion that the thoracolumbar fascia may play a major role in LBP is supported by its increased thickness [39] and reduced shear strain in subjects with chronic LBP [38]. But pain radiation after fascia injection was also similar to that seen in pseudoradicular LBP patients [18], and even consistent with that given by patients with lumbar facet joint syndrome [51]. "
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    Pain 09/2014; 155:222-231. DOI:10.1016/j.pain.2013.09.025 · 5.21 Impact Factor
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    • "Recent studies have demonstrated involvement of connective tissue structures in the aetiology of low back pain (Langevin et al., 2009), yet there is little research regarding the possible role of muscular fascia in idiopathic scoliosis or postural hyperkyphosis. One case-study (LeBauer et al., 2008) has examined the effects of a manual therapy technique (myofascial release) on an adult with idiopathic scoliosis but similar studies on pubescent or adolescent subjects are lacking. "
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    Journal of Bodywork and Movement Therapies 12/2013; 18(4). DOI:10.1016/j.jbmt.2013.12.011
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    • "It has long been known that scar tissue is a common cause of chronic musculoskeletal pain. Evidences have been produced suggesting that connective tissue may become thicker and less compliant in patients with chronic pain, possible as a result of chronic inflammation and fibrosis [2-4]. Therefore, the normal response to mechanical stretch may be dampened by disturbance of the viscoelastic properties of the subcutaneous connective tissue as a consequence of fibroblast remodeling promoted by inflammatory mediators, like neurotrophins, cytokines, peptides, protons, free radicals, histamine, bradykinin, serotonin, and prostanoids [5]. "
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