Koppenhaver Shane L, Scutella Dominique, Sorrell Brooke A, Yahalom Joshua, Fernández-de-Las-Peñas Cesar, Childs John D, Shaffer Scott W, Shinohara Minoru
Baylor University Doctoral Program in Physical Therapy, Dallas, TX, USA.
U.S. Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX, USA.
Clin Biomech (Bristol). 2019 Feb;62:113-120. doi: 10.1016/j.clinbiomech.2019.01.010. Epub 2019 Jan 30.
Quantifying stiffness of the lumbar spine musculature using shear-wave elastography (SWE) maybe beneficial in the diagnosis and treatment of non-specific low back pain (LBP). The primary purpose of this study was to establish normative parameter and variance estimates of lumbar spine muscle stiffness at rest and during submaximal contraction levels using SWE in healthy individuals. A second aim was to determine the relationship between lumbar spine muscle stiffness and a variety of demographic, anthropometric, and medical history variables.
This cross-sectional study included stiffness measurements of the lumbar musculature in 120 asymptomatic individuals using ultrasound SWE. The lumbar erector spinae muscle was measured during rest only and lumbar multifidus muscle was measured during rest and during submaximal contraction using a prone contralateral arm lift. Statistical comparisons of shear modulus were made between sex (male vs. female) and muscle condition (erector spinae rest, lumbar multifidus rest, lumbar multifidus contracted) using 2 × 3 repeated measures analysis of variance (ANOVA). Univariate associations between shear modulus and age, sex, BMI, activity level, and history of back pain were assessed using correlation analysis.
Shear modulus at rest was approximately 4 kPa for the erector spinae muscles and approximately 6 kPa for the lumbar multifidus muscles. Shear modulus substantially increased during contraction, and varied by sex, BMI, and self-reported activity level, with men and more active individuals generally having stiffer muscles.
Variability in shear modulus of the lumbar musculature may be mediated through a combination of muscle size and contractile state, which is consistent with our findings of higher stiffness in the more postural lumbar multifidi muscles, during contraction, and in larger and more active individuals. These findings should inform and be accounted for in future comparative clinical studies.
使用剪切波弹性成像（SWE）量化腰椎肌肉组织的硬度可能有助于非特异性下腰痛（LBP）的诊断和治疗。本研究的主要目的是利用SWE确定健康个体在静息状态和次最大收缩水平时腰椎肌肉硬度的标准参数及方差估计值。第二个目的是确定腰椎肌肉硬度与各种人口统计学、人体测量学和病史变量之间的关系。
这项横断面研究包括使用超声SWE对120名无症状个体的腰部肌肉进行硬度测量。仅在静息状态下测量竖脊肌，在静息状态和次最大收缩状态下测量多裂肌，次最大收缩状态采用俯卧对侧手臂上举的方式。使用2×3重复测量方差分析（ANOVA）对性别（男性与女性）和肌肉状态（竖脊肌静息、多裂肌静息、多裂肌收缩）之间的剪切模量进行统计学比较。使用相关分析评估剪切模量与年龄、性别、体重指数、活动水平和背痛病史之间的单变量关联。
竖脊肌静息时的剪切模量约为4kPa，多裂肌约为6kPa。收缩过程中剪切模量大幅增加，且因性别、体重指数和自我报告的活动水平而异，男性和活动较多的个体肌肉通常更硬。
腰椎肌肉组织剪切模量的变异性可能是由肌肉大小和收缩状态共同介导的，这与我们在更具姿势性的多裂肌、收缩过程中以及体型较大和活动较多的个体中发现的更高硬度一致。这些发现应为未来的比较临床研究提供参考并加以考虑。
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