Ann Rehabil Med.  2012 Apr;36(2):173-181. 10.5535/arm.2012.36.2.173.

The Relationship between Cross Sectional Area and Strength of Back Muscles in Patients with Chronic Low Back Pain

• Lee HJ
• Lim WH
• Park JW
• Kwon BS
• Ryu KH
• Lee JH
• Park YG

• KMID: 2266754
• DOI: http://doi.org/10.5535/arm.2012.36.2.173

Abstract

OBJECTIVE
To evaluate the relationship between the cross sectional area (CSA) and isokinetic strength of the back muscles in patients with chronic low back pain. METHOD: Data of twenty-eight middle-aged patients with chronic back pain were analyzed retrospectively. CSAs of both paraspinal muscles and the disc at the L4-L5 level were measured in MRI axial images and the relative CSAs (rCSA: CSA ratio of muscle and disc) were calculated. The degree of paraspinal muscle atrophy was rated qualitatively. Isokinetic strengths (peak torque, peak torque per body weight) of back flexor and extensor were measured with the isokinetic testing machine. Multiple regression analysis with backward elimination was used to evaluate relations between isokinetic strength and various factors, such as CSA or rCSA and clinical characteristics in all patients. The same analysis was repeated in the female patients.
RESULTS
In analysis with CSA and clinical characteristics, body mass index (BMI) and CSA were significant influencing factors in the peak torque of the back flexor muscles. CSA was a significant influencing factor in the peak torque of total back muscles. In analysis with rCSA and clinical characteristics, BMI was significant in influencing the peak torque of the back flexors. In female patients, rCSA was a significant influencing factor in the peak torque per body weight of the back flexors, and age and BMI were influencing factors in the peak torque of back flexors and total back muscles.
CONCLUSION
In middle-aged patients with chronic low back pain, CSA and rCSA were influencing factors in the strength of total back muscles and back flexors. Also, gender and BMI were influencing factors.

Keyword

Low back pain; Muscle strength; Muscle strength dynamometer; Magnetic resonance imaging

MeSH Terms

Back Pain
Body Mass Index
Body Weight
Female
Humans
Low Back Pain
Magnetic Resonance Imaging
Muscle Strength
Muscle Strength Dynamometer
Muscles
Muscular Atrophy
Retrospective Studies
Torque

Figure

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  Fig. 1 Cross sectional area of paraspinal muscles. T1 axial images obtained at the L4-L5 level, showing the lumbar paraspinal muscles. MF: Multifidus muscle, ES: Erector spinae muscle, PS: Psoas muscle, Disc: Intervertebral disc, MF+ES: Paraspinal muscle.

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  Fig. 2 Biodex® isokinetic dynamometer (Biodex Corporation, New York, USA). The fixed axis of the machine was aligned with the subject's anterior superior iliac supine (ASIS). Spinal range of motion was not limited. The angular velocity was set at 60°/sec.

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