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MRI Assessment of Responses to Manipulative Treatment of Individuals With Low Back Pain

Journal: The Journal of the American Osteopathic Association Date: 2009/08, 109(8):Pages: 426. doi: Subito , type of study: case control study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2009.109.8.425/html)

Keywords:

case control study [42]
low back pain [429]
magnetic resonance imaging [15]
OMT [3102]
osteopathic manipulative treatment [3124]

Abstract:

Introduction: Despite the palpatory findings of altered tissue compliance of skeletal muscle in patients with low back pain (LBP) there is little empiric evidence describing whether asymmetries in paraspinal muscle activation levels exist (side-to-side differences in the degree of muscle activation), and whether osteopathic manipulative treatment (OMT) alters this paraspinal muscle asymmetry (MA). Hypothesis: We hypothesized that subjects with acute LBP (<3-wk duration) would exhibit greater paraspinal MA compared to control subjects, and that OMT would attenuate this MA. Methods: Muscle functional magnetic resonance imaging (MRI) was used to determine side-to-side differences in the transverse relaxation time (T2) of the psoas (Ps), quadratus lumborum (QL), erector spinae (ES), and multifidus (Mu) muscles in nine subjects with acute LBP and nine asymptomatic, age-matched controls. The subjects with LBP underwent a single OMT session and MRIs were repeated immediately following and 48 hours after the intervention to evaluate MA in T2. Pain (1-10 visual analog scale) was also compared before and after OMT. Results: The LBP subjects exhibited greater MA for the QL than control subjects (P=.05; 29.1+4.3% vs 15.9+4.3% T2 MA). A mean difference in MA was also observed between LBP subjects and controls for the Ps muscle (22.7+6.9% vs 9.5+3.0% T2 MA); however, this difference failed to reach significance (P=.11). Mean MA differences observed for the ES and Mu muscles were small and also fell below significant levels (P=.24 and .60, respectively). OMT attenuated the MA in the Ps immediately and 48 hours following the intervention (P=.03; Pre: 22.7+6.9% T2 MA, Immediately Post: 6.0+4.9% T2 MA, 48-hours Post: 9.5+2.2% T2 MA). Small decreases in mean MA also occurred in the ES and QL, but fell short of statistical significance (P=.27). A slight increase was observed in Mu MA following OMT (P=.04, Pre: 1.8+0.4% T2 MA, Immediately Post: 3.0±0.6% T2 MA, 48-hours Post: 4.1+0.8% T2 MA). Pain was reduced immediately and 48 hours following OMT (P<.01; Pre: 3.0+0.9, Immediately Post: 1.5+0.5, 48-hours Post: 1.9+0.6). Conclusions: T2-weighted MR images revealed significant MA in LBP subjects compared with controls. In LBP subjects, MAs fell in the Ps and possibly in the ES and QL following OMT and rose slightly in the Mu.


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