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Cited by 410Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyMyofascial pain diagnosis and treatment

Changes in the Cross-Sectional Area of Multifidus and Psoas in Patients With Unilateral Back Pain: The Relationship to Pain and Disability

Barker, Karen L., Shamley, Delva R., Jackson, David·2004·Spine
DOI 10.1097/01.brs.0000144405.11661.eb
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Abstract

In Brief Study Design. Prospective, cross-sectional observational study. Objectives. The aim of this study was to determine if there was an association between wasting of psoas and multifidus as observed on MRI scans and the presenting symptoms, reported pathology, pain, or disability of a cohort of patients presenting with unilateral low back pain. Summary of Background Data. Current physiotherapy practice is often based on localized spine stabilizing muscle exercises; most attention has been focused on transversus abdominus and multifidus with relatively little on psoas. Method. Fifty consecutive patients presenting to a back pain triage clinic with unilateral low back pain lasting more than 12 weeks were recruited. The cross-sectional surface area (CSA) of the muscles was measured. Duration of symptoms, rating of pain, self-reported function, and the presence of neural compression were recorded. Results. Data analysis compared the CSA between the symptomatic and asymptomatic sides. There was a statistically significant difference in CSA between the sides (P < 0.001). There was a positive correlation between the percentage decrease in CSA of psoas on the affected side and with the rating of pain (rho = 0.608, P < 0.01), reported nerve root compression (rho = 0.812, P < 0.01), and the duration of symptoms (rho = 0.886, P < 0.01). There was an association between decrease in the CSA of multifidus and duration of symptoms. Conclusions. Atrophy of multifidus has been used as one of the rationales for spine stabilization exercises. The evidence of coexisting atrophy of psoas and multifidus suggests that a future area for study should be selective exercise training of psoas, which is less commonly used in clinical practice. Prospective cross-sectional study to determine the association between wasting of psoas multifidus the presenting symptoms pain disability of patients with unilateral low back pain. Selective ipsilateral atrophy was found specific to the symptomatic side. This finding has implications for the rehabilitation of back pain particularly psoas strengthening.

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  • Chronic low back pain can become a complex condition in its own right, with persistent central nervous system changes and structural changes in the back.

    “There is growing evidence that cLBP, like other chronic pain conditions, can progress beyond a symptomatic state to a complex condition unto itself,109 involving persistent anatomical and functional changes in the central nervous system9, 93, 100 in addition to structural changes in the back (e.g., degenerative spinal changes, atrophy or asymmetry of para-spinal muscles).10, 11, 14”

    From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [10]

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Authors
Barker, K. L., Shamley, D. R., & Jackson, D.
Affiliations
  • Nuffield Orthopaedic Centre (GB)
  • Oxford Brookes University (GB)
Corresponding author
Barker, Karen L.
ORCID
Venue
Spine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2004-11
Volume
29
Issue
22
Pages
E515-E519
ISSN
0362-2436 (ISSN-L)
DOI
10.1097/01.brs.0000144405.11661.eb
OpenAlex
W1967347300
Cited by
410
References
27
Citations by year
2026: 11 · 2025: 12 · 2024: 12 · 2023: 18 · 2022: 29 · 2021: 34 · 2020: 22 · 2019: 25 · 2018: 23 · 2017: 21 · 2016: 26 · 2015: 26 · 2014: 28 · 2013: 22 · 2012: 16
FWCI
4.97
Type
journal article
Language
en
Open access
closed
Locations
  • Spine (publishedVersion)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
Keywords
psoas muscle, multifidus, muscle atrophy, cross-sectional area, nerve root compression, pain duration, back pain rehabilitation
MeSH terms
Adult, Aged, Cross-Sectional Studies, Female, Persons with Disabilities, Humans, Lumbar Vertebrae, Magnetic Resonance Imaging, Male, Middle Aged, Muscular Atrophy, Prospective Studies, Confidence Intervals, Psoas Muscles, Low Back Pain, Muscle, Skeletal, Statistics, Nonparametric

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