Background & Aims
Non-specific low back pain has become a serious public health problem in latest years. The prevalence of low back pain is reported to be 84% in lifetime (1). Recently, an increasing number of studies have reported that fascia, due to its rich nociceptive innervations, may play a role in chronic pain, especially in some non-specific low back pain conditions (2,3).
This study aims to investigate the biomechanical parameters of thoracolumbar fascia (TLF) and pain-related properties including pain intensity, pressure pain threshold (ppt) and pain sensitivity in young adults with non-specific chronic low back pain (LBP), both those experiencing chronic LBP and without LBP.
Methods
This study was conducted with a total of 50 participant, including those with chronic lower back pain in the experimental group (n=25, %48 women(12) and %51 men(13) ) whose ages changes between 19-26 and those without chronic lower back pain in the control group(n=25, %56 women(14), %44 men(11) ) whose ages changes between 18-29. While 80% of individuals in the LBP group were right-dominant, 88% of those in the control group were right-dominant.
Both groups underwent assessments related to pain properties. Specifically, the Numerical Pain Scale(NMS) was used to assess subjective pain intensity(4), the Digital Algometer was used for assessing pressure pain treshold(5), the Pain Sensitivity Scale(PSS) was used to assess pain sensitivity(6) and the Myotonometer MyotonPRO was used to assess biomechanical parameters, including stiffness(s), elasticity(d) and tonus (f) of the TFL at the level of Lumbal 1,3 vertebrae(L1,L3) and under 12th costa (7-10).
Results
There was no statistically significant difference between groups in terms of age(p=0.148), BMI (p=0.122). Pain intensity at rest,night and morning showed significant difference in LBP group, being higher than in the control group(p<0.001,p<0.001,p<0.001). Pain treshold showed statistical significance by being higher in the control group at the level of left latissimus dorsi(p=0.043), right side of the L1 (p=0.024), left side of the L1 and L3(p=0.024,p=0.034).There was no difference in pain sensitivity scores in the LBP group compared to the control group (p=0.449).In addition, stiffnes showed statistical significance in right side of Latissumis Dorsi in the LBP group, being higher than in the control group(p=0.027).
Conclusions
The results of our study showed that the pain threshold of TLF was lower and TLF stiffness was higher in the LBP group comparison to the control group. Considering that pain and stiffness can influence rehabilitation approaches, this information can be crucial for both patients and clinicians, particularly because it may be necessary to focus on these areas.
This study contributes to our understanding of the relationships between the biomechanical properties of the thoracolumbar fascia and pain parameters in patients with low back pain. The evidence from this study suggests that not only the muscular structure but also the fascial structures should be targeted in exercise and treatment methods in the rehabilitation of LBP patients. In this context, our study results indicate that, in individuals with chronic lower back pain, it is necessary to focus not only on muscle tissue but also on fascia.
References
1. Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain.
Lancet. 2012 Feb 4;379(9814):482-91. doi: 10.1016/S0140-6736(11)60610-7.
Epub 2011 Oct 6. PMID: 21982256.
2. Yahia L, Rhalmi S, Newman N, Isler M. Sensory innervation of human
thoracolumbar fascia. An immunohistochemical study. Acta Orthop Scand. 1992
Apr;63(2):195-7. doi: 10.3109/17453679209154822. PMID: 1590057.
3. Wilke J, Schleip R, Klingler W, Stecco C. The Lumbodorsal Fascia as a Potential
Source of Low Back Pain: A Narrative Review. Biomed Res Int.
2017;2017:5349620. doi: 10.1155/2017/5349620. Epub 2017 May 11. PMID:
28584816; PMCID: PMC5444000.
4. Chiarotto A, Maxwell LJ, Ostelo RW, Boers M, Tugwell P, Terwee CB. Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review. J Pain. 2019 Mar;20(3):245-263. doi: 10.1016/j.jpain.2018.07.009. Epub 2018 Aug 10. PMID: 30099210.
5. Fischer AA: Pressure threshold measurement for diagnosis of myofascial pain and evaluation of treatment results. Clin J Pain 1986;2:207–14
6.Ruscheweyh R, Vermeuer B, Dany K, et al. Validation of the pain sensitivity questionnaire in chronic pain patients. Pain 2012;153:12108
7. https://www.myoton.com/technology/
8. Sanjana F, Chaudhry H, Findley T. Effect of MELT method on thoracolumbar connective tissue: The full study. J Bodyw Mov Ther. 2017 Jan;21(1):179-185. doi: 10.1016/j.jbmt.2016.05.010. Epub 2016 Jun 3. PMID: 28167175.
9. Kurashina W, Iijima Y, Sasanuma H, Saito T, Takeshita K. Evaluation of muscle stiffness in adhesive capsulitis with Myoton PRO. JSES Int. 2022 Sep 17;7(1):25-29. doi: 10.1016/j.jseint.2022.08.017. PMID: 36820433; PMCID: PMC9937826.
10. Wu Z, Zhu Y, Xu W, Liang J, Guan Y, Xu X. Analysis of Biomechanical Properties of the Lumbar Extensor Myofascia in Elderly Patients with Chronic Low Back Pain and That in Healthy People. Biomed Res Int. 2020 Feb 18;2020:7649157. doi: 10.1155/2020/7649157. PMID: 32149135; PMCID: PMC7049445.
Presenting Author
Naime Ulu?
Poster Authors
Naime Ulug
PhD
Atilim University
Lead Author
Süleyman Korkusuz
At?l?m Üniveristesi
Lead Author
Nureddin Berkay Beyazk?l?ç
At?l?m University
Lead Author
Elvin Tosun
At?l?m University
Lead Author
Ghazal Saniei
At?l?m University
Lead Author
Mahtap Rahimikia
At?l?m University
Lead Author
Kamyab Sadeghzadeh
At?l?m University
Lead Author
Bü?ra Korkusuz
At?l?m University
Lead Author
Sema Nur Aslan
At?l?m University
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Low Back Pain