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Research project: Clinical utility of ultrasound imaging in the management of low back pain - completed

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 We all either know someone with low back pain (LBP) or have suffered from it ourselves. In fact, on any given day 10 million people in North America experience LBP. Many things can contribute to LBP but how the trunk muscles work is thought to play an important part, as researchers have shown that these muscles function differently to normal in people with lasting and recurring pain. Specifically, they have found a lack of activity of muscles deep in the back, abdomen and pelvis combined with over activity of muscles nearer the surface of the body. Some people with LBP also have problems with urinary incontinence.

Low back pain (LBP) and urinary incontinence (UI) are common and represent a significant health concern. Low back pain and UI can be interrelated and occur due to many factors, however there is increasing evidence of altered muscle function in people with lasting and recurring symptoms; specifically, diminished size and delayed activity of deep muscles and over activity of superficial muscles in the lumbo-pelvic region.

These changes do not automatically recover when pain is eliminated and are not always resolved with traditional exercise programs. Although the biomedical evidence is sound and has resulted in advances in how persons with LBP are rehabilitated, there is still a significant gap between the basic discoveries and their application in clinical practice. Hence, there has not been a significant reduction in the prevalence and reoccurrence of LBP.

One plausible explanation is that no objective tool has existed to enable physiotherapists to detect changes in muscle function (specifically those located deep) in a typical clinical setting. Ultrasound  imaging (USI), the same tool used to view unborn babies, is a potential tool as it is safe, non-invasive, clinically accessible, and permits physiotherapists to measure changes in muscle thickness (including deep muscles) during assessment.  (Whittaker et al., 2007; Journal of  Orthopaedics &  Sports Physical Therapy: Special Issue.  37(8): 435-449) doi:10.2519/jospt.2007.2350  
 The purpose of the proposed project is to determine the clinical utility of USI in routine physiotherapy practice, specifically to:

1. detect altered function/behavior of the abdominal wall muscles (amount, time course and symmetry of changes in muscle thickness) and bladder (shape and position) in a LBP population versus a control cohort during clinically relevant tests.

2. identify patterns of altered muscle function/behavior within a LBP cohort in order to guide the type of therapeutic interventions that may be beneficial.

The hypothesis is that those with LBP will demonstrate different muscle/bladder characteristics on USI to those of controls and that these will present as two obvious profiles of muscle behavior (diminished or augmented) consistent with existing evidence obtained using the sophisticated tools; indwelling electromyography (EMG) and magnetic resonance imaging (MRI).

The project involves six studies. The first two are aimed at establishing if a clinical environment is conducive to valid and reliable USI measures. The third is an observational study comparing muscle and bladder USI characteristics between LBP and control cohorts while subjects perform clinically relevant tests (e.g. straight leg raise, abdominal drawing in). The fourth involves the development of an automated facility to better analyse real-time ultrasound video clips and the fifth is aimed at investigating the construct validity of USI against EMG. The outcome of the project will determine whether USI can enhance the assessment of individuals with LBP and provide a basis for further investigation of the potential impact of this tool on treatment effectiveness, and hence advance the standard of care for people with these problems.  

Associated research groups

Musculoskeletal Cluster
Shadow Musculoskeletal Biomedical Research Unit
Health Technologies USRG

Project team

Ms J Whittaker. Prof M Stokes, Professor of Neuromusculoskeletal Rehabilitation, Prof V Humphrey, Professor of Acoustics, Institute of Sound and Vibration Research 

Project funder

Ion Medical Solutions  (USA)

Associated research themes

Rehabilitative Ultrasound Imaging
Health Technologies
Low back pain

Related research groups

Active Living and Rehabilitation

Conferences and events associated with this project:

Whittaker JL, Warner MB, Stokes M. Ultrasound Imaging Transducer Motion during Clinical Lumbopelvic Manoeuvres. 3rd International Conference on Movement Dysfunction Edinburgh, UK, October 2009.

Whittaker JL, Warner MB, Stokes M. Induced Transducer Orientation during Ultrasound Imaging: Effects on Abdominal Muscle Thickness and Bladder Position. 3rd International Conference on Movement Dysfunction Edinburgh, UK, October 2009.


Key Publications

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