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Randomized controlled trial. To contrast the efficacy of two exercise programs-multifidus retraining program (MRP) and traditional back exercises (TBE)-on pain and functional disability in individuals with chronic low back pain. Low back pain is a common musculoskeletal disorder. Mechanical low back pain does not involve nerve roots. Stability of the spine is provided by the ligaments and muscles of the lower back and abdomen. Although weakness of the superficial trunk and abdominal muscles are the primary risk factors, recent studies have demonstrated the involvement of weakness and lack of control of the deep trunk muscles, especially the multifidus and transverse abdominis muscles. Therefore, exercises to restore optimal lumbar multifidus function are important in rehabilitation strategies. Thirty individuals were randomly assigned to receive TBE, where exercises focused on the superficial muscles of abdomen and low back (control, group A) and MRP, where exercises focused on the deep multifidus muscles fibers (experimental, group B). Groups were examined to find the effect of these exercises on visual analog scale rated pain (visual analogical scale) and functional disability assessed by the Oswestry disability questionnaire. The exercise program lasted for 6 weeks on alternate days, with 20 repetitions of each exercise, with each move held for 5-8 seconds. Subjects were evaluated at the start of the study and after completion of the 6-week exercise program. As compared to baseline, both treatments were effective in relieving pain and improving disability (p<0.001). The MRP group had significant gains for pain and functional disability when compared to the TBE group (both p<0.001). Both techniques lessen pain and reduce disability. MRP is superior to TBE in reducing pain and improving function.

Pilates is an effective exercise method for rehabilitating musculoskeletal disorders as its principles are based on the activation of local muscles. This study aimed to compare the subjects with and without Pilates experience to find out the effect of the experience on the core muscle activity and muscle co-contraction, and to examine the relationship between the core muscle activation level and the kinematic data. This study involved 32 subjects, including 16 experienced Pilates practitioners and 16 non-experienced subjects. The knee stretch on the reformer was performed in three different positions: flat back with a neutral pelvis, round back with posteriorly tilted pelvis (RPP), and extended back anteriorly tilted pelvis (EAP). The electromyography of the internal oblique (IO), rectus abdominis (RA), multifidus (MU), and iliocostalis lumborum (IL) muscles were measured, as well as kinematic data from a 3D motion analysis system. Compared to the non-experienced subjects, the experienced subjects activated the IO muscles more than the RA muscles, and the most significant difference was seen in the RPP position (p < 0.05). The experienced patients activated the MU muscles more often than the IL muscles, with the most significant difference observed in the RPP position and the least significant in the EAP position (p < 0.05). All kinematic data and muscle activity (IO, IO/RA ratio, MU/IL ratio) showed significant differences between the experienced and non-experienced subjects (p < 0.05). The subjects presented a moderate correlation between muscle activation and core stability. It was confirmed that the experienced Pilates practitioners activated the abdominal and low back core muscles effectively, and the stability of the pelvis and trunk were better than that of the non-experienced participants. In addition, the better the trunk stability was maintained, the larger and more accurate movement of the mobility segment was observed.

Purpose Aerobic exercise produces beneficial outcomes in patients with low back pain and partially attenuates the fibrotic changes to the multifidus in a model of intervertebral disc (IVD) degeneration. More targeted exercise might be required to fully attenuate these fibrotic alterations. This study aimed to investigate whether activation of the multifidus induced by neurostimulation could reduce fibrosis of the multifidus in a model of IVD degeneration in sheep. Methods IVD degeneration was induced in 18 merino sheep via a partial thickness unilateral annulus fibrosus lesion to the L1/2 and L3/4 IVDs. All sheep received an implantable neurostimulation device that provides stimulation of the L2 medial branch of the dorsal ramus. Three months after surgery, the animals were assigned to Injury or Activated groups. Activated animals received neurostimulation and the Injury group received no stimulation. Six months after surgery, the multifidus was harvested at L2 and L4. Van Gieson’s, Sirius Red and immunofluorescence staining for Collagen-I and -III and quantitative PCR was used to examine fibrosis. Muscle harvested from a previous study without IVD injury was used as a control. Results Neurostimulation of the multifidus attenuated IVD degeneration dependent increases in the connective tissue, including Collagen-I but not Collagen-III, compared to the Injury group at L4. No measures of the multifidus muscle at L2, which received no stimulation, differed between the Injury and Activated groups. Conclusions These data reveal that targeted activation of the multifidus muscle attenuates IVD degeneration dependent fibrotic alterations to the multifidus.

Delayed onset muscle soreness (DOMS) of the lower back is considered a surrogate for acute low back pain (aLBP) in experimental studies. Of note, it is often unquestioningly assumed to be muscle pain. To date, there has not been a study analyzing lumbar DOMS in terms of its pain origin, which was the aim of this study. Sixteen healthy individuals (L-DOMS) were enrolled for the present study and matched to participants from a previous study (n = 16, L-PAIN) who had undergone selective electrical stimulation of the thoracolumbar fascia and the multifidus muscle. DOMS was induced in the lower back of the L-DOMS group using eccentric trunk extensions performed until exhaustion. On subsequent days, pain on palpation (100-mm analogue scale), pressure pain threshold (PPT), and the Pain Sensation Scale (SES) were used to examine the sensory characteristics of DOMS. Pain on palpation showed a significant increase 24 and 48 h after eccentric training, whereas PPT was not affected (p > 0.05). Factor analysis of L-DOMS and L-PAIN sensory descriptors (SES) yielded a stable three-factor solution distinguishing superficial thermal (“heat pain “) from superficial mechanical pain (“sharp pain”) and “deep pain.” “Heat pain “ and “deep pain” in L-DOMS were almost identical to sensory descriptors from electrical stimulation of fascial tissue (L-PAIN, all p > 0.679) but significantly different from muscle pain (all p < 0.029). The differences in sensory description patterns as well as in PPT and self-reported DOMS for palpation pain scores suggest that DOMS has a fascial rather than a muscular origin.

Reduced lumbar multifidus (LM) cross-sectional area (CSA) has been linked with non-specific chronic low back pain (NCLBP); hence, lumbar stabilization exercise (LSE) is typically used as treatment. Real-time ultrasound imaging (RUSI) biofeedback can enhance performance and retention in LM activation. This study aimed to compare the effects of LSE with or without RUSI-biofeedback in patients with NCLBP. A single-blind, three-arm, parallel randomized controlled trial involving 90 participants, randomized into LSE RUSI-biofeedback, LSE no-biofeedback , or minimal intervention ( n  = 30 per group) was conducted. All interventions were administered twice weekly for 8 weeks, and outcomes (LM-CSA, pain, disability, and quality of life) were evaluated before and at 8-week and 20-week follow-ups. Compared to LSE no-biofeedback and minimal intervention, LSE RUSI-biofeedback demonstrated a greater increase ( p  < 0.05) in LM-CSA at 8 weeks (mean [95%CI] difference: 0.81 [0–1.62] and 1.79 [0.91–2.65], respectively) and at 20 weeks (1.61 [0.79–2.42] and 2.66 [1.79–2.53], respectively). LSE RUSI-biofeedback showed a greater improvement ( p  < 0.05) in mental health scores at 8 weeks (3.63 [0.32–6.94]) and 20 weeks (7.34 [4.03–10.60]) compared to LSE no-biofeedback . However, LSE no-biofeedback showed a greater physical health scores at 20 weeks (− 4.89 [− 7.92 to − 1.86]) compared to LSE RUSI-biofeedback . No significant differences ( p  > 0.05) were found between LSE RUSI-biofeedback and LSE no-biofeedback for pain or disability. The increase in LM-CSA significantly correlated with changes in pain (r = − 0.40 to − 0.50, p  < 0.05) and disability (r = − 0.38 to − 0.42, p  < 0.05). In conclusion, LSE with or without RUSI-biofeedback improved LM-CSA, pain, disability, and quality of life. However, LSE RUSI-biofeedback led to a greater increase in LM-CSA. Such an increase appears to be related to changes in pain and disability. Trial registration: The study was registered in the Pan African Clinical Trials Registry (16/01/2018; PACTR201801002980602).

Purpose To investigate the effects of early functional training within a 12-week rehabilitation program on walking distance and lumbar multifidus atrophy following lumbar fusion surgery. Methods A total of 52 patients who underwent lumbar fusion surgery were randomly assigned to either the early functional training group (n = 26) or the routine rehabilitation group (n = 26). The early functional training group (FT group) began a progressive functional training program within the first 12 weeks post-surgery, while the routine rehabilitation group (RH group) started the same training program 12 weeks after surgery. The primary outcome was the walking distance, measured as the 6-minute walk distance (6MWD) at the 3-month, and 6-month follow-up. Secondary outcomes included the cross-sectional area (CSA) of the multifidus muscles, the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI) score, the Short Form 36 Health Survey (SF-36) subscales, including the Physical Component Summary (PCS) and Mental Component Summary (MCS), and the incidence of adverse events. The primary aim was evaluated using a 2-way mixed-model analysis of covariance (ANCOVA), with treatment group as the between-subjects factor and time as the within-subjects factor, after adjusting for baseline measures. Results Among the total patients, 38 (73.1%) left with at least one follow-up result, and 29 (55.8%) completed all treatment sessions and obtained an MRI assessment. The mixed-model ANCOVA revealed a significant group-by-time interaction for the 6MWD (F = 6.214, p  = 0.003). Patients in the FT group demonstrated superior 6MWD compared to the GH group at 3 months (95% CI: 32.51 to 101.88, p  < 0.001). No significant differences were found between the two groups at the 6-month follow-up (95% CI: –15.34 to 54.03, p  = 0.271). Regarding secondary outcomes, no significant group-by-time effects were found for ODI (F = 1.221, p  = 0.299), PCS (F = 0.166, p  = 0.847), or MCS (F = 0.282, p  = 0.755). No significant differences were found in the CSA of multifidus muscles between the groups. Nine patients (17.3%) experienced adverse events. Conclusion Early functional training after lumbar fusion was not superior to routine rehabilitation in improving walking distance, multifidus atrophy, pain, physical function, and quality of life during the 6-month follow-up. Trial registration number (TRN) : ChiCTR2300068296.

Background Chronic low back pain (CLBP) is associated with structural and functional alterations in the lumbar-multifidus (LM) muscle, a key-stabilizer of the spine. In this pilot study, Pennation-angle, a well-established muscle architecture marker not previously assessed in CLBP, was evaluated using ultrasound to compare LM structure between CLBP-patients and healthy-controls and examine its relationship with muscle thickness, pain-intensity and activity-levels. Methods This cross-sectional study included 40 adults aged 18–35 years (20 CLBP-patients, 20 healthy-controls) at AIIMS Jodhpur. Bilateral ultrasound-imaging at the L4–L5 level was performed, and the average of right and left measurements was used to quantify superficial and deep LM pennation-angle and muscle-thickness. Pain intensity (NRS-scale) and physical activity levels were recorded. Group comparisons were performed using t-tests or Mann–Whitney U tests; correlations by Pearson’s or Spearman’s coefficients. Results CLBP participants showed significantly reduced superficial-pennation angle (7.03 ± 0.98° vs. 8.85 ± 1.25°, p  < 0.001; Cohen’s d  = − 1.62), superficial muscle-thickness (1.07 ± 0.187 cm vs. 1.29 ± 0.258 cm, p  = 0.004; d  = − 0.96), and deep muscle-thickness (1.18 ± 0.190 cm vs. 1.32 ± 0.190 cm, p  = 0.026; d  = − 0.73), while deep-pennation angle showed no group difference ( p  = 0.235; d  = − 0.38). Superficial-pennation angle correlated positively with superficial muscle-thickness ( r  = 0.678, p  < 0.001). NRS showed weak negative trends with all LM parameters. Physical activity distributions differed but were statistically non-significant (χ²=2.88, p  = 0.237), although effect size indicated a small-to-moderate trend toward higher sedentary behaviour in CLBP (Cramer’s V = 0.268). Conclusion The observed reduction in LM pennation-angle and muscle-thickness reflects potential architectural compromise and disuse-related atrophy in CLBP. The strong angle–thickness correlation supports the interdependence of muscle size and fiber orientation. Although pain-intensity and activity-levels were not statistically associated to LM morphology, their negative and sedentary trends may still reflect behavioural and pain-related influences on subtle muscle decline. CLBP patients demonstrate distinct LM architectural alterations, emphasizing the value of ultrasound-based assessment and supporting targeted rehabilitation strategies focused on restoring LM function and morphology. Institutional ethics committee registration number AIIMS/IEC/2025/5525.

Introduction and hypothesis The aim of our study is to examine the changes in core muscle functions during pregnancy. Methods Our study was carried out in 67 primigravida pregnant women. Superficial electromyography (EMG) and non-invasive 2D/3D ultrasonography (USG) were used to evaluate core muscle (diaphragm, transversus abdominus [TA], internal oblique [IO]–external oblique [EO] muscles, pelvic floor muscles, multifidus) function during pregnancy. Pelvic floor muscle strength was also measured by a digital palpation method (PERFECT system). USG was used to measure expected fetal weight and the diastasis recti (DR) distance. Mann–Whitney U test was used to show changes in trimesters in the core muscles, and Spearman correlation analysis was used to determine the relationship. Results In the third trimester, an nonsignificant increase in EMG parameters was observed in all of the core muscles. Although a statistically significant decrease was observed in muscle thickness values measured by EO and IO USG in the third trimester, DR was found to increase at all levels ( p  < 0.005). When we evaluated both trimesters and all pregnant women together, no relationship was found between all core muscles and pelvic floor muscles in the data evaluated by EMG and USG. We found a negative correlation in USG values between fetal weight and IO and the upper part of the rectus abdominus muscle, and a positive correlation between the EMG data of the EO and rectus abdominus muscles. Conclusions In women, the coactivation relationship between the core muscles may disappear during pregnancy. As the trimesters progress during pregnancy, a decrease in thickness and an increase in muscle activity can be observed in the core muscles. Pregnant women can be given exercise training for core muscles for protection in both the prenatal and postnatal periods. But more research needs to be done.

Background The lumbar multifidus (LM) plays a key role in static and dynamic stability; however, studies of LM motor unit behavior have yet to be extensively investigated. This study aimed to assess the test-retest reliability of motor unit behavior measurements using electromyography decomposition (dEMG) and to investigate the motor unit behavior under different speeds and loads in asymptomatic participants. Methods In this experimental repeated-measures design, 29 male and female asymptomatic participants were recruited. Motor unit behavior was measured during two sets of 60-second active trunk flexion exercises using dEMG under two speeds (15 and 25 repetitions/minute) and two loads (5% and 10% body weight). The action potential amplitude and motor unit firing rate were derived. Intraclass correlation coefficients (ICC) were used to determine within-session test-retest reliability, and a two-factor repeated-measure ANOVA was used to determine the effects of load and speed. Results Findings demonstrated acceptable within-session test-retest reliability (ICC > 0.70) for most parameters. Significantly greater peak and average amplitudes and average firing rates were seen with an increase in speed, while greater average amplitudes and firing rates were seen with an increase in load. Conclusion These findings support the use of measures of LM motor unit behavior. Exercises at greater speeds and loads increase LM firing rates and amplitudes. A better understanding of LM motor unit behavior may aid our understanding of rehabilitation protocols for low back pain.

Background Chronic non-specific low back pain (CNSLBP) is often associated with morphological changes in the lumbar multifidus muscle (LMF), such as reduced cross-sectional area (CSA) and increased fat infiltration, compromising spinal stability and function. Core stabilization exercises aim to enhance neuromuscular control by targeting deep trunk muscles. However, few randomized trials have investigated their effects on MRI-based muscle morphology and clinical outcomes. This study aimed to compare the effects of an 8-week core stabilization exercise program versus conventional physiotherapy on LMF morphology, pain intensity, disability, and core stability in individuals with CNSLBP. Methods In this two-arm, parallel-group randomized controlled trial, 36 individuals with CNSLBP (> 3 months) were randomized to a Core Exercise Group (CEG, n  = 18) or a Conventional Physiotherapy Group (CPG, n  = 18). The 8-week intervention included a 4-week supervised clinical phase and a 4-week home-based phase. The primary outcome was the CSA of the LMF, as this parameter was used for the sample size calculation. Secondary outcomes included LMF fat infiltration (Goutallier grade), pain intensity (visual analog scale), functional disability (Oswestry Disability Index), and core stability (Sahrmann test). Assessments were conducted at baseline and post-intervention. We analyzed within-group change, between-group differences, and group × time interactions using mixed ANOVA; when assumptions were violated, we used non-parametric alternatives (including ART ANOVA). Effect sizes were reported. Results Thirty-one participants completed the trial (CEG, n  = 15; CPG, n  = 16). Both groups showed significant improvements in clinical and functional outcomes ( p  < 0.05). The CEG additionally demonstrated greater CSA increases—especially at L3–L5 levels ( p  < 0.01)—and more notable reductions in fat infiltration ( p  < 0.05). Activity-related pain decreased by 4.4 points in the CEG versus 1.8 points in the CPG ( p  < 0.001). Functional disability improved by 31 points in the CEG compared to 10 points in the CPG ( p  < 0.001). Core stability increased to a median Sahrmann test level of 4 in the CEG versus 3 in the CPG ( p  < 0.001). Conclusions Core stabilization exercises yielded superior improvements in LMF morphology, pain relief, functional recovery, and trunk control compared to conventional physiotherapy in individuals with CNSLBP. These findings support the integration of core-focused rehabilitation strategies into standard clinical practice for CNSLBP. Trial registration ClinicalTrials.gov Identifier: NCT05302349, protocol ID: 2022–695, registered on March 21, 2022.