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Reduced shear strain and deformability of the thoracolumbar fascia has been linked to low back pain. A number of ultrasound examination methods have been developed for laboratory rather than clinical practice. The aim of this study was to examine the reliability and discriminative validity (patients vs. healthy individuals) of an ultrasound (US) measurement method for the quantification of thoracolumbar fascia deformation (TLFD). A cross-sectional study with US assessment and rater blinding was conducted in a manual therapy clinic and a university laboratory. 16 acute low back pain (aLBP) patients and 15 healthy individuals performed a standardized trunk extension task. US measurements of TLFD were carried out independently by two raters by imaging the TLF in the starting and ending positions of the movement. Intra-rater and inter-rater reliability were calculated using intraclass correlation coefficients (ICCs) and minimal detectable changes (MDC) were calculated. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off for TLFD to discriminate the study groups. Kappa statistics were performed to assess rater agreement in discrimination. Intra-rater reliability was excellent (ICC: .92, MDC: 5.54 mm, p  < .001) and inter-rater reliability was good (ICC: .78, MDC: 8.70 mm, p  < .001). The cut-off for TLFD was 6 mm with a sensitivity of 100% and a specificity of 93.75% and the raters agreed moderately (κ = 0.74, p  < .001) when distinguishing patients and controls. The reliability of the US method for assessing TLFD is moderate to excellent, and the ability to discriminate aLBP patients from healthy individuals is moderate. The method could be used to capture an additional parameter in morphological aLBP screenings.

Background The posture of performance-oriented sport climbers adapts in a way that likely promotes the development of low back pain. The thoracolumbar fascia, while also contributing to performance, seems to be involved in that process. Furthermore, there has been evidence of the stiffening of the fascial structures in disorders associated with negative affectivity. The study aims to investigate the relationship between the autonomic nervous system and the deformability of the thoracolumbar fascia in a sport climber in a natural setting. Case presentation Over a 30 day period, a 50-year-old German male reported daily morning resting heart rate variability and daily inventory of stressful events. The thoracolumbar fascia deformation was measured daily using ultrasound in a manual therapy clinic. A time series analysis was performed to detect possible time-delayed relationships between the variables. A cluster analyses revealed two distinguishable heart rate variability clusters (heart rate variability clusters 1 and 2). Both clusters were correlated with thoracolumbar fascia deformation and daily inventory of stressful events. Higher heart rate variability cluster 1 immediately caused lower thoracolumbar fascia deformation. Heart rate variability cluster 1 parameters mediated the effect of daily inventory of stressful events on a decrease in thoracolumbar fascia deformation with a 2-day delay. One heart rate variability cluster 2 parameter mediated the effect of daily inventory of stressful events on an increase in thoracolumbar fascia deformation with a 7-day delay. Conclusion Heart rate variability cluster 1 values, which probably indicate sympathetic nervous system activity, are directly related to thoracolumbar fascia. Presumably, the sympathetic nervous system mediated the effect of daily inventory of stressful events on a lower thoracolumbar fascia deformation with a 2-day delay, followed by a supercompensation, most likely parasympathetically mediated. Coaches and trainers should be aware of these mechanisms and consider monitoring during training to minimize potential additional risk factors for impaired performance and health.

Alterations in posture, lumbopelvic kinematics, and movement patterns are commonly seen in patients with low back pain. Therefore, strengthening the posterior muscle chain has been shown to result in significant improvement in pain and disability status. Recent studies suggest that thoracolumbar fascia (TLF) has a major impact on the maintenance of spinal stability and paraspinal muscle activity, and thus is likely to have an equal impact on deadlift performance. Aim of the study was to evaluate the role of thoracolumbar fascia deformation (TFLD) during spinal movement in track and field athletes (TF) as well as individuals with and without acute low back pain (aLBP). A case-control study was performed with  = 16 aLBP patients (cases) and two control groups: untrained healthy individuals (UH,  = 16) and TF (  = 16). Participants performed a trunk extension task (TET) and a deadlift, being assessed for erector spinae muscle thickness (EST) and TLFD using high-resolution ultrasound imaging. Mean deadlift velocity (VEL) and deviation of barbell path (DEV) were measured by means of a three-axis gyroscope. Group differences for TLFD during the TET were examined using ANOVA. Partial Spearman rank correlations were calculated between TLFD and VEL adjusting for baseline covariates, EST, and DEV. TLFD during deadlifting was compared between groups using ANCOVA adjusting for EST, DEV, and VEL. TLFD during the TET differed significantly between groups. TF had the largest TLFD (-37.6%), followed by UH (-26.4%), while aLBP patients had almost no TLFD (-2.7%). There was a strong negative correlation between TLFD and deadlift VEL in all groups (r = -0.65 to -0.89) which was highest for TF (  = -0.89). TLFD during deadlift, corrected for VEL, also differed significantly between groups. TF exhibited the smallest TLFD (-11.9%), followed by aLBP patients (-21.4%), and UH (-31.9%). TFLD maybe a suitable parameter to distinguish LBP patients and healthy individuals during lifting tasks. The cause-effect triangle between spinal movement, TFLD and movement velocity needs to be further clarified. https://drks.de/register/de/trial/DRKS00027074/, German Clinical Trials Register DRKS00027074.

Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae and multifidus muscle (ESM) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality (GC) were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). GC showed a direct effect of TLF deformation on ESM activation only in the aLBP group (p < 0.03). Conclusions: The results suggest that in aLBP, ESM activity is significantly affected by TLF, whereas this relationship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.

Background: A new method for quantifying thoracolumbar fascia deformation (TLFD) and its shear capacity has been introduced, and its reliability for discriminating patients with low back pain (LBP) from healthy controls has been demonstrated in a recent paper. The aim of this study was to investigate the method in terms of criterion validity. Methods: First, the concurrent validity of the TLFD ultrasound measurement method (TLFD_US) was tested in vitro, using a custom-made tissue sliding device that mimics tissue shearing and generates ground truth data. Second, ultrasound images and videos of TLFD were acquired from 10 acute LBP patients and 10 healthy controls by a blinded assessor. In vivo, the concurrent validity of TLFD_US and speckle tracking analysis was then tested. Third, the contribution of the surrounding tissue layers of the erector spinae muscle and dermis to TLFD was calculated using multiple linear regression. Results: The in vitro concurrent validity between TLFD_US and ground truth was excellent (ICC = 0.99; p < 0.001). In vivo, the concurrent validity between TLFD_US and speckle tracking analysis was large (r = 0.701; p < 0.001). Multiple linear regression revealed a large effect regarding the relationship between dermis shear and TLFD (R2 = 0.353; p = 0.01). Conclusions: TLFD_US showed excellent criterion validity. Its suitability for capturing morphological parameters of the thoracolumbar fascia is further reinforced.