Effects of isometric non machine-based strength training on the cross-sectional area of the paravertebral muscles on MRI

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1 Effects of isometric non machine-based strength training on the cross-sectional area of the paravertebral muscles on MRI Poster No.: C-2410 Congress: ECR 2010 Type: Topic: Authors: Keywords: DOI: Scientific Exhibit Musculoskeletal S. Lescher, B. Bender, V. Gstrein, R. Esper, K. Gruber, S. Felber; Koblenz/DE low back pain, paravertebral muscles, non machine-based isometric strength training /ecr2010/C-2410 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 13

2 Purpose The purpose of this MRI study was to determine potential effects of isometric non machine-based strength training on the cross-sectional area (CSA) of the paravertebral muscles in volunteers during a company internal prevention program. Low back pain is a major health problem in western society and it is the second leading cause of manpower loss and decreases productivity significantly (1, 2). 80% of the general population suffer from back pain at least once during their lifetime (1, 2). Previous studies have employed CT and MR imaging to measure volumes of the back muscles after spaceflight and the effects of machine training in patients with chronic low back pain (3, 4, 5, 6). MRI studies have shown structural changes including atrophy and fatty degeneration of the paravertebral muscles in patients who suffer from chronic low back pain as compared to healthy controls (4, 5, 6). The need for active exercise in the treatment of chronic low back pain was postulated, however, it is unclear which exercise regimen is the most effective (7). There is no evidence of positive effects of company internal prevention programs on the paravertebral muscles volume. We aimed to evaluate the effects of isometric training on the back muscle cross sectional areas (CSA) in healthy subjects. Images for this section: Page 2 of 13

3 Fig. 1: Company internal prevention program Page 3 of 13

4 Methods and Materials The study had been approved by the ethic committee of the Johannes-Gutenberg Universität Mainz. Fourteen volunteers, who were participiants of a company internal prevention program, were studied to analyze the effect of 3 months active therapy on back muscle size. The prevention program included an isometric non machine-based exercise program which was repeated on a daily basis for 3 months. Assessments of cross-sectional area of the erector spinae muscle (using MRI) were made at three different levels of the lower back before and after exercise, using computerized image analysis techniques. For statistical analysis the current SPSS version was employed. Statistical significance was accepted at p < The intra- and interrater reliability were calculated by Pearson correlation. Images for this section: Page 4 of 13

5 Fig. 1: The positioning of the transversal images. The three lower levels were included in the analyses. Page 5 of 13

6 Fig. 2: Transversal MR image shows the area measurement of the erector spinae muscle. Page 6 of 13

7 Results The study included fourteen subjets with different fitness levels and different histories of low back pain. Three of them had undergone surgery for lumbar disc disease 5-15 years before entering this study. Eleven out of fourteen subjects completed the training. The CSA were measured in each subject at two time points 4 weeks apart by two trained operators blinded to the probands identity. The recorded CSA values exhibited an intraand interrater correlation coefficient from to Paired T-test statistical analysis showed a significant increase in the CSA of the paravertebral muscles in an intraindividual comparison of each participant after the three months training period. The mean increase of the CSA was 8%. The relative increase in muscle size was comparable between non-operated subjects and those who had undergone spinal surgery before. Images for this section: Page 7 of 13

8 Fig. 1: CSA (mm²) of the paravertebral muscles before and after the three months prevention programm. The participants P02, P04 and P08 had undergone surgery for lumbar disc disease before entering the study. Fig. 2: Intrarater Correlation for two measurements of the CSA of the paravertebral muscles at the same disc level at two measure points Page 8 of 13

9 Conclusion Three months of isometric training was sufficient to effect measurable changes in backmuscle size. We demonstrated the usefulness of MRI to measure the changes of the CSA of the low back muscles. These results represent a rationale for further studies to determine the effect of different training methods on the cross sectional area of the back muscles to verify the profit of the exercise programs and to correlate structural changes with clinical symptoms in chronic low back pain. References 1. Robert Koch Institut, Gesundheitsberichterstattung des Bundes, Gesundheitssurvey Statistisches Bundesamt, Presseexemplar. Gesundheit - Krankheitskosten 2002, Wiesbaden LeBlanc A, Lin C, Shackelford L, et al. Muscle volume, MRI relaxation times (T2), and body composition after spaceflight. J Appl Physiol. 2000; 89: Parkkola R, Kujala U, Rytokoski U. Response of the trunk muscles to training assessed by magnetic resonance imaging and muscle strength. Eur J Appl Physiol Occup Physiol. 1992; 65: Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with low back pain and healthy control subjects. Spine. 1993; 18: Reid S, Hazard RG, Fenwick JW. Isokinetic trunk-strength deficits in people with and without low-back pain: a comparative study with consideration of effort. J Spinal Disord. 1991; 4: Danneels L, Vanderstraeten G, Cambier D, et al. Effects of three different training modalities on the cross sectional area of the lumbar multifidus Page 9 of 13

10 muscle in patients with chronic low back pain. Br J Sports Med. 2001; 35: Personal Information Contact Information: Dr. med. Stephanie Lescher Institut für diagnostische und interventionelle Radiologie Chefarzt: Prof. Dr. med. Stephan Felber Stiftungsklinikum Mittelrhein Koblenz Johannes-Müller-Str. 7, D Koblenz stephanie.lescher@stiftungsklinikum.de Images for this section: Page 10 of 13

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12 Fig. 1: Dr. med. Stephanie Lescher Fig. 2: Institut für diagnostische und interventionelle Radiologie Chefarzt: Prof. Dr. med. Stephan Felber Page 12 of 13

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