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Open Access Highly Accessed Research article

Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain

Helene M Langevin12*, Debbie Stevens-Tuttle1, James R Fox1, Gary J Badger3, Nicole A Bouffard1, Martin H Krag2, Junru Wu4 and Sharon M Henry5

Author Affiliations

1 Departments of Neurology, Given Building, University of Vermont, Burlington VT 05405, USA

2 Department of Orthopaedics & Rehabilitation, Stafford Building, University of Vermont, Burlington VT 05405, USA

3 Department of Medical Biostatistics, Hills Building, University of Vermont, Burlington VT 05405, USA

4 Department of Physics, Cook Building, University of Vermont, Burlington VT 05405, USA

5 Department of Rehabilitation & Movement Science, Rowell Building, University of Vermont, Burlington VT 05405, USA

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BMC Musculoskeletal Disorders 2009, 10:151  doi:10.1186/1471-2474-10-151

Published: 3 December 2009

Abstract

Background

Although the connective tissues forming the fascial planes of the back have been hypothesized to play a role in the pathogenesis of chronic low back pain (LBP), there have been no previous studies quantitatively evaluating connective tissue structure in this condition. The goal of this study was to perform an ultrasound-based comparison of perimuscular connective tissue structure in the lumbar region in a group of human subjects with chronic or recurrent LBP for more than 12 months, compared with a group of subjects without LBP.

Methods

In each of 107 human subjects (60 with LBP and 47 without LBP), parasagittal ultrasound images were acquired bilaterally centered on a point 2 cm lateral to the midpoint of the L2-3 interspinous ligament. The outcome measures based on these images were subcutaneous and perimuscular connective tissue thickness and echogenicity measured by ultrasound.

Results

There were no significant differences in age, sex, body mass index (BMI) or activity levels between LBP and No-LBP groups. Perimuscular thickness and echogenicity were not correlated with age but were positively correlated with BMI. The LBP group had ~25% greater perimuscular thickness and echogenicity compared with the No-LBP group (ANCOVA adjusted for BMI, p < 0.01 and p < 0.001 respectively).

Conclusion

This is the first report of abnormal connective tissue structure in the lumbar region in a group of subjects with chronic or recurrent LBP. This finding was not attributable to differences in age, sex, BMI or activity level between groups. Possible causes include genetic factors, abnormal movement patterns and chronic inflammation.