Technical and measurement reportMeasurement of segmental cervical multifidus contraction by ultrasonography in asymptomatic adults
Introduction
Neck pain, which has been thought to be caused by neck trauma or occupational repetitive injuries, is extremely prevalent in modern society (Cote et al., 1998; Cote et al., 2000). In a Canadian study of adults, 64% of respondents reported that they had experienced neck pain during their life time and 54% reported that neck pain had occurred during the previous 6 months (Cote et al., 1998). Moreover, nearly 5% of the respondents reported that they had been considerably disabled because of neck pain during the previous 6 months (Cote et al., 1998). These findings highlight the need to better understand the pathogenesis of the cervical spine. Novel measurement techniques can help to advance this understanding.
The deep muscles play major roles in maintaining segmental stability, (Panjabi et al., 1989; Kristjansson and Jonsson, 2002; Kristjansson et al., 2003) and evidence suggests an association between deep muscle dysfunction and spinal pain (Hides et al., 1994, Hides et al., 1996; Hayashi et al., 2002; Kristjansson, 2004). The importance of deep lumbar muscles (Panjabi et al., 1989; Hides et al., 1994; Hides et al., 1996) and abdominal muscles (Hodges and Richardson, 1996; Hodges and Richardson, 1997) for controlling back stability has been demonstrated in biomechanical models (Panjabi et al., 1989) and clinical experiments (Hides et al., 1994, Hides et al., 1996; Hodges and Richardson, 1996, Hodges and Richardson, 1997). Furthermore, in patients with low back pain, intervertebral segmental muscle atrophy has been found (Hides et al., 1994, Hides et al., 1996; Campbell et al., 1998) with use of magnetic resonance imaging (MRI) (Campbell et al., 1998) or ultrasonography (US) (Hides et al., 1994, Hides et al., 1996). Similarly, muscle atrophy has been noted after neck injury (Hayashi et al., 2002; Kristjansson, 2004). In addition, altered configuration of the cervical lordosis has been found in patients with neck disorders (Ueki et al., 1995; Kristjansson and Jonsson, 2002; Kristjansson et al., 2003). One possible explanation for this altered configuration is the inability of the deep cervical segmental muscles to maintain cervical alignment (Kristjansson, 2004).
MRI is considered to be the gold standard (Westbrook and Kaut, 1993; Hides et al., 1995; Esformes and Narici, 2002) for measuring the lumbar multifidus at rest (Hides et al., 1994, Hides et al., 1996; Stokes et al., 2005), and US has also been demonstrated to be a valid and reliable method. US has the advantages of a lower cost (Esformes and Narici, 2002; Kristjansson, 2004) and the ability to provide non-invasive visualization of the change in architecture of the deep cervical (Esformes and Narici, 2002; Hodges et al., 2003; Kristjansson, 2004) and lumbar muscles (Ito et al., 1998). Furthermore, good reliability was obtained in measuring the thickness of the transversus abdominis muscle during the hollowing maneuver (McMeeken et al., 2004). However, to our knowledge, there have been no reports on the validity and reliability of US for measuring the cervical multifidus muscle during contraction. Changes in the dimensions of the cervical multifidus during contraction with maximum resistance are also unknown. US was suggested to be the reliable method for detecting isometric contractions of low maximal voluntary contraction (Hodges et al., 2003), but the changes in muscle dimensions and force differed among the muscles tested (Hodges et al., 2003; McMeeken et al., 2004).
The purposes of this study were to determine the reliability of US for measuring changes in the dimensions of the cervical multifidus muscle during rest and contraction and to evaluate the validity of US as compared with MRI. The specific aims were to (1) investigate the intra-rater, intersession reliability of US for measuring the thickness, width, area, and shape ratio of the cervical multifidus at the C4, C5, and C6 levels at rest and during isometric head extension with cranio-cervical spine maintained in a flexed position against individual maximum resistance; (2) compare US and MRI measurements of the thickness, width, area, and shape ratio of the cervical multifidus at the C4, C5, and C6 levels under static condition; and (3) determine the change in the dimensions of the cervical multifidus at the C4, C5, and C6 levels during contraction.
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Participants
After Institutional Review Board (IRB) approval, 17 asymptomatic volunteers (age, 26.75±3.8 years) were recruited (Table 1). Most of the participants exercised routinely (mean of 1.4±0.7 times per week, for a mean of 1.5±1.0 h each time). Criteria for exclusion were a history of trauma to the cervical, thoracic, or lumbar spine, previous surgery of the spine, and neck pain within the previous three months. All participants gave their informed consent after the nature of the procedures had been
Reliability and validity of US
The CVw for muscle thickness, width, area, and shape ratio of the cervical multifidus muscle at rest were within 10%, with the exception of the shape ratio at the C4 level (CVw=11.39%). During contraction, the CVw was within 10% for thickness at the C4–C6 levels, width at the C4 and C5 levels, and area at the C4 level. Hence, the CVw was less than 10% for the measurement of muscle thickness at the C4–C6 levels, both at rest and during contraction (Table 2).
There were significant relationships
Discussion
In the present study, we attempted to determine whether US was a reliable and valid method for measuring the dimensions of the cervical multifidus at rest and during contraction. Intra-rater, intersession reliability for measurement of muscle thickness was acceptable during both rest and contraction. Compared with MRI, US had an acceptable validity for measuring the thickness of the cervical multifidus muscle but not for measuring its width and area. Additionally, US detected significant
Conclusion
Using noninvasive, real-time US with a standard protocol, the thickness of the cervical multifidus muscle at the C4, C5, and C6 levels in asymptomatic young adults could be quantified during contraction. The application of this methodology for individuals with chronic neck pain should be further explored.
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