Paraspinal Muscles and Intervertebral Dysfunction: Part Two
Received 2 December 2002; received in revised form 15 January 2003
Abstract
Background
One of the diagnostic characteristics of the manipulable spinal lesion—a musculoskeletal disturbance that is claimed to be detected with manual palpation and corrected with manipulation—is said to be altered segmental tissue texture. Little evidence for the nature of abnormal paraspinal tissue texture exists, but indirect evidence from experimental studies supports the plausibility of the concept of protective muscle spasm, although investigations of increased paraspinal electromyography (EMG) associated with low back pain suggests complex changes in motor control rather than simple protective reflexes.
Objectives
To review the literature for evidence that may support or refute proposed explanations for clinically observed altered paraspinal tissue texture associated with the manipulable spinal lesion. This review aims to highlight areas that require further research and make recommendations for future studies.
Data Source
MEDLINE and CINAHL databases were searched using various combinations of the keywords paraspinal, muscle, palpation, EMG, spine, low back pain, pain, myofascial, hardness, manipulation, reliability, and somatic dysfunction, along with searching the bibliographies of selected articles and textbooks.
Data Extraction
All relevant data were used.
Results
Decreased paraspinal muscle activity and strength associated with low back pain is well established, and there is evidence of changes in muscle fiber composition and localized selective multifidus atrophy. Disturbances in microcirculation have been implicated in nonparaspinal muscle pain. The effect of spinal manipulation on paraspinal EMG activity is inconclusive but promising.
Conclusion
Little direct evidence exists to support the existence or nature of paraspinal tissue texture change that is claimed to be detected with palpation. The proposal of segmental reflex paraspinal muscle contraction was not supported, at least in association with low back pain. There appears to be a complex relationship between deep paraspinal muscle inhibition during dynamic activity and nonvoluntary guarding behavior during static activity. The relationship between these findings and palpable tissue change is speculative, but increased activity, decreased activity, or both may be responsible for paraspinal tissues detected as abnormal with palpation. Recommendations are outlined for future research.
aSchool of Health Science, Victoria University, Melbourne, Australia
bCentre for Aging, Rehabilitation, Exercise and Sport, Victoria University, Melbourne, Australia
Gary Fryer, School of Health Science, City Campus Victoria University, PO Box 14428 MCMC, Melbourne 8001, Australia
ABSTRACT