Low back pain home-exercise program for MS patients with focus on Multifidus muscle
Summary
Multiple sclerosis (MS) is an inflammatory disease that causes brain, optic nerve and spinal cord demyelination, affecting over 400,000 americans.1The neurological symptoms, like muscle weakness, cause multiple comorbidities and chronic disability. Currently, MS is the most common non-traumatic cause of disability in patients between 20 to 50 years old.2 Low back pain is present in 42-52% of patients, reaching 76% of patients in a French cohort.3 As there is no cure, approaches that improve quality of life while decreasing pain are needed.
The multifidus muscle stabilizes the lumbar spine and its atrophy is associated to chronic back pain.4, 5.Oriented rehabilitation can increase the size and control of this muscle, improving lower back pain. 6,7
We propose a pilot study to evaluate the feasibility of a home-exercise program for the diagnosis and treatment of low back pain in MS patients that are not pregnant or do not have a prior diagnosis of lumbar radiculopathy or fibromyalgia. This novel tool would target the multifidus muscle and could be taught in person or in online appointments.
- Primary aim: study the feasibility of a home-exercise program in patients with MS younger then 50 years old with expanded disability status scale between 1.5 to 6.
- Secondary aim: Evaluate the relation of the cross-section area of the multifidus muscle measured by ultrasound, as its activation measured by electroneuromyography with pain and mobility in patients with multiple sclerosis.
- Exploratory aim: design a novel home-exercise program that can be taught on-line or through an app that addresses back pain based in the rehabilitation of the multifidus muscle.
This project is innovative because it targets an existing and common complaint of pack pain with the evaluation of the multifidus muscle, whose function has never been studied in MS patients. If the projects’ feasibility is confirmed, the program can be extended to a larger population of patients with MS, other neurological diseases, and to patients with back pain related to multifidus muscle dysfunction. This new rehabilitation program can be used as a platform for patients with back pain that can be available on-line through an app or membership.
References
1 Zwibel, HL; Smrtka, J. Improving the Quality of Life in Multiple Sclerosis: an unmet need. Am J Manag Care.(2011);17suppl5;S139-45
2 Dimitrov LG, Turner B. What’s new in multiple sclerosis?Br J Gen Pract.(2014);64(629):612-3.
3 Massot C et al. Low back pain in patients with multiple sclerosis: A systematic review and the prevalence in a French multiple sclerosis population. Rev Neurol.(2020) 5:S0035-3787(20)30683-4.
4- Goubert D et al. Structural Changes of Lumbar Muscles in Non-specific Low Back Pain: A Systematic Review. Pain Physician (2016) 19(7):E985-E1000.
5- Ranger TA et al. Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J. (2017);17(11):1729-1748.
6- Pillastrini P et al. Exercise and tropism of the multifidus muscle in low back pain: a short review.J Phys Ther Sci. (2015);27(3):943-5.
7- Russo M et al. Muscle Control and Non-specific Chronic Low Back Pain. Neuromodulation. (2018);21(1):1-9.