Recent work utilizing ultrasound imaging demonstrated that individuals with low back pain (LBP) have increased thickness and decreased mobility of the thoracolumbar fascia (TLF), an indication that the TLF may play a role in LBP. This study used a porcine injury model (microsurgically induced local injury)—shown to produce similar results to those observed in humans with LBP—to test the hypothesis that TLF mechanical properties may also be altered in patients with LBP. Perimuscular TLF tissue was harvested from the noninjured side of vertebral level L3-4 in pigs randomized into either control (n = 5) or injured (n = 5) groups. All samples were tested with a displacement-controlled biaxial testing system using the following protocol: cyclic loading/unloading and stress relaxation tests at 25%, 35%, and then 45% of their resting length. Tissue anisotropy was also explored by comparing responses to loading in longitudinal and transverse orientations. Tissues from injured pigs were found to have greater stretch–stretch ratio moduli (measure of tissue stiffness), less energy dissipation, and less stress decay compared to tissues from control pigs. Responses across these variables also depended on loading orientation. Clinical significance: these findings suggest that a focal TLF injury can produce impairments in tissue mechanical properties away from the injured area itself. This could contribute to some of the functional abnormalities observed in human LBP.

References

1.
Jacobs
,
J. J.
,
2008
, “
The Burden of Musculoskeletal Diseases in the United States
,” American Academy of Orthopaedic Surgeons, Rosemont, IL.
2.
Friedly
,
J.
,
Standaert
,
C.
, and
Chan
,
L.
,
2010
, “
Epidemiology of Spine Care: The Back Pain Dilemma
,”
Phys. Med. Rehabil. Clin. North Am.
,
21
(
4
), pp.
659
677
.
3.
Waddell
,
G.
,
2004
,
The Back Pain Revolution
,
Churchill Livingstone
,
Edinburgh, NY
.
4.
Weiner
,
S. S.
, and
Nordin
,
M.
,
2010
, “
Prevention and Management of Chronic Back Pain
,”
Best Pract. Res., Clin. Rheumatol.
,
24
(
2
), pp.
267
279
.
5.
van Dieen
,
J. H.
,
Selen
,
L. P. J.
, and
Cholewicki
,
J.
,
2003
, “
Trunk Muscle Activation in Low-Back Pain Patients, an Analysis of the Literature
,”
J. Electromyogr. Kinesiol.
,
13
(
4
), pp.
333
351
.
6.
Leinonen
,
V.
,
Kankaanpaa
,
M.
,
Airaksinen
,
O.
, and
Hanninen
,
O.
,
2000
, “
Back and Hip Extensor Activities During Flexion/Extension: Effects of Low Back Pain and Rehabilitation
,”
Arch. Phys. Med. Rehabil.
,
81
(
1
), pp.
32
37
.
7.
Delitto
,
A.
,
George
,
S. Z.
,
Van Dillen
,
L.
,
Whitman
,
J. M.
,
Sowa
,
G.
,
Shekelle
,
P.
,
Denninger
,
T. R.
, and
Godges
,
J. J.
,
2012
, “
Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association
,”
J. Orthop. Sports Phys. Ther.
,
42
(
4
), pp.
A1
A57
.
8.
Brumagne
,
S.
,
Janssens
,
L.
,
Knapen
,
S.
,
Claeys
,
K.
, and
Suuden-Johanson
,
E.
,
2008
, “
Persons With Recurrent Low Back Pain Exhibit a Rigid Postural Control Strategy
,”
Eur. Spine J.
,
17
(
9
), pp.
1177
1184
.
9.
Mok
,
N. W.
,
Brauer
,
S. G.
, and
Hodges
,
P. W.
,
2004
, “
Hip Strategy for Balance Control in Quiet Standing Is Reduced in People With Low Back Pain
,”
Spine
,
29
(
6
), pp.
E107
E12
.
10.
Kent
,
P.
, and
Keating
,
J. L.
,
2005
, “
Classification in Nonspecific Low Back Pain: What Methods Do Primary Care Clinicians Currently Use?
,”
Spine
,
30
(
12
), pp.
1433
1440
.
11.
Leeuw
,
M.
,
Goossens
,
M. E. J. B.
,
Linton
,
S. J.
,
Crombez
,
G.
,
Boersma
,
K.
, and
Vlaeyen
,
J. W. S.
,
2007
, “
The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence
,”
J. Behav. Med.
,
30
(
1
), pp.
77
94
.
12.
Hodges
,
P.
, and
Smeets
,
R.
,
2015
, “
Interaction Between Pain, Movement, and Physical Activity. Short-Term Benefits, Long-Term Consequences, and Targets for Treatment
,”
Clin. J. Pain
,
31
(
2
), pp.
97
107
.
13.
Langevin
,
H. M.
, and
Sherman
,
K. J.
,
2007
, “
Pathophysiological Model for Chronic Low Back Pain Integrating Connective Tissue and Nervous System Mechanisms
,”
Med. Hypotheses
,
68
(
1
), pp.
74
80
.
14.
Willard
,
F.
,
Vleeming
,
A.
,
Schuenke
,
M.
,
Danneels
,
L.
, and
Schleip
,
R.
,
2012
, “
The Thoracolumbar Fascia: Anatomy, Function and Clinical Considerations
,”
J. Anat.
,
221
(
6
), pp.
507
536
.
15.
Langevin
,
H. M.
,
Fox
,
J. R.
,
Koptiuch
,
C.
,
Badger
,
G. J.
,
Greenan-Naumann
,
A. C.
,
Bouffard
,
N. A.
,
Konofagou
,
E. E.
,
Lee
,
W.-N.
,
Triano
,
J. J.
, and
Henry
,
S. M.
,
2011
, “
Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain
,”
BMC Musculoskeletal Disord.
,
12
(
1
), pp.
203
211
.
16.
Bishop
,
J. H.
,
Fox
,
J. R.
,
Maple
,
R.
,
Loretan
,
C.
,
Badger
,
G. J.
,
Henry
,
S. M.
,
Vizzard
,
M. A.
, and
Langevin
,
H. M.
,
2016
, “
Ultrasound Evaluation of the Combined Effects of Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model
,”
PLoS One
,
11
(
1
), p. e0147393.
17.
Liao
,
J.
, and
Vesely
,
I.
,
2004
, “
Relationship Between Collagen Fibrils, Glycosaminoglycans, and Stress Relaxation in Mitral Valve Chordae Tendineae
,”
Ann. Biomed. Eng.
,
32
(
7
), pp.
977
983
.
18.
Gooyers
,
C.
,
2014
, “
Exploring Interactions Between Force, Repetition and Posture on Low Back Joint Loading and Intervertebral Disc Injury
,”
Ph.D. thesis
, University of Waterloo, Waterloo, ON.https://uwspace.uwaterloo.ca/handle/10012/8707
19.
Eilaghi
,
A.
,
Flanagan
,
J. G.
,
Brodland
,
G. W.
, and
Ethier
,
C. R.
,
2009
, “
Strain Uniformity in Biaxial Specimens Is Highly Sensitive to Attachment Details
,”
ASME J. Biomech. Eng.
,
131
(
9
), p.
091003
.
20.
Hammer
,
N.
,
Lingslebe
,
U.
,
Aust
,
G.
,
Milani
,
T. L.
,
Hädrich
,
C.
, and
Steinke
,
H.
,
2012
, “
Ultimate Stress and Age-Dependent Deformation Characteristics of the Iliotibial Tract
,”
J. Mech. Behav. Biomed. Mater.
,
16
, pp.
81
86
.
21.
Trindade
,
V.
,
Martins
,
P.
,
Santos
,
S.
,
Parente
,
M.
,
Jorge
,
R. N.
,
Santos
,
A.
,
Santos
,
L.
, and
Fernandes
,
J.
,
2012
, “
Experimental Study of the Influence of Senescence in the Biomechanical Properties of the Temporal Tendon and Deep Temporal Fascia Based on Uniaxial Tension Tests
,”
J. Biomech.
,
45
(
1
), pp.
199
201
.
22.
Shadwick
,
R.
,
1990
, “
Elastic Energy Storage in Tendons: Mechanical Differences Related to Function and Age
,”
J. Appl. Physiol.
,
68
(
3
), pp.
1033
1040
.
23.
Corr
,
D. T.
, and
Hart
,
D. A.
,
2013
, “
Biomechanics of Scar Tissue and Uninjured Skin
,”
Adv. Wound Care
,
2
(
2
), pp.
37
43
.
24.
Legerlotz
,
K.
,
Riley
,
G. P.
, and
Screen
,
H. R. C.
,
2013
, “
GAG Depletion Increases the Stress-Relaxation Response of Tendon Fascicles, But Does Not Influence Recovery
,”
Acta Biomater.
,
9
(
6
), pp.
6860
6866
.
25.
Thornton
,
G. M.
,
Leask
,
G.
,
Shrive
,
N.
, and
Frank
,
C.
,
2000
, “
Early Medial Collateral Ligament Scars Have Inferior Creep Behaviour
,”
J. Orthop. Res.
,
18
(
2
), pp.
238
246
.
26.
Henderson
,
E. R.
,
Friend
,
E. J.
,
Toscano
,
M. J.
,
Parsons
,
K. J.
, and
Tarlton
,
J. F.
,
2015
, “
Biomechanical Comparison of Canine Fascia Lata and Thoracolumbar Fascia: An In Vitro Evaluation of Replacement Tissues for Body Wall Reconstruction
,”
Vet. Surg.
,
44
(1), pp.
126
134
.
27.
Kirilova
,
M.
,
Stoytchev
,
S.
,
Pashkouleva
,
D.
, and
Kavardzhikov
,
V.
,
2011
, “
Experimental Study of the Mechanical Properties of Human Abdominal Fascia
,”
Med. Eng. Phys.
,
33
(
1
), pp.
1
6
.
28.
Pavan
,
P.
,
Stecco
,
C.
,
Darwish
,
S.
,
Natali
,
A.
, and
De Caro
,
R.
,
2011
, “
Investigation of the Mechanical Properties of the Plantar Aponeurosis
,”
Surg. Radiol. Anat.
,
33
(
10
), pp.
905
911
.
29.
Stecco
,
C.
,
Pavan
,
P.
,
Pachera
,
P.
,
De Caro
,
R.
, and
Natali
,
A.
,
2014
, “
Investigation of the Mechanical Properties of the Human Crural Fascia and Their Possible Clinical Implications
,”
Surg. Radiol. Anat.
,
36
(
1
), pp.
25
32
.
30.
Schuenke
,
M.
,
Vleeming
,
A.
,
Van Hoof
,
T.
, and
Willard
,
F.
,
2012
, “
A Description of the Lumbar Interfascial Triangle and Its Relation With the Lateral Raphe: Anatomical Constituents of Load Transfer Through the Lateral Margin of the Thoracolumbar Fascia
,”
J. Anat.
,
221
(
6
), pp.
568
576
.
31.
Germscheid
,
N. M.
,
Thornton
,
G. M.
,
Hart
,
D. A.
, and
Hildebrand
,
K. A.
,
2011
, “
A Biomechanical Assessment to Evaluate Breed Differences in Normal Porcine Medial Collateral Ligaments
,”
J. Biomech.
,
44
(
4
), pp.
725
731
.
32.
Corey
,
S. M.
,
Vizzard
,
M. A.
,
Badger
,
G. J.
, and
Langevin
,
H. M.
,
2011
, “
Sensory Innervation of the Nonspecialized Connective Tissues in the Low Back of the Rat
,”
Cells Tissues Organs
,
194
(
6
), pp.
521
530
.
33.
Hoheisel
,
U.
,
Rosner
,
J.
, and
Mense
,
S.
,
2015
, “
Innervation Changes Induced by Inflammation of the Rat Thoracolumbar Fascia
,”
Neuroscience
,
300
, pp.
351
359
.
34.
Tesarz
,
J.
,
Hoheisel
,
U.
,
Wiedenhöfer
,
B.
, and
Mense
,
S.
,
2011
, “
Sensory Innervation of the Thoracolumbar Fascia in Rats and Humans
,”
Neuroscience
,
197
, pp.
302
308
.
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