Jonas Verbrugghe

Feasibility, accuracy and safety of a percutaneous fine-needle biopsy technique to obtain qualitative muscle samples of the lumbar multifidus and erector spinae muscle in persons with low back pain

The lumbar muscular system, in particular the lumbar multifidus muscle (LM) and the erector spinae muscle (ES), plays an important role in stabilizing and mobilizing the lumbar spine. Based on the topography, the lumbar paraspinal muscles can be classified into local and global muscles. LM is part of the local system, whereas ES is part of the global system. Therefore, it is interesting to investigate the muscle fibre type composition in both muscles. There is accumulating evidence that nonspecific chronic low back pain is associated with lumbar muscle dysfunction. To further elucidate this lumbar paraspinal muscle dysfunction, it is important to understand the structural characteristics of individual muscle fibres of LM and ES. Muscle fibre type composition can be investigated in muscle tissue samples. So far, muscle samples are taken by using invasive procedures that are not well tolerated. The aim of this article was to evaluate the feasibility, accuracy and safety of a percutaneous fine‐needle biopsy technique to obtain muscle samples from LM and ES in persons with nonspecific chronic low back pain and to evaluate the feasibility of performing immunofluorescence analysis of myosin heavy chain isoform expression to investigate muscle fibre type composition. Preliminary investigations in cadavers were performed to determine the optimal vertebral level and puncture site to obtain muscle samples of LM and ES through a single skin puncture. In 15 persons with nonspecific chronic low back pain, muscle samples of LM and ES were taken under local anaesthesia with the percutaneous fine‐needle biopsy technique, preceded by determination of the puncture site with ultrasonography. Muscle fibre type composition was investigated using immunofluorescence analysis of myosin heavy chain expression. The subjects reported little or no pain and were willing to repeat the procedure. The obtained muscle tissue contained transverse‐sectioned muscle fibres in which muscle fibre contractile characteristics of the paraspinal muscles could be evaluated with immunofluorescence analysis of the myosin heavy chains. We can conclude that percutaneous microbiopsy appears to be feasible and accurate, and safe to use to obtain muscle tissue from the paraspinal muscles. The use of ultrasonography to determine the puncture site is necessary to ensure biopsy of the correct muscles and to ensure the safety of the procedure.

Skill training preferences and technology use in persons with neck and low back pain

Abstract Background: Neck pain (NP) and low back pain (LBP) are highly prevalent. Exercise therapy helps, but effect sizes and therapy compliance remain low. Client-centred therapy and technology use may play a role to improve therapy outcomes. To offer technology supported rehabilitation matching patient’s goals, training preferences for rehabilitation and technology familiarity need to be known. Purpose: This study aims to (1) inventory training preferences and motives, (2) evaluate whether these change during rehabilitation, and (3) evaluate familiarity with using technologies, in persons with NP/LBP. Method: Semi-structured interviews were conducted with regard to training preferences and usage of mainstream technological devices. Results: Persons with NP (n = 40) preferred to train on “lifting”, “prolonged sitting” and “driving a car”. Persons with LBP (n = 40) preferred to train on “household activities”, “lifting” and “prolonged walking”. Motives were predominantly “ability to work” and “ability to do free time occupations”. Preferences shifted in ranking but remained the same during rehabilitation. Participants were familiar with the surveyed technologies. Conclusion: Persons with NP or LBP prefer to train on exercises supporting the improvement of everyday life skills. They use technologies in their professional and personal life, which may lower the threshold for the adoption of rehabilitation technologies. Implications for rehabilitation Persons with neck pain (NP) and persons with low back pain (LBP) prefer to train on specific activities that limit their functional ability during daily tasks. The underlying motives linked to preferred training activities are predominantly “being able to work” and “being able to perform free time occupations”. Persons with NP and persons with LBP are accustomed to the use of mainstream technologies and the integration of these technologies in rehabilitation settings seems feasible. In order to enable technology supported rehabilitation that is client-centred, technologies need to offer an extensive number of exercises that support (components of) patient training preferences.