Rehabilitative ultrasound imaging of the lumbar multifidus muscle: measuring morphology

Stokes, Maria (2006) Rehabilitative ultrasound imaging of the lumbar multifidus muscle: measuring morphology. UNSPECIFIED , A10-A11. (doi:10.2519/jospt.2006.0301).


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What Is Known?

The lumbar multifidus muscle has been characterized using
rehabilitative ultrasound imaging (RUSI) in normal populations2,8
and people with spinal pathology.4,5,6 The reliability1,8 and validity3
of the technique have been demonstrated. Morphological features
quantified for multifidus include cross-sectional area (CSA), linear
dimensions (muscle depth/thickness and width) and shape ratios,
with normal reference ranges established.8 Multifidus shape at the
fourth lumbar vertebra (L4) is usually round or oval but a
triangular muscle may indicate hypertrophy.8 At L5 the muscle
usually appears triangular due to the shape of adjacent bony

Linear dimensions are predictive of CSA but the strength of this
relationship is influenced by regularity of shape8 and wasting.5 The
CSA is symmetrical sides) in normal populations and marked asymmetry occurs with
acute low back pain (LBP)5 and idiopathic scoliosis.6 Recovery of
size after LBP is not automatic and requires specific rehabilitation
of multifidus.4 Size measurements and description of shape are
potentially useful for clinical evaluation, and research into the
effects of pathology and interventions.

What Is Unknown?

While data on multifidus morphology are increasing, different
normal populations need to be studied to document the effects of
factors such as ethnicity and habitual physical activity, particularly
in sporting groups.

Size is highly correlated with strength in some muscles but this
relationship is difficult to quantify in multifidus, as isolated force
cannot be measured. The relationship between changes in muscle
thickness and electrical activity is also unknown. The quality of the
image can be poor in the presence of spinal pathology and in
older people, possibly due to infiltration of fat and other
noncontractile tissue, which needs to be quantified. The mechanism
of wasting and whether it is a cause or effect of injury are

What Are the Future Directions and Research Priorities?

If RUSI is to become a routine aid to physical therapy practice
and a robust research tool, standardized protocols for obtaining
measurements are needed. The validity of using linear measurements
to assess the CSA of irregularly shaped muscles requires
attention. Comprehensive studies of different normal populations
are needed to generate reference databases for assessing changes
due to pathology and effects of interventions. Longitudinal epidemiological
studies of multifidus are needed to determine those at
risk of developing LBP, whether wasting occurs before the onset of
injury/pain and to help elucidate the mechanisms of wasting. The
contribution of noncontractile tissue to CSA needs to be quantified
to determine true muscle size, particularly with pathology and
aging. The sonographic technique of elastography is potentially
useful for distinguishing the biomechanical behavior of these

Item Type: Conference or Workshop Item (UNSPECIFIED)
Digital Object Identifier (DOI): doi:10.2519/jospt.2006.0301
ISSNs: 0190-6011 (print)
Related URLs:
Keywords: ultrasound imaging, paraspinal muscles, lumbar multifidus
Subjects: R Medicine > RM Therapeutics. Pharmacology
Q Science > QP Physiology
Q Science > QM Human anatomy
Divisions: University Structure - Pre August 2011 > School of Health Sciences
University Structure - Pre August 2011 > Superseded (SOHPRS)
ePrint ID: 58606
Date :
Date Event
October 2006Published
Date Deposited: 15 Aug 2008
Last Modified: 31 Mar 2016 12:40

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