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Small Multifidus Muscle Size Predicts Football Injuries.

Hides JA, Stanton WR, Mendis MD, Franettovich Smith MM, Sexton MJ - Orthop J Sports Med (2014)

Bottom Line: Previous studies have shown that football players with relatively more severe preseason and playing season hip, groin, and thigh injuries had a significantly smaller multifidus muscle compared with players with no lower limb injuries.Sensitivity and specificity of the model were 60.6% and 84.9% for the preseason and 91.8% and 45.8% for the playing season, respectively.As size of the multifidus muscle has been shown to be modifiable with training and has been associated with reduced pain and occurrence of injuries, this information could be incorporated in current programs of injury prevention.

View Article: PubMed Central - PubMed

Affiliation: School of Physiotherapy, Australian Catholic University, Brisbane, Queensland, Australia. ; Mater/ACU Back Stability Clinic, Mater Health Services, South Brisbane, Queensland, Australia.

ABSTRACT

Background: In Australian football, lower limb injuries have had the highest incidence and prevalence rates. Previous studies have shown that football players with relatively more severe preseason and playing season hip, groin, and thigh injuries had a significantly smaller multifidus muscle compared with players with no lower limb injuries. Rehabilitation of the multifidus muscle, with restoration of its size and function, has been associated with decreased recurrence rates of episodic low back pain and decreased numbers of lower limb injuries in football players. Assessment of multifidus muscle size and function could potentially be incorporated into a model that could be used to predict injuries in football players.

Purpose: To examine the robustness of multifidus muscle measurements as a predictor of lower limb injuries incurred by professional football players.

Study design: Cohort study; Level of evidence, 2.

Methods: Ultrasound examinations were carried out on 259 male elite football players at the start of the preseason and 261 players at the start of the playing season. Injury data were obtained from records collected by the Australian Football League (AFL) club staff during the preseason and the playing season.

Results: Decreased size of the multifidus muscle at L5 consistently predicted injury in the preseason and playing season. Asymmetry of the multifidus muscle and low back pain were significantly related to lower limb injuries in the preseason, and having no preferred kicking leg was related to season injuries. Seasonal change in the size of the multifidus muscle indicating a decrease in muscle mass was linked to injury. Sensitivity and specificity of the model were 60.6% and 84.9% for the preseason and 91.8% and 45.8% for the playing season, respectively.

Conclusion: A model was developed for prediction of lower limb injuries in football players with potential utility for club medical staff. Of particular note is the finding that changes in muscle size from the preseason to the playing season predicted injury.

Clinical relevance: As size of the multifidus muscle has been shown to be modifiable with training and has been associated with reduced pain and occurrence of injuries, this information could be incorporated in current programs of injury prevention.

No MeSH data available.


Related in: MedlinePlus

(A) Transverse image of the multifidus muscle and cross-sectional area measurement at L5. SP, L5 spinous process; ST, subcutaneous tissue. (B) Parasagittal image of the multifidus muscle and thickness measurements of the muscle at rest and on contraction. S, sacrum (used to indicate direction of image); ST, subcutaneous tissue.
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fig1-2325967114537588: (A) Transverse image of the multifidus muscle and cross-sectional area measurement at L5. SP, L5 spinous process; ST, subcutaneous tissue. (B) Parasagittal image of the multifidus muscle and thickness measurements of the muscle at rest and on contraction. S, sacrum (used to indicate direction of image); ST, subcutaneous tissue.

Mentions: The ultrasound imaging apparatus (GE LOGIQ e; GE Healthcare) was equipped with a 5-MHz convex array transducer. Subjects were positioned in a prone position. The lumbar spinous processes were palpated and marked with a pen prior to imaging. Subjects were instructed to relax the paraspinal musculature, electroconductive gel was then applied, and the transducer placed transversely over the relevant spinous process. Bilateral transverse images of the multifidus muscle were obtained where possible except in the case of larger muscles, where left and right sides were imaged separately (Figure 1A). The thickness of the multifidus muscle was also imaged in the parasagittal (longitudinal) section (Figure 1B), allowing visualization of the L5/S1 zygapophyseal joints, multifidus muscle bulk, and thoracolumbar fascia.33 Prior to testing contraction of the multifidus muscle, all subjects received an initial explanation of the type of contraction required, which was isometric and voluntary. Subjects were instructed to take a relaxed breath in and out, pause their breathing, and then try to “swell” or contract the muscle. For the isometric contraction, players were instructed not to move their spine or pelvis when they contracted the muscle. Ultrasound images were stored for offline analysis and subsequently measured by a member of the research team. OsiriX (http://www.osirix-viewer.com/) was used for image visualization and measurement. For measurements of multifidus CSA, the border of the muscle was traced on both sides. For thickness measurements, the multifidus muscle was measured using linear measurements from the tip of the L5/S1 zygapophyseal joint to the inside edge of the superior border of the multifidus muscle at rest33 and on contraction.34


Small Multifidus Muscle Size Predicts Football Injuries.

Hides JA, Stanton WR, Mendis MD, Franettovich Smith MM, Sexton MJ - Orthop J Sports Med (2014)

(A) Transverse image of the multifidus muscle and cross-sectional area measurement at L5. SP, L5 spinous process; ST, subcutaneous tissue. (B) Parasagittal image of the multifidus muscle and thickness measurements of the muscle at rest and on contraction. S, sacrum (used to indicate direction of image); ST, subcutaneous tissue.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555600&req=5

fig1-2325967114537588: (A) Transverse image of the multifidus muscle and cross-sectional area measurement at L5. SP, L5 spinous process; ST, subcutaneous tissue. (B) Parasagittal image of the multifidus muscle and thickness measurements of the muscle at rest and on contraction. S, sacrum (used to indicate direction of image); ST, subcutaneous tissue.
Mentions: The ultrasound imaging apparatus (GE LOGIQ e; GE Healthcare) was equipped with a 5-MHz convex array transducer. Subjects were positioned in a prone position. The lumbar spinous processes were palpated and marked with a pen prior to imaging. Subjects were instructed to relax the paraspinal musculature, electroconductive gel was then applied, and the transducer placed transversely over the relevant spinous process. Bilateral transverse images of the multifidus muscle were obtained where possible except in the case of larger muscles, where left and right sides were imaged separately (Figure 1A). The thickness of the multifidus muscle was also imaged in the parasagittal (longitudinal) section (Figure 1B), allowing visualization of the L5/S1 zygapophyseal joints, multifidus muscle bulk, and thoracolumbar fascia.33 Prior to testing contraction of the multifidus muscle, all subjects received an initial explanation of the type of contraction required, which was isometric and voluntary. Subjects were instructed to take a relaxed breath in and out, pause their breathing, and then try to “swell” or contract the muscle. For the isometric contraction, players were instructed not to move their spine or pelvis when they contracted the muscle. Ultrasound images were stored for offline analysis and subsequently measured by a member of the research team. OsiriX (http://www.osirix-viewer.com/) was used for image visualization and measurement. For measurements of multifidus CSA, the border of the muscle was traced on both sides. For thickness measurements, the multifidus muscle was measured using linear measurements from the tip of the L5/S1 zygapophyseal joint to the inside edge of the superior border of the multifidus muscle at rest33 and on contraction.34

Bottom Line: Previous studies have shown that football players with relatively more severe preseason and playing season hip, groin, and thigh injuries had a significantly smaller multifidus muscle compared with players with no lower limb injuries.Sensitivity and specificity of the model were 60.6% and 84.9% for the preseason and 91.8% and 45.8% for the playing season, respectively.As size of the multifidus muscle has been shown to be modifiable with training and has been associated with reduced pain and occurrence of injuries, this information could be incorporated in current programs of injury prevention.

View Article: PubMed Central - PubMed

Affiliation: School of Physiotherapy, Australian Catholic University, Brisbane, Queensland, Australia. ; Mater/ACU Back Stability Clinic, Mater Health Services, South Brisbane, Queensland, Australia.

ABSTRACT

Background: In Australian football, lower limb injuries have had the highest incidence and prevalence rates. Previous studies have shown that football players with relatively more severe preseason and playing season hip, groin, and thigh injuries had a significantly smaller multifidus muscle compared with players with no lower limb injuries. Rehabilitation of the multifidus muscle, with restoration of its size and function, has been associated with decreased recurrence rates of episodic low back pain and decreased numbers of lower limb injuries in football players. Assessment of multifidus muscle size and function could potentially be incorporated into a model that could be used to predict injuries in football players.

Purpose: To examine the robustness of multifidus muscle measurements as a predictor of lower limb injuries incurred by professional football players.

Study design: Cohort study; Level of evidence, 2.

Methods: Ultrasound examinations were carried out on 259 male elite football players at the start of the preseason and 261 players at the start of the playing season. Injury data were obtained from records collected by the Australian Football League (AFL) club staff during the preseason and the playing season.

Results: Decreased size of the multifidus muscle at L5 consistently predicted injury in the preseason and playing season. Asymmetry of the multifidus muscle and low back pain were significantly related to lower limb injuries in the preseason, and having no preferred kicking leg was related to season injuries. Seasonal change in the size of the multifidus muscle indicating a decrease in muscle mass was linked to injury. Sensitivity and specificity of the model were 60.6% and 84.9% for the preseason and 91.8% and 45.8% for the playing season, respectively.

Conclusion: A model was developed for prediction of lower limb injuries in football players with potential utility for club medical staff. Of particular note is the finding that changes in muscle size from the preseason to the playing season predicted injury.

Clinical relevance: As size of the multifidus muscle has been shown to be modifiable with training and has been associated with reduced pain and occurrence of injuries, this information could be incorporated in current programs of injury prevention.

No MeSH data available.


Related in: MedlinePlus