Vol 5-1 Original Article

Association Between Multifidus Intramyocellular Lipids and Pain-Related Disorders, Lumbar Spine Dysfunction, Gait Disturbance in Patients with Chronic Low Back Pain: A Cross-Sectional Study Using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire

Background and aims: Fat degeneration in the multifidus muscle (Mm) was more common than in other trunk muscles. We hypothesised that the lipid contents of the Mm and patient-reported quality of life (QOL) are related. However, there are no papers examining the association between fatty degeneration of the Mm and patient-reported QOL using magnetic resonance spectroscopy (MRS). This cross-sectional study aimed to investigate the association between patient-reported QOL, evaluated with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and the intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) contents of the Mm and psoas major (PM) by MRS in patients with chronic low back pain (CLBP).

Materials and Methods:

Forty-eight patients (mean age, 64.2 ± 13.2 years; age range, 41–79 years) with nonspecific CLBP underwent MRS for the quantification of IMCL and EMCL of the right Mm and PM in a volume of interest at L4/L5. All subjects underwent MRS and completed the JOABPEQ in the same day. We performed multiple linear regression analysis of the IMCL and EMCL contents of the Mm and PM with the five domains of the JOABPEQ adjusted for age, sex, and body mass index.

Results: The IMCL content of the Mm was correlated with pain-related disorders (standardised partial regression coefficient (β)=−0.59, p<0.01), lumbar spine dysfunction (β=−0.64, p<0.01), and social life dysfunction (β=−0.31, p<0.01) which showed moderate negative correlation, but not with psychological disorders. The EMCL content of the Mm was not correlated with the five domains of the JOABPEQ. The IMCL and EMCL contents of the PM was not correlated with the five domains of the JOABPEQ.

Conclusions: IMCL content of the Mm was significantly correlated with the pain-related disorders, lumbar spine dysfunction, gait disturbance, and social life dysfunction domain scores of the JOABPEQ. Future studies using magnetic resonance spectroscopy of the Mm in patients with CLBP may help optimize exercise strategies using IMCL as an index to enhance patient-reported quality of life.

DOI: 10.29245/2767-5122/2023/1.1133 View / Download Pdf
Vol 5-1 Review Article

Object Relations Theory: A Primer for Rehabilitation Psychologists

Object Relations (OR) has been identified as one of the four major schools of psychoanalysis1. This article provides a comprehensive review of OR practice and theory in the context of rehabilitation psychology. Extensive data are presented on five of the most prominent pioneer object relations theorists, including Melanie Klein, W. R. D. Fairbairn, Michal Balint, Harry Guntrip, and D. W. Winnicott. All of these individuals have contributed significantly to object relations theory. Melanie Klein and W. R. D Fairbairn have been credited with founding the object relations perspective, Michael Balint has been touted as the leading object relations theorist, Harry Guntrip was analyzed by both Fairbairn and Winnicott, and D.W. Winnicott is probably the most creative and respected psychoanalytic theorist since Sigmund Freud. All five of these theorists brought a fresh, new perspective on psychoanalytic theory and practice, and their contributions may be used to better understand the personality development of persons with a disability and to inform the practice of rehabilitation psychology.

DOI: 10.29245/2767-5122/2023/1.1131 View / Download Pdf
Vol 5-1 Case Report

A Single Session of Spinal Decompression with Oscillation and Videofluoroscopy

Background: Computerized spinal decompression using the intervertebral differential dynamics (IDD) therapy protocol has achieved 86–92% positive results in reducing back pain. There are many causes of back pain, and one of the most common is a degenerative disc. The etiology of a degenerative disc is not completely understood, but it can be related to acute injuries, repetitive stress, nutrition, genetic factors, and oxidative stress1. Standard of care may include physical therapy or manipulation to introduce movement to the spinal vertebrae. IDD Therapy® uses a calculated, sinusoidal, logarithmic primary waveform to separate the spinal vertebrae. More recent studies have shown that the addition of a secondary waveform gives a significant increase in efficacy. We observed these effects on the spine during an IDD Therapy® session.

Methods: Images of the intervertebral space were taken by videofluoroscopy during the IDD Therapy® session.

Results: The expected separation of L5-S1 was achieved. We also noted the separation profile of the vertebrae was uniquely uniform despite the graduated pressures, particularly when the secondary oscillation waveform was introduced. L5-S1 separation was 1 mm in size, and the anterior–posterior correlation was significant (p<0.05).

Conclusion: Active oscillatory signaling introduced during the high-tension period of treatment may lead to more compliant muscle re-education and thus enhanced uniform separation of the vertebrae. We believe that IDD Therapy® using Accu-Spina® may achieve 92% positive results because the secondary oscillatory signal induces mechanotransduction of mechanical stimuli into electrochemical activity at the cellular level. Further research will lead to greater confidence and further exploration of mechanotransduction in intradiscal cellular tissues.

DOI: 10.29245/2767-5122/2023/1.1132 View / Download Pdf