Abstract
Purpose
Lumbar paraspinal muscle dysfunction and low back pain are strongly correlated. Muscle atrophy is common in LBP and is recognised by MRI scan. Corticosteroid injections and physical rehabilitation programs are advocated for treatment of LBP.
The purpose is to evaluate efficacy of specific lumbar multifidus muscle retraining exercises and perifacet multifidus injections in treatment of Low Back Pain (LBP) and referred leg pain.
Method
63 patients with non-specific LBP, with or without leg pain, were randomised to three treatment groups. MR images of paraspinal muscle and the atrophy classified. A-Control group, standard physiotherapy for 10 weeks. B-Multifidus rehabilitation program for 10 weeks. C-Perifacet injection (multifidus injection) with methylprednisolone.
ODI was primary outcome measure and the SF-36, modified Zung Depression Index and others were secondary outcome measures.
Results
56 patients completed trial. ODI improved from a mean of 29.9 to 25.9, but there were no statistically significant differences between groups. 62% of patients were at risk/had major psychological overlay. LBP improved most in group C (Perifacet injection) (P< 0.02), mean improvement in SF-36 bodily pain score was 21.2 (with a 95% CI of 2.1-44.0) while PF and SF were improved most in group B (multifidus rehabilitation) (P< 0.03).
Conclusion
Perifacet injection and a multifidus retraining program are more effective than standard physiotherapy in relieving pain and improving physical capacity respectively. Multifidus rehabilitation program is the recommended treatment for non-specific LBP, as the ultimate goal should be to restore function. Perhaps the combination of perifacet injection to relieve pain followed by multifidus retraining program is the best treatment option. No change in the multifidus muscle was seen over time.
