Date Available


Year of Publication


Document Type



Health Sciences


Rehabilitation Sciences

First Advisor

Terry R. Malone


The purposes of this dissertation were to determine: 1) the relationship betweenmuscle thickness change (MTC) as measured by rehabilitative ultrasound imaging(RUSI) and EMG activity in the lumbar multifidus (LM), 2) if motor control changesproduced by experimentally induced pain are measurable with RUSI, 3) if a differenceexists in MTC between subjects with low back pain (LBP) classified in the treatmentbasedclassification system (TBC) system and controls, 4) if MTC improves followingintervention.Current literature suggests sub-groups of patients with LBP exist and responddifferently to treatment, challenging whether the majority of LBP is "nonspecific". TheTBC system categorizes subjects into one of four categories (stabilization, mobilization,direction specific exercise, or traction). Currently, only stabilization subjects receive anintervention emphasizing stability. Because recent research has demonstrated that motorcontrol impairments of lumbar stabilizing muscles are present in most subjects with LBP,it is hypothesized that impairments may be present across the TBC classifications.Study 1: Established the relationship between MTC as measured by RUSI andEMG in the LM. Study 2: Assessed MTC of the LM during control and painfulconditions to determine if induced pain changes in LM and transverse abdominis (TrA)are measurable with RUSI. Study 3: Measured MTC of the LM and TrA in subjects withLBP classified in the TBC system and 20 controls. Subjects completed a stabilizationprogram and were re-tested.The inter-tester reliability of the RUSI measurements was excellent (ICC3,3 =.91,SEM=3.2%). There was a curvilinear relationship (r = .79) between thickness changeand EMG activity. There was a significant difference (p andlt; .01) between control andpainful conditions on 4 of the 5 LM tasks tested and on the TrA task. There was adifference in MTC between subjects and controls on the loaded LM test which varied bylevel and category. All categories were different from control on the TrA. Followingintervention the TrA MTC improved (p andlt; .01). The LM MTC did not (p values from .13-.86).These findings suggest MTC can be clinically measured and that deficits existwithin TBC system. Significant disability and pain reduction were measured.



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