Extending Ultrasound Elastography to Manual Treatment Methods
Condition: Back Pain
MeSH terms: Back Pain
Study type: Observational

Summary: 
      Manual treatment offers benefit to some patients suffering from back pain but little is known
      about which of the many tissue layers are affected. This study will help identify which
      tissues may be stimulated sufficiently to be a source for the clinical effects of treatment
      and to prioritize future work to understand mechanisms of back pain and to improve care.

      Current soft-tissue ultrasound elastography techniques, under static condition, will be
      extended to quantify relative displacement and strains(active and passive)across the depth of
      tissue strata that arise from small amplitude motions during continuous passive motion
      clinical procedures and in weight bearing postures. Relative movement of the stratified
      layers of the back, from treatment and task-generated perturbations, will enable the
      elastography interrogation of the tissue.
    

Detailed description: 
      1. Tissue displacement and strain differs dependent on comparable tasks, in recumbent vs
           upright postures and muscular activation.

           - Refine motion tracking and stabilization of manual elastography, used in preliminary
           study, to evaluate layered tissue strain patterns during clinical continuous passive
           motion (flexion, extension and lateral bending) and standardized weight bearing (stance,
           flexion to 15 degrees and arm-extended weight holding).

        2. Relative muscle activity is significantly related to muscle strain ratio.

           - Evaluate the biceps as a simple model, in parallel, for displacement and elastography
           changes.

        3. Displacement and strain decrease monotonically as depth of paraspinal tissue from the
           surface increases.

           - Evaluate the timing relationship of total passive loads, myoelectric paraspinal
           behavior displacement/strain characteristics at the l4/l5 level for the longissimus,
           intermuscular fascia and multifidus at baseline and during standardize weight bearing
           tasks as well as at recumbent baseline, during and return to neutral for prone and
           lateral recumbent continuous passive motion maneuvers.

        4. Change in tissue displacement and strains differ between healthy and unhealthy
           individuals when change in muscle activity and tissue layer are taken into account.

             -  Assess any differences in displacement and strain characteristics of the layered
                longissimus, intermuscular fascia and multifidus between healthy and chronic low
                back patients in the timing relationship to movement, total passive load amplitudes
                and myoelectric activity.
    

Observational model: Cohort
Sampling method: Non-Probability Sample
Study population: 
        Group 1: Fifteen healthy volunteers from Canadian Memorial Chiropractic College (CMCC)
        community.

        Group 2: 30 Subjects (15 healthy volunteers and 15 chronic low back pain)
      
Keywords: Musculoskeletal