Chronic Low Back Pain-Associated Paraspinal Muscle Dysfunction is not the Result of a Constitutionally Determined "Adverse" Fiber-type Composition

Study Design. Investigative case control study. Objectives. To determine whether excessive paraspinal muscle fatigue in chronic low back pain results from a paucity of muscle type I fiber content. Summary of Background Data. Paraspinal muscle function is vital for spinal protection. Prospective studies suggest that excessive paraspinal muscle fatigability may increase risk of first-time low back pain. As contractile performance of the paraspinal muscles is governed by their constitutionally determined fiber composition, the question arises whether a constitutionally determined "adverse" composition could predispose to low back pain through impaired spinal protection. Methods. Thirty-five male patients with chronic low back pain were compared with 32 male control patients of similar age and anthropometry. During Sorensen and 60% of maximum voluntary isometric contraction fatigue tests, median frequency declines in the paraspinal muscle surface electromyograph signal were monitored and correlated with muscle histomorphometry. Results. Patients were weaker than controls during maximum voluntary isometric contractions (84.47 [28.44] vs. 98.74 [18.11] kg, respectively; P = 0.02) and more fatigable during their Sorensen tests (endurance time 105.29 [28.53] vs. 137.50 [40.38] sec, respectively; P <0.01). There were no between-group differences in median frequency declines during the Sorensen (-0.37 [0.16] vs. -0.36 [0.12]%.sec-1) or 60% maximum voluntary isometric contraction (-0.42 [0.31] vs. -0.51 [0.29]%.sec-1) tests, for patients and controls, respectively. There were no between-group differences in the percent number of paraspinal muscle type I fibers (64 [11] vs. 64 [9]%) or the percent area occupied by type I fibers (67 [11] vs. 69 [9]%), for patients and controls, respectively. Type I and II muscle fiber narrow diameters were similar for both groups. Conclusion. In the patients with chronic low back pain tested, their associated paraspinal muscle dysfunction was not the result of a constitutionally determined "adverse" fiber type composition.