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. 2016 Jan 28;11(1):e0147393.
doi: 10.1371/journal.pone.0147393. eCollection 2016.

Ultrasound Evaluation of the Combined Effects of Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model

Free PMC article

Ultrasound Evaluation of the Combined Effects of Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model

James H Bishop et al. PLoS One. .
Free PMC article


The persistence of back pain following acute back "sprains" is a serious public health problem with poorly understood pathophysiology. The recent finding that human subjects with chronic low back pain (LBP) have increased thickness and decreased mobility of the thoracolumbar fascia measured with ultrasound suggest that the fasciae of the back may be involved in LBP pathophysiology. This study used a porcine model to test the hypothesis that similar ultrasound findings can be produced experimentally in a porcine model by combining a local injury of fascia with movement restriction using a "hobble" device linking one foot to a chest harness for 8 weeks. Ultrasound measurements of thoracolumbar fascia thickness and shear plane mobility (shear strain) during passive hip flexion were made at the 8 week time point on the non-intervention side (injury and/or hobble). Injury alone caused both an increase in fascia thickness (p = .007) and a decrease in fascia shear strain on the non-injured side (p = .027). Movement restriction alone did not change fascia thickness but did decrease shear strain on the non-hobble side (p = .024). The combination of injury plus movement restriction had additive effects on reducing fascia mobility with a 52% reduction in shear strain compared with controls and a 28% reduction compared to movement restriction alone. These results suggest that a back injury involving fascia, even when healed, can affect the relative mobility of fascia layers away from the injured area, especially when movement is also restricted.

Conflict of interest statement

Competing Interests: The authors have declared no competing interests exist.


Fig 1
Fig 1. Movement restriction and fascia injury methods.
(A) Hobble device used to induce movement restriction. (B) Location of fascia injury. (C) Location of fascia injury plane.
Fig 2
Fig 2. Ultrasound data acquisition methods.
(A) Location of ultrasound images used for determination of fascia thickness. (B) Method used for acquisition of ultrasound cine-recording during passive trunk flexion.
Fig 3
Fig 3. Location of tissue zones used for measurement of tissue thickness in ultrasound images.
D: dermis, SST: superficial subcutaneous tissue, DST: deep subcutaneous tissue, TF: thoracolumbar fascia.
Fig 4
Fig 4. Pig growth over the course of the experiment.
There were no significant weight differences among groups at 0, 5, and 8 weeks.
Fig 5
Fig 5. Gait analysis.
Gait speed (m/sec) was measured at week 8. There was a significant main effect of movement restriction on gait speed (ANOVA p = .03), but no significant effect of injury (ANOVA p = 2.56).
Fig 6
Fig 6. Ultrasound measurements of tissue thickness.
The tissue thickness in four Zones (See Fig 3 for Zone locations) was measured at the L3-4 vertebral level on the non-intervention side. There was no significant difference in the combined thickness of dermis and superficial connective tissue (Zone 1) among groups (p = 0.60). The thickness of Zone 2 (deep subcutaneous tissue and perimuscular fascia), Zone 3 (deep subcutaneous tissue) and Zone 4 (perimuscular fascia) all were significantly greater in the injured pigs compared with the other groups (ANOVA, main effect of injury for p = .007 (Zone 2), p = .026 (Zone 3) p = .04 (Zone 4)).
Fig 7
Fig 7. Perimuscular fascia shear strain measurements.
Both injury and movement restriction (hobble) led to a significant reduction in thoracolumbar fascia shear strain (ANOVA main effects of injury p = .027, and hobble p = .021). There was no significant interaction between the effects of injury and hobble.

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