Trunk Muscle Characteristics: Differences Between Sedentary Adults With and Without Unilateral Lower Limb Amputation

Arch Phys Med Rehabil. 2021 Jul;102(7):1331-1339. doi: 10.1016/j.apmr.2021.02.008. Epub 2021 Mar 5.


Objective: The primary purpose of this study was to compare trunk muscle characteristics between adults with and without unilateral lower limb amputation (LLA) to determine the presence of modifiable trunk muscle deficits (ie, impaired activity, reduced volume, increased intramuscular fat) evaluated by ultrasonography (US) and magnetic resonance imaging (MRI). We hypothesized that compared with adults without LLA (controls), individuals with transfemoral or transtibial LLA would demonstrate reduced multifidi activity, worse multifidi and erector spinae morphology, and greater side-to-side trunk muscle asymmetries.

Design: Cross-sectional imaging study.

Setting: Research laboratory and imaging center.

Participants: Sedentary adults (n=38 total) with LLA (n=9 transfemoral level; n=14 transtibial level) and controls without LLA (n=15).

Interventions: Not applicable.

Main outcome measures: We examined bilateral multifidi activity using US at levels L3/L4-L5/S1. MRI was performed using 3-dimensional quantitative fat-water imaging; bilateral L1-L5 multifidi and erector spinae were manually traced, and muscle volume (normalized to body weight) and percentage intramuscular fat were determined. Between-group and side-to-side differences were evaluated.

Results: Compared with adults without LLA, participants with LLA demonstrated reduced sound-side multifidi activity; those with transfemoral LLA had larger amputated-side multifidi volume, whereas those with transtibial LLA had greater sound- and amputated-side erector spinae intramuscular fat (P<.050). With transfemoral LLA, side-to-side differences in erector spinae volume, as well as multifidi and erector spinae intramuscular fat, were found (P<.050).

Conclusions: Impaired trunk muscle activity and increased intramuscular fat may be modifiable targets for intervention after LLA.

Keywords: Amputation; Artificial limbs; Atrophy; Back; Disuse; Magnetic resonance imaging; Paraspinal muscles; Rehabilitation; Reliability; Ultrasonography.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amputees*
  • Back Muscles / diagnostic imaging*
  • Back Muscles / physiopathology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Lower Extremity
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Sedentary Behavior*
  • Torso / diagnostic imaging*
  • Torso / physiopathology*
  • Ultrasonography