Biotensegrity: Thoracolumbar Fascial Integrity in Chronic Low Back Pain
Biotensegrity: Thoracolumbar Fascial Integrity in Chronic Low Back Pain
This is a prospective study on chronic low back pain patients aimed at investigating how
 findings on a physical examination and musculoskeletal ultrasound may correlate with
 myofascial damage in the lower back. By comparing these findings with a control group and
 collecting follow up data on patients treated in the course of normal clinical practice, the
 investigators will be able to discern if fascial pathology contributes to chronic low back
 pain and if this treatment approach may provide clinical benefit to patients in the form of
 pain reduction and/or reduction in pain medication use.
This is a prospective, observational clinical study that will be run through a private
 practice clinic.

 New patients to the clinic that complain of chronic lower back pain will be evaluated for
 inclusion and exclusion criteria and appropriately recruited and enrolled into the study. The
 baseline evaluation will take approximately 1.5hours to complete, and will include the
 following: a standardized pain scale questionnaire; a baseline questionnaire that assesses
 duration of current pain and previous interventions; physical examination with novel
 techniques to assess strength; and musculoskeletal ultrasound in the lower back.

 Specific physical examination techniques will assess strength of the subject on both prone
 straight leg raise as well as hip external rotation. Then, the investigators will test how
 adding myofascial tension along the lower back may affect these results. Musculoskeletal
 ultrasound will examine specifically the aponeurosis of the erector spinae and the posterior
 layer of the thoracolumbar fascia at T11, T12, and L1. These areas will be graded on a
 4-point scale (0 to 3), evaluating compressibility and heterogeneity of the tissue.

 Participants who have myofascial damage identified on ultrasound and are scheduled for
 injection treatment as part of normal clinical care will have a diagnostic injection of
 prolotherapy (0.3% lidocaine + 15% dextrose) in those areas as the first step of the
 procedure. Pre and post injection muscle testing will be performed. The treatment session
 then will be completed per normal clinical care; this may include injection at other
 locations and injection of autologous platelet-rich plasma. Routine follow-up will be
 scheduled at 3 months.

 At 3 months, the follow-up visit will include the following: the same pain scale
 questionnaire; a follow-up questionnaire to assess changes in function and pain medication;
 physical examination as before; musculoskeletal ultrasound in the specified areas.

 New patients to the clinic who do not have chronic low back pain >12 weeks will be asked to
 participate as controls, and will undergo a similar questionnaire, and the same physical
 examination and musculoskeletal ultrasound.
Inclusion Criteria:

 -  Age > or = 18 years old

 -  Chronic lower back pain > or = 12 weeks duration

 Exclusion Criteria:

 -  History of stroke preventing bilateral muscle strength testing

 -  History of scoliosis that may affect myofascial dynamics

 -  Acute radiculopathy/sciatica or pain that limits movement for physical examination

 -  Unable to lie prone for physical examination