Device-assisted muscle strengthening in the rehabilitation of patients after surgically stabilized vertebral fractures
Abstract
Kramer M, Dehner C, Katzmaier P, Neuwirth F, Ebert V, Elbel M, Hartwig E. Device-assisted muscle strengthening in the rehabilitation of patients after surgically stabilized vertebral fractures.
Objectives
To investigate the effects of a device-assisted muscle strengthening exercise program on the surgically traumatized multifidus musculature and on the intact longissimus and iliocostal muscles and to assess the possible relationship between patients’ reported pain symptoms and changes in muscle strength or changes in cross-sectional area (CSA) of the musculature.
University-affiliated center for ambulant physiotherapy.
Participants
Fifteen patients who had undergone dorsal osteosynthesis for treatment of thoracolumbar vertebral fracture and who complained of persistent back pain.
Intervention
Twelve-week device-assisted training exercise program.
Main outcome measures
Patients’ pain score, muscle strength, and the CSA of the paravertebral musculature determined by magnetic resonance imaging (MRI) were assessed before and after the exercise program.
Results
MRI findings revealed no increase in the CSA of the multifidus muscle in any patient (median change, −.27cm2). All patients, however, exhibited hypertrophy of both the longissimus and iliocostal muscles (median change, 1.39cm2). Significant increase in muscle strength was observed in 14 of 16 patients (median increase, 56%; range, 0.7%−126.4%). The median overall pain score improved from 19 (range, 7–24) to 16 (range, 5–27). The change in muscle strength and muscle CSA, however, showed no correlation. There was also no correlation between increase in muscle strength and changes in pain scores.
Conclusions
The device-assisted training program resulted in hypertrophy of the iliocostal and longissimus muscles and an increase in muscle strength in patients with surgically stabilized vertebral fractures. About half of the patients reported relief of pain. No correlation was found between hypertrophy, increase in muscle strength, and relief of pain. The surgically damaged multifidus musculature, however, did not show any change in CSA and was not accessible to rehabilitative measures.
aDepartment of Trauma, Hand and Reconstructive Surgery, University of Ulm, Ulm, Germany.
bDepartment of Diagnostic Radiology, University of Ulm, Ulm, Germany.
Reprint requests to Michael Kramer, MD, Unfall-, Hand- und Wiederherstellungschirurgie, Universität Ulm, Steinhövelstr 9, 89075 Ulm, Germany
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT