Researchers measure spine height to see if certain therapies are targeting a specific area of the back and help patients better manage pain.
Snap, crack and pop it’s not the sound of a beloved breakfast cereal, but noises that at least 61 percent of Americans may have experienced before an onset of low back pain.
Americans spend at least $50 billion each year on low back pain, according to the National Institutes of Health. The condition is the second most common neurological ailment in the U.S. only headache is more common.
Treatment for lumbar (low back) pain has traditionally included physical therapy, hot or cold remedies, medication and sometimes surgery.
Repurposing Popular Technology
But Jean-Michel Brismée, PT, Sc.D., associate professor, and Troy Hooper, MPT, ATC, Ph.D., assistant professor in the Doctor of Science Program in Physical Therapy, Department of Rehabilitation Sciences, are working with researchers from the Free University of Brussels in Belgium, Stéphane Sobczak, PT, Ph.D., and Pierre-Michel Dugailly, PT, Ph.D., to develop a way to use ultrasound technology to measure spine height changes, and ultimately find new ways to help physical therapists and their patients better manage lumbar pain.
“The main purpose is to educate the therapist and the patient so they know what to do,” Brismée said. “If we’ve got that technology it may be that we can push the envelope to answer more questions and to help more patients.”
Ultrasound imaging uses a small transducer and ultrasound gel to expose the body to high-frequency sound waves. Ultrasound is safe and painless, and produces real-time pictures of the inside of the body.
Ultrasound has long been used as a non-invasive and safe way to examine many of the body's internal organs, including the heart, liver, kidneys, bladder, uterus and thyroid.
In 2012, the U.S. Food and Drug Administration endorsed the use of a 3-D automated breast ultrasound system and conventional mammograms to boost cancer detection rates for women with dense breasts.
“There’s a lot of applications for ultrasound in the body in general and what we focus on most in rehabilitation is what’s called musculoskeletal ultrasound,” Hooper said. “As physical therapists, we’re not going to diagnose an injury per say, physicians oftentimes will do that, but we use it a lot for training purposes.”
Some lower back pain and compression can be prevented using at-home exercises.
Behind the Pain
The height of the disks between a person’s vertebrae changes over the course of a day, Hooper said. When you wake up in the morning, you’ve been lying down, and water moves into the disk and it thickens, increasing the height of your spine. As you sit, walk or run throughout the day, gravity compresses the disks, pushing water out, and shortening the spine.
“In people who have certain types of low back pain, that process kind of gets out of whack and the disk thins too much,” Hooper said. “One of the problems with people who have low back pain is that the disks that are in between the vertebrae tend to deteriorate over time and degenerate, and they kind of bulge and flatten out.”
In addition to limiting work and recreational activities, low back pain and nerve root compression can cause weakness in the legs, loss of balance, loss of feeling and overall disturbance, which is especially worrisome in the elderly because of increased risk of falling.
Prevention and Relief
“We can help prevent that with some specific positions or exercises people can easily adopt at home during the day,” Brismée said.
There are five segments in the lumbar spine. The bottom two segments, L4 and L5, typically give people the most problems, Hooper said. Physical therapists often work with patients to show them exercises or positions that will lengthen the spine and relieve pain in the back and legs.
Research has shown that when the spine grows, 60 percent of that growth comes from the lumbar spine.
“We know people grow with some exercises, we know from other studies that it happens in the lumbar spine,” Brismée said. “We just don't know exactly if there are specific exercises or positions we can use to increase the height of the lower lumbar spine segments.”
In the past, a device called a stadiometer has been used to accurately measure the height of a person’s entire spinal column from head to trunk. And while these measurements are beneficial to determine spine height, shrinkage and exercises and positions to promote lengthening of a patient’s spine, therapists cannot focus on isolated segments of the lower back to see if the exercises are targeting those specific areas.
“With the ultrasound we can take a picture, and we can measure those specific segments and see if our treatment is affecting the segments that we really want to help,” Hooper said.