Virginia Research Day 2025

Medical Student Research Clinical

30 Physical Exam Maneuvers Suggestive for TIF Involvement in Chronic Low Back Pain

Jacob Barnett, OMSIII; Nicole Fremarek, DO, MBA; David Risov, DO; Per Brolinson, DO; Mathew Chung, DO; Georgina Flynn-Smith, MBEE; Vincent Wang, PHD; Albert Kozar, Do, FAOASM, R-MSK Corresponding author: jbarnett@vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus

exams were performed on all subjects at baseline and in CLBP subjects during treatment dates and follow up dates. Assessments included supine and prone examinations and a lower extremity motor control analysis focusing on hip extension firing patterns (HEFP). Examiners used palpatory feel and patient feedback to gauge muscle recruitment sequences. During these various techniques, regions of the TLF fascia and areas of structural compensation were tested. Data were analyzed to assess abnormal structural patterns in relation to functional impairment, providing insights into CLBP severity. Results: Preliminary data of the first 40 subjects will be presented at the time of the poster. Discussion: The TLF appears to undergo morphological alterations that contribute to fascial stiffness and pain, likely driven by inflammation, fibrosis leading to reduced glide motion. Utilizing specific physical exam techniques can isolate

specific regions of TLF showing relatively (High/ Low) (Sensitivity/Specificity) in CLBP evaluation. Limitations include variability in textbook presentation of exam techniques affecting training, inter-examiner differences despite standardized training, and patient factors such as perception of examinations and pain location, potentially impacting exam consistency and reported findings Future studies should focus on refining these maneuvers, standardizing assessment protocols to reduce potential differences in results based on who is performing the exam. This research states the need for further examination of TLF-specific physical exams as diagnostic adjuncts in CLBP management, which may provide cost-effective and accessible means of early detection and treatment stratification in clinical practice where imaging may not be readily available. TLF study approved by VCOM IRB 10/13/2023 , protocol #: 2023-154

Intro/ Background: Chronic low back pain (CLBP) is a condition that significantly impacts quality of life worldwide. The thoracolumbar fascia (TLF) is a complex tissue structure that has emerged as a critical focus in understanding a potential etiology of CLBP. The TLF is intimately involved in spinal stability, load distribution, and muscular coordination. Recent research implicates alterations in TLF integrity, thickness, and glide motion in patients with CLBP. Despite advancements in imaging and diagnostic modalities, reliable physical exam maneuvers to assess TLF-related dysfunctions in CLBP remain underexplored. This study aims to synthesize specific physical exam maneuvers identifying TLF dysfunction as a potential source of low back pain. Methods: A sample of 18-50 year old men & women were recruited with no LBP (NLBP), acute LBP (ALBP), and CLBP. As secondary outcomes of a larger dually funded DoD and AOA study, physical

153 2025 Research Recognition Day