Virginia Research Day 2025

Medical Student Research Clinical

31 Passive Glide Assessment of TLF as a Biomarker for CLBP

Marian Pedreira, OMS-3; David Risov, DO; Nicole Fremarek, DO, MBA; Matthew Chung, DO; Georgina Flynn-Smith, MBEE; Gunnar Brolinson, DO; Vincent Wang, PhD; Albert Kozar, DO, FAOASM, R-MSK Corresponding author: mpedreira@vt.vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus

TLF layer is a biomarker for CLBP compared to those without pain. METHODS: Preliminary prospective data from a DoD & AOA-funded study from a convenience sample of 16 subjects with no pain were compared with 18 subjects with CLBP in men & women ages 18-50. Dynamic passive glide of the posterior layer of TLF was measured at L3-4 bilaterally during 20 degrees of controlled passive flexion. 70-second video clips of 5 cycles were recorded and the (means vs best) glide was compared between NLBP and CLBP subjects. Participants underwent an initial history, physical exam, and ultrasound imaging. Post treatment follow-up scans in CLBP subjects were performed at 2,4,6,12 and 24 weeks. RESULTS: This preliminary report of the first 35 subjects (16 NLBP, 18 CLBP, 1 Acute LBP) found that of 18 subjects with CLBP, 15 were found to have a passive TLF glide below the 30th percentile of those

with NLBP. Of the 16 NLBP subjects, five of them had restricted glide. DISCUSSION: US assessment findings confirm that CLBP individuals have reduced passive TLF glide of the posterior layer in passive flexion when compared to those without pain. Potential study limitations include participant recruitment of CLBP individuals and attrition of participants during follow up scans. The development of our objective analysis of sonographic images has high potential impact in the assessment of TLF integrity, injury, and healing via reliable US imaging biomarkers. We anticipate that the tools developed will advance diagnostic and clinical treatment approaches for low back pain, especially for military personnel as these treatments are transferable to the battlefield. Approved by the VCOM IRB, protocol number #2023 154, 10/24/2023.

INTRODUCTION: Chronic low back pain (CLBP) is a leading cause of disability that presents significant clinical challenges. In a study by Gun et al. 34.7% of active-duty soldiers sought care for low back pain over a two-year period (2016-2018). Microinjuries and swelling of the thoracolumbar fascia (TLF) has been identified as an emerging source of CLBP due to the nociceptive potential of its inner layer. Research by Vinning et al. and Langevin et al. indicates that shear strain between the layers of thoracolumbar fascia (TLF) are reduced in CLBP. Fede et al. have linked impaired TLF gliding to the hyperactivation of nerve endings in the multifidus muscle, leading to inflammation and pain. Thus far, only studies by Suarez-Ramos et al. using hydro dissection and van Amstel et al. Hand et al. employing myofascial release have demonstrated any improvement in TLF glide with treatment. Ultrasound imaging of the TLF’s posterior layer can quantify glide motion between its layers. This study aims to investigate if reduced passive glide of the posterior

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