Fat infiltration of the multifidus in whiplash?
An acute or chronic whiplash associated disorder (WAD) is associated with neck pain, radiating arm pain, headache and/ or dizziness. Recent research has provided evidence that for greater fat infiltration in patients suffering from WADs in comparison to those with non-traumatic neck pain.
This study investigated the fat infiltration at different cervical levels of the multificus muscle bilaterally and compared these to healthy controls using a 2-point Dixon water- and fat separated MRI.
Individuals with severe WAD showed a 38% greater fat infiltration compared to patients with a mild to moderate WAD. No differences were found between healthy controls and patients with mild to moderate WAD. No differences were found between differenct cervical segments.
Various explanations have been given for the expression of muscle fat infiltration such as disuse, segmental nerve irritation or injury and damage to segmental structures. Other studies suggest reductions in the alpha-motor-neuron drive. This study did not include posttraumatic stress, so it is unknown whether fat infiltration of the multifidus muscle only is related to WAD.
There have been various studies, which have investigated the fat infiltration in the multifidus muscle in the lower back. It seems there is a relation between an abnormal neuromuscular control.
For physiotherapists, it is important to be able to recognize a neuromuscular disorder. The main aim of the treatment would be to restore this using exercises and specific neuromuscular techniques.
Further research should include more participants to be able to increase the statistical power of the results between a moderate to mild WAD and a severe WAD.
> From: Karlsson et al., J Orthop Sports Phys Ther 46 (2016) 886-893(Epub ahead of print). All rights reserved to Journal of Orthopaedic & Sports Physical Therapy. Click here for the Pubmed summary.