The Association of Lumbar Paraspinal Muscle Size and Quality With Physical Function, Disability, and Pain in Adults With Chronic Low Back Pain

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Abstract
OBJECTIVE: To examine associations between lumbar paraspinal muscle morphology and physical function, disability, and pain in chronic low back pain (LBP). DESIGN: Cross-sectional study. METHODS: Cross-sectional area (CSA) and attenuation of the erector spinae and multifidi (upper: L1-L3; lower: L4-S1), psoas, and quadratus lumborum (L3) were measured from computed tomography images. Performance-based physical function was assessed using the five times sit-to-stand, 2-minute walk, 4-meter walk, active sit-up, and single-leg stance tests. Disability and symptoms were evaluated using the Oswestry Disability Index, the numeric pain rating scale, and painDETECT. Linear and logistic regression analyses were conducted, adjusting for age, sex, and body mass index (BMI). RESULTS: We analyzed data from 193 adults (age: 55.0 ± 16.0 years; BMI: 27.2 ± 4.0; 55% female). Lower erector spinae CSA was associated with walking speed ( β = .00006, P = .021); upper erector spinae CSA, with balance ( β = .002, P = .039); lower multifidi CSA, with neuropathic symptoms ( β = −.010, P = .017); and quadratus lumborum CSA, with abdominal endurance ( β = −.006, P = .012). Upper erector spinae attenuation was associated with abdominal endurance ( β = .046, P = .047), whereas quadratus lumborum attenuation was associated with balance ( β = .046, P = .018). CONCLUSION: Lumbar paraspinal muscle morphology was associated with physical function and neuropathic symptoms in people with chronic LBP. JOSPT Open 2026;4(2):181-195. Epub 16 February 2026. doi:10.2519/josptopen.2026.0202

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