Maryse Fortin

Spine disorders are one of the leading causes of disability worldwide, with lumbar spine conditions such as chronic low back pain (CLBP) and lumbar spinal stenosis among the most common. Despite a substantial body or research, clinical care for these patients has seen little advancement and associated healthcare costs are exorbitant. To better serve both patients and healthcare systems, some posit that new treatments rooted in cutting-edge science are urgently needed. In the meantime, how can we refine our diagnostics strategies and care delivery models to optimize patient outcomes and reduce healthcare utilization? This Research Topic, "Highlights in Spine Disorders," presents glimpses into efforts to address these critical challenges.Dougherty & Beehler present a theory-driven approach to CLBP management, conceptualizing chronic pain as a biopsychosocial syndrome. Their practical program leverages a shared workspace within the electronic medical record to facilitate coordinated care between chiropractic and behavioral health practitioners. The initiative, titled "Joining Forces" is described by the authors as an efficient model for delivering multidisciplinary care grounded in chronic pain theory, using existing clinical resources. As the authors highlight, effective CLBP management necessitates addressing both pathoanatomic and psychosocial contributors to pain and disability. Lastly, Surapuchong & Pongpirul brief research report evaluated whether radiological parameters measured on standing whole-spine radiographs (e.g., sagittal vertical axis, SVA) are associated with MRI-defined severity of lumbar disc herniation. While SVA showed an association with severe canal compromised, its limited accuracy suggests that it should not be used as exclusive screening tool but may still offer supportive information for referral decisions in resource-limited settings.As editors, we hope the novel approaches presented in these papers will inspire others to think outside the box in ways that challenge existing paradigms and improve outcomes for the countess individuals who continue to suffer from spinal disorders, as well as the healthcare systems that deliver their care.

Background: Muscular dysfunction of the lumbar-pelvic-hip complex is a hallmark of chronic low back pain (cLBP). This dysfunction is partly driven by muscle morphometry and composition, highlighting their importance in cLBP. Exercise-based interventions are commonly used in cLBP management; however, the extent to which different therapeutic approaches influence gluteal muscle health remains unclear. Aquatic therapy may offer a distinct therapeutic environment by reducing spinal loading while facilitating progressive muscle activation. Objectives: This study aimed to (1) investigate the effects of aquatic therapy (AT) versus standard care (SC) on gluteal muscle size, intramuscular fat (IMF) and strength in patients with cLBP and (2) investigate whether positive changes in gluteal muscle health (i.e., size, composition, strength) are associated with concomitant improvements in patient-oriented outcomes. Methods: This randomized controlled trial included 34 participants with moderate-to-severe cLBP. The participants were randomized to either AT ( n = 18) or SC ( n = 16). Both groups completed a 10-week supervised intervention program consisting of 2 sessions per week. The baseline and postintervention assessments included pelvic magnetic resonance imaging, gluteal strength testing, and patient-reported questionnaires. Changes in muscle-related and patient-oriented outcomes within and between groups were analyzed using repeated-measures analysis of covariance, with baseline disability as a covariate. Results: Repeated measures analysis of covariance revealed no significant changes in gluteal muscle volume in either group. Significant decreases in IMF were observed in the gluteus maximus (-2.56 [95%CI: -4.47 to -0.64], p = 0.01) and gluteus medius (-1.00 [95%CI: -1.97 to -0.04], p = 0.04) in the AT group, with no significant changes in the SC group. Both groups demonstrated significant increases in gluteal maximus (AT:55.20 [95%CI: 31.84 to 78.55], p < 0.001; SC:41.45 [95%CI: 16.52 to 66.38], p = 0.002) and medius (AT:72.34 [95%CI: 44.62 to 100.05], p < 0.001; SC:43.91 [95%CI: 14.32 to 73.49], p = 0.005) strength. Improvements in gluteus IMF were moderately correlated with increases in physical quality of life (gluteus maximus: r =-0.33; gluteus medius: r =-0.31) and decreases in pain catastrophizing (gluteus minimus: r = 0.39). Conclusion: The AT group demonstrated significant improvements in strength and IMF content, suggesting potential musculoskeletal benefits health in individuals with cLBP. Trial registration: This study was registered at ClinicalTrials.gov (NCT05823857 on 10/04/2023).

Introduction: Exercise therapy is the most recommended treatment for chronic low back pain (LBP), with evidence supporting modest effects, likely due to the heterogeneity of patient presentations. Evidence suggests that matching individuals to the most appropriate exercise type could improve outcomes. Systematic reviews also emphasise that effective exercise interventions should be patient centred, target paraspinal muscle health and be of sufficient duration. This study addresses these gaps using a targeted care approach to identify a homogenous sample that is more likely to respond to our interventions. The inclusion of a sample with predominant nociceptive pain profile will be performed with the integration of the Pain and Disability Drivers Management Model (PDDM) and the Lumbar Spine Instability Questionnaire (LSIQ). The primary aim of this two-arm randomised controlled trial is to compare the effectiveness of motor control plus isolated lumbar extension exercises (MC+ILEX, arm 1) to free-weight resistance training (arm 2) in reducing LBP-related disability. Secondary aims include examining whether changes in multifidus composition mediate disability improvements comparing intervention effects on muscle size and quality, strength, mobility, pain, quality of life, sleep, physical activity and satisfaction; exploring baseline LSIQ scores and sex/gender as moderators of treatment response; and investigating participants’ perceptions and experiences of exercise therapy. Methods and analysis: A total of 106 participants will be recruited through primary and secondary care and randomised (1:1) to receive either MC+ILEX or free-weight resistance training. Both groups will complete 48 exercise sessions over 16 weeks. The primary outcome will be disability at 16 weeks, measured by the Oswestry Disability Index. Secondary outcomes include multifidus muscle composition and size, lumbar and gluteal muscle strength, hip range of motion, pain, physical and mental function, satisfaction and recovery, health-related quality of life, sleep quality and physical activity levels. Linear mixed-effects models will be used to assess primary and secondary outcomes. Regression analyses will explore whether baseline LSIQ scores moderate treatment effects on multifidus composition and other outcomes. A subsample of participants will undergo semistructured interviews before and after the intervention to explore their illness perceptions, illness mindsets, perceptions of exercise therapy, as well as their experiences and satisfaction with the two exercise interventions. Reflexive thematic analysis will be used to analyse qualitative data. Ethics and dissemination: This study received ethics approval from the Central Ethics Research Committee of the Quebec Minister of Health and Social Services (CCER-25-26-14). Results will be submitted to peer-reviewed journals and scientific meetings. Trial registration number: ISRCTN14864451 .

Background: Multimodal exercise programs do not specifically target lumbar paraspinal musculature, but incorporate aspects of different exercises to have an overall benefit. Objective: To investigate the effect of a multimodal exercise program on paraspinal muscle volume and composition, and patient outcomes in individuals with chronic low back pain (CLBP). Methods: Thirty-four participants with CLBP either completed a 14-week high-intensity training program (n = 8) including cardiorespiratory and resistance exercises 3 sessions per week or were waitlisted (n = 26). Participants underwent magnetic resonance imaging at baseline and post-intervention to assess paraspinal muscle volume (cm3) and fatty infiltration (% FI) at L3-L4, L4-L5, and L5-S1. Pain, disability, quality of life, pain-related fear (catastrophizing and Kinesiophobia), and anxiety were assessed via validated self-reported questionnaires. Results: Mixed-design ANOVA revealed no significant time × group interactions for paraspinal muscle volume and %FI. An exploratory analysis revealed a significant increase in multifidus %FI in the control group at L3-L4, L4-L5, and L5-S1, with a concomitant increase in multifidus volume at L3-L4 and L5-S1. The exercise group had a significant increase in multifidus %FI and volume at L5-S1. Significant time × group interactions for pain, disability, catastrophizing and kinesiophobia, and a main effect of group in physical and mental health were found. Significant correlations were found between changes in patient-reported and functional outcomes with paraspinal muscle morphology. Conclusion: Multimodal exercise programs may help prevent LBP-related paraspinal muscle atrophy and %FI, and lead to concomitant improvements in pain, disability and pain-related fear in individuals with CLBP.

Introduction: The Achilles tendon (AT) plays a crucial role in force transmission and movement efficiency, and greater tendon stiffness may enhance elastic energy storage and improve performance in explosive movements. Shear-wave elastography (SWE) enables reliable, non-invasive assessment of tendon stiffness, yet its associations with other ultrasound (US)-derived properties and functional outcomes remain insufficiently defined in athletes. Limited normative data exists for university-level basketball players, despite the relevance of tendon adaptations and asymmetries in this population. Therefore, this study aimed to examine AT stiffness, thickness, echo intensity (EI), and fibrillar pattern in male and female university basketball athletes, and to explore their associations with ROM, injury history, and performance measures. Methods: Thirty-one university basketball athletes participated in this cross-sectional study. US imaging and SWE measured AT stiffness, thickness, and EI in both the dominant jumping leg (DJL) and the non-dominant jumping leg (NDJL). Functional assessments included a single-leg vertical jump, heel raise (HR) test, and ankle dorsiflexion ROM. Participants also provided demographic information and injury history data. Results: Female players had lower AT thickness compared to males and showed a trend toward lower stiffness. No significant differences in stiffness, thickness, or EI were observed between the dominant and non-dominant jumping legs. Male players with a prior lower-body injury exhibited lower AT stiffness. Correlation analyses revealed no consistent associations between AT properties and performance or ROM, although a strong negative correlation between AT thickness and EI emerged in both sexes. Discussion: Considering sex and injury history when interpreting tendon properties is crucial, and future larger-scale, longitudinal studies are needed to better understand how tendon characteristics evolve and inform training and injury prevention strategies.

Anxiety, depression, and pain-related fears are highly prevalent among individuals with chronic low back pain (CLBP). While aquatic therapy is a promising treatment modality for CLBP, its effects on psychological factors remain poorly understood. To compare the effects of aquatic therapy (AT) versus standard care (SC) on psychological outcomes, pain, and disability in CLBP. In this two-arm randomized controlled trial, 34 participants with CLBP were assigned to AT (n = 18) or SC (n = 16). Both groups received bi-weekly individual sessions over 10 weeks. Pain, disability, quality of life, anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance were assessed using the following validated questionnaires; Numerical Pain Rating Scale, Modified Oswestry Low Back Pain Disability Index, Short-Form 12 Item Survey Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Insomnia Severity Index, respectively. Mixed-design analysis of covariance revealed no significant group*time interactions for any outcomes (all p > 0.05). Both groups improved significantly in pain, disability, quality of life, pain catastrophizing, and anxiety (all p < 0.05). Only AT demonstrated significant reductions in kinesiophobia (p = 0.002) and sleep disturbance (p = 0.001). Aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with CLBP. www.clinicaltrials.gov identifier is NCT05823857.