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A novel subgrouping approach to low back pain : exploring differences in lumbar muscle morphology and function : a cross-sectional study

Rahmat Adnan (UGent) , Lieven Danneels (UGent) , Tine Willems (UGent) , Sophie Van Oosterwijck (UGent) , Evy Dhondt, Dorien Goubert (UGent) and Jessica Van Oosterwijck (UGent)
(2026) JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION.
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Abstract
Background Classifying low back pain (LBP) based solely on symptom duration may be insufficient to explain underlying paraspinal muscle degeneration and dysfunction in recurrent and chronic LBP cases.Methods Fifty-nine females (45 with non-specific low back pain, 14 pain-free controls) were categorized into subgroups using cluster analysis based on personal, pain-related, psychological, and functional characteristics. Lumbar paraspinal muscle structure was assessed using T1-weighted Dixon MRI to measure muscle cross-sectional area (CSA), fat CSA, and muscle fat index (MFI). Muscle function was evaluated using T2-weighted MRI to determine resting T2 values (T2-rest) and T2 shift following muscle activation (T2-shift) at three specific lumbar levels: upper L3 (UL L3), upper L4 (UL L4), and lower L4 (LL L4).Results Four new LBP subgroups were identified and compared to HC (healthy control (n = 14), 23.6%): Neutral (NT; n = 5, 8.5%), Personal and Pain Affected (PA; n = 9, 15.3%), Maladaptive cognition affected (MCA; n = 25, 42.4%), and Personal, Pain, Psychological, and Functional Affected (PPFA; n = 6, 10.2%). NT resembled HC indicating healthy lumbar muscle, PA subgroup showed with a higher fat CSA and MFI in paraspinals muscle. PA and MCA exhibited localized muscle hyperactivity. PPFA subgroups remained metabolically inactive.Conclusions This novel LBP subgrouping framework revealed distinct patterns of paraspinal muscle fatty infiltration and dysfunction. Fatty infiltration and hyperactivity were linked to BMI, chronicity, and cognitive traits; hypoactivity was found in those with broad psychosocial and functional impairments.
Keywords
low back pain, paraspinal muscle, cluster analysis, MRI, fat infiltration, muscle dysfunction, MORRIS DISABILITY QUESTIONNAIRE, CATASTROPHIZING SCALE, HOSPITAL ANXIETY, DEPRESSION SCALE, TRUNK MUSCLES, MANAGEMENT, INFILTRATION, RELIABILITY, STABILITY, REMISSION

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MLA
Adnan, Rahmat, et al. “A Novel Subgrouping Approach to Low Back Pain : Exploring Differences in Lumbar Muscle Morphology and Function : A Cross-Sectional Study.” JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION, 2026, doi:10.1177/10538127261416001.
APA
Adnan, R., Danneels, L., Willems, T., Van Oosterwijck, S., Dhondt, E., Goubert, D., & Van Oosterwijck, J. (2026). A novel subgrouping approach to low back pain : exploring differences in lumbar muscle morphology and function : a cross-sectional study. JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION. https://doi.org/10.1177/10538127261416001
Chicago author-date
Adnan, Rahmat, Lieven Danneels, Tine Willems, Sophie Van Oosterwijck, Evy Dhondt, Dorien Goubert, and Jessica Van Oosterwijck. 2026. “A Novel Subgrouping Approach to Low Back Pain : Exploring Differences in Lumbar Muscle Morphology and Function : A Cross-Sectional Study.” JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION. https://doi.org/10.1177/10538127261416001.
Chicago author-date (all authors)
Adnan, Rahmat, Lieven Danneels, Tine Willems, Sophie Van Oosterwijck, Evy Dhondt, Dorien Goubert, and Jessica Van Oosterwijck. 2026. “A Novel Subgrouping Approach to Low Back Pain : Exploring Differences in Lumbar Muscle Morphology and Function : A Cross-Sectional Study.” JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION. doi:10.1177/10538127261416001.
Vancouver
1.
Adnan R, Danneels L, Willems T, Van Oosterwijck S, Dhondt E, Goubert D, et al. A novel subgrouping approach to low back pain : exploring differences in lumbar muscle morphology and function : a cross-sectional study. JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION. 2026;
IEEE
[1]
R. Adnan et al., “A novel subgrouping approach to low back pain : exploring differences in lumbar muscle morphology and function : a cross-sectional study,” JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION, 2026.
@article{01KKTTJW855W6MSNKXQYJ9CYBC,
  abstract     = {{Background Classifying low back pain (LBP) based solely on symptom duration may be insufficient to explain underlying paraspinal muscle degeneration and dysfunction in recurrent and chronic LBP cases.Methods Fifty-nine females (45 with non-specific low back pain, 14 pain-free controls) were categorized into subgroups using cluster analysis based on personal, pain-related, psychological, and functional characteristics. Lumbar paraspinal muscle structure was assessed using T1-weighted Dixon MRI to measure muscle cross-sectional area (CSA), fat CSA, and muscle fat index (MFI). Muscle function was evaluated using T2-weighted MRI to determine resting T2 values (T2-rest) and T2 shift following muscle activation (T2-shift) at three specific lumbar levels: upper L3 (UL L3), upper L4 (UL L4), and lower L4 (LL L4).Results Four new LBP subgroups were identified and compared to HC (healthy control (n = 14), 23.6%): Neutral (NT; n = 5, 8.5%), Personal and Pain Affected (PA; n = 9, 15.3%), Maladaptive cognition affected (MCA; n = 25, 42.4%), and Personal, Pain, Psychological, and Functional Affected (PPFA; n = 6, 10.2%). NT resembled HC indicating healthy lumbar muscle, PA subgroup showed with a higher fat CSA and MFI in paraspinals muscle. PA and MCA exhibited localized muscle hyperactivity. PPFA subgroups remained metabolically inactive.Conclusions This novel LBP subgrouping framework revealed distinct patterns of paraspinal muscle fatty infiltration and dysfunction. Fatty infiltration and hyperactivity were linked to BMI, chronicity, and cognitive traits; hypoactivity was found in those with broad psychosocial and functional impairments.}},
  author       = {{Adnan, Rahmat and Danneels, Lieven and Willems, Tine and Van Oosterwijck, Sophie and Dhondt, Evy and Goubert, Dorien and Van Oosterwijck, Jessica}},
  issn         = {{1053-8127}},
  journal      = {{JOURNAL OF BACK AND MUSCULOSKELETAL REHABILITATION}},
  keywords     = {{low back pain,paraspinal muscle,cluster analysis,MRI,fat infiltration,muscle dysfunction,MORRIS DISABILITY QUESTIONNAIRE,CATASTROPHIZING SCALE,HOSPITAL ANXIETY,DEPRESSION SCALE,TRUNK MUSCLES,MANAGEMENT,INFILTRATION,RELIABILITY,STABILITY,REMISSION}},
  language     = {{eng}},
  pages        = {{17}},
  title        = {{A novel subgrouping approach to low back pain : exploring differences in lumbar muscle morphology and function : a cross-sectional study}},
  url          = {{http://doi.org/10.1177/10538127261416001}},
  year         = {{2026}},
}
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