• Wesselink E
• de Raaij E
• Pevenage P
• van der Kaay N
• Pool J

• Adipose Tissue
• Affiliation / EMGO Institute for Health and Care Research
• Affiliation / Paramedical Centre Fytac
• Affiliation / University of Applied Sciences Utrecht. Research Group Lifestyle and Health
• Affiliation / VU University. Department of Health Sciences
• Affiliation(G) / Netherlands / Amsterdam
• Affiliation(G) / Netherlands / Genemuiden
• Affiliation(G) / Netherlands / Leiden
• Affiliation(G) / Netherlands / Utrecht
• Avoidance Learning
• Fear / psychology
• Low Back Pain
• Magnetic Resonance Imaging
• Open Access Document

Background: Intramuscular adipose tissue (IMAT) is a feature of degenerative muscle composition and is a common feature in populations with chronic low back pain (CLBP). Avoidance behavior is a possible cause of morphological muscle composition due to disuse of the paraspinal muscles. Therefore it is of clinical interest to determine the association between fear-avoidance beliefs and IMAT of the paraspinal muscles in populations with CLBP.

Methods: In this cross-sectional study, we examined twenty-four adults, featuring a mean age of 48.63 years (SD ± 14.73), with CLBP. Axial T2-weighted Magnetic Resonance Imaging (MRI) images were selected on the same level as the intervertebral disc of segments L4-L5 and L5-S1. After determine the region of interest, the amount of IMAT was measured by an automatic-threshold method to distinguish fat from muscle tissue. Fear-avoidance beliefs were measured with the Fear-Avoidance Beliefs Questionnaire, with regard to Physical Activity (FABQ-PA). Bivariate correlation and multiple regression analysis were used to determine the association between IMAT of the paraspinal muscles and fear-avoidance beliefs.

Results: There is a significant bivariate association between the FABQ-PA and ES IMAT (r = 0.484, P = 0.017), but not for LMM (r = 0.228, P = 0.284). The association between the FABQ-PA and ES IMAT remained moderate after adjusting for covariates (β = 0.381, P = 0.028).

Conclusion: Fear-avoidance beliefs are moderately associated with ES IMAT and poorly associated with LMM IMAT in a population with CLBP. Results should be interpreted with caution due to a small and selected study population.

Author keywords: Adipose tissue — Chronic low back pain — Avoidance behavior — MRI

Author affiliations: EW, EdR, NvdK, JP: Research Group Lifestyle and Health, University of Applied Sciences Utrecht, The Netherlands; EW: Paramedical Centre Fytac, Genemuiden, The Netherlands; EdR, JP: Department of Health Sciences, VU University, Amsterdam, The Netherlands; EdR, JP: EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; PP: MRI Centre, Amsterdam, The Netherlands; NvdK: Physiotherapy van der Kaay, Leiden, The Netherlands

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