1.Ultrasonic morphological characteristics of superficial and deep thoracolumbar paraspinal muscles in patients with moderate adolescent idiopathic scoliosis
Shanshan ZHANG ; Yanjun WANG ; Zhiwei LIAN ; Yi XU ; Binbin YANG ; Qiuli LIANG ; Chuhuai WANG
Chinese Journal of Spine and Spinal Cord 2025;35(4):366-375
Objectives:To explore the morphological changes of the superficial and deep thoraolumbar paraspinal muscles on both convex and concave sides during rest and contraction states in patients with mod-erate adolescent idiopathic scoliosis(AIS),and their effects on scoliosis angle,to analyze the relations between scoliosis angle and the morphological changes of paraspinal muscles.Methods:21 AIS patients(thoracic Cobb angle 20°-45°,S-shaped with the main curve in thoracic segment,4 males and 17 females,aged 13.9±1.6 years old)treated in our hospital from July 2020 to December 2023 and 21 healthy subjects(7 males and 14 females,aged 14.6±1.4 years old)were prospectively enrolled.The morphological data of thoracolumbar paraspinal muscles were collected with musculoskeletal ultrasound,including the resting thickness and thick-ness during maximum voluntary isometric contraction(MVIC)of superficial erector spinae(ES)and multifidus(MF)muscles of AIS patients on both convex and concave sides(left and right sides of healthy controls).The differences in resting thickness,contraction thickness,change rate of contraction thickness,and total resting thickness and total contraction thickness(ES+MF)of superficial and deep thoracolumbar paravertebral muscles between the two groups were analyzed,and the structural characteristics of the thoracolumbar paravertebral muscles on the convex and concave sides of AIS were analyzed.The correlation between Cobb angle in tho-racolumbar segment and morphological indexes(resting thickness,contraction thickness change rates)of ES and MF muscles was analyzed,and the influence of scoliosis severity on the morphology of superficial and deep paravertebral muscle was further analyzed.Results:In AIS patients,the mean thoracic Cobb angle were 31.62°±7.68°,and mean lumbar Cobb angle were 19.52°±6.48°.Comparing with healthy controls,patients with AIS were significantly different in resting thickness,contraction thickness and thickness change rates of tho-racic paraspinal muscles on both convex and concave sides,and the resting thickness of ES in thoracic seg-ment on concave side was less than that on the convex side,which of MF was less on the convex side than on the concave side(P<0.01).The contraction thickness of thoracic MF muscles on the convex and concave sides in S-type AIS patients was smaller than that in healthy controls(P<0.05),while the contraction thickness of thoracic ES muscles on the convex and concave side wasn't statistically different from that of healthy con-trols,and the contraction thickness change rate of ES muscles on the convex and MF on the concave side of thoracic segment in AIS patients was significantly decreased(P<0.05).There was no significant difference in the total resting thickness of thoracic(convex and concave)paravertebral muscles(ES+MF)between AIS patients and the corresponding segments(left and right)of control group(P>0.05),and there was no statistically signifi-cant difference in the total resting thickness of thoracic paravertebral muscle between the convex and concave sides of AIS patients(P>0.05).The total contraction thickness of thoracic paravertebral muscle(ES+MF)in AIS patients was lower than that in control group(P<0.05).Compared with the control group,the resting thickness,contraction thickness and thickness change rate of lumbar MF muscle on the convex and concave sides in AIS patients were significantly reduced(P<0.05),and the contraction thickness change rate of the lumbar ES muscle on the concave side was less than that of the control group(P<0.05).There were no significant differ-ences in resting thickness and contraction thickness between the convex and concave paravertebral muscles in AIS patients(P>0.05).The total resting thickness(ES+MF)and total contraction thickness(ES+MF)of lumbar(convex and concave)paraspinal muscles in AIS patients were lower than those in control group(P<0.05).There was a significant negative correlation between the Cobb angle of the main thoracic curve and the rest-ing thickness of the thoracic MF muscle on the concave and the change rate of the contraction thickness of the thoracic ES muscle on the convex in S-type AIS patients(r=-0.53/-0.45,P<0.05).There was no signifi-cant correlation between the Cobb angle of lumbar segment and the change rates of the resting thickness and contraction thickness of ES and MF muscles on both convex and concave sides(P>0.05).Conclusions:In pa-tients with moderate S-type AIS,there are different muscle morphological changes in the paraspinal muscles on both convex and concave sides of the main thoracic curve,and the concave paravertebral muscle is more affected by scoliosis;The contraction function of the bilateral deep core stabilizing muscles in the lumbar re-gion is markedly decreased.Different patterns of superficial and deep muscle atrophy and contractility decline may be a key cause of spinal movement disorder and scoliosis progression in AIS patients.
2.The dynamic plantar pressure distribution of persons with chronic plantar fasciitis
Xiulan HAN ; Shanshan ZHANG ; Guifang ZHANG ; Zhiwei LIAN ; Shanshan BAO ; Zhenfa ZHANG ; Chuhuai WANG
Chinese Journal of Physical Medicine and Rehabilitation 2025;47(8):721-726
Objective:To analyze the dynamic plantar pressure distribution of persons with chronic plantar fasciitis (PF).Methods:Twenty persons with unilateral, chronic PF were recruited as the PF group, while twenty-three healthy counterparts were recruited as the control group. A foot-pressure measurement system was used to collect data describing the plantar pressure for each subject with or without PF while walking. The pressure data included the load of peak plantar pressure (PP), the mean plantar pressure (MP), the total foot ground contact area (TCA), and the load percentage and the foot ground contact area beneath the medial heel (MH), the lateral heel (LH), the medial longitudinal arch (MLA), the lateral longitudinal arch (LLA), the first metatarsal head (M1), the second to third metatarsal heads (M2-3), the fourth to fifth metatarsal heads (M4-5), the hallux (T1), and toes two to five (T2-5).Results:In the PF group, significant differences were observed during walking between the affected and unaffected feet in terms of PP [(2.41±0.44)kg/cm 2 versus (3.02±0.63)kg/cm 2]. Both were significantly greater than among the control group. Asymmetry in the load distribution was identified beneath the MH, M2-3, M1, MLA, M4-5 and T2-5 among the chronic PF group. There were also significant differences between the affected foot of the chronic PF group and the non-dominant foot of the control group with regard to the load percentage beneath the LH, M4-5, T2-5, M2-3 and T1. The load percentage under the LH was significantly higher under the unaffected foot of the PF group than under the dominant foot of the control group. In terms of ground contact area, the T2-5 area of the affected foot of the PF group was significantly smaller than that of the unaffected foot, as well as compared to the non-dominant foot of the control group. The TCA of both feet among the PF group was significantly smaller than under the corresponding feet of the control group. Conclusions:Patients with chronic plantar fasciitis apply plantar pressure asymmetrically during walking. They tend to shift their weight laterally onto the asymptomatic foot. During walking, those with PF apply higher plantar pressure over a smaller ground contact area.
3.Ultrasonic morphological characteristics of superficial and deep thoracolumbar paraspinal muscles in patients with moderate adolescent idiopathic scoliosis
Shanshan ZHANG ; Yanjun WANG ; Zhiwei LIAN ; Yi XU ; Binbin YANG ; Qiuli LIANG ; Chuhuai WANG
Chinese Journal of Spine and Spinal Cord 2025;35(4):366-375
Objectives:To explore the morphological changes of the superficial and deep thoraolumbar paraspinal muscles on both convex and concave sides during rest and contraction states in patients with mod-erate adolescent idiopathic scoliosis(AIS),and their effects on scoliosis angle,to analyze the relations between scoliosis angle and the morphological changes of paraspinal muscles.Methods:21 AIS patients(thoracic Cobb angle 20°-45°,S-shaped with the main curve in thoracic segment,4 males and 17 females,aged 13.9±1.6 years old)treated in our hospital from July 2020 to December 2023 and 21 healthy subjects(7 males and 14 females,aged 14.6±1.4 years old)were prospectively enrolled.The morphological data of thoracolumbar paraspinal muscles were collected with musculoskeletal ultrasound,including the resting thickness and thick-ness during maximum voluntary isometric contraction(MVIC)of superficial erector spinae(ES)and multifidus(MF)muscles of AIS patients on both convex and concave sides(left and right sides of healthy controls).The differences in resting thickness,contraction thickness,change rate of contraction thickness,and total resting thickness and total contraction thickness(ES+MF)of superficial and deep thoracolumbar paravertebral muscles between the two groups were analyzed,and the structural characteristics of the thoracolumbar paravertebral muscles on the convex and concave sides of AIS were analyzed.The correlation between Cobb angle in tho-racolumbar segment and morphological indexes(resting thickness,contraction thickness change rates)of ES and MF muscles was analyzed,and the influence of scoliosis severity on the morphology of superficial and deep paravertebral muscle was further analyzed.Results:In AIS patients,the mean thoracic Cobb angle were 31.62°±7.68°,and mean lumbar Cobb angle were 19.52°±6.48°.Comparing with healthy controls,patients with AIS were significantly different in resting thickness,contraction thickness and thickness change rates of tho-racic paraspinal muscles on both convex and concave sides,and the resting thickness of ES in thoracic seg-ment on concave side was less than that on the convex side,which of MF was less on the convex side than on the concave side(P<0.01).The contraction thickness of thoracic MF muscles on the convex and concave sides in S-type AIS patients was smaller than that in healthy controls(P<0.05),while the contraction thickness of thoracic ES muscles on the convex and concave side wasn't statistically different from that of healthy con-trols,and the contraction thickness change rate of ES muscles on the convex and MF on the concave side of thoracic segment in AIS patients was significantly decreased(P<0.05).There was no significant difference in the total resting thickness of thoracic(convex and concave)paravertebral muscles(ES+MF)between AIS patients and the corresponding segments(left and right)of control group(P>0.05),and there was no statistically signifi-cant difference in the total resting thickness of thoracic paravertebral muscle between the convex and concave sides of AIS patients(P>0.05).The total contraction thickness of thoracic paravertebral muscle(ES+MF)in AIS patients was lower than that in control group(P<0.05).Compared with the control group,the resting thickness,contraction thickness and thickness change rate of lumbar MF muscle on the convex and concave sides in AIS patients were significantly reduced(P<0.05),and the contraction thickness change rate of the lumbar ES muscle on the concave side was less than that of the control group(P<0.05).There were no significant differ-ences in resting thickness and contraction thickness between the convex and concave paravertebral muscles in AIS patients(P>0.05).The total resting thickness(ES+MF)and total contraction thickness(ES+MF)of lumbar(convex and concave)paraspinal muscles in AIS patients were lower than those in control group(P<0.05).There was a significant negative correlation between the Cobb angle of the main thoracic curve and the rest-ing thickness of the thoracic MF muscle on the concave and the change rate of the contraction thickness of the thoracic ES muscle on the convex in S-type AIS patients(r=-0.53/-0.45,P<0.05).There was no signifi-cant correlation between the Cobb angle of lumbar segment and the change rates of the resting thickness and contraction thickness of ES and MF muscles on both convex and concave sides(P>0.05).Conclusions:In pa-tients with moderate S-type AIS,there are different muscle morphological changes in the paraspinal muscles on both convex and concave sides of the main thoracic curve,and the concave paravertebral muscle is more affected by scoliosis;The contraction function of the bilateral deep core stabilizing muscles in the lumbar re-gion is markedly decreased.Different patterns of superficial and deep muscle atrophy and contractility decline may be a key cause of spinal movement disorder and scoliosis progression in AIS patients.
4.Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing
Zhaoqiang XU ; Yan LI ; Jiahui PENG ; Haoyu XIE ; Yu CHEN ; Chuhuai WANG
Chinese Journal of Rehabilitation Theory and Practice 2025;31(4):466-475
Objective To compare trunk muscle activation,muscle co-contraction levels and plantar pressure distribution between patients with chronic low back pain(cLBP)and healthy subjects during static standing.Methods From July,2021 to July,2022,17 healthy subjects(healthy control group)and 18 cLBP patients(cLBP group)were recruited from the Department of Rehabilitation Medicine,the First Affiliated Hospital of Sun Yat-sen Uni-versity.Demographic information was collected for both groups,as well as the pain intensity,functional disabili-ty,and center of pressure displacement parameters of the cLBP group in static standing.A plantar pressure plate was used to record plantar pressure distribution in static standing task.Simultaneously,a wireless surface electro-myography(sEMG)system was used to record the activity of the transverse abdominis(TrA),erector spinae(ES)and lumbar multifidus(LM).The activation levels of each muscle and the co-contraction index(CCI)between trunk muscle pairs were analyzed.Results Compared with the healthy control group,the cLBP group showed higher activation levels of the bilateral LM(∣t∣>2.479,P<0.05)and higher lumbar-abdominal muscle CCI of left LM-left TrA(t=2.212,P=0.042),left LM-right TrA(t=2.868,P=0.008)and right LM-right TrA(U=75.000,P=0.009).In the cLBP group,pres-sure decreased in the right big toe region(t=2.825,P=0.009),and increased in the right medial and left lateral heel regions(U<77.000,P<0.05).Conclusions During static standing,patients with cLBP require higher level of trunk muscle activation and co-contrac-tion,with a posterior shift in plantar pressure distribution,which might be due to the adoption of different postur-al compensation strategies to maintain postural stability.
5.Characteristics of trunk muscle activation and plantar pressure distribution in patients with chronic low back pain in static standing
Zhaoqiang XU ; Yan LI ; Jiahui PENG ; Haoyu XIE ; Yu CHEN ; Chuhuai WANG
Chinese Journal of Rehabilitation Theory and Practice 2025;31(4):466-475
Objective To compare trunk muscle activation,muscle co-contraction levels and plantar pressure distribution between patients with chronic low back pain(cLBP)and healthy subjects during static standing.Methods From July,2021 to July,2022,17 healthy subjects(healthy control group)and 18 cLBP patients(cLBP group)were recruited from the Department of Rehabilitation Medicine,the First Affiliated Hospital of Sun Yat-sen Uni-versity.Demographic information was collected for both groups,as well as the pain intensity,functional disabili-ty,and center of pressure displacement parameters of the cLBP group in static standing.A plantar pressure plate was used to record plantar pressure distribution in static standing task.Simultaneously,a wireless surface electro-myography(sEMG)system was used to record the activity of the transverse abdominis(TrA),erector spinae(ES)and lumbar multifidus(LM).The activation levels of each muscle and the co-contraction index(CCI)between trunk muscle pairs were analyzed.Results Compared with the healthy control group,the cLBP group showed higher activation levels of the bilateral LM(∣t∣>2.479,P<0.05)and higher lumbar-abdominal muscle CCI of left LM-left TrA(t=2.212,P=0.042),left LM-right TrA(t=2.868,P=0.008)and right LM-right TrA(U=75.000,P=0.009).In the cLBP group,pres-sure decreased in the right big toe region(t=2.825,P=0.009),and increased in the right medial and left lateral heel regions(U<77.000,P<0.05).Conclusions During static standing,patients with cLBP require higher level of trunk muscle activation and co-contrac-tion,with a posterior shift in plantar pressure distribution,which might be due to the adoption of different postur-al compensation strategies to maintain postural stability.
6.The dynamic plantar pressure distribution of persons with chronic plantar fasciitis
Xiulan HAN ; Shanshan ZHANG ; Guifang ZHANG ; Zhiwei LIAN ; Shanshan BAO ; Zhenfa ZHANG ; Chuhuai WANG
Chinese Journal of Physical Medicine and Rehabilitation 2025;47(8):721-726
Objective:To analyze the dynamic plantar pressure distribution of persons with chronic plantar fasciitis (PF).Methods:Twenty persons with unilateral, chronic PF were recruited as the PF group, while twenty-three healthy counterparts were recruited as the control group. A foot-pressure measurement system was used to collect data describing the plantar pressure for each subject with or without PF while walking. The pressure data included the load of peak plantar pressure (PP), the mean plantar pressure (MP), the total foot ground contact area (TCA), and the load percentage and the foot ground contact area beneath the medial heel (MH), the lateral heel (LH), the medial longitudinal arch (MLA), the lateral longitudinal arch (LLA), the first metatarsal head (M1), the second to third metatarsal heads (M2-3), the fourth to fifth metatarsal heads (M4-5), the hallux (T1), and toes two to five (T2-5).Results:In the PF group, significant differences were observed during walking between the affected and unaffected feet in terms of PP [(2.41±0.44)kg/cm 2 versus (3.02±0.63)kg/cm 2]. Both were significantly greater than among the control group. Asymmetry in the load distribution was identified beneath the MH, M2-3, M1, MLA, M4-5 and T2-5 among the chronic PF group. There were also significant differences between the affected foot of the chronic PF group and the non-dominant foot of the control group with regard to the load percentage beneath the LH, M4-5, T2-5, M2-3 and T1. The load percentage under the LH was significantly higher under the unaffected foot of the PF group than under the dominant foot of the control group. In terms of ground contact area, the T2-5 area of the affected foot of the PF group was significantly smaller than that of the unaffected foot, as well as compared to the non-dominant foot of the control group. The TCA of both feet among the PF group was significantly smaller than under the corresponding feet of the control group. Conclusions:Patients with chronic plantar fasciitis apply plantar pressure asymmetrically during walking. They tend to shift their weight laterally onto the asymptomatic foot. During walking, those with PF apply higher plantar pressure over a smaller ground contact area.
7.Exercise intervention for spinal curvature abnormality in children and adolescents:a bibliometrics analysis
Xuan LI ; Peng DOU ; Xuanchao WANG ; Haimei JIANG ; Jingyi RAO ; Shuping QIAN ; Chuhuai WANG ; Yi XU
Chinese Journal of Rehabilitation Theory and Practice 2024;30(10):1140-1150
Objective To analyze the hotspots and frontiers of researches related to exercise intervention for spinal curvature abnor-malities in children and adolescents. Methods Articles related to exercise intervention for spinal curvature abnormalities in children and adolescents were re-trieved from CNKI and Web of Science Core Collection,from January,2014 to December,2023.The literatures were analyzed wtih CiteSapce 6.2.R3 in terms of disciplines,countries,institutes and keywords. Results A total of 233 articles were retrived,including 71 articles in Chinese and 162 articles in English.The annual pub-lication volume was on the rise.China was the country with the highest number of publications.South Korea was seen a sudden increase in recent literature.For Chinese,the institutions with the largest number of publication were the Department of Health and Exercise Science in Tianjin University of Sport and Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital).While the institutions with the largest number of publication in English were Marmara University and Hong Kong Polytechnic University.The English literatures covered a wide range of disciplines,including clinical medicine,sports medicine,neurolo-gy and psychology.Common high-frequency keywords in both Chinese and English literatures were idiopathic scoliosis,Cobb's angle and Schroth exercise.The latest bursting words included physical health in Chinese,and health-related quality of life and respiratory muscle strength in English. Conclusion The research popularity related to exercise intervention for spinal curvature abnormality in children and ado-lescents is generally on the rise.The research hotspots focus on four main areas:disease,quality of life,research advances and clinical treatment.More attention should be paid to the effect and dosage of exercise intervention on the respiratory function,as well as the effect of Chinese medicine exercise therapy on pediatric patients with abnormal spinal curvature diseases.Future work should focus on constructing an evidence-based Chinese/West-ern medicine exercise prevention and treatment system in the context of China's national conditions,advancing high-quality randomized controlled trials,strengthening interdisciplinary and international collaborations,and fo-cusing on the development and evaluation of personalized exercise intervention programs.
8.Association between leukocyte telomere length and cataracts: a bidirectional Mendelian randomization study
CHEN Rong ; Mokoumani Wen ; KE Xiaohong ; WANG Chuhuai
Journal of Preventive Medicine 2024;36(7):580-583
Objective:
To examine the association between leukocyte telomere length and cataract using bidirectional Mendelian randomization (MR) approach, so as to provide the basis for early diagnosis and prevention of cataracts.
Methods:
Leukocyte telomere length data were collected through a meta analysis of genome-wide association studies (GWAS), including 78 952 participants, and the GWAS data of cataract were collected through the UK Biobank, including 8 890 cases and 454 120 controls. A bidirectional MR analysis was performed using the inverse-variance weighted (IVW) method, and single nucleotide polymorphisms (SNPs) which were associated with leukocyte telomere length were selected as instrumental variables. The heterogeneity was assessed using the Cochran's Q test, the horizontal pleiotropy was assessed using the MR-Egger regression and the outlier was verified with the leave-one-out and MR-PRESSO test.
Results:
Forward MR analysis results showed that shortened leukocyte telomere length had an increased risk of cataract (OR=0.991, 95%CI: 0.990-0.997). Reverse MR analysis results showed no statistically significant association between leukocyte telomere length and cataract (P>0.05). Cochran's Q test detected no heterogeneity, and neither the MR-Egger regression nor the MR-PRESSO test revealed horizontal pleiotropy of instrumental variables (both P>0.05). Leave-one-out analysis showed robustness of the MR analysis results.
Conclusion
Shorter leukocyte telomere length might be associated with increased risk of cataract.
9.Effect of crocin on myocardial injury and energy metabolism in rats with chronic heart failure
Yali HU ; Pengpeng ZHANG ; Chao FENG ; Jianhua TANG ; Keqin LIU ; Xiaoyuan YANG ; Ning GUO ; Chuhuai GAO ; Rui WANG
Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2023;25(12):1364-1368
Objective To determine the effect of crocin regulating miR-139-5p/ATF4 axis on myo-cardial injury and energy metabolism in rats with CHF.Methods A total of 84 male SPF SD rats were randomly divided into sham operation group,model group,crocin low-,medium-and high-dose groups,captopril group and crocin+miR-139-5p inhibitor group,with 12 in each group.Car-diac function indexes,myocardial histomathological morphology,apoptotic rate,myocardial injury indexes,heart failure indexes,inflammatory indexes,oxidative stress indexes,myocardial ATP content,SDH activity,and miR-139-5p and ATF4 mRNA expression levels were detected in rats.The targeting relationship between miR-139-5p and ATF4 was verified.Results Compared with the conditions in the model group,crocin treatment at different doses reduced apoptotic rate of cardiomyocytes,decreased MDA content,LVEDD and LVESD values and cTnI,cTnT,CK-MB,NT-proBNP,TNF-α and IL-1β levels,and declined ATF4 mRNA level,and increased LVEF and LVFS values,SOD activity,ATP content,SDH activity and miR-139-5p level(P<0.05).Com-pared with the crocin high-dose group,the crocin+miR-139-5p inhibitor group had higher apop-totic rate of cardiomyocytes[(22.68±3.25)%vs(11.94±1.38)%,P<0.05],increased LVEDD and LVESD value,raised MAD content and cTnI,cTnT,CK-MB,NT-proBNP,TNF-α and IL-1βlevel,and elecated ATF4 mRNA level,and decreased LVEF and LVFS value,SOD activity,ATP content,SDH activity and miR-139-5p level(P<0.05).There was a targeting relationship be-tween miR-139-5p and ATF4.Conclusion Crocin can improve myocardial injury and energy me-tabolism in CHF rats,which may be related to its regulation of miR-139-5p/ATF4 axis.
10.Nonlinear analysis of electromyography signals from the deep lumbar multifidus of patients with chronic low back pain
Shanshan ZHANG ; Zhenfa ZHANG ; Shimin HUANG ; Ying WU ; Lianghua FAN ; Wen WU ; Chuhuai WANG
Chinese Journal of Physical Medicine and Rehabilitation 2023;45(9):815-819
Objective:To explore any changes in the electromyographic (EMG) signals from the deep lumbar multifidus (DM) of patients with chronic low back pain (cLBP).Methods:Twenty-five cLBP patients formed the cLBP group, while twenty-eight healthy counterparts similar in sex, age and education background were chosen as the control group. EMG signals were recorded during maximum isometric voluntary contraction of the DM. Two-way repeated measures analysis of variance was applied to compare the two groups′ signals′ Lempel-Ziv (LZ) complexity values at rest and during the maximum strength, strength endurance and relaxation stages of contraction. Pearson correlation coefficients were computed relating the LZ complexity to pain duration and intensity, as well as to Oswestry disability index (ODI) values in the cLBP group.Results:The cLBP patients reported a mean symptom duration of 5.96±4.69 years, with an average VAS score of 4.00±1.04 and ODI of 17.12±10.49. They reported greater pain intensity during needle insertions, needle removal, muscle contraction and relaxation than the healthy controls. There were significant differences in LZ complexity among the four stages of contraction with all of the subjects. The LZ complexity was significantly lower in the maximum strength and strength endurance states, but higher in the relaxation after contraction states in the cLBP group. Pain duration was negatively correlated with the nonlinear index of DM during contraction.Conclusion:Continuous pain stimulation will affect the coordinated control of the deep multifidus muscle, leading to decreased control of core muscles via the central nervous system. That provides insight into the mechanisms underlying activation and coordinated control during chronic pain.


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