{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T20:48:50Z","timestamp":1787431730781,"version":"build-2736575974"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002911","name":"Universidad Complutense de Madrid","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002911","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evaluation of muscle tenderness is encouraged in the diagnosis of low back pain (LBP). However, manual palpation is poorly reliable and objective methods to quantify muscle stiffness are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate quadratus lumborum muscle stiffness differences between individuals with chronic non-specific low back pain (LBP) and pain-free controls, analyze side-to-side stiffness differences, and assess the diagnostic accuracy of shear wave elastography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted recruiting 40 patients with chronic non-specific LBP and 40 asymptomatic controls. Variables assessed included muscle stiffness using shear wave elastography metrics (shear wave speed (SWS) and Young\u2019s modulus (YM)), pain chronicity, pain intensity, pain-related disability (using the Oswestry Disability Index) and symptoms associated with central sensitization (using the Central Sensitization Inventory). Diagnostic accuracy was evaluated through sensitivity, specificity, and receiver operating characteristic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant side-to-side stiffness differences were observed within either group (both,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). Quadratus lumborum muscle stiffness was significantly lower in LBP patients compared to controls (SWS\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010; YM\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). The receiver operating characteristic analysis for both metrics showed poor discriminatory ability (&lt;\u20090.7). A modest balance between sensitivity (SWS 70%; YM 75%) and specificity (SWS 97.5%; YM 50%) was found.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although greater stiffness was expected due to the associated prevalence of trigger points in patients with LBP, quadratus lumborum muscle stiffness was significantly lower in patients suffering chronic non-specific LBP compared to controls. Despite significant differences, the diagnostic accuracy of shear wave elastography was poor, requiring further research to improve the diagnostic utility of shear wave elastography.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-025-09114-2","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T09:12:59Z","timestamp":1752138779000},"page":"5449-5458","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Quadratus lumborum muscle stiffness in chronic non-specific low back pain: a diagnostic accuracy study"],"prefix":"10.1007","volume":"34","author":[{"given":"M\u00f3nica","family":"L\u00f3pez-Redondo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davinia","family":"Vicente-Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"\u00c1lvarez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Rold\u00e1n-Ruiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"S\u00e1nchez-Jorge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Buffet-Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Jos\u00e9","family":"D\u00edaz-Arribas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Antonio","family":"Valera-Calero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"9114_CR1","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/S0140-6736(16)30970-9","volume":"389","author":"C Maher","year":"2017","unstructured":"Maher C, Underwood M, Buchbinder R (2017) Non-specific low back pain. Lancet 389:736\u2013747. https:\/\/doi.org\/10.1016\/S0140-6736(16)30970-9.","journal-title":"Lancet"},{"key":"9114_CR2","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/S0140-6736(21)00733-9","volume":"398","author":"NN Knezevic","year":"2021","unstructured":"Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP (2021) Low back pain. Lancet 398:78\u201392. https:\/\/doi.org\/10.1016\/S0140-6736(21)00733-9.","journal-title":"Lancet"},{"key":"9114_CR3","doi-asserted-by":"publisher","first-page":"2791","DOI":"10.1007\/S00586-018-5673-2","volume":"27","author":"CB Oliveira","year":"2018","unstructured":"Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CWC, Chenot JF et al (2018) Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27:2791\u20132803. https:\/\/doi.org\/10.1007\/S00586-018-5673-2.","journal-title":"Eur Spine J"},{"key":"9114_CR4","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/J.PTSP.2022.11.011","volume":"59","author":"NA Abd Rahman","year":"2023","unstructured":"Abd Rahman NA, Li S, Schmid S, Shaharudin S (2023) Biomechanical factors associated with non-specific low back pain in adults: a systematic review. Phys Ther Sport 59:60\u201372. https:\/\/doi.org\/10.1016\/J.PTSP.2022.11.011.","journal-title":"Phys Ther Sport"},{"key":"9114_CR5","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/J.JPAIN.2021.07.012","volume":"23","author":"CK Wong","year":"2022","unstructured":"Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M et al (2022) Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis. J Pain 23:509\u2013534. https:\/\/doi.org\/10.1016\/J.JPAIN.2021.07.012.","journal-title":"J Pain"},{"key":"9114_CR6","doi-asserted-by":"publisher","first-page":"3633","DOI":"10.1007\/S00402-021-03959-0","volume":"142","author":"DC Fel\u00edcio","year":"2022","unstructured":"Fel\u00edcio DC, Filho JE, de Oliveira TMD, Pereira DS, Rocha VTM, Barbosa JMM et al (2022) Risk factors for non-specific low back pain in older people: a systematic review with meta-analysis. Arch Orthop Trauma Surg 142:3633\u20133642. https:\/\/doi.org\/10.1007\/S00402-021-03959-0.","journal-title":"Arch Orthop Trauma Surg"},{"key":"9114_CR7","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/J.JPAIN.2023.10.010","volume":"25","author":"W Van Bogaert","year":"2024","unstructured":"Van Bogaert W, Liew BXW, Fern\u00e1ndez-de-las-Pe\u00f1as C, Valera-Calero JA, Varol U, Coppieters I et al (2024) Exploring interactions between sex, pain characteristics, disability, and quality of life in people with chronic spinal pain: a structural equation model. J Pain 25:791\u2013804. https:\/\/doi.org\/10.1016\/J.JPAIN.2023.10.010.","journal-title":"J Pain"},{"key":"9114_CR8","first-page":"985","volume":"19","author":"D Goubert","year":"2016","unstructured":"Goubert D, Oosterwijck J, Van, Meeus M, Danneels L (2016) Systematic review structural changes of lumbar muscles in non-specific low back pain. Pain Physician 19:985\u20131000","journal-title":"Pain Physician"},{"key":"9114_CR9","doi-asserted-by":"publisher","first-page":"833","DOI":"10.2519\/jospt.2013.4840","volume":"43","author":"RJ Park","year":"2013","unstructured":"Park RJ, Tsao H, Claus A, Cresswell AG, Hodges PW (2013) Recruitment of discrete regions of the psoas major and quadratus lumborum muscles is changed in specific sitting postures in individuals with recurrent low back pain. J Orthop Sports Phys Ther 43:833\u2013840. https:\/\/doi.org\/10.2519\/jospt.2013.4840.","journal-title":"J Orthop Sports Phys Ther"},{"key":"9114_CR10","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1016\/j.jelekin.2013.01.010","volume":"23","author":"RJ Park","year":"2013","unstructured":"Park RJ, Tsao H, Cresswell AG, Hodges PW (2013) Changes in direction-specific activity of psoas major and quadratus lumborum in people with recurring back pain differ between muscle regions and patient groups. J Electromyogr Kinesiol 23:734\u2013740. https:\/\/doi.org\/10.1016\/j.jelekin.2013.01.010.","journal-title":"J Electromyogr Kinesiol"},{"key":"9114_CR11","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1016\/j.spinee.2017.07.002","volume":"17","author":"TA Ranger","year":"2017","unstructured":"Ranger TA, Cicuttini FM, Jensen TS, Peiris WL, Hussain SM, Fairley J et al (2017) Are the size and composition of the paraspinal muscles associated with low back pain? A systematic review. Spine J 17:1729\u20131748. https:\/\/doi.org\/10.1016\/j.spinee.2017.07.002.","journal-title":"Spine J"},{"key":"9114_CR12","first-page":"144","volume":"13","author":"M Kamaz","year":"2007","unstructured":"Kamaz M, Kire\u015fi D, O\u011fuz H, Emlik D, Levendo\u011flu F (2007) CT measurement of trunk muscle areas in patients with chronic low back pain. Diagn Interv Radiol 13:144\u2013148","journal-title":"Diagn Interv Radiol"},{"key":"9114_CR13","doi-asserted-by":"publisher","first-page":"173","DOI":"10.2519\/jospt.2017.7002","volume":"47","author":"JM Sions","year":"2017","unstructured":"Sions JM, Elliott JM, Pohlig RT, Hicks GE (2017) Trunk muscle characteristics of the multifidi, erector spinae, psoas, and quadratus lumborum in older adults with and without chronic low back pain. J Orthop Sports Phys Ther 47:173\u2013179. https:\/\/doi.org\/10.2519\/jospt.2017.7002.","journal-title":"J Orthop Sports Phys Ther"},{"key":"9114_CR14","first-page":"142","volume":"14","author":"GG de Franca","year":"1991","unstructured":"de Franca GG, Levine LJ (1991) The quadratus lumborum and low back pain. J Manipulative Physiol Ther 14:142\u2013149","journal-title":"J Manipulative Physiol Ther"},{"key":"9114_CR15","doi-asserted-by":"publisher","first-page":"1964","DOI":"10.1111\/pme.12224","volume":"14","author":"JJ Iglesias-Gonz\u00e1lez","year":"2013","unstructured":"Iglesias-Gonz\u00e1lez JJ, Mu\u00f1oz-Garc\u00eda MT, Rodrigues-de-Souza DP, Alburquerque-Send\u00edn F, Fern\u00e1ndez-de-Las-Pe\u00f1as C (2013) Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain Med 14:1964\u20131970. https:\/\/doi.org\/10.1111\/pme.12224.","journal-title":"Pain Med"},{"key":"9114_CR16","doi-asserted-by":"publisher","first-page":"100044","DOI":"10.1016\/j.arrct.2020.100044","volume":"2","author":"A Holm-Jensen","year":"2020","unstructured":"Holm-Jensen A, Kjaer P, Schi\u00f8ttz-Christensen B, Ziegler DS, Andersen S, Myburgh C (2020) The interexaminer reproducibility and prevalence of lumbar and gluteal myofascial trigger points in patients with radiating low back pain. Arch Rehabil Res Clin Transl 2:100044. https:\/\/doi.org\/10.1016\/j.arrct.2020.100044.","journal-title":"Arch Rehabil Res Clin Transl"},{"key":"9114_CR17","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/0304-3959(94)90125-2","volume":"58","author":"NK Hua","year":"1994","unstructured":"Hua NK, Van der Does E (1994) The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain 58:317\u2013323. https:\/\/doi.org\/10.1016\/0304-3959(94)90125-2.","journal-title":"Pain"},{"key":"9114_CR18","doi-asserted-by":"publisher","first-page":"997645","DOI":"10.3389\/fpain.2022.997645","volume":"3","author":"S-J Sirh","year":"2022","unstructured":"Sirh S-J, Sirh S-W, Mun H-Y, Sirh H-M (2022) Importance of quadratus lumborum muscle trigger point injection and prolotherapy technique for lower back and buttock pain. Front Pain Res (Lausanne Switzerland) 3:997645. https:\/\/doi.org\/10.3389\/fpain.2022.997645.","journal-title":"Front Pain Res (Lausanne Switzerland)"},{"key":"9114_CR19","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1097\/AJP.0000000000000875","volume":"36","author":"L Li","year":"2020","unstructured":"Li L, Stoop R, Clijsen R, Hohenauer E, Fern\u00e1ndez-de-Las-Pe\u00f1as C, Huang Q et al (2020) Criteria used for the diagnosis of myofascial trigger points in clinical trials on physical therapy: updated systematic review. Clin J Pain 36:955\u2013967. https:\/\/doi.org\/10.1097\/AJP.0000000000000875.","journal-title":"Clin J Pain"},{"key":"9114_CR20","doi-asserted-by":"publisher","first-page":"868","DOI":"10.4329\/wjr.v8.i11.868","volume":"8","author":"N Winn","year":"2016","unstructured":"Winn N, Lalam R, Cassar-Pullicino V (2016) Sonoelastography in the musculoskeletal system: current role and future directions. World J Radiol 8:868\u2013879. https:\/\/doi.org\/10.4329\/wjr.v8.i11.868.","journal-title":"World J Radiol"},{"key":"9114_CR21","doi-asserted-by":"publisher","first-page":"1913","DOI":"10.1016\/J.APMR.2023.02.022","volume":"104","author":"F Zaina","year":"2023","unstructured":"Zaina F, C\u00f4t\u00e9 P, Cancelliere C, Di Felice F, Donzelli S, Rauch A et al (2023) A systematic review of clinical practice guidelines for persons with non-specific low back pain with and without radiculopathy: identification of best evidence for rehabilitation to develop the who\u2019s package of interventions for rehabilitation. Arch Phys Med Rehabil 104:1913\u20131927. https:\/\/doi.org\/10.1016\/J.APMR.2023.02.022.","journal-title":"Arch Phys Med Rehabil"},{"key":"9114_CR22","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1016\/J.ULTRASMEDBIO.2023.12.021","volume":"50","author":"EFM Zhou","year":"2024","unstructured":"Zhou EFM, Wong AYL, Zheng YP, Lam KHS, Fu SN (2024) Reliability of ultrasound shear wave elastography for evaluating psoas major and quadratus lumborum stiffness: gender and physical activity effects. Ultrasound Med Biol 50:564\u2013570. https:\/\/doi.org\/10.1016\/J.ULTRASMEDBIO.2023.12.021.","journal-title":"Ultrasound Med Biol"},{"key":"9114_CR23","doi-asserted-by":"publisher","first-page":"S31","DOI":"10.4103\/SJA.SJA_543_18","volume":"13","author":"S Cuschieri","year":"2019","unstructured":"Cuschieri S (2019) The STROBE guidelines. Saudi J Anaesth 13:S31\u2013S34. https:\/\/doi.org\/10.4103\/SJA.SJA_543_18.","journal-title":"Saudi J Anaesth"},{"key":"9114_CR24","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jclinepi.2019.09.015","volume":"117","author":"CM Faggion","year":"2020","unstructured":"Faggion CM (2020) EQUATOR reporting guidelines should also be used by clinicians. J Clin Epidemiol 117:149\u2013150. https:\/\/doi.org\/10.1016\/j.jclinepi.2019.09.015.","journal-title":"J Clin Epidemiol"},{"key":"9114_CR25","doi-asserted-by":"publisher","first-page":"177","DOI":"10.4103\/2452-2473.357348","volume":"22","author":"H Akoglu","year":"2022","unstructured":"Akoglu H (2022) User\u2019s guide to sample size estimation in diagnostic accuracy studies. Turk J Emerg Med 22:177\u2013185. https:\/\/doi.org\/10.4103\/2452-2473.357348.","journal-title":"Turk J Emerg Med"},{"key":"9114_CR26","doi-asserted-by":"publisher","first-page":"102670","DOI":"10.1016\/j.msksp.2022.102670","volume":"62","author":"G Plaza-Manzano","year":"2022","unstructured":"Plaza-Manzano G, Fern\u00e1ndez-de-las-Pe\u00f1as C, Cleland JA, Conde-Lima R, Navarro-Santana MJ, Valera-Calero JA et al (2022) Lumbar multifidus thickness changes during active leg raising with ultrasound imaging can detect patients with chronic non-specific low back pain. Musculoskelet Sci Pract 62:102670. https:\/\/doi.org\/10.1016\/j.msksp.2022.102670.","journal-title":"Musculoskelet Sci Pract"},{"key":"9114_CR27","doi-asserted-by":"publisher","first-page":"7","DOI":"10.4103\/0974-1208.97779","volume":"5","author":"K Suresh","year":"2012","unstructured":"Suresh K, Chandrashekara S (2012) Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci 5:7\u201313. https:\/\/doi.org\/10.4103\/0974-1208.97779.","journal-title":"J Hum Reprod Sci"},{"key":"9114_CR28","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1152\/jn.00084.2018","volume":"120","author":"ML Latash","year":"2018","unstructured":"Latash ML (2018) Muscle coactivation: definitions, mechanisms, and functions. J Neurophysiol 120:88\u2013104. https:\/\/doi.org\/10.1152\/jn.00084.2018.","journal-title":"J Neurophysiol"},{"key":"9114_CR29","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/MRR.0B013E3282FC0F93","volume":"31","author":"AM Boonstra","year":"2008","unstructured":"Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE (2008) Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 31:165\u2013169. https:\/\/doi.org\/10.1097\/MRR.0B013E3282FC0F93.","journal-title":"Int J Rehabil Res"},{"key":"9114_CR30","doi-asserted-by":"publisher","first-page":"1596","DOI":"10.1007\/S00586-012-2173-7","volume":"21","author":"J Tonosu","year":"2012","unstructured":"Tonosu J, Takeshita K, Hara N, Matsudaira K, Kato S, Masuda K et al (2012) The normative score and the cut-off value of the oswestry disability index (ODI). Eur Spine J 21:1596\u20131602. https:\/\/doi.org\/10.1007\/S00586-012-2173-7.","journal-title":"Eur Spine J"},{"key":"9114_CR31","doi-asserted-by":"publisher","unstructured":"Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ (2016) Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus; 5. https:\/\/doi.org\/10.1186\/S40064-016-3515-4.","DOI":"10.1186\/S40064-016-3515-4"},{"key":"9114_CR32","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/J.EDUREV.2010.12.001","volume":"6","author":"JTE Richardson","year":"2011","unstructured":"Richardson JTE (2011) Eta squared and partial Eta squared as measures of effect size in educational research. Educ Res Rev 6:135\u2013147. https:\/\/doi.org\/10.1016\/J.EDUREV.2010.12.001.","journal-title":"Educ Res Rev"},{"key":"9114_CR33","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1097\/JTO.0B013E3181EC173D","volume":"5","author":"JN Mandrekar","year":"2010","unstructured":"Mandrekar JN (2010) Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 5:1315\u20131316. https:\/\/doi.org\/10.1097\/JTO.0B013E3181EC173D.","journal-title":"J Thorac Oncol"},{"key":"9114_CR34","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4103\/0301-4738.37595","volume":"56","author":"R Parikh","year":"2008","unstructured":"Parikh R, Mathai A, Parikh S, Sekhar GC, Thomas R (2008) Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol 56:45. https:\/\/doi.org\/10.4103\/0301-4738.37595.","journal-title":"Indian J Ophthalmol"},{"key":"9114_CR35","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","volume":"41","author":"MJ Hjermstad","year":"2011","unstructured":"Hjermstad MJ, Fayers PM, Haugen DF, Caraceni A, Hanks GW, Loge JH et al (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage 41:1073\u20131093. https:\/\/doi.org\/10.1016\/j.jpainsymman.2010.08.016.","journal-title":"J Pain Symptom Manage"},{"key":"9114_CR36","doi-asserted-by":"publisher","first-page":"4849","DOI":"10.3390\/JCM12144849\/S1","volume":"12","author":"I Schuttert","year":"2023","unstructured":"Schuttert I, Wolff AP, Schiphorst Preuper RHR, Malmberg AGGA, Reneman MF, Timmerman H (2023) Validity of the central sensitization inventory to address human assumed central sensitization: newly proposed clinically relevant values and associations. J Clin Med 12:4849. https:\/\/doi.org\/10.3390\/JCM12144849\/S1.","journal-title":"J Clin Med"},{"key":"9114_CR37","doi-asserted-by":"publisher","unstructured":"Cao QW, Peng BG, Wang L, Huang YQ, Jia DL, Jiang H et al (2021) Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World J Clin Cases 9:2077\u201389. https:\/\/doi.org\/10.12998\/WJCC.V9.I9.2077.","DOI":"10.12998\/WJCC.V9.I9.2077"},{"key":"9114_CR38","doi-asserted-by":"publisher","unstructured":"Andersson EA, Grundstr\u00f6m H, Thorstensson a diverging intramuscular activity patterns in back and abdominal muscles during trunk rotation. Spine (Phila Pa 1976) 2002;27. https:\/\/doi.org\/10.1097\/00007632-200203150-00014.","DOI":"10.1097\/00007632-200203150-00014"},{"key":"9114_CR39","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/J.JMPT.2005.08.005","volume":"28","author":"CJ Colloca","year":"2005","unstructured":"Colloca CJ, Hinrichs RN (2005) The Biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: a review of literature. J Manipulative Physiol Ther 28:623\u2013631. https:\/\/doi.org\/10.1016\/J.JMPT.2005.08.005.","journal-title":"J Manipulative Physiol Ther"},{"key":"9114_CR40","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/AJP.0B013E31817E13B6","volume":"25","author":"N Lucas","year":"2009","unstructured":"Lucas N, MacAskill P, Irwig L, Moran R, Bogduk N (2009) Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. Clin J Pain 25:80\u201389. https:\/\/doi.org\/10.1097\/AJP.0B013E31817E13B6.","journal-title":"Clin J Pain"},{"key":"9114_CR41","doi-asserted-by":"publisher","first-page":"179","DOI":"10.2519\/JOSPT.2020.8821","volume":"50","author":"AV Dieterich","year":"2020","unstructured":"Dieterich AV, Yavuz U\u015e, Petzke F, Nordez A, Falla D (2020) Neck muscle stiffness measured with shear wave elastography in women with chronic nonspecific neck pain. J Orthop Sports Phys Ther 50:179\u2013188. https:\/\/doi.org\/10.2519\/JOSPT.2020.8821.","journal-title":"J Orthop Sports Phys Ther"},{"key":"9114_CR42","doi-asserted-by":"publisher","unstructured":"Young BA, Koppenhaver SL, Timo-Dondoyano RM, Baumann K, Scheirer VF, Wolff A et al (2021) Ultrasound shear wave elastography measurement of the deep posterior cervical muscles: reliability and ability to differentiate between muscle contraction States. J Electromyogr Kinesiol 56. https:\/\/doi.org\/10.1016\/J.JELEKIN.2020.102488.","DOI":"10.1016\/J.JELEKIN.2020.102488"},{"key":"9114_CR43","doi-asserted-by":"publisher","unstructured":"Valera-Calero JA, S\u00e1nchez-Jorge S, Buffet-Garc\u00eda J, Varol U, Gallego-Sendarrubias GM, \u00c1lvarez-Gonz\u00e1lez J (2021) Is shear-wave elastography a clinical severity indicator of myofascial pain syndrome? An observational study. J Clin Med 10. https:\/\/doi.org\/10.3390\/jcm10132895.","DOI":"10.3390\/jcm10132895"},{"key":"9114_CR44","doi-asserted-by":"publisher","unstructured":"Xie Y, Thomas L, Johnston V, Coombes BK (2023) Cervical and axioscapular muscle stiffness measured with shear wave elastography: a comparison between different levels of work-related neck disability. J Electromyogr Kinesiol; 69. https:\/\/doi.org\/10.1016\/J.JELEKIN.2023.102754.","DOI":"10.1016\/J.JELEKIN.2023.102754"},{"key":"9114_CR45","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1177\/09645284221104831","volume":"41","author":"JA Valera-Calero","year":"2023","unstructured":"Valera-Calero JA, S\u00e1nchez-Jorge S, Buffet-Garc\u00eda J, Varol U, Fern\u00e1ndez-de-Las-Pe\u00f1as C, \u00c1lvarez-Gonz\u00e1lez J (2023) Changes in stiffness at active myofascial trigger points of the upper trapezius after dry needling in patients with chronic neck pain: a randomized controlled trial. Acupunct Medicine: J Br Med Acupunct Soc 41:121\u2013129. https:\/\/doi.org\/10.1177\/09645284221104831.","journal-title":"Acupunct Medicine: J Br Med Acupunct Soc"},{"key":"9114_CR46","doi-asserted-by":"publisher","unstructured":"Vatovec R, Voglar M (2024) Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord 25. https:\/\/doi.org\/10.1186\/S12891-024-07241-3.","DOI":"10.1186\/S12891-024-07241-3"},{"key":"9114_CR47","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1016\/J.SPINEE.2021.10.018","volume":"22","author":"T Seyedhoseinpoor","year":"2022","unstructured":"Seyedhoseinpoor T, Taghipour M, Dadgoo M, Sanjari MA, Takamjani IE, Kazemnejad A et al (2022) Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J 22:660\u2013676. https:\/\/doi.org\/10.1016\/J.SPINEE.2021.10.018.","journal-title":"Spine J"},{"key":"9114_CR48","doi-asserted-by":"publisher","unstructured":"Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J et al (2014) Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev; 2014. https:\/\/doi.org\/10.1002\/14651858.CD000963.PUB3.","DOI":"10.1002\/14651858.CD000963.PUB3"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-09114-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-025-09114-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-025-09114-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T10:04:47Z","timestamp":1766052287000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-025-09114-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":48,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["9114"],"URL":"https:\/\/doi.org\/10.1007\/s00586-025-09114-2","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,8]]},"assertion":[{"value":"27 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Clinical Ethics Committee of Francisco de Vitoria University (ID: UFV 15\/2024).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Institutional review board statement"}},{"value":"Informed consent was obtained from all subjects involved in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The authors declare no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}