{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T21:11:38Z","timestamp":1789593098791,"version":"build-2803163510"},"reference-count":47,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004489","name":"Mitacs Accelerate","doi-asserted-by":"publisher","award":["IT19855"],"award-info":[{"award-number":["IT19855"]}],"id":[{"id":"10.13039\/501100004489","id-type":"DOI","asserted-by":"publisher"}]},{"name":"McGill Radiology Practice Plan","award":["IT19855"],"award-info":[{"award-number":["IT19855"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Individuals with chronic low back pain (CLBP) have altered lumbar multifidus stiffness properties compared to healthy controls. Although neuromuscular electrical stimulation (NMES) application to the multifidus might affect stiffness, this has never been investigated. The aims of this study were to examine the effect of a single NMES treatment on multifidus stiffness and pain intensity in CLBP patients. Methods: 30 participants (13 male, 17 female) were randomized to one of two intervention (\u2018phasic\u2019 and \u2018combined\u2019) protocols with the StimaWELL 120MTRS system. Multifidus stiffness at L4 and L5 was measured via shear-wave elastography (SWE) at rest and in standing prior to, and 15 min after, a 20 min NMES treatment. Pain intensity was measured pre- and post-treatment with the numerical pain rating scale (NPRS). Results: There were significant increases in resting shear modulus at right L4 (p = 0.001) and bilaterally at L5 (p = 0.017; p = 0.020) in the \u2018combined\u2019 intervention group, and a significant between-group difference at right L4 (p &lt; 0.001). There were significant decreases in standing shear modulus at right L4 (p = 0.015) and left L5 (p = 0.036) in the \u2018combined\u2019 intervention group, and a significant between-group difference at left L5 (p = 0.016). Both groups experienced significant decreases in pain intensity (MD combined group = 1.12, 95% CI [0.34, 1.90], p = 0.011) (MD phasic group = 1.42, 95% CI [0.68, 2.16], p = 0.001). Conclusions: There were multiple significant changes in multifidus stiffness in the combined group, but not in the phasic group. Both groups experienced significant decreases in low back pain intensity.<\/jats:p>","DOI":"10.3390\/diagnostics14222594","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T04:53:05Z","timestamp":1731991985000},"page":"2594","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The Immediate Effect of a Single Treatment of Neuromuscular Electrical Stimulation with the StimaWELL 120MTRS System on Multifidus Stiffness in Patients with Chronic Low Back Pain"],"prefix":"10.3390","volume":"14","author":[{"given":"Daniel","family":"Wolfe","sequence":"first","affiliation":[{"name":"Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4817-1274","authenticated-orcid":false,"given":"Geoffrey","family":"Dover","sequence":"additional","affiliation":[{"name":"Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada"},{"name":"School of Health, Concordia University, Montreal, QC H4B 1R6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4173-1892","authenticated-orcid":false,"given":"Mathieu","family":"Boily","sequence":"additional","affiliation":[{"name":"McGill University Health Centre, Montreal, QC H4A 3J1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryse","family":"Fortin","sequence":"additional","affiliation":[{"name":"Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada"},{"name":"School of Health, Concordia University, Montreal, QC H4B 1R6, Canada"},{"name":"Centre de R\u00e9adaptation Constance-Lethbridge du CIUSSS du Centre-Ouest de l\u2019\u00cele-de-Montreal, Montreal, QC H4B 1T3, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1002\/art.34347","article-title":"A systematic review of the global prevalence of low back pain","volume":"64","author":"Hoy","year":"2012","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","article-title":"What low back pain is and why we need to pay attention","volume":"391","author":"Hartvigsen","year":"2018","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"De Simone, M., Choucha, A., Ciaglia, E., Conti, V., Pecoraro, G., Santurro, A., Puca, A.A., Cascella, M., and Iaconetta, G. (2024). Discogenic low back pain: Anatomic and pathophysiologic characterization, clinical evaluation, biomarkers, AI, and treatment options. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195915"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e3495","DOI":"10.1097\/MD.0000000000003495","article-title":"Refined phenotyping of modic changes: Imaging biomarkers of prolonged severe low back pain and disability","volume":"95","author":"Karppinen","year":"2016","journal-title":"Medicine"},{"key":"ref_5","first-page":"E985","article-title":"Structural changes of lumbar muscles in non-specific low back pain: A systematic review","volume":"19","author":"Goubert","year":"2016","journal-title":"Pain. Physician."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jelekin.2019.05.004","article-title":"Shear wave elastography investigation of multifidus stiffness in individuals with low back pain","volume":"47","author":"Murillo","year":"2019","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.math.2008.09.006","article-title":"The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle","volume":"14","author":"Wallwork","year":"2009","journal-title":"Man. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.math.2006.02.004","article-title":"The lumbar multifidus: Does the evidence support clinical beliefs?","volume":"11","author":"MacDonald","year":"2006","journal-title":"Man. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/S0140-6736(18)30489-6","article-title":"Prevention and treatment of low back pain: Evidence, challenges, and promising directions","volume":"391","author":"Foster","year":"2018","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.jmpt.2023.04.005","article-title":"Bilateral asymmetrical limb proprioceptive neuromuscular facilitation effects on pain, multifidus activity, range of motion, and disability in low back pain: A randomized controlled trial","volume":"45","author":"Baig","year":"2022","journal-title":"J. Manipulative Physiol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.3233\/BMR-210211","article-title":"Effect of direct vibration on the activity of deep trunk muscles of patients with non-specific chronic low back pain","volume":"35","author":"Kim","year":"2022","journal-title":"J. Back. Musculoskelet. Rehabil."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1001\/jama.2010.344","article-title":"Will this patient develop persistent disabling low back pain?","volume":"303","author":"Chou","year":"2010","journal-title":"JAMA."},{"key":"ref_13","unstructured":"Knight, K.L., and Draper, D.O. (2013). Application procedures: Electrotherapy. Therapeutic Modalities: The Art and Science, Lippincott Williams & Williams. [2nd ed.]."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.bjpt.2018.10.003","article-title":"Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: A randomized controlled trial","volume":"23","author":"Alrwaily","year":"2019","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Songjaroen, S., Sungnak, P., Piriyaprasarth, P., Wang, H.K., Laskin, J.J., and Wattananon, P. (2021). Combined neuromuscular electrical stimulation with motor control exercise can improve lumbar multifidus activation in individuals with recurrent low back pain. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-94402-2"},{"key":"ref_16","first-page":"201","article-title":"Neuromuscular electrical stimulation for skeletal muscle function","volume":"85","author":"Doucet","year":"2012","journal-title":"Yale J. Biol. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.3233\/WOR-213452","article-title":"Repeated standing back extension exercise: Influence on muscle shear modulus change after lumbodorsal muscle fatigue","volume":"68","author":"Kumamoto","year":"2021","journal-title":"Work"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Vatovec, R., Kozinc, \u017d., and Voglar, M. (2022). The effects of isometric fatigue on trunk muscle stiffness: Implications for shear-wave elastography measurements. Sensors, 22.","DOI":"10.3390\/s22239476"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/joa.12978","article-title":"Posture-related stiffness mapping of paraspinal muscles","volume":"234","author":"Creze","year":"2019","journal-title":"J. Anat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102078","DOI":"10.1016\/j.msksp.2019.102078","article-title":"Lumbar muscle stiffness is different in individuals with low back pain than asymptomatic controls and is associated with pain and disability, but not common physical examination findings","volume":"45","author":"Koppenhaver","year":"2020","journal-title":"Musculoskelet. Sci. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.clinbiomech.2017.09.008","article-title":"Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers","volume":"49","author":"Masaki","year":"2017","journal-title":"Clin. Biomech."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fortin, M., Wolfe, D., Dover, G., and Boily, M. (2022). The effect of phasic versus combined neuromuscular electrical stimulation using the StimaWELL 120MTRS system on multifidus muscle morphology and function in patients with chronic low back pain: A randomized controlled trial protocol. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05578-1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1097\/01.brs.0000164099.92112.29","article-title":"Responsiveness of the numeric pain rating scale in patients with low back pain","volume":"30","author":"Childs","year":"2005","journal-title":"Spine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1177\/0954411916656022","article-title":"Non-invasive assessment of human multifidus muscle stiffness using ultrasound shear wave elastography: A feasibility study","volume":"230","author":"Moreau","year":"2016","journal-title":"Proc. Inst. Mech. Eng, H."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1002\/mus.24104","article-title":"Muscle shear modulus measured with ultrasound shear-wave elastography across a wide range of contraction intensity","volume":"50","author":"Yoshitake","year":"2014","journal-title":"Muscle Nerve"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1148\/rg.2017160116","article-title":"Shear-wave elastography: Basic physics and musculoskeletal applications","volume":"37","author":"Taljanovic","year":"2017","journal-title":"Radiographics."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.spinee.2021.10.018","article-title":"Alteration of lumbar muscle morphology and composition in relation to low back pain: A systematic review and meta-analysis","volume":"22","author":"Seyedhoseinpoor","year":"2022","journal-title":"Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e3592","DOI":"10.7717\/peerj.3592","article-title":"Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography","volume":"5","author":"Leung","year":"2017","journal-title":"PeerJ."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chalchat, E., Gennisson, J.L., Pe\u00f1ailillo, L., Oger, M., Malgoyre, A., Charlot, K., Bourrilhon, C., Siracusa, J., and Garcia-Vicencio, S. (2020). Changes in the viscoelastic properties of the vastus lateralis muscle with fatigue. Front. Physiol., 11.","DOI":"10.3389\/fphys.2020.00307"},{"key":"ref_30","first-page":"7","article-title":"Limits to human performance caused by muscle fatigue","volume":"53","author":"Allen","year":"2003","journal-title":"Phys. News Mag."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1519\/JSC.0000000000002855","article-title":"Effect of a high-intensity isometric potentiating warm-up on bat velocity","volume":"33","author":"Gilmore","year":"2019","journal-title":"J. Strength. Cond. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00421-003-0798-2","article-title":"The effect of an active warm-up on surface EMG and muscle performance in healthy humans","volume":"89","author":"Stewart","year":"2003","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.jmpt.2015.10.004","article-title":"Fiber typing of the erector spinae and multifidus muscles in healthy controls and back pain patients: A systematic literature review","volume":"38","author":"Cagnie","year":"2015","journal-title":"J. Manipulative Physiol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Garcia-Retortillo, S., and Ivanov, P.C. (2022). Inter-muscular networks of synchronous muscle fiber activation. Front. Netw. Physiol., 2.","DOI":"10.3389\/fnetp.2022.1059793"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1016\/j.conb.2011.05.017","article-title":"Spikes alone do not behavior make: Why neuroscience needs biomechanics","volume":"21","author":"Tytell","year":"2011","journal-title":"Curr. Opin. Neurobiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.neuron.2015.02.042","article-title":"Neuromechanical principles underlying movement modularity and their implications for rehabilitation","volume":"86","author":"Ting","year":"2015","journal-title":"Neuron"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s00421-023-05193-5","article-title":"Adaptability of the load sharing between the longissimus and components of the multifidus muscle during isometric trunk extension in healthy individuals","volume":"123","author":"Tier","year":"2023","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.math.2005.07.001","article-title":"Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism","volume":"10","year":"2005","journal-title":"Man. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"De Ridder, E.M., Van Oosterwijck, J.O., Vleeming, A., Vanderstraeten, G.G., and Danneels, L.A. (2013). Posterior muscle chain activity during various extension exercises: An observational study. BMC Musculoskelet. Disord., 14.","DOI":"10.1186\/1471-2474-14-204"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/jes.0b013e318156e785","article-title":"Electrical stimulation as a modality to improve performance of the neuromuscular system","volume":"35","author":"Vanderthommen","year":"2007","journal-title":"Exerc. Sport. Sci. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1007\/s00421-013-2780-y","article-title":"Effect of neuromuscular electrical stimulation intensity over the tibial nerve trunk on triceps surae muscle fatigue","volume":"114","author":"Doix","year":"2014","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_42","first-page":"13","article-title":"Stretching has sustained effects on range of motion and passive stiffness of the hamstring muscles","volume":"18","author":"Iwata","year":"2019","journal-title":"J. Sports Sci. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2519\/jospt.2020.8821","article-title":"Neck muscle stiffness measured with shear wave elastography in women with chronic nonspecific neck pain","volume":"50","author":"Dieterich","year":"2020","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jbmt.2019.10.009","article-title":"Effects of the russian current in the treatment of low back pain in women: A randomized clinical trial","volume":"24","author":"Batistella","year":"2020","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"446","DOI":"10.32098\/mltj.03.2019.20","article-title":"Neuromuscular electrical stimulation associated with core stability exercises in nonspecific postural low back pain: A randomized clinical trial","volume":"9","year":"2019","journal-title":"Muscles Ligaments Tendons J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.12968\/ijtr.2018.0063","article-title":"The analgesic action of Aussie current in women with non-specific chronic lumbar pain","volume":"26","author":"Pelegrini","year":"2019","journal-title":"Int. J. Ther. Rehabil."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/PHM.0000000000001552","article-title":"Effect of pain education, cryotherapy, and transcutaneous electrical nerve stimulation on the pain, functional capacity, and quality of life in patients with nonspecific chronic low back pain: A single-blind randomized controlled trial","volume":"100","author":"Caldas","year":"2021","journal-title":"Am. J. Phys. Med. Rehabil."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2594\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:34:54Z","timestamp":1760114094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/22\/2594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,19]]},"references-count":47,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["diagnostics14222594"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14222594","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,19]]}}}