{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T07:23:24Z","timestamp":1773300204503,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Princess Nourah Bint Abdulrahman University","award":["PNURSP2025R117"],"award-info":[{"award-number":["PNURSP2025R117"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cesarean birth (CB) is linked to nonspecific low back pain (NSLBP). Different properties of the muscular tissue, including contractile, biomechanical, and viscous properties, may reflect its physiological or pathological condition. This study aimed to measure these properties of lumbar paravertebral muscles (LPVMs) and their relationship with post-CB mothers with moderate-severity NSLBP and match their measurements to those of the controls. Methods: Sixty women were included in this case\u2013control research. They were divided into two equal groups: Group (A) representing cases, consisted of 30 females who experienced CB and complained of moderate-severity NSLBP, and Group (B) representing controls, consisted of 30 healthy females who had never experienced pregnancy with no or mild-severity NSLBP. Results: The statistical analysis between the two groups yielded significant differences in the right and left LPVMs\u2019 tone (p = 0.002 and 0.015), relaxation time (p = 0.002 and 0.022), and creep (p = 0.013 and 0.008), respectively. On the other side, there were non-significant differences in the right and left LPVMs\u2019 stiffness (p = 0.055 and 0.367) and elasticity (p = 0.115 and 0.231), respectively. The regression analysis\u2019s final model indicated a strong overall performance (Nagelkerke: 1.00). Conclusions: The LPVMs of post-CB mothers with moderate-severity NSLBP showed remarkable changes in both contractile and viscous properties: muscle tone notably decreased, while viscosity increased. However, biomechanical properties like stiffness and elasticity showed negligible changes. This fitted regression analysis illustrated the holistic strong effect of LPVMs\u2019 properties as risk factors contributing to post-CB NSLBP, emphasizing their consideration in diagnosis and intervention strategies for such cases.<\/jats:p>","DOI":"10.3390\/jcm14030719","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T05:49:54Z","timestamp":1737611394000},"page":"719","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Do Lumbar Paravertebral Muscle Properties Show Changes in Mothers with Moderate-Severity Low Back Pain Following a Cesarean Birth? A Case\u2013Control Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6127-7482","authenticated-orcid":false,"given":"Mohamed G.","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Physical Therapy for Women\u2019s Health, Faculty for Physical Therapy, South Valley University, Qena 83523, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abeer A.","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Neurology, Faculty for Physical Therapy, Cairo University, Giza 12613, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7553-271X","authenticated-orcid":false,"given":"Walaa M.","family":"Ragab","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Neurology, Faculty for Physical Therapy, Cairo University, Giza 12613, Egypt"},{"name":"Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoda M.","family":"Zakaria","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Neurology, Faculty for Physical Therapy, Cairo University, Giza 12613, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5950-0497","authenticated-orcid":false,"given":"Reem M.","family":"Alwhaibi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6309-3484","authenticated-orcid":false,"given":"Zizi M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1413-0215","authenticated-orcid":false,"given":"Rehab S.","family":"Mamoon","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy for Women\u2019s Health, Faculty for Physical Therapy, South Valley University, Qena 83523, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/j.ajog.2005.03.063","article-title":"Evidence-based surgery for cesarean delivery","volume":"193","author":"Berghella","year":"2005","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Betr\u00e1n, A.P., Ye, J., Moller, A.B., Zhang, J., G\u00fclmezoglu, A.M., and Torloni, M.R. (2016). The increasing trend in caesarean section rates: Global, regional and national estimates: 1990\u20132014. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0148343"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/j.wombi.2019.03.009","article-title":"Analysis of the cesarean section rate using the 10-Group Robson classification at Benha University Hospital, Egypt","volume":"33","author":"Jadoon","year":"2020","journal-title":"Women Birth"},{"key":"ref_4","unstructured":"Egypt\u2019s Central Agency for Public Mobilization and Statistics (CAPMAS) (2022, August 30). Egypt Family Health Survey: Development in Obstetric Care Between 2014 and 2021, Available online: https:\/\/amwalalghad.com\/wp-content\/uploads\/2022\/08\/%D8%B9%D8%B1%D8%B6-%D9%86%D9%87%D8%A7%D8%A6%D9%89-30-8-2022.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e005671","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: Global and regional estimates","volume":"6","author":"Ye","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_6","unstructured":"World Health Organization (2021, June 16). Cesarean Section Rates Continue to Rise, Amid Growing Inequalities in Access. Available online: https:\/\/www.who.int\/news\/item\/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rifai, A. (2017). Trend of cesarean deliveries in Egypt and its associated factors: Evidence from national surveys, 2005\u20132014. BMC Pregnancy Childbirth, 17.","DOI":"10.1186\/s12884-017-1591-2"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Elnakib, S., Abdel-Tawab, N., Orbay, D., and Hassanein, N. (2019). Medical and non-medical reasons for cesarean section delivery in Egypt: A hospital-based retrospective study. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2558-2"},{"key":"ref_9","unstructured":"Organization for Economic Co-operation and Development (OECD) (2010). Education at a Glance 2010: OECD Indicators, OECD."},{"key":"ref_10","first-page":"1","article-title":"The global numbers and costs of additionally needed and unnecessary cesarean sections performed per year: Overuse as a barrier to universal coverage","volume":"30","author":"Gibbons","year":"2010","journal-title":"World Health Rep."},{"key":"ref_11","first-page":"178","article-title":"Cesarean delivery: Counseling issues and complication management","volume":"91","author":"Quinlan","year":"2015","journal-title":"Am. Fam. Physician"},{"key":"ref_12","first-page":"14342","article-title":"Prevalence of low back pain and its impact on quality of life in postpartum women","volume":"7","author":"Parikh","year":"2016","journal-title":"Int. J. Sci. Res."},{"key":"ref_13","unstructured":"Australian Commission on Safety and Quality in Health Care (ACSQHC) (2018). The Second Australian Atlas of Healthcare Variation."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/00132582-199101000-00028","article-title":"Epidural anesthesia and long-term backache after childbirth","volume":"10","author":"MacArthur","year":"1991","journal-title":"Obstet. Anesth. Dig."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Fan, C., Guidolin, D., Ragazzo, S., Figueiredo, A., Souza, D., Lima, A., Oliveira, S., Andrade, S., Gama, L., and Santos, L. (2020). Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae. Medicina, 56.","DOI":"10.3390\/medicina56060260"},{"key":"ref_16","unstructured":"Ali, M.G., Yousef, A.M., Okeel, F.M., Sarhan, M.A.M., Alwhaibi, R., Zakaria, H.M., Mohammed, A.A., Mamoon, R.S., and Auais, M. (2024, January 17\u201319). Exploring Mechanical Changes in the Transversus Abdominis Muscle Following Cesarean Delivery in Postpartum Women. Proceedings of the 2nd Edition of the Global Conference on Gynecology & Women\u2019s Health, Baltimore, MD, USA. Available online: https:\/\/gynecology.magnusconferences.com\/program\/scientific-program\/2024\/exploring-mechanical-changes-in-the-transversus-abdominis-muscle-following-cesarean-delivery-in-postpartum-women."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/S1050-6411(03)00041-5","article-title":"Trunk muscle activation in low-back pain patients: An analysis of the literature","volume":"13","author":"Selen","year":"2003","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.clinbiomech.2019.12.026","article-title":"Quantified biomechanical properties of lower lumbar myofascia in younger adults with chronic idiopathic low back pain and matched healthy controls","volume":"73","author":"Ilahi","year":"2020","journal-title":"Clin. Biomech."},{"key":"ref_19","unstructured":"Kamaya, A., and Wong-You-Cheong, J. (2021). Diagnostic Ultrasound: Abdomen and Pelvis, Elsevier-Health Sciences Division. [2nd ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Darby, S.A., and Frysztak, R.J. (2014). Neuroanatomy of the spinal cord. Clinical Anatomy of the Spine, Spinal Cord, and ANS, Elsevier.","DOI":"10.1016\/B978-0-323-07954-9.00009-8"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1519\/JPT.0000000000000119","article-title":"Reproducible measurements of muscle characteristics using the MyotonPRO device: Comparison between individuals with and without paratonia","volume":"41","author":"Hobbelen","year":"2018","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Struzik, A., Karamanidis, K., Lorimer, A., Keogh, J.W.L., and Gajewski, J. (2021). Application of leg, vertical, and joint stiffness in running performance: A literature overview. Appl. Bionics Biomech., 2021.","DOI":"10.1155\/2021\/9914278"},{"key":"ref_23","unstructured":"Myoton (2013). MyotonPRO User Manual, Myoton. [6th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/cpf.12505","article-title":"Associations of the trunk skeletal musculature and dietary intake to biomarkers of cardiometabolic health after spinal cord injury","volume":"38","author":"Abilmona","year":"2018","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6015","DOI":"10.21037\/qims-23-1796","article-title":"Assessment of lumbar paraspinal muscle morphology using mDixon Quant magnetic resonance imaging (MRI): A cross-sectional study in healthy subjects","volume":"14","author":"Krkoska","year":"2024","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"464","DOI":"10.2519\/jospt.2019.8827","article-title":"Changes in structure and function of the back muscles in low back pain: Different time points, observations, and mechanisms","volume":"49","author":"Hodges","year":"2019","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.jbmt.2021.09.032","article-title":"The immediate effect of a spinal mobilization intervention on muscle stiffness, tone and elasticity in subjects with lower back pain: A randomized cross-over trial","volume":"29","author":"Hamilton","year":"2022","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lo, W.L.A., Yu, Q., Mao, Y., Li, W., Hu, C., and Li, L. (2019). Lumbar muscles biomechanical characteristics in young people with chronic spinal pain. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2935-z"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1097\/j.pain.0000000000000507","article-title":"Do we need a third mechanistic descriptor for chronic pain states?","volume":"157","author":"Kosek","year":"2016","journal-title":"Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2545","DOI":"10.1016\/j.pain.2014.09.014","article-title":"Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain","volume":"155","author":"Boonstra","year":"2014","journal-title":"Pain"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wu, Z., Wang, Y., Ye, Z., Guan, Y., Ye, X., Chen, Z., Li, C., Chen, G., Zhu, Y., and Du, J. (2021). Effects of age and sex on properties of lumbar erector spinae in healthy people: Preliminary results from a pilot study. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.718068"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1007\/s00586-010-1502-y","article-title":"An updated overview of clinical guidelines for the management of non-specific low back pain in primary care","volume":"19","author":"Koes","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.jbmt.2012.01.015","article-title":"Myoton pro: A novel tool for the assessment of mechanical properties of fascial tissues","volume":"16","author":"Peipsi","year":"2012","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1007\/s00421-018-3867-2","article-title":"Reliability of tensiomyography and myotonometry in detecting mechanical and contractile characteristics of the lumbar erector spinae in healthy volunteers","volume":"118","author":"Lohr","year":"2018","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hu, X., Lei, D., Li, L., Leng, Y., Yu, Q., Wei, X., and Lo, W.L.A. (2018). Quantifying paraspinal muscle tone and stiffness in young adults with chronic low back pain: A reliability study. Sci. Rep., 8.","DOI":"10.1038\/s41598-018-32418-x"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1046\/j.1469-7580.1997.19040505.x","article-title":"Muscle fibre size and type distribution in thoracic and lumbar regions of erector spinae in healthy subjects without low back pain: Normal values and sex differences","volume":"190","author":"Mannion","year":"1997","journal-title":"J. Anat."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Devant\u00e9ry, K., Morin, M., Grimard, J., and Gaudreault, N. (2023). Effects of a Myofascial Technique on the Stiffness and Thickness of the Thoracolumbar Fascia and Lumbar Erector Spinae Muscles in Adults with Chronic Low Back Pain: A Randomized Before-and-After Experimental Study. Bioengineering, 10.","DOI":"10.3390\/bioengineering10030332"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Alcaraz-Clariana, S., Garc\u00eda-Luque, L., Garrido-Castro, J.L., Aranda-Valera, I.C., Ladehesa-Pineda, L., Puche-Larrubia, M.\u00c1., Carmona-P\u00e9rez, C., Rodrigues-de-Souza, D.P., and Alburquerque-Send\u00edn, F. (2021). Paravertebral muscle mechanical properties in patients with axial spondyloarthritis or low back pain: A case-control study. Diagnostics, 11.","DOI":"10.3390\/diagnostics11101898"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Li, Y., Yu, J., Zhang, J., Zhang, Z., and Wang, X. (2022). Quantifying the stiffness of lumbar erector spinae during different positions among participants with chronic low back pain. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270286"},{"key":"ref_40","unstructured":"Magee, D.J., Zachazewski, J.E., Quillen, W.S., and Manske, R.C. (2016). Pathology and Intervention in Musculoskeletal Rehabilitation, Saunders. [2nd ed.]."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Abboud, J., Nougarou, F., and Descarreaux, M. (2016). Muscle activity adaptations to spinal tissue creep in the presence of muscle fatigue. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149076"},{"key":"ref_42","first-page":"152","article-title":"Comparison of incidence of low back pain in women with normal vaginal delivery and cesarean section","volume":"29","author":"Rasheed","year":"2017","journal-title":"J. Pak. Orthop. Assoc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"102154","DOI":"10.1016\/j.msksp.2020.102154","article-title":"Risk factors for pelvic girdle pain postpartum and pregnancy-related low back pain postpartum: A systematic review and meta-analysis","volume":"48","author":"Wiezer","year":"2020","journal-title":"Musculoskelet. Sci. Pract."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/719\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:34:05Z","timestamp":1759919645000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":43,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030719"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030719","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,23]]}}}