title: Association of strength, muscle balance, and atrophy with pain and function in patients with degenerative spondylolisthesis.
abstract: OBJECTIVE
  To analyze the relationship of strength, muscular balance, and atrophy with pain and function in patients with degenerative spondylolisthesis.
  
  
  METHODS
  Transversal, descriptive, and observational.
  
  
  METHODS
  Institutional review board approval was obtained for this study. Twenty six patients ages 50 years and older, with degenerative spondylolisthesis at L4-L5. Measurements included Pain Visual Analogue Scale scores (VAS), Oswestry Disability Index scores (ODI), and isokinetic trunk testing; assessment of multifidus atrophy and spinal stenosis was performed by Magnetic Resonance Imaging (MRI).
  
  
  METHODS
  Statistical analysis was performed using SPSS version 17.0 software for Windows. Pearson's correlation was used to ascertain the correlation between variables. ANOVA with analysis of covariance was used to determine the correlation between the remainder variables. Significance was set at p < 0.05.
  
  
  RESULTS
  Of the 26 patients studied, with an average age of 60.23 ± 7.6 years, 20 had grade I spondylolisthesis and 6 were grade II. Correlation between the ODI scores and spondylolisthesis grading was significant (r=0.576, p=0.005); correlation between agonist/antagonist ratio in the isokinetic test (predominant extensor muscles over flexors) with the ODI scores was also significant (r=0.446, p=0.02), regardless of spinal stenosis. No correlation was found between functionality and pain with strength or multifidus atrophy.
  
  
  CONCLUSIONS
  Muscle trunk imbalance with predominance of extensor over flexor muscles is associated with functional disability. Rehabilitation programs should be designed to improve muscle balance rather than muscle strength alone.
authors.affiliation: Department of Spine Rehabilitation, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Tania Inés
authors.initials: TI
authors.lastname: Nava-Bringas
authors.affiliation: Department of Imaging, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ramírez-Mora
authors.affiliation: Department of Spine Rehabilitation, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Roberto
authors.initials: R
authors.lastname: Coronado-Zarco
authors.affiliation: Department of Spine Rehabilitation, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Salvador Israel
authors.initials: SI
authors.lastname: Macías-Hernández
authors.affiliation: Department of Spine Rehabilitation, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Eva
authors.initials: E
authors.lastname: Cruz-Medina
authors.affiliation: Department of Spine Rehabilitation, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Arellano-Hernández
authors.affiliation: Department of Spine Rehabilitation, National Institute for Rehabilitation, México City, Mexico.
authors.forename: Mario
authors.initials: M
authors.lastname: Hern Ndez-López
authors.affiliation: Department of Research, National Institute for Rehabilitation, México City, Mexico.
authors.forename: S R
authors.initials: SR
authors.lastname: León-Hernández
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D009133:Muscular Atrophy / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D013168:Spondylolisthesis / Q000503:physiopathology*
keywords: Multifidus atrophy; degenerative spondylolisthesis; functionality; pain; strength