Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Obez Olgularda Erektör Spina Kasları ve Fizik Tedavide Kullanılan Terapötik Ajanlar Açısından Hedef Doku Derinliği
Erector Spina Muscles in Obese Cases and Target Tissue Depth in Terms of Therapeutic Agents Used in Physical Therapy
Seda SERTEL MEYVACIa, Ayşe NUMANOĞLU AKBAŞb, Mustafa HIZALc
aBolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Anatomi ABD, Bolu, TÜRKİYE
bCumhuriyet Üniversitesi Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Bölümü, Sivas, TÜRKİYE
cBolu Abant İzzet Baysal Üniversitesi Tıp Fakültesi, Radyoloji ABD, Bolu, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2021;6(4):837-44
doi: 10.5336/healthsci.2020-79902
Article Language: TR
Full Text
ÖZET
 Amaç: Lumbal bölge patolojilerinin tedavisi için sıklıkla kullanılan terapötik ajanların hedef doku derinliği 3-5 cm arasındadır. Bu çalışmanın amacı, obez olgularda lumbal bölgede deri yüzeyi ile erektör spina kasları arasındaki adipoz doku artışına bağlı yumuşak doku kalınlığını (YDK) belirlemektir. Gereç ve Yöntemler: Çalışmamıza; 18 yaş üstü, beden kitle indeksi 30 kg/m2 -40 kg/m2 arasında olan 30 kadın ve 36 erkek olmak üzere toplam 66 olgu dâhil edildi. Bilgisayarlı tomografi görüntüleri üzerinden YDK; L1-L5 lumbal vertebralar seviyesinde derinin en yüzeyel kısmı ile erektör spina kaslarının lamina superficialisi arasındaki mesafe mediyal, intermediyal ve lateral bölgelerden ölçülerek yapıldı. Erektör spina kaslarının maksimum antero-posterior mesafesi (ESAP) ölçüldü. Bulgular: Çalışmamıza dâhil edilen olgulardan beden kitle indeksi 30,00-34,99 kg/m2 olan 41 (%62,12) olgu 1. derece obez, 35,0-39,99 kg/m2 olan 25 (%38,88) olgu ise 2. derece obez olarak sınıflandırıldı. L1-L5 arasında tüm seviyeler için sağ ve sol taraf ölçümlerinde 2. derece obez olguların YDK değer aralıkları daha genişti (p=0,001-0,010 değerleri arasında). En yüksek YDK değeri 2. derece obez olguların L5 seviyesi lateral ölçümü için bulundu. Birinci derece obez olgularla 2. derece obez olguların ESAP dağılımlarında sol L4 değerleri arasında fark bulundu (p=0,037). Birinci derece obez olguların sol L4 ESAP değeri daha yüksekti. Sonuç: Çalışmamızın sonucunda, 2. derece obez olguların büyük kısmında L4- L5 seviyesinde adipoz dokunu artmasına bağlı olarak YDK'nin artmış olduğu görüldü. Fizyoterapi modalitelerinin hedef doku olan erektör spina kasının yüzeyine ulaşabileceği, ancak tüm dokuda terapötik etkiler oluşturmakta limitli etkileri olabileceği düşünüldü. Lumbal bölgeye uygulanacak terapötik ajanların seçiminde, hastaların YDK kalınlığı gibi antropometrik özelliklerin göz önünde bulundurulması gerektiği sonucuna varıldı.

Anahtar Kelimeler: Adipoz doku; bilgisayarlı tomografi; fizyoterapi modaliteleri; bel kasları; obezite
ABSTRACT
 Objective: The therapeutic agents commonly used for the treatment of lumbal region pathologies has target tissue depths between 3-5 centimeters. The aim of this study is to determine the soft tissue thickness (STT) due to adipose tissue increase between the skin surface and erector spina muscles in the lumbar region in obese patients. Material and Methods: A total of 66 cases, including 30 females and 36 males over the age of 18 years old with a body mass index between 30 kg/m2 -40 kg/m2 were included in this study. STT measurement were made by measuring the distance between the most superficial part of the skin and the lamina superficialis of the erector spinae muscles from the medial, intermedial, and lateral regions at the level of the L1-L5 lumbar vertebrae via computed tomography images. The maximum antero-posterior distance (ESAP) of the erector spinae muscles was measured. Results: Among cases included in our study; forty one (62.12%) cases with a body mass index between 30.00-34.99 kg/m2 were classified as class I obesity, and 25 (38.88%) cases with a body mass index of 35.0-39.99 kg/m2 were classified as class II obesity. STT of patients with class II obesity were wider (p=0.001-0.010 among the values) at right and left side measurements for all levels between L1- L5. The highest STT was found for lateral measurement of L5 level in class II obese patients. A difference was found between left L4 ESAP values of class I obese patients and class II obese patients (p=0.037). The left L4 ESAP value was higher in class I obese patients. Conclusion: As a result of our study, it was observed that STT increased due to the increase in adipose tissue in the majority of class II obese patients at L4-L5 level. It was thought that physiotherapy modalities can reach the surface of the target tissue, the erector spinae muscle, but may have limited effects on creating therapeutic effects in the entire tissue. It was concluded that the anthropometric properties such as STT of the patients should be taken into consideration in the selection of therapeutic agents to be applied to the lumbar region.

Keywords: Adipose tissue; computed tomography; physical therapy modalities; back muscles; obesity
REFERENCES:
  1. Allen RJ. Physical agents used in the management of chronic pain by physical therapists. Phys Med Rehabil Clin N Am. 2006;17(2):315-45. [Crossref] [PubMed] 
  2. ter Haar G. Therapeutic ultrasound. Eur J Ultrasound. 1999;9(1):3-9. [Crossref] [PubMed] 
  3. Miller DL, Smith NB, Bailey MR, Czarnota GJ, Hynynen K, Makin IR; Bioeffects Committee of the American Institute of Ultrasound in Medicine. Overview of therapeutic ultrasound applications and safety considerations. J Ultrasound Med. 2012;31(4):623-34. [Crossref] [PubMed] [PMC] 
  4. Chahade WH, Battistella LR, Biasoli MC. Low back pain (LBP): physical therapy approach. Temas de Reumatologia Clinica. 2001;2:24-32. [Link] 
  5. Draper DO. Facts and misfits in ultrasound therapy: steps to improve your treatment outcomes. Eur J Phys Rehabil Med. 2014;50(2):209-16. [PubMed] 
  6. Draper DO, Castel JC, Castel D. Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound. J Orthop Sports Phys Ther. 1995;22(4):142-50. [Crossref] [PubMed] 
  7. Hayes BT, Merrick MA, Sandrey MA, Cordova ML. Three-MHz ultrasound heats deeper ınto the tissues than originally theorized. J Athl Train. 2004;39(3):230-4. [PubMed] [PMC] 
  8. Lehmann JF, DeLateur BJ, Silverman DR. Selective heating effects of ultrasound in human beings. Arch Phys Med Rehabil. 1966;47(6):331-9. [PubMed] 
  9. Şimşek N, Kırdı N. Elektroterapide Temel Prensipler ve Klinik Uygulamalar. 1. Baskı. Ankara: Pelikan Kitabevi; 2015. [Link] 
  10. Garrett CL, Draper DO, Knight KL. Heat distribution in the lower leg from pulsed short-wave diathermy and ultrasound treatments. J Athl Train. 2000;35(1):50-5. [PubMed] [PMC] 
  11. Yıldırım A. Kronik diskojenik bel ağrıları ve cerrahi dışı tedavi yöntemleri: güncelleme. [Chronic discogenic low back pain and non-surgical treatment methods: an update]. Dicle Tip Dergisi. 2016;43(1):181-91. [Crossref] 
  12. Kola I. Rehabilitation of lower back pain with manual therapy and electrotherapy. International Journal of Information Research and Review. 2019;6(12):6654-7. [Link] 
  13. Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976). 2010;15;35(11):E488-504. [Crossref] [PubMed] 
  14. Oksuz E. Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine (Phila Pa 1976). 2006;1;31(25):E968-72. [Crossref] [PubMed] 
  15. Dario AB, Ferreira ML, Refshauge KM, Lima TS, Ordo-ana JR, Ferreira PH. The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. Spine J. 2015;1;15(5):1106-17. [Crossref] [PubMed] 
  16. Mawston GA, Boocock MG. Lumbar posture biomechanics and its influence on the functional anatomy of the erector spinae and multifidus. Physical Therapy Reviews. 2015;20(3):178-86. [Crossref] 
  17. Macintosh JE, Bogduk N. The attachments of the lumbar erector spinae. Spine (Phila Pa 1976). 1991;16(7):783-92. [Crossref] [PubMed] 
  18. Irlbeck T, Janitza S, Poros B, Golebiewski M, Frey L, Paprottka PM, et al. Quantification of adipose tissue and muscle mass based on computed tomography scans: comparison of eight planimetric and diametric techniques ıncluding a step-by-step guide. Eur Surg Res. 2018;59(1-2):23-34. [Crossref] [PubMed] 
  19. World Health Organization [İnternet]. Waist circumference and waist-hip ratio: report of a WHO expert consultation. Erişim linki: [Link] 
  20. Englesbe MJ, Lee JS, He K, Fan L, Schaubel DE, Sheetz KH, et al. Analytic morphomics, core muscle size, and surgical outcomes. Ann Surg. 2012;256(2):255-61. [Crossref] [PubMed] 
  21. Gomez-Perez SL, Haus JM, Sheean P, Patel B, Mar W, Chaudhry V, et al. Measuring abdominal circumference and skeletal muscle from a single cross-sectional computed tomography ımage: a step-by-step guide for clinicians using national institutes of health imagej. JPEN J Parenter Enteral Nutr. 2016;40(3):308-18. Erratum in: JPEN J Parenter Enteral Nutr. 2016;40(5):742-3. [Crossref] [PubMed] [PMC] 
  22. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5):997-1006. [Crossref] [PubMed] 
  23. Stolk RP, Wink O, Zelissen PM, Meijer R, van Gils AP, Grobbee DE. Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue. Int J Obes Relat Metab Disord. 2001;25(9):1346-51. [Crossref] [PubMed] 
  24. Bertin E, Marcus C, Ruiz JC, Eschard JP, Leutenegger M. Measurement of visceral adipose tissue by DXA combined with anthropometry in obese humans. Int J Obes Relat Metab Disord. 2000;24(3):263-70. [Crossref] [PubMed] 
  25. Onat A, Avci GS, Barlan MM, Uyarel H, Uzunlar B, Sansoy V. Measures of abdominal obesity assessed for visceral adiposity and relation to coronary risk. Int J Obes Relat Metab Disord. 2004;28(8):1018-25. [Crossref] [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com