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Low back pain (LBP) is a condition that affects millions of people each year. It is the leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation. 

Al Kozar, DO, knows a little something about LBP.  

Dr. Kozar is a professor of Osteopathic Manipulative Medicine and sports medicine at С����Ƶ-Virginia. He is also a practicing physician at the С����Ƶ Sports & Osteopathic Medicine practice in Blacksburg where he regularly treats patients suffering from LBP. He points out that chronic back pain can have a major impact on the quality of life because in addition to biological and mechanical challenges, it also has psychosocial implications. “Everybody responds differently, based on their upbringing and how their family addressed pain and how much the pain affects their ability to do their work or their daily activities,” he says. “We often put up with back pain until it prevents us from doing those things. But pain tells us there is dysfunction somewhere in the musculoskeletal system.” 

Dr. Kozar is collaborating with Vincent Wang, Ph.D., director of Virginia Tech’s , on two research projects to better understand the causes of back pain and how to treat it more effectively.  

Like Dr. Kozar, Wang is an expert in the musculoskeletal system. His laboratory in Virginia Tech’s has received millions of dollars in funding to “support a variety of projects related to skeletal soft tissue biomechanics, repair, and healing.” The new research will build on and will include faculty and students at both С����Ƶ and Virginia Tech. The researchers will recruit people who have LBP, as well as people who don’t, to perform ultrasound imaging on their thoracolumbar fascia (TLF). Ultrasound is a useful diagnostic tool, in part because it does not use ionizing radiation, is inexpensive and is effective in detecting soft tissue changes.  

The TLF is integral to body movement. It has an important mechanical function in enabling us to bend over and pick things up, and it is a proprioceptive structure, meaning that it helps our bodies sense movement, action and our location in space. Dysfunction in this large soft tissue complex may be a frequent cause of LBP. However, TLF is also incredibly thin—only about 5 mm thick—so its injury is difficult to diagnose clinically. Medical imaging techniques such as ultrasound allow physicians and researchers to more effectively investigate changes not only to a patient’s TLF structure but also the glide motion within the layers of the TLF. 

The teams are partnering on two funded projects related to diagnosing and treating LBP. The first project will take 24 months and is being funded by the United States Department of Defense (DoD) because service members and veterans often suffer from LBP due to the nature of their work. The DoD funding will enable the teams to study the effectiveness of a novel treatment called hydrodissection, which involves using ultrasound guidance to apply a dextrose solution to the TLF to separate its tissue layers and restore any glide restriction that might be contributing to causing a patient’s pain.  

Additional funding from the will enable an 18-month study on how osteopathic manipulative treatments can do essentially the same thing—relieve the restriction in the TLF.  

Dr. Kozar anticipates that he will spend more than 1,500 hours over the next two years using ultrasound to acquire images of patients’ TLF. Wang’s research team will then perform detailed computer-based image analyses to help them quantify lower back flexibility and examine potential relationships between pain, function and imaging metrics. In addition to using conventional image analyses, the researchers will develop artificial intelligence approaches to objectively determine whether an image is from an individual with LBP.  

“We hope these tools will further facilitate and improve clinical diagnosis, treatment and care of patients—not just within our group, but more broadly among clinicians and researchers in the field,” Wang says. Their research is particularly important because, he observes, “LBP can be experienced at any age, and we see these projects as valuable opportunities to extract valuable information from TLF ultrasound images in a manner that hasn’t been done before.” 

Dr. Kozar’s team will study the clinical efficacy of osteopathic manipulative treatments and track patients over time. “We will be testing some physical exam maneuvers to see if they will be able to predict that a patient’s pain is being caused by TLF as opposed to something else,” he says. Dr. Kozar has been using these maneuvers for several years and the research will help him understand their effectiveness at predicting an issue with a patient’s TLF.