Apparent diffusion in nucleus pulposus is associated with pain and mobility improvements after spinal mobilization for acute low back pain

ABSTRACT Pain perception, trunk mobility in flexion, extension, and lateral flexion, and apparent diffusion coefficient ( ADC ) within nucleus pulposus of all lumbar discs were collected before and after posterior-to-anterior mobilization in 16 adults with acute low back pain. ADC was computed from diffusion maps and 3 specific portions of the nucleus pulposus were investigated: anterior ( ADC ant ), middle ( ADC mid ), and posterior ( ADC post ), and their mean as ADC all , a summary measure of ADC within nucleus pulposus. Pain ratings were significantly reduced after mobilization, and mobility of the trunk was significantly increased. Concomitantly, a significant increase in ADC all values was observed. The greatest ADC all changes were observed at the L 3 -L 4 and L 4 -L 5 levels and were mainly explained by changes in ADC ant and ADC post . The simultaneous reduction in pain and increase of water diffusion within nucleus pulposus has has been previously observed in subjects with chronic conditions and exists in the acute phase of the disease. Since the largest changes in ADC were observed at the periphery of the nucleus pulposus, and taken together with pain decrease, our results suggest that increased peripheral random motion of water molecules is implicated in the modulation of the intervertebral disc nociceptive response.