About

Dr Kyra De Coninck joined the University of Kent as a lecturer in sports therapy in 2005 and completed her PGCHE in 2007. Prior to this, she ran a successful sports massage practice and taught massage to a wide range of students and health practitioners for more than 10 years. 

She teaches undergraduate and postgraduate modules in sports massage, sports injuries and soft tissue techniques. Kyra trained in musculoskeletal ultrasound imaging at Centre for Ultrasound Studies, University of Bournemouth in 2009. She is also a member of the Anatomical Society. 

Her research interest focuses on understanding the structure, function and dysfunction of specialised connective tissues, such as fascia. Fascia consists of thin layers which wrap around every muscle, bone and organ in the body. These fascial layers transmit forces and allow muscles to slide over each other during movement.  

Kyra's PhD thesis investigates how ultrasound imaging can be used to measure the differences in thoracolumbar fascia, in the lower back, in a range of populations with lower back pain. She has presented her research at conferences and scientific meetings in UK, Canada, Italy and Romania.

Kyra continues, together with students, to provide sports massage to athletes at a number of national and international events and championships. 

Research interests

Dr Kyra De Coninck's general research interests include the anatomy and function of fascia, myofascial pain and adaptation of fascia to mechanical loading. She is a PhD candidate at the School. Her thesis consists of an investigation of the interaction between chronic pain, physical activity and changes within the fascia network.

Studies include ultrasound imaging of thoracolumbar fascia in a sedentary and athletic population, both with and without lower back pain.

Kyra has presented on the subject of fascia and tissue repair at the Defence Medical Rehabilitation Centre at Headley Court, the European School of Osteopathy and the Third International Fascia Research Congress in Vancouver.

She is a reviewer for the American Journal of Sports Medicine and a member of the School’s Health Research Group.

Teaching

Publications

Article

  • De Coninck, K., Hambly, K., Dickinson, J. and Passfield, L. (2018). Measuring the morphological characteristics of thoracolumbar fascia in ultrasound images: an inter-rater reliability study. BMC Musculoskeletal Disorders [Online] 19. Available at: http://dx.doi.org/10.1186/s12891-018-2088-5.
    BACKGROUND: Chronic lower back pain is still regarded as a poorly understood multifactorial condition. Recently, the thoracolumbar fascia complex has been found to be a contributing factor. Ultrasound imaging has shown that people with chronic lower back pain demonstrate both a significant decrease in shear strain, and a 25% increase in thickness of the thoracolumbar fascia. There is sparse data on whether medical practitioners agree on the level of disorganisation in ultrasound images of thoracolumbar fascia. The purpose of this study was to establish inter-rater reliability of the ranking of architectural disorganisation of thoracolumbar fascia on a scale from ‘very disorganised’ to ‘very organised’. METHODS: An exploratory analysis was performed using a fully crossed design of inter-rater reliability. Thirty observers were recruited, consisting of 21 medical doctors, 7 physiotherapists and 2 radiologists, with an average of 13.03 ± 9.6 years of clinical experience. All 30 observers independently rated the architectural disorganisation of the thoracolumbar fascia in 30 ultrasound scans, on a Likert-type scale with rankings from 1 = very disorganised to 10 = very organised. Internal consistency was assessed using Cronbach’s alpha. Krippendorff’s alpha was used to calculate the overall inter-rater reliability. RESULTS: The Krippendorf’s alpha was .61, indicating a modest degree of agreement between observers on the different morphologies of thoracolumbar fascia.The Cronbach’s alpha (0.98), indicated that there was a high degree of consistency between observers. Experience in ultrasound image analysis did not affect constancy between observers (Cronbach’s range between experienced and inexperienced raters: 0.95 and 0.96 respectively). CONCLUSIONS: Medical practitioners agree on morphological features such as levels of organisation and disorganisation in ultrasound images of thoracolumbar fascia, regardless of experience. Further analysis by an expert panel is required to develop specific classification criteria for thoracolumbar fascia.

Conference or workshop item

  • De Coninck, K., Hambly, K., Passfield, L., Dickinson, J. and Muthumayandi, K. (2015). Inter-observer agreement of thoracolumbar fascia morphology: an exploratory analysis of ultrasound images. In: Fourth International Fascia Research Congress. Elsevier, pp. 668-669. Available at: https://doi.org/10.1016/j.jbmt.2015.07.005.
    BACKGROUND: Ultrasound imaging (USI) has been shown to be a valid method to investigate the morphology of the thoracolumbar fascia (TLF) [1]. A USI-based study has demonstrated that the TLF of subjects with chronic lower back pain (LBP) is on average 25% thicker and more disorganised compared to a control group [1]. The aim of this study is to explore inter-observer agreement between a range of clinicians on (dis)organisation of TLF in ultrasound images. There are currently no validated methods for the evaluation of USI of TLF.
    METHODS: Design: an exploratory analysis using a fully crossed design of inter-observer agreement. This study was approved by the University of Kent’s School of Sport and Exercise Sciences Research and Ethics Committee (Prop. 163 – 2013). Participants: Thirty observers consisting of 21 (70%) Medical Doctors, 7 (23%) physiotherapists and 2 (6%) radiologists, with a combined total average of 13 years of clinical experience (± SD 9.4). 57% had no experience in USI, 36% had experience ranging from monthly to daily evaluations of USI, no observers had experience in evaluating USI of TLF. Protocol: A sub-set of thirty ultrasound scans of TLF were randomly selected from a data set of 308 scans of subjects with and without LBP (from a larger study conducted by the first author). All scans were anonymised and displayed on a desktop computer, or projected on a screen. All observers viewed and rated each of the 30 scans independently on a Likert-type scale from 1(very disorganised) to 10 (very organised). Inter-observer agreement was assessed using a two-way mixed, consistency, average measures intra-class correlation (ICC), the Cronbach’s Alpha, to assess consistency among observers. The Krippendorff’s Alpha (Kalpha) [2] reliability estimate was used to assess agreement.
    RESULTS: The resulting ICC was in the excellent range, ICC = 0.98, indicating that observers had a high degree of consistency, suggesting that (dis)organisation was rated similarly across observers. Observers without USI experience scored an ICC = 0.96, observers with USI experience scored an ICC = 0.95, again both in the excellent range. In this small cohort, experience in USI does not appear to impact on consistency. The Krippendorff’s ordinal alpha ? was .621, indicating a modest degree of agreement.
    CONCLUSIONS: The high ICC and modest Kalpha suggest that a minimal amount of measurement error was introduced by the independent observers, and therefore statistical power for subsequent analyses is not substantially reduced. This will allow for further analysis of USI images of TLF in terms of morphology and classification. This could ultimately, lead to a meaningful evaluation of treatments of TLF.
  • De Coninck, K., Passfield, L., Arkesteijn, M. and Dietz, K. (2012). An ultrasound evaluation of the relationship between changes in the lumbar perimuscular layer and Body Mass Index in people with non-specific lower back pain. In: Fascia Research Conference. Elsevier, pp. 152-153. Available at: http://dx.doi.org/10.1016/j.jbmt.2012.01.065.
    BACKGROUND Mechanisms underlying non-specific lower back pain are still poorly understood. In an ultrasound-based study, Langevin et al. [1] found differences in the lumbar connective tissue structures in people with non-specific lower back pain (LBP) compared to people without (no-LBP). The aim of this study is to extend the work of Langevin and colleagues, and evaluate the relationship between the lumbar perimuscular layer and Body Mass Index (BMI) in LBP and no-LBP people.
    METHODS This study is a cross-sectional study design. Ultrasound imaging was used to investigate the echogenicity and thickness of the lumbar perimuscular layer in 45 participants (31 LBP, 14 no-LBP). The outcome measures were the thickness and echogenicity of the lumbar perimuscular layer. Longitudinal B-Mode ultrasound images were taken bi-laterally on an area 2 cm lateral to the midpoint between the spinous processes of L2-3,at a frequency of 18MHz, depth of 3 cm, (EsoateMyLab 25Gold, Firenze, Italy) using a 4 cm linear probe (Esaote LA435, Firenze, Italy) . Images were converted to grey-scale in Matlab (Mathworks, USA). The borders of the perimuscular layer were identified by a blinded investigator. Thickness was calculated in pixels and echogenicity as the average grey-scale value. Data was analysed using ANCOVA and linear regression.
    RESULTS The LBP and no-LBP groups did not significantly differ in age, sex, BMI or level of physical activity. Age (r= .452, p =.002) and BMI (r= .374, p =.013) showed significant positive correlations with perimuscular thickness, but not with perimuscular echogenicity. BMI significantly predicted perimuscular thickness (ANCOVA: p = .016), whereas group membership did not (ANCOVA:p=.168). Perimuscular echogenicity could be significantly predicted only by considering the interaction between group membership and BMI. The interaction between BMI and group membership accounted for 16% of the observed changes in perimuscular echogenicity (ANCOVA:p=.006). The interaction arose because in the no-LBP group, echogenicity significantly decreased as BMI increased (Regression:p = .005). In contrast, there was no systematic relationship between perimuscular echogenicity and BMI in the LBP group (Regression:p = .391).
    CONCLUSIONS Measurements of echogenicity can only be accounted for by considering group membership (LBP and no-LBP) and BMI values jointly. The relationship between BMI and echogenicity (negative correlation) in the no-LBP group is not found in participants with LBP. Possible causes, which require further investigation, include: sub-failure, changes in movement patterns, chronic inflammation, fibrosis, and/or fatty tissue infiltration.
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