Hodges Paul W, Moseley G Lorimer
Department of Physiotherapy, The University of Queensland, Brisbane, Qld 4072, Australia.
J Electromyogr Kinesiol. 2003 Aug;13(4):361-70. doi: 10.1016/s1050-6411(03)00042-7.
Many authors report changes in the control of the trunk muscles in people with low back pain (LBP). Although there is considerable disagreement regarding the nature of these changes, we have consistently found differential effects on the deep intrinsic and superficial muscles of the lumbopelvic region. Two issues require consideration; first, the potential mechanisms for these changes in control, and secondly, the effect or outcome of changes in control for lumbopelvic function. Recent data indicate that experimentally induced pain may replicate some of the changes identified in people with LBP. While this does not exclude the possibility that changes in control of the trunk muscles may lead to pain, it does argue that, at least in some cases, pain may cause the changes in control. There are many possible mechanisms, including changes in excitability in the motor pathway, changes in the sensory system, and factors associated with the attention demanding, stressful and fearful aspects of pain. A new hypothesis is presented regarding the outcome from differential effects of pain on the elements of the motor system. Taken together these data argue for strategies of prevention and rehabilitation of LBP.
许多作者报告了腰痛（LBP）患者躯干肌肉控制方面的变化。尽管对于这些变化的性质存在相当大的分歧，但我们一直发现对腰骶部区域的深层固有肌肉和浅层肌肉有不同的影响。有两个问题需要考虑：第一，这些控制变化的潜在机制；第二，控制变化对腰骶部功能的影响或结果。最近的数据表明，实验诱导的疼痛可能会重现LBP患者中发现的一些变化。虽然这并不排除躯干肌肉控制变化可能导致疼痛的可能性，但它确实表明，至少在某些情况下，疼痛可能导致控制变化。有许多可能的机制，包括运动通路兴奋性的变化、感觉系统的变化，以及与疼痛的注意力需求、压力和恐惧方面相关的因素。提出了一个关于疼痛对运动系统各要素的不同影响结果的新假设。综合这些数据，支持LBP的预防和康复策略。
