Learman Kenneth E, Myers Joseph B, Lephart Scott M, Sell Timothy C, Kerns G Jay, Cook Chad E
Department of Physical Therapy, Youngstown State University, Youngstown, Ohio, USA.
J Manipulative Physiol Ther. 2009 Feb;32(2):118-26. doi: 10.1016/j.jmpt.2008.12.004.
The purpose of this study was to examine the immediate effects of spinal manipulative therapy (SMT) on trunk proprioception in subjects with asymptomatic chronic low back pain (CLBP) and determine if those effects lasted 1 week.
This unbalanced randomized controlled crossover design examined 33 subjects with CLBP. Proprioception was tested via joint position sense, threshold to detect passive motion (TTDPM), direction of motion (DM), and force reproduction. Each subject received lumbar manipulation or a sham procedure followed by proprioception retest. This procedure was repeated 1 week later using the opposing treatment. Subjects receiving SMT in the second session returned a third time receiving the sham procedure again.
Spinal manipulative therapy produced an effect for TTDPM in the manipulation first group (P = .008), the sham procedure produced an effect for joint position sense in the sham first group (P = .005). Spinal manipulative therapy had a 1-week effect for the manipulation first group (P = .006). No effect was noted for either DM or force reproduction.
Results suggest SMT had minimal immediate effect on trunk proprioception. The effects noted occurred in session 1, implicating learning as a potential source. Learning, from repetitive proprioception training, may enhance neuromuscular control in subjects with CLBP before the use of therapeutic exercise. Subjects showed smaller deficits than previously reported for TTDPM or DM, suggesting proprioception deficits may correlate with pain level.
本研究旨在探讨脊柱手法治疗（SMT）对无症状慢性下腰痛（CLBP）患者躯干本体感觉的即时影响，并确定这些影响是否持续1周。
本非平衡随机对照交叉设计研究了33例CLBP患者。通过关节位置觉、被动运动检测阈值（TTDPM）、运动方向（DM）和力量再现来测试本体感觉。每位受试者接受腰椎手法治疗或假手术，随后进行本体感觉复测。1周后使用相反的治疗方法重复此过程。在第二阶段接受SMT的受试者第三次返回时再次接受假手术。
在手法治疗先进行组中，脊柱手法治疗对TTDPM产生了影响（P = .008），在假手术先进行组中，假手术对关节位置觉产生了影响（P = .005）。手法治疗先进行组中，脊柱手法治疗有1周的效应（P = .006）。未观察到DM或力量再现方面的影响。
结果表明SMT对躯干本体感觉的即时影响极小。观察到的影响出现在第一阶段，这表明学习可能是一个潜在原因。在进行治疗性锻炼之前，通过重复本体感觉训练进行学习，可能会增强CLBP患者的神经肌肉控制。与先前报道的TTDPM或DM相比，受试者表现出的缺陷较小，这表明本体感觉缺陷可能与疼痛程度相关。
