Department of Exercise Science, School of Public Health and the Department of Developmental Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC, USA.
J Orthop Sports Phys Ther. 2010 May;40(5):256-64. doi: 10.2519/jospt.2010.3284.
Single-group, prospective, repeated-measures design.
To determine differences in the changes of diffusion of water in the L5-S1 intervertebral disc between subjects with nonspecific low back pain (LBP) who reported an immediate reduction in pain intensity of 2 or greater on an 11-point (0-10) numeric rating scale after a 10-minute session of lumbar joint mobilization, followed by prone press-up exercises, compared to those who did not report an immediate reduction in pain intensity of 2 or greater on the pain scale.
Combining lumbar joint mobilization and prone press-up exercises is a common intervention for patients with LBP; however, there is conflicting evidence regarding the effectiveness and efficacy of this approach. Increased knowledge of the physiologic effects of the combined use of these treatments, and the relationship to pain reports, can lead to refinement of their clinical application.
Twenty adults, aged 22 to 54, participated in this study. All subjects reported LBP of at least 2 on an 11-point (0-10) verbally administered numeric rating scale at the time of enrollment in the study and were classified as being candidates for the combination of joint mobilization and prone press-ups. Subjects underwent T2- and diffusion-weighted lumbar magnetic resonance imaging scans before and immediately after receiving a 10-minute session of lumbar pressures in a posterior-to-anterior direction and prone press-up exercises. Subjects who reported a decrease in current pain intensity of 2 or greater immediately following treatment were classified as immediate responders, while the remainder were classified as not-immediate responders. The apparent diffusion coefficient, representing the diffusion of water in the nucleus pulposis, was calculated from the midsagittal diffusion-weighted images.
Following treatment, immediate responders (n = 10) had a mean increase in the apparent diffusion coefficient in the middle portion of the L5-S1 intervertebral disc of 4.2% compared to a mean decrease of 1.6% for the not-immediate responders (P<.005).
In a group of subjects with LBP, who were classified as being candidates for extension-based treatment, the report of an immediate reduction in pain intensity of 2/10 of greater after a treatment of posterior-to-anterior-directed pressures, followed by prone press-up exercises, was associated with an increase in diffusion of water in the nuclear region of the L5-S1 intervertebral disc. Subjects who did not report a pain reduction of at least 2/10 did not have a change in diffusion. J Orthop Sports Phys Ther 2010;40(5):256-264, Epub 12 March 2010. doi:10.2519/jospt.2010.3284.
单组、前瞻性、重复测量设计。
确定在接受 10 分钟腰椎关节松动术和俯趴俯卧撑治疗后，报告疼痛强度立即降低 2 或以上（11 点数字评定量表，0-10）的非特异性下腰痛（LBP）患者与未报告疼痛强度立即降低 2 或以上的患者之间，L5-S1 椎间盘水扩散变化的差异。这些患者在接受治疗后，11 点数字评定量表的疼痛评分。背景：腰椎关节松动术和俯趴俯卧撑结合是治疗 LBP 的常用方法；然而，这种方法的有效性和疗效存在争议。增加对这些治疗方法联合使用的生理效应的了解，以及与疼痛报告的关系，可以促进其临床应用的改进。
20 名年龄在 22 至 54 岁之间的成年人参与了这项研究。所有受试者在研究入组时均报告至少有 2 点的 LBP（11 点数字评定量表，0-10），并被归类为接受腰椎关节松动术和俯趴俯卧撑联合治疗的候选者。受试者在接受 10 分钟的后前向腰椎压力和俯趴俯卧撑治疗前后接受 T2 和扩散加权腰椎磁共振成像扫描。报告治疗后疼痛强度立即降低 2 或以上的患者被归类为即刻反应者，而其余患者被归类为非即刻反应者。表观扩散系数表示核髓质中水的扩散，从正中矢状扩散加权图像计算得出。
治疗后，即刻反应者（n=10）L5-S1 椎间盘中间部分的表观扩散系数平均增加 4.2%，而即刻反应者（n=10）的平均减少 1.6%（P<.005）。
在一组被归类为接受伸展治疗的 LBP 受试者中，报告在接受后前向压力治疗后，疼痛强度立即降低 2/10 或以上，然后进行俯趴俯卧撑治疗，与 L5-S1 椎间盘核区水扩散增加有关。未报告疼痛减轻至少 2/10 的受试者没有扩散变化。《美国骨科物理治疗杂志》2010 年；40（5）：256-264，2010 年 3 月 12 日在线发表。doi:10.2519/jospt.2010.3284。
