Lewis Sandra, Holmes Paul, Woby Steve, Hindle Jackie, Fowler Neil
Institute for Performance Research, Manchester Metropolitan University, Crewe, United Kingdom.
Man Ther. 2012 Feb;17(1):27-33. doi: 10.1016/j.math.2011.08.001. Epub 2011 Sep 7.
Individuals with low back pain (LBP) often exhibit elevated paraspinal muscle activity compared to asymptomatic controls during static postures such as standing. This hyperactivity has been associated with a delayed rate of stature recovery in individuals with mild LBP. This study aimed to explore this association further in a more clinically relevant population of NHS patients with LBP and to investigate if relationships exist with a number of psychological factors. Forty seven patients were recruited from waiting lists for physiotherapist-led rehabilitation programmes. Paraspinal muscle activity while standing was assessed via surface electromyogram (EMG) and stature recovery over a 40-min unloading period was measured on a precision stadiometer. Self-report of pain, disability, anxiety, depression, pain-related anxiety, fear of movement, self-efficacy and catastrophising were recorded. Correlations were found between muscle activity and both pain (r=0.48) and disability (r=0.43). Muscle activity was also correlated with self-efficacy (r=-0.45), depression (r=0.33), anxiety (r=0.31), pain-related anxiety (r=0.29) and catastrophising (r=0.29) and was a mediator between self-efficacy and pain. Pain was a mediator in the relationship between muscle activity and disability. Stature recovery was not found to be related to pain, disability, muscle activity or any of the psychological factors. The findings confirm the importance of muscle activity within LBP, in particular as a pathway by which psychological factors may impact on clinical outcome. The mediating role of muscle activity between psychological factors and pain suggests that interventions that are able to reduce muscle tension may be of particular benefit to patients demonstrating such characteristics, which may help in the targeting of treatment for LBP.
与无症状对照组相比，下背痛（LBP）患者在站立等静态姿势下通常表现出椎旁肌活动增强。这种活动亢进与轻度LBP患者身高恢复速度延迟有关。本研究旨在进一步探讨这种关联，研究对象为更具临床相关性的国民保健制度（NHS）下背痛患者群体，并调查其与一些心理因素之间是否存在关系。从物理治疗师主导的康复项目等候名单中招募了47名患者。通过表面肌电图（EMG）评估站立时的椎旁肌活动，并使用精密身高计测量40分钟卸载期内的身高恢复情况。记录疼痛、残疾、焦虑、抑郁、疼痛相关焦虑、运动恐惧、自我效能感和灾难化思维的自我报告。发现肌肉活动与疼痛（r = 0.48）和残疾（r = 0.43）之间存在相关性。肌肉活动还与自我效能感（r = -0.45）、抑郁（r = 0.33）、焦虑（r = 0.31）、疼痛相关焦虑（r = 0.29）和灾难化思维（r = 0.29）相关，并且是自我效能感和疼痛之间的中介因素。疼痛是肌肉活动与残疾之间关系的中介因素。未发现身高恢复与疼痛、残疾、肌肉活动或任何心理因素有关。研究结果证实了肌肉活动在下背痛中的重要性，特别是作为心理因素可能影响临床结局的一种途径。肌肉活动在心理因素和疼痛之间的中介作用表明，能够降低肌肉紧张度的干预措施可能对具有此类特征的患者特别有益，这可能有助于针对下背痛进行精准治疗。
