Research Centre for Clinical Kinaesiology, School of Healthcare Studies, Cardiff University, Cardiff, Wales, UK.
Spine (Phila Pa 1976). 2012 Apr 15;37(8):E486-95. doi: 10.1097/BRS.0b013e31823b00ce.
A cross-sectional study between subgroups of nonspecific chronic low back pain (NSCLBP) and asymptomatic controls.
To investigate NSCLBP subgroup differences in spinal position sense and trunk muscle activity when repositioning thoracic and lumbar spine into neutral (midrange) spinal position during sitting and standing.
Patients with NSCLBP report aggravation of symptoms during sitting and standing. Impaired motor control in NSCLBP, associated with sitting and standing postures nearer the end range of spinal motion, may be a contributing factor. Rehabilitation improving neutral (midrange) spinal position control is advocated. Postural and motor control alterations vary in different NSCLBP subgroups, potentially requiring specific postural interventions. There is limited evidence on whether subgroup differences exist when performing neutral spine position tasks.
Ninety patients with NSCLBP and 35 asymptomatic controls were recruited. Two blinded practitioners classified NSCLBP into subgroups of active extension pattern and flexion pattern. Participants were assisted into neutral spine position and asked to reproduce this position 4 times. Absolute, variable, and constant errors were calculated. Three-dimensional thoracic and lumbar kinematics quantified the repositioning accuracy and surface electromyography assessed back and abdominal muscles activity bilaterally.
Irrespective of subclassification, patients with NSCLBP produced significantly greater error magnitude and variability than the asymptomatic controls, but subgroup differences were detected in the error direction. Subgroup differences in the trunk muscle activity were not consistently identified. Although both subgroups produced significantly higher abdominal activity, subclassification revealed difference in superficial multifidus activity during standing, with flexion pattern producing significantly greater activity than the asymptomatic controls.
Subgroups of NSCLBP had similar neutral spinal position deficits regarding error magnitude and variability, but subclassification revealed clear subgroup differences in the direction of the deficit. The trunk muscle activation was shown to be largely nondiscriminatory between subgroups, with the exception of superficial lumbar multifidus.
非特异性慢性下腰痛（NSCLBP）亚组与无症状对照组的横断面研究。
研究 NSCLBP 亚组在坐姿和站立时重新定位胸腰椎至中立（中间范围）脊柱位置时，脊柱位置感和躯干肌肉活动的差异。
NSCLBP 患者报告在坐姿和站立时症状加重。NSCLBP 患者运动控制受损，与接近脊柱运动末端范围的坐姿和站立姿势有关，可能是一个促成因素。提倡康复改善中立（中间范围）脊柱位置控制。不同的 NSCLBP 亚组存在不同的姿势和运动控制改变，可能需要特定的姿势干预。在执行中立脊柱位置任务时，是否存在亚组差异的证据有限。
招募了 90 名 NSCLBP 患者和 35 名无症状对照者。两名盲法从业者将 NSCLBP 分为主动伸展模式和弯曲模式亚组。参与者被辅助进入中立脊柱位置，并要求重复 4 次。计算绝对、变量和恒定误差。三维胸腰椎运动学定量了重新定位的准确性，表面肌电图评估了双侧背部和腹部肌肉的活动。
无论亚分类如何，NSCLBP 患者的误差幅度和变异性明显大于无症状对照组，但在误差方向上检测到亚组差异。躯干肌肉活动的亚组差异未被一致识别。尽管两个亚组都产生了明显更高的腹部活动，但亚分类揭示了站立时浅层多裂肌活动的差异，弯曲模式的活动明显大于无症状对照组。
NSCLBP 的亚组在中立脊柱位置的缺陷方面具有相似的误差幅度和变异性，但亚分类揭示了缺陷方向的明显亚组差异。躯干肌肉激活在亚组之间基本没有区别，除了浅层腰椎多裂肌。
