Department of Rehabilitation and Sport Medicine, Second Medical Faculty, Charles University and University Hospital Motol, Prague, Czech Republic.
J Orthop Sports Phys Ther. 2012 Apr;42(4):352-62. doi: 10.2519/jospt.2012.3830. Epub 2011 Dec 21.
A case-control study.
To examine the function of the diaphragm during postural limb activities in patients with chronic low back pain and healthy controls.
Abnormal stabilizing function of the diaphragm may be an etiological factor in spinal disorders. However, a study designed specifically to test the dynamics of the diaphragm in chronic spinal disorders is lacking.
Eighteen patients with chronic low back pain due to chronic overloading, as ascertained via clinical assessment and magnetic resonance imaging, and 29 healthy subjects were examined. Both groups presented with normal pulmonary function test results. A dynamic magnetic resonance imaging system and specialized spirometric readings were used with subjects in the supine position. Measurements during tidal breathing (TB) and isometric flexion of the upper and lower extremities against external resistance with TB were performed. Standard pulmonary function tests, including respiratory muscle drive (PI(max) and PE(max)), were also assessed.
Using multivariate analysis of covariance, smaller diaphragm excursions and higher diaphragm position were found in the patient group (P<.05) during the upper extremity TB and lower extremity TB conditions. Maximum changes were found in costal and middle points of the diaphragm. A 1-way analysis of covariance showed a steeper slope in the middle-posterior diaphragm in the patient group both in the upper extremity TB and lower extremity TB conditions (P<.05).
Patients with chronic low back pain appear to have both abnormal position and a steeper slope of the diaphragm, which may contribute to the etiology of the disorder.
病例对照研究。
研究慢性下背痛患者和健康对照组在姿势性肢体活动中膈肌的功能。
膈肌的稳定功能异常可能是脊柱疾病的一个病因因素。然而，缺乏专门针对慢性脊柱疾病中膈肌动力学的研究。
对 18 例因慢性超负荷导致慢性下背痛的患者和 29 名健康受试者进行了研究。两组受试者均有正常的肺功能测试结果。使用动态磁共振成像系统和专门的呼吸描记法，让受试者处于仰卧位进行检查。在静息呼吸（TB）和四肢对抗外部阻力的等长屈曲时进行测量。还评估了标准肺功能测试，包括呼吸肌驱动（PI(max)和 PE(max)）。
使用多变量协方差分析，在患者组中，上肢 TB 和下肢 TB 时，膈肌的运动幅度较小，膈肌位置较高（P<.05）。最大的变化发生在膈肌的肋部和中部。单向协方差分析显示，在患者组中，上肢 TB 和下肢 TB 时，膈肌中后段的斜率更陡（P<.05）。
慢性下背痛患者的膈肌位置和斜率似乎都异常，这可能是导致该疾病的原因之一。
