Spine Biomechanics Laboratory, Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
Spine (Phila Pa 1976). 2012 Nov 1;37(23):E1469-75. doi: 10.1097/BRS.0b013e31826c97e5.
A quantitative biomechanical analysis of mechanism of pain alteration in 4 cases of low back pain.
To investigate the contributions of a number of biomechanical factors associated with pain alteration.
Some clinicians use mechanically based manual interventions in attempt to reduce low back pain. However, the mechanism of pain alteration remains unknown.
A sample was formed with 4 patients with low back pain seeking consults for pain relief. All could produce "catches" of pain with movement. Manual interventions involving coached changes in motion and muscle activation attempted to reduce pain. Electromyographic and kinematic data were collected before and after intervention. These data were input to an anatomically detailed spine model that calculated muscle force, joint compression and shear, and spine stability.
Using a clinically significant criterion of pain reduction of 2 or more, 3 of 4 subjects reduced pain immediately upon the intervention. Using a change of 10% as a criterion for biological significance for kinematic and kinetic variables, each subject demonstrated a different reaction. For example, subject 1 demonstrated increased stability, subject 2 increased mediolateral shear, subject 3 increased mediolateral shear and decreased spine flexion, and subject 4 increased stability. The pain-reducing interventions required to obtain these results were also different for each individual.
Immediate pain reduction can be achieved by altering muscle-activation and movement patterns. However, the combination for optimal success seems to be different for every individual. Pain provocation tests help to "tune" the intervention. This also suggests that patient-classification schemes may need more refinement to address this heterogeneity.
4 例腰痛患者疼痛改变机制的定量生物力学分析。
探讨与疼痛改变相关的多种生物力学因素的作用。
一些临床医生使用基于力学的手法干预来试图减轻腰痛。然而，疼痛改变的机制仍不清楚。
对 4 例腰痛寻求缓解疼痛的患者进行了样本研究。所有患者在运动时都能产生“疼痛发作”。手法干预包括指导运动和肌肉激活的变化，以减轻疼痛。在干预前后收集肌电图和运动学数据。这些数据被输入到一个解剖学上详细的脊柱模型中，该模型计算肌肉力、关节压缩和剪切以及脊柱稳定性。
使用疼痛减轻 2 或更多的临床显著标准，4 名受试者中有 3 名在干预后立即减轻了疼痛。使用运动学和动力学变量变化 10%作为生物学意义的标准，每个受试者表现出不同的反应。例如，受试者 1 表现出稳定性增加，受试者 2 增加了横向剪切，受试者 3 增加了横向剪切和减少了脊柱前屈，受试者 4 增加了稳定性。为了获得这些结果，每个个体所需的止痛干预也不同。
通过改变肌肉激活和运动模式可以立即减轻疼痛。然而，对于每个个体来说，最佳成功的组合似乎是不同的。疼痛诱发试验有助于“调整”干预。这也表明患者分类方案可能需要进一步细化，以解决这种异质性。
