在一组被认为已准备好恢复正常活动的下背部受伤患者进行的可控功能任务期间，躯干神经肌肉模式的改变。
Trunk neuromuscular pattern alterations during a controlled functional task in a low back injured group deemed ready to resume regular activities.
作者信息
Hubley-Kozey Cheryl, Moreside Janice M, Quirk D Adam
机构信息
Schools of Physiotherapy, Dalhousie University, Halifax, NS, Canada Biomedical Engineering, Dalhousie University, Halifax, NS, Canada Health and Human Performance, Dalhousie University, Halifax, NS, Canada.
Schools of Physiotherapy, Dalhousie University, Halifax, NS, Canada Biomedical Engineering, Dalhousie University, Halifax, NS, Canada.
出版信息
Work. 2014;47(1):87-100. doi: 10.3233/WOR-131689.
BACKGROUND
Trunk neuromuscular alterations have been found in those with chronic low back pain, but less well studied are whether responses are altered in those deemed recovered following an injury. Furthermore, coordinated trunk muscle responses are deemed important for normal spinal function, but there are no studies of temporal patterns early after a low back injury. Determining whether altered trunk muscle patterns exist early after injury could improve our understanding of recovery by providing an objective assessment of functional recovery and risk of re-injury.
OBJECTIVE
To determine if amplitude and temporal characteristics of trunk neuromuscular patterns differ during a dynamic functional task in a group of participants with recent (within 12 weeks) low back injury (LBI), but deemed ready to resume normal activities, when compared to those with no similar history of injury (ASYM).
PARTICIPANTS
35 participants in each group (17 females) were matched for age and body mass index (BMI); (ASYM 36 yrs, BMI 26, LBI 39 yrs, BMI 27).
METHODS
Participants performed a controlled lifting task (2.9 kg) in a standing maximum reach position, which altered frontal and sagittal plane moments of force. Electromyographic activity of 24 trunk muscle sites, as well as thoracic and pelvis position via an electromagnetic sensor was collected. Principal component analyses extracted the temporal and amplitude waveform patterns. Mixed model ANOVAs tested for effects (p< 0.05) in the main patterns. Preliminary data regarding re-injury status after 1 year was included.
RESULTS
Three principal patterns explained 97% of the variance, with the LBI group demonstrating increased amplitude and a more constant level of activity compared to the ASYM group. The LBI group also demonstrated more thoracic motion in all 3 axes during this highly constrained task. The no re-injury group had lower activation than the re-injury group, but similar temporal patterns.
CONCLUSIONS
Despite the perception of readiness to return to work and low pain scores, the temporal and amplitude muscle activation patterns were altered in this LBI group indicating that differences exist compared to a non-low back injured group. The differences are not just relative amplitude differences among muscles but include differences in the temporal response to the flexion moment.
背景
慢性下腰痛患者已被发现存在躯干神经肌肉改变，但对于受伤后被认为已康复的患者其反应是否改变的研究较少。此外，协调的躯干肌肉反应被认为对正常脊柱功能很重要，但尚无关于下背部损伤后早期时间模式的研究。确定损伤后早期是否存在改变的躯干肌肉模式，可通过对功能恢复和再次受伤风险进行客观评估，增进我们对恢复情况的理解。
目的
确定近期（12周内）下背部损伤（LBI）但被认为已准备好恢复正常活动的一组参与者，与无类似损伤史（ASYM）的参与者相比，在动态功能任务期间躯干神经肌肉模式的幅度和时间特征是否存在差异。
参与者
每组35名参与者（17名女性），年龄和体重指数（BMI）相匹配；（ASYM组36岁，BMI 26；LBI组39岁，BMI 27）。
方法
参与者在站立位最大伸展位置执行一项受控的举重任务（2.9千克），该任务改变了额状面和矢状面的力矩。收集24个躯干肌肉部位的肌电图活动，以及通过电磁传感器测量的胸廓和骨盆位置。主成分分析提取时间和幅度波形模式。混合模型方差分析测试主要模式中的效应（p<0.05）。纳入了关于1年后再次受伤状态的初步数据。
结果
三种主要模式解释了97%的方差，与ASYM组相比，LBI组表现出幅度增加和更持续的活动水平。在这项高度受限的任务中，LBI组在所有三个轴上也表现出更多的胸廓运动。未再次受伤组的激活程度低于再次受伤组，但时间模式相似。
结论
尽管感觉已准备好重返工作岗位且疼痛评分较低，但该LBI组的时间和幅度肌肉激活模式发生了改变，表明与非下背部受伤组相比存在差异。这些差异不仅包括肌肉之间的相对幅度差异，还包括对屈曲力矩的时间反应差异。
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