反复性下背痛病史对负荷功能性前伸活动中自主预发性腹部激活的影响。

Effect of recurrent low back pain history on volitional pre-emptive abdominal activation during a loaded functional reach activity.

机构信息

*Center for Rehabilitation Research, SAHS, Texas Tech University Health Sciences Center, Lubbock, TX; and †Doctor of Physical Therapy Program, Campbell University, Buies Creek, NC.

出版信息

Spine (Phila Pa 1976). 2014 Jan 15;39(2):E89-96. doi: 10.1097/BRS.0000000000000091.

DOI:10.1097/BRS.0000000000000091

PMID:24153166

Abstract

STUDY DESIGN

A 2 (group) × 2 (abdominal contraction) × 2 (reach activity) crossover mixed design with repeated measures for contraction and activity examined the effects of a loaded (4.6 kg) forward-reach activity and abdominal drawing-in maneuver (ADIM) on transversus abdominis (TrA) contraction in subjects with nonspecific low back pain (NSLBP) history versus controls.

OBJECTIVE

We measured TrA contraction during a loaded forward-reach activity while using the ADIM and examined if a NSLBP history affects TrA activity.

SUMMARY OF BACKGROUND DATA

The ADIM supports trunk stability during function. Clinicians incorporate ADIM during patients' functional tasks. Pain-free individuals can sustain ADIM during function, such as forward-reach. However, this has not been tested in those with a NSLBP history.

METHODS

Eighteen normal subjects and 18 subjects with a history of NSLBP participated. A blinded investigator recorded M-mode ultrasound imaging measurements of TrA thickness (mm) during 4 conditions as follows: (1) quiet standing without ADIM; (2) quiet standing with ADIM; (3) loaded forward-reach without ADIM; and (4) loaded forward-reach with ADIM.

RESULTS

A mixed analysis of variance demonstrated a significant main effect for group (F [1, 34] = 5.404, P = 0.026; ), where TrA thickness was greater for NSLBP history (7.41 + 2.34 mm) versus controls (5.9 + 2.46 mm). A significant main effect was observed for abdominal contraction (F [1, 34] = 49.57, P < 0.0001; ), where TrA thickness was greater during ADIM (7.47 + 2.7 mm) versus without ADIM (5.84, 1.92 m). A significant main effect was observed for forward-reach activity (F [1, 34] = 12.79, P = 0.001; ), where TrA thickness was greater during a loaded forward-reach (7.04 + 2.6 mm) versus quiet standing (6.2 + 2.4 mm). There were no significant interactions.

CONCLUSION

Individuals can use a volitional pre-emptive ADIM for trunk protection during loaded forward-reach, potentially reducing injury risk. A NSLBP history increases TrA activation during ADIM, suggesting an enhanced protective role.

LEVEL OF EVIDENCE

摘要

研究设计

一项 2（组）×2（腹部收缩）×2（伸展活动）交叉混合设计，对收缩和活动进行重复测量，研究了在有非特异性下腰痛（NSLBP）病史的受试者与对照组中，负荷（4.6 公斤）前伸活动和腹部内收运动（ADIM）对腹横肌（TrA）收缩的影响。

目的

我们在进行负荷前伸活动时测量 TrA 收缩，并检查 NSLBP 病史是否会影响 TrA 活动。

背景资料概要

ADIM 在功能活动中支持脊柱稳定性。临床医生在患者的功能任务中使用 ADIM。无疼痛的个体可以在功能活动（如前伸）中维持 ADIM。然而，这在有 NSLBP 病史的个体中尚未得到测试。

方法

18 名正常受试者和 18 名有 NSLBP 病史的受试者参加了研究。一名盲法研究者记录了 4 种情况下 M 模式超声成像测量的 TrA 厚度（mm）：（1）无 ADIM 的安静站立；（2）有 ADIM 的安静站立；（3）无 ADIM 的负荷前伸；（4）有 ADIM 的负荷前伸。

结果

混合方差分析显示，组间存在显著的主效应（F [1, 34] = 5.404，P = 0.026），其中有 NSLBP 病史者的 TrA 厚度更大（7.41+2.34mm），而对照组的 TrA 厚度更小（5.9+2.46mm）。腹部收缩有显著的主效应（F [1, 34] = 49.57，P < 0.0001），ADIM 时 TrA 厚度更大（7.47+2.7mm），而无 ADIM 时 TrA 厚度更小（5.84，1.92mm）。前伸活动有显著的主效应（F [1, 34] = 12.79，P = 0.001），前伸活动时 TrA 厚度更大（7.04+2.6mm），而安静站立时 TrA 厚度更小（6.2+2.4mm）。没有显著的交互作用。