Southampton Solent University , Southampton, Hampshire , UK.
Curr Med Res Opin. 2014 May;30(5):865-911. doi: 10.1185/03007995.2013.875465. Epub 2014 Jan 17.
'Disuse' and 'Deconditioning' in relation to low back pain (LBP) are terms often used interchangeably. Discussions of 'disuse' refer to general physical inactivity, which evidence suggests does not differ between symptomatic and asymptomatic persons. 'Deconditioning' refers to a decrease in function, commonly both cardiovascular/aerobic fitness and muscular strength/endurance, again noting little difference. However, examination of decreased function relating specifically to lumbar extensor musculature deconditioning has yet to be examined, corroborating all possible methods. Thus, this review attempts to reappraise the deconditioning hypothesis in LBP, specifically considering lumbar extensor deconditioning.
A literature review was conducted examining both cross-sectional and prospective data on specific lumbar extensor deconditioning and LBP. A narrative approach and 'snowballing' style literature search was used involving initial use of PubMed and Google Scholar databases searching up to December 2012. Included were studies utilizing the following three research methods, allowing specific induction of the role of such deconditioning; (1) strength/endurance testing of the isolated lumbar extensor musculature, (2) imaging and histochemical examination of the lumbar extensor musculature, and (3) fatigue testing of the lumbar extensor musculature using electromyography.
RESULTS/FINDINGS: Despite issues interpreting individual studies due to methods, the majority of evidence suggests LBP is associated with decreased strength/endurance, atrophy, and excessive fatigability of the lumbar extensors. Prospective studies also suggest lumbar extensor deconditioning may be a common risk factor predicting acute low back injury and LBP.
The hypothesis of specific lumbar extensor deconditioning as being a causal factor in LBP is presently well supported. It is by no means the only causative factor and further research should more rigorously test this hypothesis addressing the methodological issues highlighted regarding previous studies. However, its role suggests specific exercise may be a worthwhile preventative and rehabilitative approach.
“失用”和“废用性萎缩”与下腰痛（LBP）经常被交替使用。“失用”的讨论是指一般的身体不活动，证据表明，在有症状和无症状的人群之间没有区别。“废用性萎缩”是指功能下降，通常包括心血管/有氧健身和肌肉力量/耐力，再次指出差异不大。然而，专门研究与腰椎伸肌废用性萎缩相关的功能下降尚未得到检验，这印证了所有可能的方法。因此，本综述试图重新评估 LBP 中的废用性萎缩假说，特别是考虑到腰椎伸肌废用性萎缩。
对特定的腰椎伸肌废用性萎缩和 LBP 的横断面和前瞻性数据进行了文献复习。采用叙述性方法和“滚雪球”式文献搜索，最初使用 PubMed 和 Google Scholar 数据库，检索截至 2012 年 12 月的文献。纳入的研究使用了以下三种研究方法，允许对这种废用性萎缩的作用进行具体的诱导：（1）孤立的腰椎伸肌的力量/耐力测试，（2）腰椎伸肌的影像学和组织化学检查，以及（3）使用肌电图对腰椎伸肌进行疲劳测试。
结果/发现：尽管由于方法的原因，对个别研究的解释存在问题，但大多数证据表明，LBP 与腰椎伸肌的力量/耐力下降、萎缩和过度疲劳有关。前瞻性研究还表明，腰椎伸肌废用性萎缩可能是预测急性下腰痛和 LBP 的常见危险因素。
特定的腰椎伸肌废用性萎缩作为 LBP 因果因素的假说目前得到了很好的支持。它绝不是唯一的致病因素，进一步的研究应该更严格地检验这一假说，解决以前研究中突出的方法学问题。然而，它的作用表明，特定的运动可能是一种值得尝试的预防和康复方法。
