不同类型慢性下腰痛患者在患侧卧位单腿抬高时的躯干控制特征

Characteristics of trunk control during crook-lying unilateral leg raising in different types of chronic low back pain patients.

作者信息

Ohe Atsushi, Kimura Teiji, Goh Ah-Cheng, Oba Akemi, Takahashi Jun, Mogami Yuji

机构信息

*Department of Rehabilitation, Tachiiri Orthopedic Clinic, Kyoto, Japan †Department of Health Sciences, Graduate School of Medicine, Shinshu University, Nagano, Japan ‡Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan §Department of Physical Therapy, School of Health Sciences, Shinshu University, Nagano, Japan ¶Department of Rehabilitation, Azumi General Hospital, Nagano, Japan ‖Department of Orthopaedic Surgery, Shinshu University, School of Medicine, Nagano, Japan; and **Department of Orthopedics, Azumi General Hospital, Nagano, Japan.

出版信息

Spine (Phila Pa 1976). 2015 Apr 15;40(8):550-9. doi: 10.1097/BRS.0000000000000828.

DOI:10.1097/BRS.0000000000000828

PMID:25868094

Abstract

STUDY DESIGN

Cross-sectional observational study.

OBJECTIVE

To quantitatively clarify the characteristics of trunk control during unilateral leg-raising movement in different types of nonspecific chronic low back pain (NS-CLBP) patients who were identified by aggravation of symptoms during trunk movement.

SUMMARY OF BACKGROUND DATA

Although there is a need to classify NS-CLBP patients for clinical decision making in physical therapy, the characteristics of trunk control during unilateral leg-raising movement in different types of NS-CLBP patients have not been quantitatively analyzed in previous studies by simultaneously measuring the lumbar spine movement, trunk muscle activity, and leg movement.

METHODS

Thirty NS-CLBP patients, of whom 13 were aggravated by trunk flexion (flexion group) and 17 were aggravated by trunk extension (extension group), and 30 healthy controls performed crook-lying unilateral leg-raising movement on the painful side in patient group and the dominant leg in controls. During the unilateral leg-raising movement, pressure changes produced by the movement of the lumbar lordotic curve, measured by a custom-made recording device, were used as indices of the lumbar spine movement. Trunk muscle activities were recorded by surface electromyography and diagnostic ultrasonography. The pressure changes and trunk muscle activities were statistically compared among the 3 groups.

RESULTS

At foot-off during unilateral leg-raising movement, the extension group demonstrated increase in pressure changes, whereas the flexion group and controls demonstrated decrease in pressure changes. Bilateral external obliques muscle activities in the extension group were significantly larger than those in the flexion group and controls (P < 0.05).

CONCLUSION

This study demonstrated that the characteristics of trunk control during unilateral leg-raising movement were different depending on the types of NS-CLBP patients. These results indicate that patients with NS-CLBP might select compensatory trunk control strategies subconsciously to prevent the manifestation of LBP. These results also suggest the importance of the different characteristics of trunk control during active limb movement in the clinical reasoning process for the management of different types of NS-CLBP patients.

LEVEL OF EVIDENCE

N/A.

摘要

研究设计

横断面观察性研究。

目的

定量阐明在躯干运动时症状加重的不同类型非特异性慢性下腰痛（NS-CLBP）患者在单侧抬腿运动过程中躯干控制的特征。

背景数据总结

尽管在物理治疗中为临床决策需要对NS-CLBP患者进行分类，但以往研究中尚未通过同时测量腰椎运动、躯干肌肉活动和腿部运动来定量分析不同类型NS-CLBP患者在单侧抬腿运动过程中躯干控制的特征。

方法

30例NS-CLBP患者，其中13例在躯干前屈时症状加重（前屈组），17例在躯干后伸时症状加重（后伸组），30例健康对照者在患者组的患侧以及对照组的优势腿进行仰卧位单侧抬腿运动。在单侧抬腿运动过程中，使用定制记录设备测量腰椎前凸曲线运动产生的压力变化，以此作为腰椎运动的指标。通过表面肌电图和诊断超声记录躯干肌肉活动。对三组之间的压力变化和躯干肌肉活动进行统计学比较。