Cooper Nicholas A, Scavo Kelsey M, Strickland Kyle J, Tipayamongkol Natti, Nicholson Jeffrey D, Bewyer Dennis C, Sluka Kathleen A
Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
Department of Rehabilitation Therapies, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
Eur Spine J. 2016 Apr;25(4):1258-65. doi: 10.1007/s00586-015-4027-6. Epub 2015 May 26.
Clinical observation suggests that hip abductor weakness is common in patients with low back pain (LBP). The purpose of this study is to describe and compare the prevalence of hip abductor weakness in a clinical population with chronic non-specific LBP and a matched sample without LBP.
One hundred fifty subjects with chronic non-specific LBP and a matched cohort of 75 control subjects were recruited. A standardized back and hip physical exam was performed. Specifically tensor fascia lata, gluteus medius, and gluteus maximus strength were assessed with manual muscle testing. Functional assessment of the hip abductors was performed with assessment for the presence of the Trendelenburg sign. Palpation examination of the back, gluteal and hip region was performed to try and reproduce the subject's pain complaint. Friedman's test or Cochran's Q with post hoc comparisons adjusted for multiple comparisons was used to compare differences between healthy controls and people with chronic low back pain for both the affected and unaffected sides. Mann-Whitney U was used to compare differences in prevalence between groups. Hierarchical linear regression was used to identify predictors of LBP in this sample.
Gluteus medius is weaker in people with LBP compared to controls or the unaffected side (Friedman's test, p < 0.001). The Trendelenburg sign is more prevalent in subjects with LBP than controls (Cochran's Q, p < 0.001). There is more palpation tenderness over the gluteals, greater trochanter, and paraspinals in people with low back pain compared to controls (Cochran's Q, p < 0.001). Hierarchical linear regression, with BMI as a covariate, demonstrated that gluteus medius weakness, low back regional tenderness, and male sex were predictive of LBP in this sample.
Gluteus medius weakness and gluteal muscle tenderness are common symptoms in people with chronic non-specific LBP. Future investigations should validate these findings with quantitative measures as well as investigate the effect of gluteus medius strengthening in people with LBP.
临床观察表明，腰背痛（LBP）患者中髋外展肌无力很常见。本研究的目的是描述和比较慢性非特异性腰背痛临床人群与无腰背痛匹配样本中髋外展肌无力的患病率。
招募了150名慢性非特异性腰背痛患者和75名对照受试者组成的匹配队列。进行了标准化的背部和髋部体格检查。具体而言，通过徒手肌力测试评估阔筋膜张肌、臀中肌和臀大肌的力量。通过评估Trendelenburg征的存在对髋外展肌进行功能评估。对背部、臀部和髋部区域进行触诊检查，以试图重现受试者的疼痛主诉。使用Friedman检验或Cochran's Q检验，并对多重比较进行事后调整，以比较健康对照组与慢性腰背痛患者患侧和未患侧之间的差异。使用Mann-Whitney U检验比较组间患病率的差异。使用分层线性回归确定该样本中腰背痛的预测因素。
与对照组或未患侧相比，腰背痛患者的臀中肌较弱（Friedman检验，p < 0.001）。LBP受试者中Trendelenburg征比对照组更常见（Cochran's Q，p < 0.001）。与对照组相比，腰背痛患者在臀部、大转子和脊柱旁的触诊压痛更明显（Cochran's Q，p < 0.001）。以BMI作为协变量的分层线性回归表明，臀中肌无力、腰部区域压痛和男性性别是该样本中腰背痛的预测因素。
臀中肌无力和臀肌压痛是慢性非特异性腰背痛患者的常见症状。未来的研究应通过定量测量来验证这些发现，并研究加强臀中肌对腰背痛患者的影响。
