Abboud Jacques, Lardon Arnaud, Boivin Frédéric, Dugas Claude, Descarreaux Martin
Département D'anatomie, Université du Québec à Trois-Rivières Trois-Rivières, QC, Canada.
Pôle Recherche Clinique Chiropratique, Institut Franco-Européen de ChiropraxieIvry-Sur-Seine, France; Département des Sciences de L'activité Physique, Université du Québec à Trois-RivièresTrois-Rivières, QC, Canada.
Front Hum Neurosci. 2017 Jan 4;10:667. doi: 10.3389/fnhum.2016.00667. eCollection 2016.
Trunk neuromuscular responses have been shown to adapt under the influence of muscle fatigue, as well as spinal tissue creep or even with the presence of low back pain (LBP). Despite a large number of studies exploring how these external perturbations affect the spinal stability, characteristics of such adaptations remains unclear. The purpose of this systematic review was to assess the quality of evidence of studies investigating trunk neuromuscular responses to unexpected trunk perturbation. More specifically, the targeted neuromuscular responses were trunk muscle activity reflex and trunk kinematics under the influence of muscle fatigue, spinal creep, and musculoskeletal pain. A research of the literature was conducted in Pubmed, Embase, and Sport-Discus databases using terms related to trunk neuromuscular reflex responses, measured by electromyography (baseline activity, reflex latency, and reflex amplitude) and/or trunk kinematic, in context of unexpected external perturbation. Moreover, independent variables must be either trunk muscle fatigue or spinal tissue creep or LBP. All included articles were scored for their electromyography methodology based on the "Surface Electromyography for the Non-Invasive Assessment of Muscles (SENIAM)" and the "International Society of Electrophysiology and Kinesiology (ISEK)" recommendations whereas overall quality of articles was scored using a specific quality checklist modified from the Quality Index. Meta-analysis was performed on reflex latency variable. A final set of 29 articles underwent quality assessments. The mean quality score was 79%. No effect of muscle fatigue on erector spinae reflex latency following an unexpected perturbation, nor any other distinctive effects was found for back muscle fatigue and reflex parameters. As for spinal tissue creep effects, no alteration was found for any of the trunk reflex variables. Finally, the meta-analysis revealed an increased erector spinae reflex latency in patients with chronic LBP in comparison with healthy controls following an unexpected trunk perturbation. The literature provides some evidence with regard to trunk adaptions in a context of spinal instability. However, most of the evidence was inconclusive due to a high methodological heterogeneity between the studies.
研究表明，躯干神经肌肉反应会在肌肉疲劳、脊柱组织蠕变甚至存在腰痛（LBP）的影响下发生适应性变化。尽管有大量研究探讨了这些外部干扰如何影响脊柱稳定性，但这种适应性变化的特征仍不清楚。本系统评价的目的是评估研究躯干对意外躯干干扰的神经肌肉反应的研究证据质量。更具体地说，目标神经肌肉反应是在肌肉疲劳、脊柱蠕变和肌肉骨骼疼痛影响下的躯干肌肉活动反射和躯干运动学。在Pubmed、Embase和Sport-Discus数据库中进行了文献检索，使用了与躯干神经肌肉反射反应相关的术语，通过肌电图（基线活动、反射潜伏期和反射幅度）和/或躯干运动学来测量，这些反应发生在意外外部干扰的情况下。此外，自变量必须是躯干肌肉疲劳、脊柱组织蠕变或腰痛。所有纳入的文章根据“用于肌肉无创评估的表面肌电图（SENIAM）”和“国际电生理与运动学学会（ISEK）”的建议对其肌电图方法进行评分，而文章的整体质量则使用从质量指数修改而来的特定质量清单进行评分。对反射潜伏期变量进行了荟萃分析。最后一组29篇文章接受了质量评估。平均质量得分是79%。未发现肌肉疲劳对意外干扰后竖脊肌反射潜伏期有影响，也未发现背部肌肉疲劳和反射参数有任何其他显著影响。至于脊柱组织蠕变的影响，未发现任何躯干反射变量有改变。最后，荟萃分析显示，与健康对照组相比，慢性腰痛患者在意外躯干干扰后竖脊肌反射潜伏期增加。文献提供了一些关于脊柱不稳定情况下躯干适应性的证据。然而，由于研究之间存在高度的方法学异质性，大多数证据尚无定论。
