Salvador-Coloma P, Arguisuelas M D, Doménech-Fernández J, Sánchez-Zuriaga D, Amer-Cuenca J J, Martínez-Gramage J, Montañez-Aguilera F J, Lisón J F
Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
Department of Surgery Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
Gait Posture. 2018 Jul;64:165-168. doi: 10.1016/j.gaitpost.2018.06.025. Epub 2018 Jun 11.
Unstable shoes were developed as a walking device to strengthen the lower extremity muscles and reduce joint loading. Many studies have reported increased muscle activity throughout the gait cycle in most of the lower limb muscles in healthy adults using these shoes. However, no previous studies have explored the effects of wearing unstable shoes on trunk muscle activity in patients with chronic low back pain (CLBP). Therefore, the aim of the present study was to compare the activity of selected trunk muscles in patients with CLBP during a gait test while walking wearing unstable shoes or conventional flat shoes (control).
Thirty-five CLBP patients (51.1 ± 12.4 y; 26 ± 3.8 kg/m2; 9.3 ± 5.2 Roland Morris Disability Questionnaire score) were recruited from the Orthopedic Surgery Service at the Hospital to participate in this cross-sectional study. All the participants underwent gait analysis by simultaneously collecting surface electromyography (EMG) data from erector spinae (ES), rectus abdominis (RA), obliquus internus (OI), and obliquus externus (OE) muscles, while walking on a treadmill with flat control shoes or experimental unstable shoes.
The results showed significantly higher %EMG activity in the ES (mean difference: 1.8%; 95% CI: 1.3-2.2), RA (mean difference: 1.5%; 95% CI: 0.3-2.7), and OI (mean difference: 1.5%; 95% CI: 0.2-2.8) in the unstable versus the flat-shoe condition, with a large effect size for the ES (Cohen's d = 1.27).
Based on these findings, the use of unstable shoes may be implicated in promoting spine stability, particularly in improving neuromuscular control of the trunk muscles in CLBP treatment.
不稳定鞋作为一种行走装置被开发出来，用于增强下肢肌肉力量并减少关节负荷。许多研究报告称，健康成年人使用这些鞋子时，在整个步态周期中大多数下肢肌肉的肌肉活动会增加。然而，以前没有研究探讨过穿着不稳定鞋对慢性下腰痛（CLBP）患者躯干肌肉活动的影响。因此，本研究的目的是比较CLBP患者在步态测试中穿着不稳定鞋或传统平底鞋（对照组）行走时所选躯干肌肉的活动情况。
从医院骨科招募了35名CLBP患者（年龄51.1±12.4岁；体重指数26±3.8kg/m²；罗兰·莫里斯残疾问卷评分9.3±5.2）参与这项横断面研究。所有参与者在跑步机上穿着平底对照鞋或实验性不稳定鞋行走时，通过同时收集竖脊肌（ES）、腹直肌（RA）、腹内斜肌（OI）和腹外斜肌（OE）的表面肌电图（EMG）数据来进行步态分析。
结果显示，与平底鞋条件相比，不稳定鞋条件下ES（平均差异：1.8%；95%置信区间：1.3 - 2.2）、RA（平均差异：1.5%；95%置信区间：0.3 - 2.7）和OI（平均差异：1.5%；95%置信区间：0.2 - 2.8）的肌电活动百分比显著更高，ES的效应量较大（科恩d值 = 1.27）。
基于这些发现，使用不稳定鞋可能有助于促进脊柱稳定性，特别是在CLBP治疗中改善躯干肌肉的神经肌肉控制方面。
