Shahbazi Moheb Seraj Majid, Sarrafzadeh Javad, Maroufi Nader, Ebrahimi Takamjani Ismail, Ahmadi Amir, Negahban Hossein
Research performed at Physical Therapy Clinic of School of Rehabilitation, Iran Universality of Medical Sciences, Tehran, Iran.
Department of Physiotherapy, chool of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
Arch Bone Jt Surg. 2018 Nov;6(6):560-569.
Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O'Sullivan's classification system (OCS).
This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using one-way analysis of variance (ANOVA) and independent t-test.
There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group, and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026). In this position, the difference in hip angles between the healthy group and FP group was statistically significant (). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP group (), however, there was a significant difference between FP group and the healthy group in the fourth Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the heterogeneous LBP group () but there was a difference between FP group and the healthy group. Lumbar/hip motion ratio (L/H ratio) was different between and within the subgroups in the second Q.
This study supported the subgrouping of LBP and showed that the difference between subgroups could be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the chain components (muscle, joint, nerve and etc.).
IV.
下腰痛（LBP）患者腰骨盆的静态和动态姿势被视为LBP临床评估和管理的两个重要方面。因此，本研究的重点是比较LBP亚组和健康受试者在躯干前屈过程中髋部和腰部区域的姿势及代偿策略。根据奥沙利文分类系统（OCS），LBP病例分为主动伸展型（AEP）和屈曲型（FP）。
本研究为横断面研究，纳入72名男性，其中21名FP型下腰痛患者、31名AEP型下腰痛患者和20名健康受试者。采用三维运动分析系统测量中立位站立姿势和躯干前屈终末位时躯干前屈过程中的腰椎和髋部角度。要求参与者在不屈膝的情况下完全弯腰。弯腰速度优先。髋部和腰部的运动范围分为四个四分位数（Q）。比较各组间的四分位数。采用单因素方差分析（ANOVA）和独立样本t检验进行数据分析。
健康组与异质性LBP组在站立位和躯干完全前屈位时的腰椎前凸无统计学显著差异。此外，健康组与同质性LBP组（FP和AEP）之间也无统计学显著差异。而且，健康组与异质性LBP组之间以及健康组与同质性LBP组（FP和AEP）之间在站立位时的髋部角度无统计学显著差异。在躯干完全前屈位时，健康组与异质性LBP组之间的髋部角度有统计学显著差异（P = 0.026）。在此位置，健康组与FP组之间的髋部角度差异有统计学意义（）。在第二个Q中，健康组与异质性LBP组之间无显著差异（），然而，在全髋运动范围的第四个Q中，FP组与健康组之间有显著差异。健康组与异质性LBP组之间无统计学显著差异（），但FP组与健康组之间有差异。第二Q中各亚组间及亚组内的腰/髋运动比值（L/H比值）不同。
本研究支持LBP的亚组划分，并表明通过将腰椎和髋部运动的总范围细分为较小部分，可以有效确定亚组之间的差异。神经肌肉系统可能会选择不同的策略来进行代偿并防止链状组成部分（肌肉、关节、神经等）进一步损伤。
IV级。
