Department of Physiotherapy, Monash University, PO Box 527, Frankston, Victoria, 3199, Australia.
Spine Centre of Southern Denmark, Hospital of Lillebaelt, Middelfart, Denmark.
BMC Musculoskelet Disord. 2019 Jan 18;20(1):28. doi: 10.1186/s12891-018-2387-x.
Interventions for low back pain (LBP) commonly target 'dysfunctional' or atypical lumbo-pelvic kinematics in the belief that correcting aberrant movement improves patients' pain and activity outcomes. If atypical kinematic parameters and postures have a relationship to LBP, they could be expected to more prevalent in people with LBP compared to people without LBP (NoLBP). This exploratory study measured, defined and compared atypical kinematic parameters in people with and without LBP.
Wireless inertial motion and EMG sensors were used to measure lumbo-pelvic kinematics during standing trunk flexion (range of motion (ROM), timing, sequence coordination, and extensor muscle activation) and in sitting (relative sitting position, pelvic tilt range) in a sample of 126 of adults without LBP and 140 chronic LBP subjects. Atypical movement was defined using the 10th/90th centiles of the NoLBP group. Mean differences and prevalence rates for atypical movement were calculated. Dichotomised pain scores for 'high-pain-on-bending' and 'high-pain-on-sitting' were tested for their association with atypical kinematic variables.
For standing flexion, significant mean differences, after adjusting for age and gender factors, were seen for the LBP group with (i) reduced ROM (trunk flexion (NoLBP 111, LBP 93, p < .0001), lumbar flexion (NoLBP 52, LBP 46, p < .0001), pelvic flexion (NoLBP 59, LBP 48, p < .0001), (ii) greater extensor muscle activation for the LBP group (NoLBP 0.012, LBP 0.25 p < .0001), (iii) a greater delay in pelvic motion at the onset of flexion (NoLBP - 0.21 s; LBP - 0.36 s, p = 0.023), (iv) and longer movement duration for the LBP group (NoLBP 2.28 s; LBP 3.18 s, p < .0001). Atypical movement was significantly more prevalent in the LBP group for small trunk (× 5.4), lumbar (× 3.0) and pelvic ROM (× 3.9), low FRR (× 4.9), delayed pelvic motion at 20 flexion (× 2.9), and longer movement duration (× 4.7). No differences between groups were seen for any sitting parameters. High pain intensity was significantly associated with small lumbar ROM and pelvic ROM.
Significant movement differences during flexion were seen in people with LBP, with a higher prevalence of small ROM, slower movement, delayed pelvic movement and greater lumbar extensor muscle activation but without differences for any sitting parameter.
针对腰痛（LBP）的干预措施通常针对“功能障碍”或不典型的腰骶部运动学，因为纠正异常运动可以改善患者的疼痛和活动结果。如果不典型运动学参数和姿势与 LBP 有关，那么与没有 LBP（NoLBP）的人相比，这些参数和姿势在 LBP 患者中可能更为普遍。这项探索性研究测量、定义并比较了有和没有 LBP 的人的不典型运动学参数。
在一个无 LBP 的 126 名成年人和 140 名慢性 LBP 受试者样本中，使用无线惯性运动和肌电图传感器测量站立时躯干屈曲（运动范围（ROM）、时间、序列协调和伸肌激活）和坐姿时的腰骶部运动学（相对坐姿、骨盆倾斜范围）。使用 NoLBP 组的第 10/90 百分位数定义异常运动。计算异常运动的平均差异和患病率。对“弯腰时疼痛高”和“坐姿时疼痛高”的二分疼痛评分与异常运动学变量进行了关联测试。
对于站立时的屈曲，在调整了年龄和性别因素后，LBP 组的以下参数存在显著的平均差异：（i）ROM 减少（躯干屈曲（NoLBP 111，LBP 93，p < 0.0001）、腰椎屈曲（NoLBP 52，LBP 46，p < 0.0001）、骨盆屈曲（NoLBP 59，LBP 48，p < 0.0001）；（ii）LBP 组伸肌激活增加（NoLBP 0.012，LBP 0.25，p < 0.0001）；（iii）在屈曲开始时骨盆运动的延迟更大（NoLBP - 0.21s；LBP - 0.36s，p = 0.023）；（iv）LBP 组的运动持续时间更长（NoLBP 2.28s；LBP 3.18s，p < 0.0001）。在 LBP 组中，小的躯干（×5.4）、腰椎（×3.0）和骨盆 ROM（×3.9）、低 FRR（×4.9）、20 屈曲时的延迟骨盆运动（×2.9）和更长的运动持续时间（×4.7）的异常运动更为普遍。两组在任何坐姿参数上均无差异。高疼痛强度与小的腰椎 ROM 和骨盆 ROM 显著相关。
在 LBP 患者中，在屈曲过程中观察到明显的运动差异，其特点是小的 ROM、较慢的运动、延迟的骨盆运动和更大的腰椎伸肌激活，但坐姿参数无差异。
