Motor Control and Neural Plasticity Laboratory, Faculty of Physical Therapy, , Mahidol University, Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
Physical Therapy & Rehabilitation Sciences Department,, Drexel University, Philadelphia, PA.
PM R. 2019 Jul;11(7):694-702. doi: 10.1002/pmrj.12002. Epub 2019 Feb 27.
BACKGROUND: Prone hip extension is used to clinically assess movement control in patients with nonspecific low back pain (LBP). Excessive lumbopelvic movements and altered muscle activation patterns are common in patients with nonspecific LBP. However, no evidence exists regarding lumbar multifidus and lumbar erector spinae muscle synergy patterns in patients with nonspecific LBP during this clinical test. OBJECTIVE: To determine the difference in lumbopelvic motion and change in muscle synergy between patients with nonspecific LBP and healthy individuals. DESIGN: A cross-sectional study design. SETTING: University physical therapy clinic and laboratory. PARTICIPANTS: Seven patients with nonspecific LBP (age [mean ± SD] 29 ± 5 years, 43% female, body mass index [BMI] of 25 ± 2 kg/m , Numeric Pain Rating Scale 6 ± 2; Oswestry Disability Index 20% ± 8%) and seven age-, sex-, and BMI-matched healthy individuals (mean age 28 ± 5 years, 43% female, BMI of 22 ± 2 kg/m ) were recruited. METHODS: Each participant performed six repetitions of prone hip extension on each side; kinematic and electromyographic data were collected simultaneously. MAIN OUTCOME MEASUREMENTS: Kinematic data were used to represent lumbopelvic motion, whereas electromyography (EMG) data were used to represent muscle activity. A paired t-test was used to determine the difference in lumbopelvic motion. Principal component analysis and two-way repeated-measures analysis of variance were used to extract muscle synergies and identify differences in muscle synergy patterns between and within groups. RESULTS: Results demonstrated no significant group difference (P > .05) in amount of lumbopelvic motion. However, healthy individuals synergistically activate lumbar multifidus and lumbar erector spinae with 81.0% variance accounted for (VAF). Patients with nonspecific LBP had an altered synergy with independent activation of lumbar multifidus on the painful side with 32.0% VAF and the lumbar multifidus on the nonpainful side, and both lumbar erector spinae with 52.2% VAF synergistically activated. CONCLUSIONS: These findings suggest that clinicians should focus on muscle activation patterns rather than the amount of lumbopelvic motion during clinical observation of prone hip extension. LEVEL OF EVIDENCE: Level III.
背景：俯卧髋关节伸展被用于临床评估非特异性下腰痛（LBP）患者的运动控制。非特异性 LBP 患者常见腰椎骨盆运动过度和肌肉激活模式改变。然而，在这项临床测试中，对于非特异性 LBP 患者的腰椎多裂肌和腰椎竖脊肌协同模式，尚无证据存在。 目的：确定非特异性 LBP 患者与健康个体之间腰椎骨盆运动和肌肉协同变化的差异。 设计：横断面研究设计。 设置：大学物理治疗诊所和实验室。 参与者：招募了 7 名非特异性 LBP 患者（年龄[均值±标准差]29±5 岁，43%女性，体重指数[BMI]为 25±2 kg/m²，数字疼痛评分 6±2；Oswestry 残疾指数 20%±8%）和 7 名年龄、性别和 BMI 匹配的健康个体（平均年龄 28±5 岁，43%女性，BMI 为 22±2 kg/m²）。 方法：每位参与者在每侧进行 6 次俯卧髋关节伸展重复运动；同时采集运动学和肌电图数据。 主要观察指标：运动学数据用于表示腰椎骨盆运动，而肌电图（EMG）数据用于表示肌肉活动。采用配对 t 检验确定腰椎骨盆运动的差异。采用主成分分析和双向重复测量方差分析提取肌肉协同，并确定组间和组内肌肉协同模式的差异。 结果：结果表明，两组间腰椎骨盆运动的差异无统计学意义（P>.05）。然而，健康个体协同激活腰椎多裂肌和腰椎竖脊肌，占 81.0%的方差（VAF）。非特异性 LBP 患者的协同作用发生改变，疼痛侧的腰椎多裂肌和非疼痛侧的腰椎多裂肌呈独立激活，分别占 32.0%和 52.2%的 VAF，双侧腰椎竖脊肌协同激活，占 52.2%的 VAF。 结论：这些发现表明，临床医生在观察俯卧髋关节伸展时，应将注意力集中在肌肉激活模式上，而不是腰椎骨盆运动的幅度上。 证据水平：III 级。
Spine (Phila Pa 1976). 2013-7-1
BMC Musculoskelet Disord. 2025-8-12
Eur J Med Res. 2025-6-10
Eur J Phys Rehabil Med. 2023-10
BMC Musculoskelet Disord. 2019-11-23
Zotero 插件