F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY 40506, USA.
College of Nursing, University of Kentucky, Lexington, KY 40506, USA.
J Biomech. 2020 Mar 26;102:109306. doi: 10.1016/j.jbiomech.2019.07.050. Epub 2019 Aug 7.
Despite the current knowledge about abnormalities in the lumbo-pelvic coordination of patients with non-specific low back pain (LBP), it is unclear how such abnormalities change with time. Timing and magnitude aspects of lumbo-pelvic coordination during a trunk forward bending and backward return task along with subjective measures of pain and disability were collected at three-time points over a six-month period from 29 patients who had non-chronic LBP at the time of enrollment in the study. To enable investigation of abnormalities in lumbo-pelvic coordination of patients, we also included lumbo-pelvic coordination data of age and gender-matched back healthy individuals from an earlier study of our group. Finally, differences in lumbo-pelvic coordination between patients with moderate-severe LBP (i.e., those whose level of pain was ≥ 4 (out of 10) at all three data collection sessions; n = 8) and patients with low-moderate LBP (n = 21) were investigated. There were clear distinctions in measures of lumbo-pelvic coordination between patients with low-moderate and moderate-severe LBP. Contrary to our expectation, however, the abnormalities in magnitude aspects of lumbo-pelvic coordination were larger (F > 4.84, P < 0.012) in patients with low-moderate LBP. These abnormalities in patients with low-moderate LBP, compared to controls, included larger (>12°) pelvic and thoracic rotations as well as smaller (>10°) lumbar flexion. The abnormal lumbo-pelvic coordination of patients with non-specific LBP, observed at baseline, persisted (F < 1.96, P > 0.156) or worsen (F > 3.48, P < 0.04) over the course of study period despite significant improvement in their pain (18% decrease; F = 12.10, P < 0.001) and disability (10% decrease; F = 4.39, P = 0.017). Distinct but lingering abnormalities in lumbo-pelvic coordination, observed in patients with low-moderate and moderate-severe LBP, might have a role in persistence and/or relapse of symptoms in patients with non-specific LBP. Such inferences, however, should further be studied in future via investigation of the relationship between abnormalities in lumbo-pelvic coordination and clinical presentation of LBP.
尽管目前已经了解到非特异性下腰痛（LBP）患者的腰骶部协调存在异常，但这些异常如何随时间变化尚不清楚。在研究入组时患有非慢性 LBP 的 29 名患者中，在六个月的时间内分三个时间点收集了躯干前屈和后伸任务期间腰骶部协调的时间和幅度方面以及疼痛和残疾的主观测量值。为了能够研究非特异性 LBP 患者腰骶部协调的异常，我们还包括了我们小组早期研究中年龄和性别匹配的健康人腰骶部协调的数据。最后，研究了中重度 LBP（即所有三个数据采集阶段疼痛水平均≥4（满分 10 分）的患者；n=8）和中轻度 LBP 患者（n=21）之间的腰骶部协调差异。中轻度和中重度 LBP 患者的腰骶部协调测量值存在明显差异。然而，与我们的预期相反，中轻度 LBP 患者的腰骶部协调幅度异常较大（F＞4.84，P＜0.012）。与对照组相比，中轻度 LBP 患者的腰骶部协调异常包括更大（＞12°）的骨盆和胸椎旋转以及更小（＞10°）的腰椎屈曲。基线时观察到的非特异性 LBP 患者的异常腰骶部协调在研究期间持续存在（F＜1.96，P＞0.156）或恶化（F＞3.48，P＜0.04），尽管他们的疼痛（18%的下降；F=12.10，P＜0.001）和残疾（10%的下降；F=4.39，P=0.017）显著改善。在中轻度和中重度 LBP 患者中观察到的腰骶部协调明显但持续存在的异常可能在非特异性 LBP 患者的症状持续存在和/或复发中起作用。然而，应该通过进一步研究腰骶部协调异常与 LBP 临床表现之间的关系，在未来对此类推断进行研究。
