Shigetoh Hayato, Nishi Yuki, Osumi Michihiro, Morioka Shu
Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Koryo, Nara, Japan.
Miura Internal Medicine Michiko Pediatrics Clinic, Marugame City, Kagawa, Japan.
J Pain Res. 2020 Dec 3;13:3247-3256. doi: 10.2147/JPR.S286280. eCollection 2020.
The cross-sectional and longitudinal associations between pain-related factors and muscle activity in patients with chronic low back pain (CLBP) are unclear. This study aimed to examine the temporal associations between them in a CLBP patient using a single-case analysis to account for an individual course.
A patient with a history of lower back pain lasting more than 3 months was studied from March 16, 2020 to May 30, 2020. Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae in the patient while performing a standing trunk flexion and re-extension task. The average value for muscle activity during each movement phase was estimated, and the flexion relaxation ratio (FRR) of all channels was subsequently calculated. Pain-related factors and disability were assessed using questionnaires. All assessments were performed nine times, along with 2-3 months of intervention. Once or twice per week, the patient received physical therapy that consisted of soft tissue mobilization, joint mobilization, nerve mobilization, and patient education. A cross-lag correlation analysis of this single case was conducted.
Pain-related factors showed a trend toward improvements in all variables when compared to those in the first assessment; however, there was no general change (increase) in FRR over time. The cross-lag correlation analysis revealed that improvements in FRR were associated with improvements in body perception disturbance ( = -0.78, p < 0.01), and that improvements in muscle activity during the extension phase were associated with improvements in pain ( = 0.75), psychological factors ( = 0.57), and disability ( = 0.67) (p < 0.05).
Our findings suggest that improvements in body perception were temporally associated with improvements in FRR, and improvements in pain, psychological factors, and disability were temporally associated with a reduction in muscle activity during the trunk extension phase in this patient with CLBP.
慢性下腰痛（CLBP）患者中疼痛相关因素与肌肉活动之间的横断面和纵向关联尚不清楚。本研究旨在通过单病例分析来研究CLBP患者中它们之间的时间关联，以考虑个体病程。
对一名有持续3个月以上下腰痛病史的患者进行了研究，研究时间为2020年3月16日至2020年5月30日。在患者进行站立位躯干屈伸任务时，记录双侧腰竖脊肌表面肌电信号。估计每个运动阶段肌肉活动的平均值，随后计算所有通道的屈伸放松率（FRR）。使用问卷评估疼痛相关因素和残疾情况。所有评估共进行9次，同时进行2 - 3个月的干预。患者每周接受1至2次物理治疗，包括软组织松动术、关节松动术、神经松动术和患者教育。对该单病例进行交叉滞后相关分析。
与首次评估相比，疼痛相关因素在所有变量上均呈现改善趋势；然而，FRR随时间并无总体变化（增加）。交叉滞后相关分析显示，FRR的改善与身体感知障碍的改善相关（r = -0.78，p < 0.01），伸展阶段肌肉活动的改善与疼痛（r = 0.75）、心理因素（r = 0.57）和残疾（r = 0.67）的改善相关（p < 0.05）。
我们的研究结果表明，在该CLBP患者中，身体感知的改善与FRR的改善在时间上相关，疼痛、心理因素和残疾的改善与躯干伸展阶段肌肉活动的减少在时间上相关。
