Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2021 Apr 1;16(4):e0249220. doi: 10.1371/journal.pone.0249220. eCollection 2021.
A plethora of evidence supports the existence of neuromuscular changes in people with chronic spinal pain (neck and low back pain), yet it is unclear whether neuromuscular adaptations persist for people with recurrent spinal pain when in a period of remission. This systematic review aimed to synthesise the evidence on neuromuscular adaptations in people with recurrent spinal pain during a period of remission. Electronic databases, grey literature, and key journals were searched from inception up to the 4th of September 2020. Eligibility criteria included observational studies investigating muscle activity, spine kinematics, muscle properties, sensorimotor control, and neuromuscular performance in adults (≥ 18 years) with recurrent spinal pain during a period of remission. Screening, data extraction, and quality assessment (Newcastle-Ottawa Scale) were conducted independently by two reviewers. Data synthesis was conducted per outcome domain. A meta-analysis with a random-effects model was performed where possible. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines (GRADE). From 8292 records, 27 and five studies were included in a qualitative and quantitative synthesis, respectively. Very low level of evidence supports muscle activity changes in people with recurrent low back pain, especially greater co-contraction, redistribution of muscle activity, and delayed postural control of deeper trunk muscles. Reduced range of motion of the lumbar spine was also found. Meaningful conclusions regarding other outcome domains or people with recurrent neck pain could not be drawn. In conclusion, people with recurrent low back pain during a period of remission show muscle activity and spine kinematics adaptations. Future research should investigate the long-term impact of these changes, as well as adaptations in people with recurrent neck pain.
大量证据表明，慢性脊柱疼痛（颈部和下背部疼痛）患者存在神经肌肉变化，但尚不清楚在缓解期反复发作性脊柱疼痛患者的神经肌肉适应性是否持续存在。本系统综述旨在综合分析缓解期反复发作性脊柱疼痛患者的神经肌肉适应性证据。从成立到 2020 年 9 月 4 日，电子数据库、灰色文献和主要期刊都进行了搜索。纳入标准包括观察性研究，研究对象为缓解期反复发作性脊柱疼痛的成年人（≥18 岁），研究内容为肌肉活动、脊柱运动学、肌肉特性、感觉运动控制和神经肌肉性能。两名审查员独立进行筛选、数据提取和质量评估（纽卡斯尔-渥太华量表）。按结果域进行数据综合。在可能的情况下，采用随机效应模型进行荟萃分析。使用推荐评估、制定与评估分级（GRADE）指南对证据的整体强度进行评级。从 8292 条记录中，分别有 27 项和 5 项研究纳入定性和定量综合分析。非常低水平的证据支持反复发作性下腰痛患者的肌肉活动变化，尤其是更大的协同收缩、肌肉活动重新分布和深层躯干肌肉的姿势控制延迟。还发现腰椎活动范围减小。对于其他结果领域或反复发作性颈痛患者，无法得出有意义的结论。总之，缓解期反复发作性下腰痛患者表现出肌肉活动和脊柱运动学适应性。未来的研究应该调查这些变化的长期影响，以及反复发作性颈痛患者的适应性。
