Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, California, United States of America.
Department of Radiology, Loma Linda Medical Center, Loma Linda University, Loma Linda, California, United States of American.
PLoS One. 2024 May 21;19(5):e0298257. doi: 10.1371/journal.pone.0298257. eCollection 2024.
OBJECTIVES: The main purpose of this research study was to compare mean modified straight-leg raise test (mSLR) and hamstring muscle length (HL) between chronic non-specific low back pain (LBP) and healthy subjects to understand the possibility of neuropathic causes in LBP population as it may impact the diagnosis and treatment of LBP. Another purpose was to compare mean mSLR between those with lumbar nerve root impingement and those without as determine by magnetic resonance imaging (MRI). METHODS: The design of the study is cross sectional and included 32 subjects with ages ranging from 18-50 years old. Clinical exam objective measures were collected such as patient questionnaires, somatosensory tests, HL range of motion, and a mSLR test, and were compared to the findings from a structural lumbar spine MRI. RESULTS: There were no significant differences in mean HL angulation and mSLR angulation between LBP and healthy subjects (p>0.05). There was no significant difference in mean HL by impingement by versus no impingement (38.3±15.6 versus 44.8±9.4, p = 0.08, Cohen's d = 0.50). On the other hand, there was a significant difference in mean mSLR angulation by impingement (57.6.3±8.7 versus 63.8±11.6, p = 0.05, Cohen's d = 0.60). CONCLUSIONS: The mSLR test was found to be associated with lumbar nerve root compression, regardless of the existence of radiating leg symptoms, and showed no association solely with the report of LBP. The findings highlight the diagnostic dilemma facing clinicians in patients with chronic nonspecific LBP with uncorrelated neuroanatomical image findings. Clinically, it may be necessary to reevaluate the common practice of exclusively using the mSLR test for patients with leg symptoms. This study may impact the way chronic LBP and neuropathic symptoms are diagnosed, potentially improving treatment methods, reducing persistent symptoms, and ultimately improving disabling effects.
目的:本研究的主要目的是比较慢性非特异性下腰痛(LBP)患者与健康受试者的改良直腿抬高试验(mSLR)均值和腘绳肌长度(HL),以了解 LBP 人群中神经病理性原因的可能性,因为这可能会影响 LBP 的诊断和治疗。另一个目的是比较 MRI 检查有腰椎神经根受压和无腰椎神经根受压患者的 mSLR 均值,以确定其是否存在腰椎神经根受压。
方法:研究设计为横断面研究,共纳入 32 名年龄在 18-50 岁之间的受试者。收集了临床检查的客观指标,如患者问卷、体感测试、HL 运动范围和 mSLR 试验,并与结构性腰椎 MRI 检查结果进行比较。
结果:LBP 患者与健康受试者的 HL 角度均值和 mSLR 角度均值无显著差异(p>0.05)。有腰椎神经根受压与无腰椎神经根受压患者的 HL 均值无显著差异(38.3±15.6 与 44.8±9.4,p=0.08,Cohen's d=0.50)。另一方面,有腰椎神经根受压患者的 mSLR 角度均值有显著差异(57.6.3±8.7 与 63.8±11.6,p=0.05,Cohen's d=0.60)。
结论:mSLR 试验与腰椎神经根受压相关,无论是否存在放射状腿部症状,与仅报告 LBP 无关。研究结果强调了在慢性非特异性 LBP 患者中,临床医生面临的诊断困境,这些患者的神经解剖学图像结果无相关性。临床上,可能有必要重新评估对有腿部症状患者仅使用 mSLR 试验的常规做法。本研究可能会影响慢性 LBP 和神经病理性症状的诊断方式,从而有可能改善治疗方法,减少持续性症状,并最终改善致残影响。
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