Zhang Tianwei, Firouzabadi Ali, Yang Daishui, Liu Sihai, Schmidt Hendrik
Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
Front Bioeng Biotechnol. 2024 Sep 4;12:1388229. doi: 10.3389/fbioe.2024.1388229. eCollection 2024.
BACKGROUND: The flexion relaxation phenomenon (FRP) is characterized by suddenly reduced paraspinal muscle activity during full flexion. Previous studies showed significant differences in FRP and flexion angles in chronic low back pain (cLBP) patients compared to individuals without back pain (no-BP). However, the relationship between FRP and flexion angles remains insufficiently understood in older populations. Thus, this study investigated the relationship between FRP and flexion angles concerning to the age and presence of cLBP. METHODS: Forty no-BP subjects (20m/20f; mean age 41.5 years) and thirty-eight cLBP patients (19m/19f; mean age 43.52 years) performed maximum full upper body flexion task. Electromyographic (EMG) measurements were conducted to assess the activity of lumbar erector spinae (ESL), thoracic erector spinae (EST), and multifidus (MF). Lumbar, thoracic, and pelvic angles at the onset (OnsetL/T/P) and offset of the FRP (OffsetL/T/P) and maximum trunk inclination (MaxL/T/P) were calculated. The FRP was evaluated using a flexion relaxation ratio (FRR). RESULTS: cLBP patients showed smaller FRR in MF and right ESL compared to no-BP individuals ( < 0.05), while no differences were found in flexion angles between two groups. Subjects over 40 showed smaller FRR in MF and ESL, and smaller flexion angles on OffsetL and MaxL ( < 0.05). Age-related analysis in the cLBP group revealed that patients over 40, compared to younger ones, had smaller FRR in MF and ESL, and smaller values in all thoracic and lumbar flexion angles ( < 0.05). While in no-BP group, significant larger flexion angles in OnsetL and OffsetT ( < 0.05) were observed in participants over 40. Pain-related analysis in the older group revealed that the cLBP patients, compared to no-BP individuals, had smaller FRR in right MF and right ESL, and smaller values in all lumbar and thoracic flexion angles ( < 0.05), while in younger group, there were no significant pain-related differences in FRR, with larger values in all lumbar flexion angles ( < 0.05). CONCLUSION: Our findings indicate a reduction or absence of FRP in cLBP patients compared to no-BP individuals, with age being a significant factor as those over 40 showed smaller FRP and flexion angles compared to younger individuals.
背景：屈曲放松现象（FRP）的特征是在完全屈曲过程中脊柱旁肌肉活动突然减少。先前的研究表明，与无背痛个体相比，慢性下背痛（cLBP）患者的FRP和屈曲角度存在显著差异。然而，在老年人群中，FRP与屈曲角度之间的关系仍未得到充分理解。因此，本研究调查了FRP与屈曲角度之间与年龄和cLBP存在与否的关系。 方法：40名无背痛受试者（20名男性/20名女性；平均年龄41.5岁）和38名cLBP患者（19名男性/19名女性；平均年龄43.52岁）进行了最大程度的上半身屈曲任务。进行肌电图（EMG）测量以评估腰竖脊肌（ESL）、胸竖脊肌（EST）和多裂肌（MF）的活动。计算FRP开始时（起始L/T/P）和结束时（结束L/T/P）以及最大躯干倾斜度（最大L/T/P）时的腰椎、胸椎和骨盆角度。使用屈曲放松率（FRR）评估FRP。 结果：与无背痛个体相比，cLBP患者的MF和右侧ESL的FRR较小（<0.05），而两组之间的屈曲角度没有差异。40岁以上的受试者MF和ESL的FRR较小，结束L和最大L时的屈曲角度较小（<0.05）。cLBP组的年龄相关分析显示，40岁以上的患者与年轻患者相比，MF和ESL的FRR较小，所有胸椎和腰椎屈曲角度的值较小（<0.05）。而在无背痛组中，40岁以上的参与者起始L和结束T时的屈曲角度显著更大（<0.05）。老年组的疼痛相关分析显示，与无背痛个体相比，cLBP患者右侧MF和右侧ESL的FRR较小，所有腰椎和胸椎屈曲角度的值较小（<0.05），而在年轻组中，FRR没有显著的疼痛相关差异，所有腰椎屈曲角度的值较大（<0.05）。 结论：我们的研究结果表明，与无背痛个体相比，cLBP患者的FRP减少或缺失，年龄是一个重要因素，因为40岁以上的人与年轻个体相比，FRP和屈曲角度较小。
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