Kanlı Kansu, Hare Yigitoglu Pembe, Özgül Ahmet
Department of Physiotherapy and Rehabilitation, Near East University Faculty of Health Sciences, Nicosia, Cyprus.
Department of Physical Medicine and Rehabilitation, Nicosia State Hospital, Nicosia, Cyprus.
Turk J Phys Med Rehabil. 2024 Aug 26;70(3):358-369. doi: 10.5606/tftrd.2024.13257. eCollection 2024 Sep.
This study aimed to examine effects of core stabilization and aerobic exercises on lumbar stabilizer muscles and diaphragm motility in individuals with chronic low back pain (CLBP).
Fifty-one patients (19 males, 32 females; mean age: 32.7±8.8 years; range, 20 to 60 years) with CLBP were included in this randomized controlled trial between March 2021 and May 2022. The patients were divided into three groups: the core group, the aerobic group, and the control group. Conventional treatments (hotpack, transcutaneous electrical nerve stimulation, ultrasound, and McKenzie exercises) were applied to all three patient groups. The core group received core stabilization exercises, and the aerobic group received aerobic exercises. The control group received only conventional treatments. Exercises were continued for six weeks. All patients were assessed through the Beck Depression Inventory (BDI), Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and Nottingham Health Profile (NHP). Trunk flexor and extensor strength, as well as trunk flexor and back extensor endurance, was examined. Structural features of the multifidus (MF), transversus abdominis (TrA), external oblique (EO), internal oblique (IO), and diaphragm muscles, as well as diaphragm motility, were evaluated with ultrasound imaging. All measurements were repeated before and after six weeks of treatment.
In all groups, post-treatment values of VAS rest/activity, trunk flexor endurance, back extensor endurance, trunk flexor/extensor muscle strength, BDI, RMDQ and, NHP scores improved significantly compared to pre-treatment (p=0.001). Resting and contraction thicknesses of TrA, MF, EO, and IO muscles increased significantly in both the core (p=0.001/0.001, p=0.001/0.002, p=0.001/0.001, and p=0.001/0.001, respectively) and aerobic groups (p=0.001/0.013, p=0.002/0.020, p=0.001/0.004, and p=0.001/0.010, respectively), while the control group did not show any significant difference (p=0.229/0.064, p=0.052/0.102, p=0.069/0.449, and p=0.094/0.146, respectively). After treatment, all groups showed significant increments in end-expiratory thickness (p=0.001), end-inspiratory thickness (p=0.001), motility of diaphragm during normal breathing (control, p=0.003; core, p=0.001; aerobic, p=0.001), and deep breathing (control, p=0.007; core, p=0.001; aerobic, p=0.001).
While aerobic and core stabilization exercises provided significant improvements in individuals with CLBP, the core stabilization group showed the best improvement in all parameters. Accordingly, the necessity of aerobic and core stabilization exercises in treatment programs comes to the fore in individuals with CLBP.
本研究旨在探讨核心稳定训练和有氧运动对慢性下腰痛（CLBP）患者腰椎稳定肌和膈肌运动的影响。
本随机对照试验纳入了51例CLBP患者（19例男性，32例女性；平均年龄：32.7±8.8岁；范围20至60岁），研究时间为2021年3月至2022年5月。患者被分为三组：核心训练组、有氧运动组和对照组。所有三组患者均接受常规治疗（热敷、经皮电刺激神经疗法、超声和麦肯齐疗法）。核心训练组接受核心稳定训练，有氧运动组接受有氧运动。对照组仅接受常规治疗。训练持续六周。所有患者均通过贝克抑郁量表（BDI）、视觉模拟量表（VAS）、罗兰·莫里斯残疾问卷（RMDQ）和诺丁汉健康量表（NHP）进行评估。检测躯干屈伸肌力量以及躯干屈伸肌耐力。使用超声成像评估多裂肌（MF）、腹横肌（TrA）、腹外斜肌（EO）、腹内斜肌（IO）和膈肌的结构特征以及膈肌运动。所有测量均在治疗六周前后重复进行。
与治疗前相比，所有组的VAS静息/活动值、躯干屈肌耐力、伸肌耐力、躯干屈伸肌力量、BDI、RMDQ和NHP评分在治疗后均显著改善（p = 0.001）。核心训练组（分别为p = 0.001/0.001、p = 0.001/0.002、p = 0.001/0.001和p = 0.001/0.001）和有氧运动组（分别为p = 0.001/0.013、p = 0.002/0.020、p = 0.001/0.004和p = 0.001/0.010）的TrA、MF、EO和IO肌肉的静息和收缩厚度均显著增加，而对照组无显著差异（分别为p = 0.229/0.064、p = 0.052/0.102、p = 0.069/0.449和p = 0.094/0.146）。治疗后，所有组的呼气末厚度（p = 0.001）、吸气末厚度（p = 0.001）、正常呼吸时膈肌运动（对照组，p = 0.003；核心训练组，p = 0.001；有氧运动组，p = 0.001）和深呼吸时膈肌运动（对照组，p = 0.007；核心训练组，p = 0.001；有氧运动组，p = 0.001）均显著增加。
虽然有氧运动和核心稳定训练对CLBP患者有显著改善，但核心稳定训练组在所有参数上的改善最佳。因此，有氧运动和核心稳定训练在CLBP患者治疗方案中的必要性凸显出来。
