Takemasa R, Yamamoto H, Tani T
Department of Orthopaedic Surgery, Kochi Medical School, Japan.
Spine (Phila Pa 1976). 1995 Dec 1;20(23):2522-30. doi: 10.1097/00007632-199512000-00012.
Trunk muscle strength and the effect of trunk muscle exercises on chronic low back pain were investigated in patients with chronic low back pain.
Patients with chronic low back pain include those with organic lumbar lesions and those without such lesions. This study analyzed the differences in trunk muscle strength and effect of trunk muscle exercises between these two groups of patients.
Previous studies have reported lower trunk muscle strength in patients with chronic low back pain and higher efficacy of trunk muscle exercises for treating chronic low back pain. However, no analysis have yet been done of differences in these parameters between patients with chronic low back pain with and without organic lumbar lesions.
One-hundred-twenty-three patients with chronic low back pain and 126 healthy individuals without low back pain (control group) underwent trunk muscle strength evaluation. The patients were further divided into two groups-- those in group 1 had detectable organic lumbar lesions and those in group 2 had no detectable organic lesions. Seventy-two of these patients performed trunk muscle exercises and the correlation between improvement in low back pain and increase in trunk muscle strength was analyzed.
Trunk flexor and extensor strengths were significantly lower in both groups. However, the flexor/extensor ratio of maximum torque was significantly higher in group 1 than in the control group, but was not significantly different between group 2 and the control group. Trunk muscle exercises reduced low back pain in both groups, but were more effective in group 2 than in group 1. The degree of correlation between increase in trunk muscle strength and improvement of low back pain also was higher in group 2 than in group 1.
This difference in flexor/extensor ratio may have been due to reduced extensor strength resulting from neurogenic muscle weakness induced by the organic lumbar lesions in group 1. The exercise-associated increase in trunk muscle strength did not completely eliminate the low back pain induced by the organic lumbar lesions in group 1. However, increasing trunk muscle strength was extremely effective in patients of Group 2, in which decreased trunk muscle strength was a major factor in chronic low back pain.
对慢性下腰痛患者的躯干肌肉力量以及躯干肌肉锻炼对慢性下腰痛的影响进行了调查。
慢性下腰痛患者包括有器质性腰椎病变的患者和无此类病变的患者。本研究分析了这两组患者在躯干肌肉力量和躯干肌肉锻炼效果方面的差异。
先前的研究报告称，慢性下腰痛患者的躯干肌肉力量较低，且躯干肌肉锻炼治疗慢性下腰痛的疗效较高。然而，尚未对有和无器质性腰椎病变的慢性下腰痛患者在这些参数上的差异进行分析。
123例慢性下腰痛患者和126例无下腰痛的健康个体（对照组）接受了躯干肌肉力量评估。患者进一步分为两组——第1组有可检测到的器质性腰椎病变，第2组无可检测到的器质性病变。其中72例患者进行了躯干肌肉锻炼，并分析了下腰痛改善与躯干肌肉力量增加之间的相关性。
两组的躯干屈肌和伸肌力量均显著较低。然而，第1组最大扭矩的屈肌/伸肌比值显著高于对照组，但第2组与对照组之间无显著差异。躯干肌肉锻炼减轻了两组的下腰痛，但第2组比第1组更有效。第2组躯干肌肉力量增加与下腰痛改善之间的相关程度也高于第1组。
屈肌/伸肌比值的这种差异可能是由于第1组器质性腰椎病变引起的神经源性肌肉无力导致伸肌力量降低。锻炼相关的躯干肌肉力量增加并未完全消除第1组器质性腰椎病变引起的下腰痛。然而，增加躯干肌肉力量对第2组患者极为有效，在该组中躯干肌肉力量下降是慢性下腰痛的主要因素。
