机械脉冲力脊椎矫正与常规理疗治疗机械性腰痛:腰部活动范围和躯干肌肌力的比较
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摘要
背景:研究发现机械性腰痛与某些姿势、肌肉和活动度特性有关。与病源学因素有关的情况包括腰椎前凸下降或过度、腹肌肌力下降、躯干屈肌和伸肌肌力失衡、腰部活动度下降等,而脊椎矫正,或称为整脊术是国外作为脊柱功能障碍和疼痛的一种保守治疗方法。目的:评价机械脉冲力脊椎矫正和常规物理因子治疗对于机械性腰痛患者主观疼痛和功能障碍指标以及腰部活动范围和躯干肌肌力的影响。方法:采用随机对照前瞻性临床研究方法,入选60例年龄18-65岁、病程在6周以上、伴有或不伴有下肢放射痛的机械性腰痛患者,随机分配到试验组(机械脉冲力脊椎矫正)和对照组(常规物理因子治疗)。2组治疗均为每周2次,共4周。在治疗前和治疗后1个月评估患者的目测类比评分、Roland-Morris功能障碍问卷评分、腰部活动范围和躯干肌肌力。结果与结论:(1)与治疗前相比,2组腰痛患者在治疗后1个月的疼痛和功能障碍均显著下降(P <0.05),试验组治疗后1个月目测类比评分显著低于对照组(P <0.05);(2)与治疗前相比,试验组治疗后1个月显示屈曲和伸展活动范围均显著改善(P <0.05);治疗后1个月试验组腰部屈曲活动范围优于对照组(P <0.05);(3)与治疗前相比,2组患者治疗后的躯干屈肌和伸肌肌力均有显著改善(P <0.05);治疗后1个月试验组的躯干伸肌肌力改善优于对照组(P <0.05);(4)提示相比于常规物理因子治疗,机械脉冲力脊椎矫正法治疗机械性腰痛在缓解疼痛以及改善腰部活动范围和躯干肌肌力方面更加有效。
BACKGROUND: Chronic low back pain has been shown to be related to gestures, muscle and activity characteristics. Etiological factors include decreased or excessive lumbar lordosis, decreased abdominal muscle strength, imbalance of trunk flexors and extensors, and decreased lumbar mobility. Spinal manipulation or chiropractic surgery is a conservative treatment for spinal dysfunction and pain at abroad. OBJECTIVE: To assess the efficacy of spinal mechanical impulsive manipulation and conventional physiotherapy by subjective pain and dysfunction as well as range of motion and trunk muscle strength in the patients with chronic low back pain.METHODS: This was a prospective, randomized controlled clinical trial. Sixty subjects with an age of 18 to 65 years, who had a primary complaint of low back pain at least 6-week duration with or without radiating pain to the lower extremity were included, and randomized into trial(spinal mechanical impulsive manipulation) and control(conventional physiotherapy) groups. Treatment programs were performed twice weekly, for 4 weeks. The Visual Analogue Scale scores, Roland-Morris dysfunction questionnaire, lumbar spinal range of motion and trunk muscle strength before and 1 month after treatment were detected. RESULTS AND CONCLUSION:(1) All subjects had a significant decrease in pain and disability after intervention(P < 0.05). The Visual Analogue Scale score at 1 month after treatment in the trial group was significantly lower than those in the control group(P < 0.05).(2) Both groups showed significant improvements in lumbar flexion, extension, flexor and extensor strength after treatment(P < 0.05). The lumbar flexion range of motion and extensor muscle strength at 1 month after treatment were increased significantly in the trial group compared with the control group(P < 0.05).(3) Both groups showed significant improvements in trunk extensor strength after treatment(P < 0.05). The trunk extensor strength improvement at 1 month after treatment in the trial group was significantly superior to that in the control group(P < 0.05).(4) These results suggest that spinal mechanical impulsive manipulation is more effective in reducing pain and improving range of motion and trunk muscle strength in patients with low back pain compared with conventional physiotherapy.
BACKGROUND: Chronic low back pain has been shown to be related to gestures, muscle and activity characteristics. Etiological factors include decreased or excessive lumbar lordosis, decreased abdominal muscle strength, imbalance of trunk flexors and extensors, and decreased lumbar mobility. Spinal manipulation or chiropractic surgery is a conservative treatment for spinal dysfunction and pain at abroad. OBJECTIVE: To assess the efficacy of spinal mechanical impulsive manipulation and conventional physiotherapy by subjective pain and dysfunction as well as range of motion and trunk muscle strength in the patients with chronic low back pain.METHODS: This was a prospective, randomized controlled clinical trial. Sixty subjects with an age of 18 to 65 years, who had a primary complaint of low back pain at least 6-week duration with or without radiating pain to the lower extremity were included, and randomized into trial(spinal mechanical impulsive manipulation) and control(conventional physiotherapy) groups. Treatment programs were performed twice weekly, for 4 weeks. The Visual Analogue Scale scores, Roland-Morris dysfunction questionnaire, lumbar spinal range of motion and trunk muscle strength before and 1 month after treatment were detected. RESULTS AND CONCLUSION:(1) All subjects had a significant decrease in pain and disability after intervention(P < 0.05). The Visual Analogue Scale score at 1 month after treatment in the trial group was significantly lower than those in the control group(P < 0.05).(2) Both groups showed significant improvements in lumbar flexion, extension, flexor and extensor strength after treatment(P < 0.05). The lumbar flexion range of motion and extensor muscle strength at 1 month after treatment were increased significantly in the trial group compared with the control group(P < 0.05).(3) Both groups showed significant improvements in trunk extensor strength after treatment(P < 0.05). The trunk extensor strength improvement at 1 month after treatment in the trial group was significantly superior to that in the control group(P < 0.05).(4) These results suggest that spinal mechanical impulsive manipulation is more effective in reducing pain and improving range of motion and trunk muscle strength in patients with low back pain compared with conventional physiotherapy.
引文
[1]Durmus D, Akyol Y, Alayli G, et al. Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain:a randomized controlled trial. Rheumatol Int. 2009;29(8):947-954.
[2]Ferreira ML, Ferreira PH, Latimer J, et al. Relationship between spinal stiffness and outcome in patients with chronic low back pain.Man Ther. 2009;14(1):61-67.
[3]Stubbs M, Harris M, Solomonow M, et al. Ligamento-muscular protective reflex in the lumbar spine of the feline. J Electromyogr Kinesiol. 1998;8(4):197-204.
[4]Bronfort G, Maiers MJ, Evans RL, et al. Supervised exercise,spinal manipulation, and home exercise for chronic low back pain:a randomized clinical trial. Spine J. 2011;11(7):585-598.
[5]Giles LG, Muller R. Chronic spinal pain syndromes:a clinical pilot trial comparing acupuncture, anonsteroidal anti-inflammatory drug,and spinal manipulation. J Manipulative Physiol Ther. 1999;22(6):376-381.
[6]陈一,俞晓杰,施海涛,等.机械力量脊椎矫正治疗老年性腰痛的临床疗效研究[J].老年医学与保健,2015,21(6):380-383,390.
[7]Goodsell M, Lee M, Latimer J. Short-term effects of lumbar posteroanterior mobilization in individuals withlow-back pain. J Manipulative Physiol Ther. 2000;23(5):332-342.
[8]Nansel D, Peneff A, Cremata E, et al. Time course considerations for the effects of unilateral lower cervicaladjustments with respect to the amelioration of cervical lateral-flexion passive end-range asymmetry. J Manipulative Physiol Ther. 1990;13(6):297-304.
[9]Colloca CJ, Keller TS. Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy.Spine(Phila Pa 1976). 2001;26(10):1117-1124.
[10]Indahl A, Kaigle AM, Reikeras O, et al. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine(Phila Pa 1976). 1997;22(24):2834-2840.
[11]Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine:implications for injury andchronic low back pain. Clin Biomech(Bristol, Avon). 1996;11(1):1-15.
[12]Ng JK, Kippers V, Parnianpour M, et al. EMG activity normalization for trunk muscles in subjects with and without backpain. Med Sci Sports Exerc. 2002;34(7):1082-1086.
[13]Fritz JM, Hebert J, Koppenhaver S, et al. Beyond minimally important change:defining a successful outcome of physicaltherapy for patients with low back pain. Spine(Phila Pa1976). 2009;34(25):2803-2809.
[14]Fritz JM, Koppenhaver SL, Kawchuk GN, et al. Preliminary investigation of the mechanisms underlying the effects ofmanipulation:exploration of a multivariate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine(Phila Pa1976). 2011;36(21):1772-1781.
[15]Dishman JD, Bulbulian R. Spinal reflex attenuation associated with spinal manipulation. Spine(Phila Pa 1976). 2000;25(19):2519-2524; discussion 2525.
[2]Ferreira ML, Ferreira PH, Latimer J, et al. Relationship between spinal stiffness and outcome in patients with chronic low back pain.Man Ther. 2009;14(1):61-67.
[3]Stubbs M, Harris M, Solomonow M, et al. Ligamento-muscular protective reflex in the lumbar spine of the feline. J Electromyogr Kinesiol. 1998;8(4):197-204.
[4]Bronfort G, Maiers MJ, Evans RL, et al. Supervised exercise,spinal manipulation, and home exercise for chronic low back pain:a randomized clinical trial. Spine J. 2011;11(7):585-598.
[5]Giles LG, Muller R. Chronic spinal pain syndromes:a clinical pilot trial comparing acupuncture, anonsteroidal anti-inflammatory drug,and spinal manipulation. J Manipulative Physiol Ther. 1999;22(6):376-381.
[6]陈一,俞晓杰,施海涛,等.机械力量脊椎矫正治疗老年性腰痛的临床疗效研究[J].老年医学与保健,2015,21(6):380-383,390.
[7]Goodsell M, Lee M, Latimer J. Short-term effects of lumbar posteroanterior mobilization in individuals withlow-back pain. J Manipulative Physiol Ther. 2000;23(5):332-342.
[8]Nansel D, Peneff A, Cremata E, et al. Time course considerations for the effects of unilateral lower cervicaladjustments with respect to the amelioration of cervical lateral-flexion passive end-range asymmetry. J Manipulative Physiol Ther. 1990;13(6):297-304.
[9]Colloca CJ, Keller TS. Electromyographic reflex responses to mechanical force, manually assisted spinal manipulative therapy.Spine(Phila Pa 1976). 2001;26(10):1117-1124.
[10]Indahl A, Kaigle AM, Reikeras O, et al. Interaction between the porcine lumbar intervertebral disc, zygapophysial joints, and paraspinal muscles. Spine(Phila Pa 1976). 1997;22(24):2834-2840.
[11]Cholewicki J, McGill SM. Mechanical stability of the in vivo lumbar spine:implications for injury andchronic low back pain. Clin Biomech(Bristol, Avon). 1996;11(1):1-15.
[12]Ng JK, Kippers V, Parnianpour M, et al. EMG activity normalization for trunk muscles in subjects with and without backpain. Med Sci Sports Exerc. 2002;34(7):1082-1086.
[13]Fritz JM, Hebert J, Koppenhaver S, et al. Beyond minimally important change:defining a successful outcome of physicaltherapy for patients with low back pain. Spine(Phila Pa1976). 2009;34(25):2803-2809.
[14]Fritz JM, Koppenhaver SL, Kawchuk GN, et al. Preliminary investigation of the mechanisms underlying the effects ofmanipulation:exploration of a multivariate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine(Phila Pa1976). 2011;36(21):1772-1781.
[15]Dishman JD, Bulbulian R. Spinal reflex attenuation associated with spinal manipulation. Spine(Phila Pa 1976). 2000;25(19):2519-2524; discussion 2525.