慢性腰痛患者的核心稳定性分析及康复干预的疗效观察
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摘要
目的:通过组间对照及康复干预前后比较,探讨慢性腰痛患者核心稳定性的特征。方法:纳入CLBP患者71例(CLBP组)及29名非CLBP患者为对照组(Non组),填写疼痛问卷并完成Y型平衡测试、八级腹桥测试,分析核心稳定性的组间差异;并对其中20位CLBP患者实施为期6周包含运动干预和健康教育的康复干预,比较干预前后的变化。结果:①CLBP组无论是动态核心稳定性还是静态核心耐力均显著下降,且双侧失衡(P<0.05),女性及老年患者的核心稳定性比男性及青年患者丢失更为明显;②CLBP患者双侧核心稳定性明显失衡(P<0.05);③6周的康复干预,可显著改善CLBP患者的核心稳定性及其双侧失衡的情况和疼痛症状(P<0.05)。结论:①核心稳定性明显下降且出现双侧失衡是CLBP患者的特征;②女性及中老年患者的功能丢失更多,在康复时应更多地关注其核心稳定性训练;③对于青年CLBP患者,推荐6周及以上以核心稳定性运动为主要内容的康复干预。
Objective: to discuss the core stability of patients with chronic low back pain(CLBP)by comparing CLBP patients with healthy people(non-CLBP) before and after the rehabilitation. Methods:71 CLBP patients(CLBP Group) and 29 health people(Non-CLBP Group) were recruited and screened.And they were tested and recorded by the VAS(Visual Analogue Scale),YBT(Y Balance Test) and ELP(Eight Level Plank);the difference between CLBP and Con groups was compared.Then,20 CLBP patients(CLBP Group) participated in a 6-week rehabilitation plan. Result:1.CLBP shows an obvious decrease of core stability and the bilateral imbalance(P<0.05),while the female and the elderly patients decreased more seriously.2.CLBP shows a significant imbalance bilaterally(P<0.05);3.The 6-week intervention significantly improved the core stability and the bilateral imbalance of young CLBP(P<0.05). Conclusions:1.The significant decrease of core stability and the bilateral imbalance are typical signs of CLBP patients.2.As the core stability of female and elderly CLBP decreases more than male and young patients,therefore the core stability training should be more focused on during the rehabilitation.3.A 6-week rehabilitation intervention is strongly recommended for the young CLBP.
Objective: to discuss the core stability of patients with chronic low back pain(CLBP)by comparing CLBP patients with healthy people(non-CLBP) before and after the rehabilitation. Methods:71 CLBP patients(CLBP Group) and 29 health people(Non-CLBP Group) were recruited and screened.And they were tested and recorded by the VAS(Visual Analogue Scale),YBT(Y Balance Test) and ELP(Eight Level Plank);the difference between CLBP and Con groups was compared.Then,20 CLBP patients(CLBP Group) participated in a 6-week rehabilitation plan. Result:1.CLBP shows an obvious decrease of core stability and the bilateral imbalance(P<0.05),while the female and the elderly patients decreased more seriously.2.CLBP shows a significant imbalance bilaterally(P<0.05);3.The 6-week intervention significantly improved the core stability and the bilateral imbalance of young CLBP(P<0.05). Conclusions:1.The significant decrease of core stability and the bilateral imbalance are typical signs of CLBP patients.2.As the core stability of female and elderly CLBP decreases more than male and young patients,therefore the core stability training should be more focused on during the rehabilitation.3.A 6-week rehabilitation intervention is strongly recommended for the young CLBP.
引文
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[15] 耿明南,丛长江.女子皮艇运动员静态平衡能力与核心力量浅析[J].辽宁体育科技,2014,36(3):33-34
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[2] KUMAR S.Epidemiology,etiology,diagnostic valuation,and treatment of low back pain[J].Curr Opin Rheumatol,1997,19(12):505-512
[3] ZAZULAK B,CHOLEWICKI J,REEVES N P.Neuromuscular control of trunk stability:Clinical implications for sports injury prevention[J].J Am Acad Orthop Surg,2008,16(9):497-505
[4] PANJABI,M.M.The stabilizing system of the spine:Part 1.function,dysfunction,adaptation,and enhancement[J].Journal of Spinal Disorders,1992,5,383-389
[5] BUTOWICZ C M,EBAUGH D D,NOEHREN B,et al.Validation of two clinical measures of core stability[J].Int J Sports Phys Ther.2016,11(1):15-23
[6] HODGES P W,RICHARDSON C A.Contraction of the abdominal muscles associated with movement of the lower limb[J].Phys Ther,1997,77(2):132-142
[7] CHOLEWICKI J,SILFIES S P,SHAH R A,et al.Delayed trunk muscle reflex responses increase the risk of low back injuries[J].Spine,2005,30(23):2614-2620
[8] GARRISON J C,BOTHWELL J M,WOLF G,et al.Y BALANCE TESTTM anterior reach symmetry at three month is related to single leg functional performance at time of return to sports following anterior cruciate ligament reconstruction[J].Int J Sports Phys Ther,2015,10(5):602-11
[9] MOTTE S,ARNOLD B L,ROSS S E.Trunk-rotation differences at maximal reach of the star excursion balance test in participants with chronic ankle instability[J].J Athl Train,2015,50(4):358-365
[10] FULLAM K,CAULFI ELD B,COUGHLAN G F,et al.Kinematic analysis of selected reach directions of the Star excursion balance test compared with the Y-balance Test [J].J Sport Rehabil,2014,23(1):27-35
[11] BUTOWICZ C M,EBAUGH D D,NOEHREN B,et al.Validation of two clinical measures of core stability[J].The International Journal of Sports Physical Therapy,2016,11(1):15-23
[12] GARRISON J C,ARNOLD A,MACKO M J,et al.Baseball players diagnosed with ulnar collateral ligament tears demonstrate decreased balance compared to healthy controls[J].J Orthop Sports Phys Ther,2013,43(10):752-758
[13] SMITH C A,CHIMERA N J,WARREN M.Association of Y balance test reach asymmetry and injury in division athletes[J].Med Sci Sports Exerc,2015,47(1):136-141
[14] 李瑞杰,温宇红,张梦雪,等.青少年男性蝶泳运动员水陆核心稳定力量训练的模式探索与实证研究[J].成都体育学院学报,2016,42(4):70-75
[15] 耿明南,丛长江.女子皮艇运动员静态平衡能力与核心力量浅析[J].辽宁体育科技,2014,36(3):33-34
[16] JONES M A,STRATTON G,REILLY T,et al.Recurrent non-specific low-back pain in adolescents:The role of exercise[J].Ergonomics,2007,50(10):9
[17] 温煦.效应量:体育科研中不应忽略的统计量[J].中国体育科技,2011,47(3):142-145
[18] 张全成,李明珠,崔广志,等.2种腰背痛康复治疗方案对比分析[J].中国校医,2012,26(2):130-132