核心稳定训练对非特异性下背痛的治疗作用

1核心稳定训练的提出在20世纪80年代,Bergmark[1]把作用于腰椎的肌肉分为两组:局部的和整体的。局部肌肉包括直接作用于腰椎并附着于腰椎的肌肉(如:多裂肌),整体肌肉(如:竖脊肌、腹直肌)传导胸椎和骨盆之间的负荷。Panjabi[2]提出:被动的、主动的和神经的亚系统起着稳定脊柱的作用。被动肌肉骨骼亚系统包括:椎体、椎间盘、韧带、关节突关节及相连的肌肉     

核心稳定性训练结合常规康复治疗对脑卒中偏瘫患者躯干肌肉厚度、活动度的meta分析

目的:探讨核心稳定性训练结合常规康复治疗对脑卒中偏瘫患者躯干肌肉厚度及活动度的影响。方法:本研究通过计算机检索Pubmed、Medline、Cochrane Library、Web of science、中国知网、万方等数据库中有关核心稳定性训练对脑卒中偏瘫患者肌肉厚度、活动度的随机对照试验,截止日期为2018年5月30日。同时对纳入本研究的文献质量进行提取和评价,采用Revman 5.3软件进行统计分析。结果:共纳入文献7篇,共150例患者。meta分析结果显示:与对照组比较,核心稳定性训练结合常规康复治疗明显提高了脑卒中偏瘫患者肌肉厚度,且差异具有显著性意义(MD=-15.73, 95%[-26.65,-4.80], P=0.005, I2=0%)。同时,脑卒中偏瘫患者躯干肌肉活动度也显著改善,且差异亦具有显著性意义(MD=-20.35, 95%[-38.96,-1.75], P=0.03, I2=65%)。结论:与对照组比较,核心稳定性训练结合常规康复治疗能有效增加脑卒中偏瘫患者躯干肌肉厚度,改善其躯干肌肉活动。后续研究中应进一步开展大样本、高质量的RCT加以验证。     

两种减压方式对腰椎管狭窄症术后对脊柱稳定性的影响研究

脊柱稳定性一直是脊柱外科手术的重点考虑因素,随着科技的发展,各种新技术、新器械的应用对于稳定脊柱生物力学系统的提高有着重要的意义。分析腰椎术后脊柱稳定性的变化,降低传统手术方式的并发症,对于手术疗效的保证具有更为重要的意义。本文通过相关文献查询、分析,综述单纯椎板减压术和椎管减压植骨融合内固定术两种不同术式对术后腰椎稳定性的影响,以便为创新术式、提搞临床疗效提供理论基础。     

核心稳定训练在非特异性腰背痛患者中应用效果的系统评价

目的系统性评价核心稳定训练与一般运动或手法治疗对非特异性腰背痛患者的康复疗效。方法计算机检索Medline、EMBASE、PubMed、Cochrane Central Register of Controlled Trials、PsycINFO、中国生物医学文献数据库、CNKI、中国科技期刊全文数据库和万方数据库,检索时间从建库到2018年10月20日。收集所有核心稳定训练对非特异性腰背痛患者康复效果的随机对照试验(RCT)和临床对照研究。2名研究者按照纳入和排除标准独立检索文献、筛选文献、评价纳入文献的质量,并提取资料,使用Revman 5.3软件进行Meta分析。结果共纳入14篇文献,均为RCT。Meta分析结果显示,核心稳定运动训练组与一般运动训练组疼痛改善对比结果(Z=4.67,P<0.001)[OR=1.01,95%CI(-1.43,-0.59)],证据显示有统计学意义(P<0.05);稳定运动训练和一般运动训练后患者的脊柱功能障碍评分对比(Z=5.03,P<0.01)[OR=-7.18,95%CI(-9.98,-4.38)],证据显示有统计学意义(P<0.05)。其他指标对比结果均无统计学意义(P>0.05)。结论核心运动组和手法治疗组都能有效地降低非特异腰背痛患者疼痛,并且核心稳定训练能促进非特异性腰背痛患者功能障碍的缓解,鼓励将核心稳定训练作为非特异性腰痛患者肌肉骨骼康复的一部分。     

护士核心能力的内涵及特征界定

核心能力（core competence）是在20世纪90年代由Prahalad和Hamel正式提出的，其后众多学者从不同角度对其进行了大量的研究，形成了多种对核心能力的不同描述。引入国内后，由于翻译的原因更是产生了诸多分歧，因而国内的研究文献也无法形成统一的概念，出现了核心能力、核心竞争力、核心胜任力等多种表述。     

推拿治疗退行性腰椎滑脱症的规范化探讨

目的：回顾近年来旨内外脊柱生物力学基础实验和退行性腰椎滑脱症的推拿临床研究，探讨推拿治疗退行性腰椎滑脱症的手法机制和对腰椎稳定性的影响。 方法：应用计算机检索PubMed和OVID数据库1950-01／2006—07脊柱生物力学研究和退行性腰椎滑脱症手法治疗的文献。检索词为“spine，biomechanics，degenerative spondylolisthesis，manipulation”并限定文献语言种类为English，同时计算机检索清华同方CNKI中国期刊全文数据库1992—01／2006—07退行性腰椎滑脱症的推拿临床治疗文献，检索词为“退行性腰椎滑脱，生物力学，推拿”，并限定语言种类为中文；此外，在图书馆手工检索1985—01／2005-12出版的相关专著。纳入标准：①脊柱生物力学研究。②退行性腰椎滑脱症推拿手法治疗。排除标准：①脊柱骨折。②手术治疗。③重复的综述与临床治疗文献。从腰椎生物力学的角度阐述手法的作用途径，评价推拿的临床疗效和对腰椎稳定性的影响。结果：共纳入文献30篇，其中3篇为研究性论著，1篇为普通高等教育“十五”国家级规划教材，将文献进行综合评价。①躯干肌的协调收缩可维持腰椎节段的结构性稳定，调节腰椎活动范围，维持脊柱的动态平衡。退行性腰椎滑脱病变节段椎间盘和关节突关节等退变明显，生物力学性能发生变化，不能发挥其稳定功能，抗剪切力下降，其腰椎旋转中心后移，应力和载荷分布不协调；同时，退行性腰椎滑脱患者腰背肌肌力下降，躯干肌肌力失衡导致腰椎曲度变化，进一步影响腰椎稳定性。②手法的作用机制可能是改善腰肌高张力状态，减小骨盆前倾角及腰椎前凸，降低剪切应力，消除神经根压迫，结合针对性的导引和功能训练可改善腰椎承重力线，改善肌肉收缩的协调性和柔顺性，提高躯干肌群的肌力和腰椎稳定性。 结论：推拿是退行性腰椎滑脱症有效的保守方法，手法的筛选、规范以及疗效的客观评估仍需进一步研究。     

自行车运动的核心技术及相关脊柱核心稳定性原理

目的:探讨自行车运动的核心技术及其与脊柱核心稳定性理论之间的联系。方法:通过文献调查研究自行车运动骑行的核心技术,包括车上定位技术与踏蹬技术,分析其中的腰椎、颈椎核心稳定性机制,包括四肢发力时与提肛、收腹的协同,身体左右摆动时对局部稳定性肌群相对应的训练作用等。结果:自行车运动对脊柱疾病的防治起着重要作用,其本身就是强化脊柱稳定性的有效训练之一,同时作为有氧运动的典型代表,通过全身的运动有助于加速脊柱疾病的康复。结论:自行车运动在脊柱疾病的保健、康复及防治领域中的价值值得进一步深入挖掘,以期为慢性退行性脊柱疾病的防治提供更为开阔的思路。     

脊柱核心稳定控制系统的研究进展

正腰痛是临床常见病,是中青年人群最主要的就诊因素之一。约2/3的人一生中要经历腰痛,其中15%会转为慢性,在美国,占工伤医疗花费的第一位[1]。腰痛容易复发以及不易彻底缓解的原因之一在于腰痛患者的脊柱核心稳定功能异常。本文将对腰痛患者的核心稳定性以及肌肉活动改变进行回顾。1核心稳定的概念核心稳定性(core stability)是能稳定人体的系统,能使椎体的中部区域保持在生理极限范围内的能力[2]。核心稳定是     

核心稳定性训练结合深层肌肉刺激对腰椎间盘突出症患者术后功能恢复的影响

目的探讨核心稳定性训练结合深层肌肉刺激对腰椎间盘突出症患者术后功能恢复的影响。方法选取2016年8月至2018年8月我院收治的91例腰椎间盘突出症拟手术治疗患者为研究对象,根据其术后康复意愿将患者分为研究组46例和对照组45例,对照组实施常规深层肌肉刺激康复护理,研究组在此基础上实施核心稳定性训练,比较两组患者腰腿痛程度(VAS)、腰椎疾患综合标准评分(JOA)及脊椎功能障碍程度评分(ODI)。结果30 d后,研究组患者VAS,JOA,ODI评分均低于对照组(P<0.05);随访后1年,研究组腰椎间盘突出症复发率显著低于对照组(P<0.05)。结论腰椎间盘突出症手术治疗后应用核心稳定训练结合深层肌肉刺激康复护理,可有效缓解腰椎和腰腿部疼痛程度,改善脊椎功能障碍程度,有利于患者早日回归正常生活和工作。     

肌肉丢失、运动干预及肌肉重建

背景：肌肉丢失是老年人肌肉质量随增龄而减少的现象,它与老年人肌肉功能退化有着密切的关系。近年来,对于肌肉丢失的机制及其运动干预效果研究有了许多新进展。目的：就肌肉丢失细胞水平的机制研究及其运动干预效果进行综述。方法：应用计算机检索 CNKI 期刊全文数据库（2000 年 1 月至 2012 年 12 月）和 PubMed 数据库（2010 年 1月至 2012 年 12 月） 有关肌肉丢失及老年抗阻训练的文献,检索词分别为＂肌肉丢失,肌肉蛋白质代谢,肌细胞,衰老,抗阻训练＂和＂sarcopenia,muscle,resistance training,aging,portein motablism。纳入与肌肉丢失、蛋白质代谢、抗阻训练相关的研究,排除陈旧、重复以及缺乏可信度的文献,最终纳入 58 篇文献进行分析。结果与结论：抗阻训练可以在一定程度上抑制肌肉丢失,使老年人肌肉质量增加,促进运动单位重组,但重组仅限于Ⅱa型和Ⅱb型纤维之间的相互转化;抗阻训练结合蛋白质补充可以有效促进老年人肌肉重建;老年人抗阻训练后的肌肉合成代谢反应较年轻人迟缓,但炎性反应较年轻人剧烈,而 Omega-3 对于消除这种炎性反应具有较好的作用。     

腰椎间盘突出症患者首次核心稳定性训练前后表面肌电信号分析

目的：分析腰椎间盘突出症患者首次核心稳定性训练前后即刻的表面肌电信号特征。方法收集诊断明确且符合纳入标准的腰椎间盘突出症患者30例,均在专业的治疗师指导下进行一次核心稳定性训练,应用Biering-Sorensen腰背肌等长收缩测试方法,于腰部两侧竖脊肌及多裂肌处记录核心稳定性训练前和训练后即刻的表面肌电信号,并提取平均肌电值（AEMG）、中位频率值（MF）进行统计学分析。结果训练前的痛侧竖脊肌MF值、多裂肌MF值、多裂肌AEMG值均小于非痛侧,差异均有统计学意义（t分别=3.44、6.06、4.02,P均＜0.05）;训练后的痛侧竖脊肌MF值、多裂肌MF值、多裂肌AEMG值仍小于非痛侧,差异均有统计学意义（t分别=2.24、6.27、4.12,P均＜0.05）;训练后痛侧竖脊肌与多裂肌AEMG值较训练前增大,但均差异无统计学意义（t分别=1.65、1.23,P均＞0.05）;训练后痛侧多裂肌MF值较训练前低,差异有统计学意义（t=3.91,P＜0.05）。结论核心稳定性训练可激活腰椎间盘突出症患者腰背部核心肌群,可针对性的应用于深层核心肌群多裂肌的强化训练。     

慢性腰痛患者躯干旋转肌群肌力与腰部稳定性的关系

目的探讨慢性非特异性腰痛患者躯干旋转力量与腰部稳定性的关系。方法对22例慢性非特异性腰痛患者,在进行悬吊运动训练前,应用Proxomed Tergumed脊柱功能评估训练系统检查患者躯干旋转时核心肌群的力量,应用悬吊运动仪器来评定腰部核心稳定性,并对两组数据进行相关性分析。结果躯干旋转时核心肌群的肌力与局部的稳定性呈正相关（r=0.876, P<0.001）。结论躯干旋转时核心肌群肌力的增强,对于改善慢性非特异性腰痛患者的局部稳定性有重要意义。     

Impact of post-manipulation corrective core exercises on the spinal deformation and lumbar strength in golfers: a case study

[Purpose] This study examined spinal shape in professional golfers with chronic back pain, and analyzed the effects of a 4-week regimen of semi-weekly manipulation and corrective core exercises on spinal shape. [Subjects] Two golfers with chronic back pain. [Methods] The pelvis and spinal vertebrae were corrected using the Thompson “drop” technique. Angle and force were adjusted to place the pelvis, lumbar spine, and thoracic vertebrae in neutral position. The technique was applied twice weekly after muscle massage in the back and pelvic areas. The golfers performed corrective, warmup stretching exercises, followed by squats on an unstable surface using the Togu ball. They then used a gym ball for repetitions of hip rotation, upper trunk extension, sit-ups, and pelvic anterior-posterior, pelvic left-right, and trunk flexion-extension exercises. The session ended with cycling as a cool-down exercise. Each session lasted 60 minutes. [Results] The difference in height was measured on the left and right sides of the pelvic bone. The pelvic tilt changed significantly in both participants after the 4-week program. [Conclusion] In golfers, core muscles are critical and are closely related to spinal deformation. Core strengthening and spinal correction play a pivotal role in the correction of spinal deformation.Key words: Chronic back pain, Manipulation, Core exercise     

悬吊模式下的核心稳定性训练对脑卒中患者平衡功能的影响

目的 观察悬吊训练模式下的核心稳定性训练对脑卒中患者平衡功能的影响。 方法 选取符合标准的60例脑卒中患者按随机数字表法分成对照组和实验组,每组30例。2组患者均接受脑卒中后常规的康复训练;在此基础上,对照组进行传统核心稳定性训练,实验组则进行悬吊训练模式下核心稳定性训练,每日训练1次,每周5次,连续训练4周。分别于治疗前和治疗4周后（治疗后）,采用Prokin平衡仪对2组患者的站立位平衡能力进行评定,并记录患者睁眼、闭眼平衡测试时的运动轨迹长度及运动椭圆面积;同时利用表面肌电图（sEMG）记录平衡测试时双侧竖脊肌和多裂肌肌电信号的平均肌电（AEMG）值。 结果 ①平衡功能变化：治疗后,睁眼闭眼平衡测试,2组患者压力中心的运动轨迹长度、运动椭圆面积均少于组内治疗前（P<0.01）;实验组患者压力中心的运动轨迹长度［睁眼（226.40±88.59）mm、闭眼（312.07±118.45）mm］、运动椭圆面积［睁眼（198.83±84.99）mm2、闭眼（303.50±123.86）mm2］均少于对照组［运动轨迹长度：睁眼（291.23±117.71）mm、闭眼（405.27±181.05）mm;运动椭圆面积：睁眼（250.47±109.23）mm2、闭眼（379.03±144.91）mm2］,组间差异有统计学意义（P<0.05）。②表面肌电图变化：治疗后,睁眼和闭眼平衡测试时,2组患者双侧竖脊肌与多裂肌的AEMG值均大于组内治疗前（P<0.01）;闭眼平衡测试时,实验组患侧多裂肌的AEMG值［（58.48±10.40）μV］显著大于对照组［（52.39±10.63）μV］,且组间差异有统计学意义（P<0.05）。 结论 悬吊训练模式下的核心稳定性训练能显著改善脑卒中患者的平衡功能,其效果优于传统核心稳定性训练。     

运动与ATP-敏感型钾离子通道

背景：在运动生理状态下，KATP 在调节冠状动脉张力、运动诱导心肌保护效应和延缓骨骼肌疲劳等多个方面具有重要作用。目的：对KATP在运动中的作用进行了综述和探讨，以期为深入了解运动调节机体代谢提供理论参考。方法：检索1991年1月至2014年6月 PubMed数据库及维普中文科技数据库文献。英文检索词为“KATP Channels；Adenosine Triphosphate；Sports；Myocardium；Ion Channels”，中文检索词为“KATP通道；三磷酸腺苷；运动；心肌；离子通道”。选择与KATP分子结构、生物学功能及调控相关，以及KATP与冠状动脉、心肌、骨骼肌疲劳及运动能力相关的文献42篇文献进行探讨。结果与结论：ATP敏感性钾离子通道可以偶联细胞内能量代谢和细胞膜兴奋性，在应对各种生理和病理应激时是保护心肌的效应器之一。长期的耐力训练则会增加骨骼肌和心肌KATP的表达，可能是心肌和骨骼肌对运动应激产生的一种适应性表现。KATP 可能参与冠状动脉血流量的调节。在运动诱导的减轻心肌缺血再灌注损伤的保护效应中，心肌KATP具有重要作用。当骨骼肌疲劳发生时，KATP的激活有利于防止ATP的过度消耗而造成肌纤维损伤和细胞死亡，有利于疲劳的快速恢复。关于KATP与运动能力的关系仍需进一步的研究。     

The effects of core muscle release technique on lumbar spine deformation and low back pain

[Purpose] The purpose of this study was to examine the effects of the core muscle release technique on correction of lumbar deformation and alleviation of low back pain. [Subjects] Ninety patients diagnosed with lumbar deformation and low back pain participated in this study. [Methods] The participants were divided into three groups according to method of treatment. The first group was treated with the core muscle release technique (CRT), the second group was treated with general exercise, and the third group was treated with electrotherapy. The core muscle release technique group received 50-minute of the core muscle release technique 5 times a week for 2 weeks, and the participants in this group were instructed not to receive any other treatments. After the 2 weeks of treatment, the patients were reexamined. The general exercise group performed Williams flexion exercises and McKenzie extension exercises 5 times a week for 2 weeks. The electrotherapy group was treated by application of electrotherapy with an interferential current therapy machine (TM-301. TOPMED. Seongnam, Republic of Korea) to the abdominal muscles and back muscles of the lumbar region. [Results] The data suggest that the core muscle release technique, general exercise, and electrotherapy all helped to decrease the alignment angle and VAS score. Of these treatment methods, however, the core muscle release technique was the most effective for treatment of lumbar spine deformation and low back pain. [Conclusion] The core muscle release technique was most effective for correction of lumbar spine deformation and pain alleviation.Key words: Core muscle release technique, Lumbar spine deformation, Low back pain     

Core strength training for patients with chronic low back pain

[Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain.Key words: Core strength training, Chronic low back pain, Resistance training     

Motor control problems in patients with spinal pain: a new direction for therapeutic exercise

Recent research into muscle dysfunction in patients with low back pain has led to discoveries of impairments in deep muscles of the trunk and back. These muscles have a functional role in enhancing spinal segmental support and control. The muscle impairments are not those of strength but rather problems in motor control. These findings call for a different approach in therapeutic exercise, namely a motor learning exercise protocol. The specific exercise approach has an initial focus on retraining the cocontraction of the deep muscles (ie, the transversus abdominis and lumbar multi-fidus Initial clinical trials point to the effectiveness of the approach in patients with both acute and chronic low back pain in terms of reducing the neuromuscular impairment and in control of pain.     

Core stability exercises on and off a Swiss ball

OBJECTIVES: To assess lumbopelvic muscle activity during different core stability exercises on and off a Swiss ball. DESIGN: Prospective comparison study. SETTING: Research laboratory. PARTICIPANTS: Eight healthy volunteers from a university population. INTERVENTION: Subjects performed 4 exercises on and off a Swiss ball: inclined press-up, upper body roll-out, single-leg hold, and quadruped exercise. MAIN OUTCOME MEASURES: Surface electromyography from selected lumbopelvic muscles, normalized to maximum voluntary isometric contraction, and median frequency analysis of electromyography power spectrum. Visual analog scale for perception of task difficulty. RESULTS: There was a significant increase in the activation of the rectus abdominus with performance of the single-leg hold and at the top of the press-up on the Swiss ball. This led to changes in the relation between the activation levels of the lumbopelvic muscles measured. CONCLUSIONS: Although there was evidence to suggest that the Swiss ball provides a training stimulus for the rectus abdominus, the relevance of this change to core stability training requires further research because the focus of stabilization training is on minimizing rectus abdominus activity. Further support has also been provided about the quality of the quadruped exercise for core stability.     

Can a functional postural exercise improve performance in the cranio-cervical flexion test? – A preliminary study

Deep cervical flexor (DCF) muscle impairment is common in patients with neck pain. Retraining function is often commenced with a motor relearning approach, requiring the patient to practice and hold a cranio-cervical flexion position in supine lying. Motor relearning requires multiple repetitions which is difficult to achieve if only exercising in supine. This preliminary study investigated the effects of training the DCF with a functional exercise: assumption of an upright lumbo-pelvic and spinal postural position, adding a neck lengthening manoeuvre. The exercise effect was evaluated by changes in sternocleidomastoid (SCM) muscle activity in the cranio-cervical flexion test (CCFT). Twenty subjects with neck pain were randomly assigned to an exercise or control group. The exercise group trained for two weeks. Pre and post-intervention, electromyographic (EMG) signals were recorded from the SCM muscles during the five stages of the CCFT. Results indicated that the exercise improved performance. SCM EMG signal amplitudes decreased across all CCFT stages, albeit significant only at the first and third stages of the test; 22 mmHg (p = 0.043) and 26 mmHg (p = 0.003). No differences were evident in the control group (all p > 0.05). There was no difference between groups for pain and disability measures. This initial study indicates that a postural exercise, convenient to perform during the working day, improves the pattern of SCM muscle activity in the CCFT. Whilst further research is necessary, these observations suggest the worth of such an exercise to augment other training in the rehabilitation of patients with neck pain.