非特异性下腰痛患者不同桥式运动时腰肌表面肌电信号的变化

目的了解非特异性下腰痛患者在行不同桥式运动时腰肌表面肌电活动的变化。方法选取正常对照与非特异性下腰痛患者各18 例,记录两组受试者行桥式运动、单足支撑桥式运动时的腰肌表面肌电信号均方根值。结果对照组行不同桥式运动时,双侧竖脊肌、多裂肌表面肌电配对比较均无显著性差异(P>0.05);各时段组间同侧同名肌肉表面肌电比较无显著性差异(P>0.05)。患者组行桥式运动时,双侧腰肌表面肌电配对比较无显著性差异(P>0.05);行单足支撑桥式运动时,支撑足侧竖脊肌肌电值较对侧大(P<0.05),前、中、后时段腰肌肌电值无显著性差异(P>0.05)。结论非特异性下腰痛患者行非对称性桥式运动时,双侧竖脊肌收缩力不平衡。     

Experimental Low Back Pain Decreased Trunk Muscle Activity in Currently Asymptomatic Recurrent Low Back Pain Patients During Step Tasks

Low back pain (LBP) patients show reorganized trunk muscle activity but if similar changes are manifest in recurrent LBP (R-LBP) patients during asymptomatic periods remains unknown. In 26 healthy and 27 currently asymptomatic R-LBP participants electromyographic activity (EMG) was recorded from trunk and gluteal muscles during series of stepping up and down on a step bench before and during experimentally intramuscular induced unilateral and bilateral LBP. Pain intensity was assessed using numeric rating scale (NRS) scores. Root mean square EMG (RMS-EMG) normalized to maximal voluntary contraction EMG and pain-evoked differences from baseline (ΔRMS-EMG) were analyzed. Step task duration was calculated from foot sensors. R-LBP compared with controls showed higher baseline RMS-EMG and NRS scores of experimental pain (P?<?.05). In both groups, bilateral compared with unilateral experimental NRS scores were higher (P?<?.001) and patients compared with controls reported higher NRS scores during both pain conditions (P?<?.04). In patients, unilateral pain decreased ΔRMS-EMG in the Iliocostalis muscle and bilateral pain decreased ΔRMS-EMG in all back and gluteal muscles during step tasks (P?<?.05) compared with controls. In controls, bilateral versus unilateral experimental pain induced increased step task duration and trunk RMS-EMG whereas both pain conditions decreased step task duration and trunk RMS-EMG in R-LBP patients compared with controls (P?<?.05).

The Value of Prognostic Screening for Patients With Low Back Pain in Secondary Care

Prognostic screening in patients with low back pain (LBP) offers a practical approach to guiding clinical decisions. Whether screening is helpful in secondary care is unclear. This prospective cohort study in adults with LBP placed on outpatient clinic waiting lists, compared the performance of the short-form Orebro Musculoskeletal Pain Screening Questionnaire, the Predicting the Inception of Chronic Pain Tool, and the STarT Back Tool. We assessed predictive validity for outcome at 4-month follow-up, by calculating estimates of discrimination, calibration, and overall performance. We applied a decision curve analysis approach to describe the clinical value of screening in this setting via comparison with a ‘treat-all’ strategy. Complete data were available for 89% of enrolled participants (n = 195). Eighty-four percent reported ‘poor outcome’ at follow-up. The area under the receiver operating characteristic curve (95% confidence interval) was .66 (.54–.78) for the Orebro Musculoskeletal Pain Screening Questionnaire, .61 (.49–.73) for the Predicting the Inception of Chronic Pain Tool, and .69 (.51–.80) for the STarT Back Tool. All instruments were miscalibrated and underestimated risk. The decision curve analysis indicated that, in this setting, prognostic screening does not add value over and above a treat-all approach. The potential for LBP patients to be misclassified using screening and the high incidence of nonrecovery indicate that care decisions should be made with the assumption that all patients are ‘at risk.’

第3腰椎横突综合征肥胖患者局部治疗的定位法

目的：探讨第3腰椎横突综合征肥胖患者局部治疗的定位法。方法：采用腰椎X线正位片标定相关点．测量并根据比例标尺换算成实际长度，在48例第3腰椎横突综合征肥胖患者体表确定穿刺点注射消炎镇痛液并行针刀疗法。结果：一次穿刺到位42例，占87.5％；二次到位5例，占10．4％；疗效优良率93．8%。结论：第3腰椎横突综合征肥胖患者局部治疗定位是关键，使用该定位法定位准确，尤其是适用于不具备C型臂X线机的医疗机构推广应用。     

Comparison of Trunk Proprioception Between Patients With Low Back Pain and Healthy Controls

Lee AS, Cholewicki J, Reeves NP, Zazulak BT, Mysliwiec LW. Comparison of trunk proprioception between patients with low back pain and healthy controls.

Objective

To determine whether proprioceptive impairments exist in patients with low back pain (LBP). We hypothesized that patients with LBP would exhibit larger trunk proprioception errors than healthy controls.

Design

Case-control study.

Setting

University laboratory.

Participants

24 patients with nonspecific LBP and 24 age-matched healthy controls.

Interventions

Not applicable.

Main Outcome Measures

We measured trunk proprioception in all 3 anatomical planes using motion perception threshold, active repositioning, and passive repositioning tests.

Results

LBP patients had significantly greater motion perception threshold than controls (P<.001) (1.3±0.9° vs 0.8±0.6°). Furthermore, all subjects had the largest motion perception threshold in the transverse plane (P<.001) (1.2±0.7° vs 1.0±0.8° for all other planes averaged). There was no significant difference between LBP and healthy control groups in the repositioning tasks. Errors in the active repositioning test were significantly smaller than in the passive repositioning test (P=.032) (1.9±1.2° vs 2.3±1.4°).

Conclusions

These findings suggest that impairments in proprioception may be detected in patients with LBP when assessed with a motion perception threshold measure.     

运用压力生物反馈行腹横肌及多裂肌协同训练治疗下背痛

目的：研究运用压力生物反馈行腹横肌及多裂肌协同训练对下背痛的近远期疗效。方法：将符合诊断标准的60例下背痛患者随机分为研究组和对照组各30例,2组均按常规给予物理治疗。研究组在此基础上加用压力生物反馈行腹横肌及多裂肌协同训练;对照组配合五点支撑法及飞燕点水法等功能训练。治疗前后采用疼痛视觉模拟评分（VAS）和SF-36健康状况调查问卷评定疼痛程度及日常生活活动能力,1年后跟踪随访复发率。结果：与治疗前比较,治疗1、6个月及1年时2组VAS评分与治疗前比较逐步下降明显,SF-36逐渐上升（P〈0．05,0．01）;与对照组比较,研究组表现更明显（P〈0．05,0．01）。1年后跟踪随访,研究组复发率明显低于对照组（10．0％与33．3％,P〈0．01）。结论;配合运用压力生物反馈行腹横肌及多裂肌协同训练可有效减轻下背痛患者的疼痛程度,改善其功能障碍,并明显降低复发率,其远期疗效巩固。     

Differences in Feedforward Trunk Muscle Activity in Subgroups of Patients With Mechanical Low Back Pain

Silfies SP, Mehta R, Smith SS, Karduna AR. Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain.

Objective

To investigate alterations in trunk muscle timing patterns in subgroups of patients with mechanical low back pain (MLBP). Our hypothesis was that subjects with MLBP would demonstrate delayed muscle onset and have fewer muscles functioning in a feedforward manner than the control group. We further hypothesized that we would find differences between subgroups of our patients with MLBP, grouped according to diagnosis (segmental instability and noninstability).

Design

Case-control.

Setting

Laboratory.

Participants

Forty-three patients with chronic MLBP (25 instability, 18 noninstability) and 39 asymptomatic controls.

Interventions

Not applicable.

Main Outcome Measures

Surface electromyography was used to measure onset time of 10 trunk muscles during a self-perturbation task. Trunk muscle onset latency relative to the anterior deltoid was calculated and the number of muscles functioning in feedforward determined.

Results

Activation timing patterns (P<.01; η=.50; 1-β=.99) and number of muscles functioning in feedforward (P=.02; η=.30; 1-β=.83) were statistically different between patients with MLBP and controls. The control group activated the external oblique, lumbar multifidus, and erector spinae muscles in a feedforward manner. The heterogeneous MLBP group did not activate the trunk musculature in feedforward, but responded with significantly delayed activations. MLBP subgroups demonstrated significantly different timing patterns. The noninstability MLBP subgroup activated trunk extensors in a feedforward manner, similar to the control group, but significantly earlier than the instability subgroup.

Conclusions

Lack of feedforward activation of selected trunk musculature in patients with MLBP may result in a period of inefficient muscular stabilization. Activation timing was more impaired in the instability than the noninstability MLBP subgroup. Training specifically for recruitment timing may be an important component of the rehabilitation program.     

神经肌肉激活技术对腰椎骨折术后腰痛的效果

目的观察神经肌肉激活技术对腰椎骨折术后腰痛患者的疗效。方法60 例腰椎骨折术后腰痛患者分为治疗组(n=30)和对照组(n=30)。两组均接受4 周共20 次音频治疗,治疗组采用神经肌肉激活技术进行腰椎稳定性训练,对照组采用腰背肌强化训练。于就诊当天、4 周后及6 个月后采用疼痛视觉模拟评分(VAS)和健康状况调查问卷简表(SF-36)进行评定。结果就诊当天,两组VAS、SF-36 评分无显著性差异(P>0.05)。治疗后,两组VAS、SF-36 评分较治疗前明显改善(P<0.01),治疗4 周及6 个月,治疗组VAS、SF-36 优于对照组(P<0.05)。结论神经肌肉激活技术能有效减轻腰椎骨折术后腰痛的发生,提高生活质量。     

Morphology Versus Function: The Relationship Between Lumbar Multifidus Intramuscular Adipose Tissue and Muscle Function Among Patients With Low Back Pain

Objective

To explore the bivariate and multivariate relations between fatty degeneration of the lumbar multifidus muscle (LMM) and LMM function among patients with low back pain (LBP).

Design

Cross-sectional clinical study.

Setting

Hospital.

Participants

Patients with LBP (N=70) referred for lumbar spine magnetic resonance imaging.

Interventions

Not applicable.

Main Outcome Measures

LMM morphology and function were measured at the L4/L5 and L5/S1 spinal levels bilaterally. Quantitative measures of LMM intramuscular adipose tissue (IMAT) were derived from T1-weighted magnetic resonance images. Function was assessed with ultrasound imaging by measuring change in LMM thickness during a submaximal contraction task. The study participants self-reported their level of LBP-related disability (Modified Oswestry Index), pain intensity (numerical pain rating scale), and physical activity (International Physical Activity Questionnaire). Bivariate and multivariate relations between LMM morphology and function were explored with correlational and hierarchical linear regression analyses, respectively. Additionally, we explored for possible covariates with potential to modify the relation between LMM IMAT and function.

Results

There were 70 participants (12 women) enrolled in the study (mean age, 45.4±11.9y). A high level of physical activity was reported by 45.5% of participates. Age, sex, and physical activity level demonstrated variable relations with LMM IMAT and LMM function. There were no significant bivariate or multivariate relations between LMM IMAT and LMM function.

Conclusions

We observed higher levels of physical activity and LMM function and less LMM IMAT than previous studies involving patients with LBP. There was no relation between LMM morphology and function in this cohort of patients with LBP. Issues specific to LMM measurement and recommendations for future research are discussed.     

Ability to Discriminate Between Healthy and Low Back Pain Sufferers Using Ultrasound During Maximum Lumbar Extension

Objective

To analyze the ability to discriminate between healthy individuals and individuals with chronic nonspecific low back pain (CNLBP) by measuring the relation between patient-reported outcomes and objective clinical outcome measures of the erector spinae (ES) muscles using an ultrasound during maximal isometric lumbar extension.

Design

Cross-sectional study with screening and diagnostic tests with no blinded comparison.

Setting

University laboratory.

Participants

Healthy individuals (n=33) and individuals with CNLBP (n=33).

Interventions

Each subject performed an isometric lumbar extension. With the variables measured, a discriminate analysis was performed using a value ≥6 in the Roland and Morris disability questionnaire (RMDQ) as the grouping variable. Then, a logistic regression with the functional and architectural variables was performed. A new index was obtained from each subject value input in the discriminate multivariate analysis.

Main Outcome Measures

Morphologic muscle variables of the ES muscle were measured through ultrasound images. The reliability of the measures was calculated through intraclass correlation coefficients (ICCs). The relation between patient-reported outcomes and objective clinical outcome measures was analyzed using a discriminate function from standardized values of the variables and an analysis of the reliability of the ultrasound measurement.

Results

The reliability tests show an ICC value >.95 for morphologic and functional variables. The independent variables included in the analysis explained 42% (P=.003) of the dependent variable variance.

Conclusions

The relation between objective variables (electromyography, thickness, pennation angle) and a subjective variable (RMDQ ≥6) and the capacity of this relation to identify CNLBP within a group of healthy subjects is moderate. These results should be considered by clinicians when treating this type of patient in clinical practice.     

误诊为腰椎退行性疾病的腰腿痛症候群(附36例报告)

目的探讨腰腿痛症候群的背景疾病,以及与腰椎退行性疾病的鉴别诊断要点。方法对我科2007年1月—2011年12月误诊为腰椎退行性疾病36例临床资料进行回顾性分析。结果本组均以腰腿痛症候群为主诉,分别在本院及外院误诊,误诊疾病:腰椎间盘突出症18例,腰椎管狭窄症8例,椎间盘源性下腰痛6例,腰椎滑脱及腰椎小关节紊乱各2例。最终确诊疾病:股骨头缺血性坏死及髋关节骨性关节炎各6例,腰椎结核5例,腰椎管内肿瘤4例,腰椎转移性恶性肿瘤、下肢动脉闭塞、骶髂关节炎各3例,胸椎间盘突出及胸椎黄韧带骨化症各2例,胸椎管肿瘤及坐骨神经疱疹性神经炎各1例。误诊时间1个月~3年。确诊前所有病例均予针对性保守治疗,确诊后予有效治疗,症状均有不同程度改善。结论炎症、肿瘤、血管病变等多种疾病均可导致相似的腰腿痛症候群。只有抛开先入为主的主观臆断,详细询问病史、认真全面查体、合理选择辅助检查措施,才可能将误诊率降至最低。     

Low Back Pain Fact Sheet for Patients and the Public

Editor's Note: This fact sheet was developed by the National Institute of Neurological Disorders and Stroke for the general public. Clinicians may duplicate and distribute this public domain document to the general public. The low back pain fact sheet addresses causes of lower back pain, who is most likely to develop low back pain, conditions associated with low back pain, how low back pain is diagnosed and treated, how it can be prevented, quick tips to a healthier back, ongoing research, and sources of additional information.     

Validity of the Fingertip-To-Floor Test and Straight Leg Raising Test in Patients With Acute and Subacute Low Back Pain: A Comparison by Sex and Radicular Pain

Ekedahl KH, Jönsson B, Frobell RB. Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.

Objective

To use self-reported disability (Roland-Morris Disability Questionnaire [RMDQ]) to assess the criterion validity of straight leg raising (SLR) test and flexion range of motion (ROM) (fingertip-to-floor test) before and after stratification by sex and presence/absence of radicular pain.

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Subjects with acute/subacute low back pain with (n=40) and without (n=35) radicular pain.

Interventions

Not applicable.

Main Outcome Measures

We examined the relationship between RMDQ (reference variable) and SLR test and fingertip-to-floor test. The sample was stratified by presence/absence of radicular pain (categorized by the dichotomous slump test).

Results

In the entire sample, fair correlations were found between both physical impairment tests (ie, SLR test and flexion ROM) and self-reported disability (.27<r>.44). After stratification by sex, the correlation between RMDQ and flexion ROM and between RMDQ and nonside-specific SLR test increased in women but decreased in men. In those with radicular pain, good correlations were found between RMDQ and flexion ROM (r=.68 for men and r=.70 for women), and moderate correlation was found between the RMDQ and SLR tests of the affected side in women (r=.60), but only fair correlation was found between the RMDQ and SLR tests of the affected side in men (r=.28).

Conclusions

After stratification by sex and presence/absence of radicular pain, the present study supports a good validity of the fingertip-to-floor test for both men and women with radicular pain. The SLR test, however, was of less value as an indicator of self-reported disability after stratification, especially for men.     

A Systematic Review of the Effectiveness of Core Stability Exercises in Patients with Non-Specific Low Back Pain

BackgroundLow back pain affects millions of people worldwide and can be a difficult condition to manage clinically. Many cases do not have a discernable etiology, further increasing the complexity of finding an effective intervention. Core stabilization exercises (CSE) strengthen the musculature that provides stability to the spine and show promising outcomes.PurposeTo examine the efficacy of CSE exercises in the treatment of NSLBP in adult patients.Study SelectionStudies were included if they had patients diagnosed with NSLBP, used CSE as a treatment for NSLBP, and were a clinical trial. Exclusion criteria were studies that did not utilize an objective pain scale, patients who had a specific diagnosed pathology contributing to the NSLBP or received treatment for their NSLBP within the prior six months.MethodsThe literature was systematically searched in the PubMed, Sports Medicine & Education Index, and CINHAL databases, using the search terms core stabilization, low back pain, and exercise. The initial search yielded 229 articles and was refined using search terms ‘NOT analysis’ in order to target randomized control trials and exclude meta-analyses to narrow the search. Full-text of the articles were assessed for eligibility by utilizing inclusion and exclusion criteria that were included in this review. Articles were assessed for quality using the PEDro scale and relevant data were extracted.ResultsFive moderate-quality studies (PEDRO range: 5-8) support CSE is an effective method to decrease pain, improve functionality, and increase core strength in patients with NSLBP. Although there are other commonly used methods to treating NSLBP, CSE have shown to be a beneficial method to treating NSLBP.ConclusionGrade B evidence suggests core stabilization exercises can be considered a favorable method for treating pain in patients with NSLBP.Level of Evidence1b     

Effect of Hamstring Flexibility on Hip and Lumbar Spine Joint Excursions During Forward-Reaching Tasks in Participants With and Without Low Back Pain

Johnson EN, Thomas JS. Effect of hamstring flexibility on hip and lumbar spine joint excursions during forward-reaching tasks in participants with and without low back pain.

Objective

To examine the correlation between hamstring flexibility and hip and lumbar spine joint excursions during standardized reaching and forward-bending tasks.

Design

Retrospective analysis of data obtained during 2 previous prospective studies that examined kinematics and kinetics during forward-reaching tasks in participants with and without low back pain (LBP).

Setting

The 2 previous studies were conducted in the Motor Control Lab at Ohio University and the Orthopaedic Ergonomics Laboratory at The Ohio State University.

Participants

Data from a total of 122 subjects from 2 previous studies: study 1: 86 subjects recovered from an episode of acute LBP (recovered) and study 2 (A.I. McCallum, unpublished data): 18 chronic LBP subjects and 18 healthy-matched controls (healthy).

Interventions

Not applicable.

Main Outcome Measure

Correlation values between hamstring flexibility as measured by straight leg raise (SLR) and amount of hip and lumbar spine joint excursions used during standardized reaching and forward-bending tasks.

Results

No significant correlation was found between hamstring flexibility and hip and lumbar joint excursions during forward-bending tasks in the LBP or recovered groups. The SLR had a significant negative correlation with lumbar spine excursions during reaching tasks to a low target in the healthy group (right SLR: P=.011, left SLR: P=.004).

Conclusions

Hamstring flexibility is not strongly related to the amount of lumbar flexion used to perform forward-reaching tasks in participants who have chronic LBP or who have recovered from LBP. More research needs to be conducted to examine the influence of hamstring flexibility on observed movement patterns to further evaluate the efficacy of flexibility training in the rehabilitation of patients with LBP.