普拉提运动对慢性下腰痛患者的疼痛和腰椎功能的影响

为了揭示普拉提运动对慢性下腰痛患者的疼痛和腰椎功能的影响,本研究选择2017年1月至2018年6月在医院确诊并接受治疗的64例慢性下腰痛患者作为研究对象,根据运动疗法分为对照组(悬吊训练法)和观察组(悬吊训练法结合普拉提运动),采用视觉模拟评分(VAS)评价患者的疼痛程度,采用Oswestry功能障碍指数(ODI)评价患者的腰椎功能障碍情况,采用运动情境动机量表(SSIMS)评价患者的运动参与动机。研究显示,治疗后观察组的VAS评分显著低于对照组(p=0.043)。观察组治疗后的ODI总评分显著低于对照组(p=0.026),观察组患者治疗后的疼痛、生活自理、提物、行走和站立5个维度评分显著低于对照组(p<0.05)。SSIMS量表的4个维度中,鉴别原则得分最高,其次为内部动机,然后是外部调节,最后为缺乏动机。本研究结果提示,普拉提运动可显著降低下腰痛患者的疼痛程度,并改善腰椎功能。此外,普拉提运动具有较好的患者认可度和喜爱度,值得在临床和运动康复训练中应用。     

Fear of Movement Is Related to Trunk Stiffness in Low Back Pain

Background

Psychological features have been related to trunk muscle activation patterns in low back pain (LBP). We hypothesised higher pain-related fear would relate to changes in trunk mechanical properties, such as higher trunk stiffness.

Objectives

To evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP.

Methods

The relationship between pain-related fear (Tampa Scale for Kinesiophobia, TSK; Photograph Series of Daily Activities, PHODA-SeV; Fear Avoidance Beliefs Questionnaire, FABQ; Pain Catastrophizing Scale, PCS) and trunk mechanical properties (estimated from the response of the trunk to a sudden sagittal plane forwards or backwards perturbation by unpredictable release of a load) was explored in a case-controlled study of 14 LBP participants. Regression analysis (r ²) tested the linear relationships between pain-related fear and trunk mechanical properties (trunk stiffness and damping). Mechanical properties were also compared with t-tests between groups based on stratification according to high/low scores based on median values for each psychological measure.

Results

Fear of movement (TSK) was positively associated with trunk stiffness (but not damping) in response to a forward perturbation (r² = 0.33, P = 0.03), but not backward perturbation (r² = 0.22, P = 0.09). Other pain-related fear constructs (PHODA-SeV, FABQ, PCS) were not associated with trunk stiffness or damping. Trunk stiffness was greater for individuals with high kinesiophobia (TSK) for forward (P = 0.03) perturbations, and greater with forward perturbation for those with high fear avoidance scores (FABQ-W, P = 0.01).

Conclusions

Fear of movement is positively (but weakly) associated with trunk stiffness. This provides preliminary support an interaction between biological and psychological features of LBP, suggesting this condition may be best understood if these domains are not considered in isolation.     

Characterization of the Muscle Electrical Properties in Low Back Pain Patients by Electrical Impedance Myography

Objectives

This study aims to investigate the electrical properties of lumbar paraspinal muscles (LPM) of patients with acute lower back pain (LBP) and to study a new approach, namely Electrical Impedance Myography (EIM), for reliable, low-cost, non-invasive, and real-time assessment of muscle-strained acute LBP.

Design

Patients with muscle-strained acute LBP (n = 30) are compared to a healthy reference group (n = 30). Electrical properties of LPM are studied.

Background

EIM is a novel technique under development for the assessment of neuromuscular disease. Therefore, it is speculated that EIM can be employed for the assessment of muscle-strained acute LBP.

Methods

Surface electrodes, in 2-electrode configurations, was used to measure the electrical properties of patient''s and healthy subject''s LPM at six different frequencies (0.02, 25.02, 50.02, 1000.02, 3000.02, and 5000.02 kHz), with the amplitude of the applied voltage limited to 200 mV. Parameters of impedance (Z), extracellular resistance (R_e), intracellular resistance (R_i), and the ratio of extracellular resistance to intracellular resistance (R_e/R_i) of LBP patient''s and healthy subject''s LPM were assessed to see if significant difference in values obtained in muscle-strained acute LBP patients existed.

Results

Intraclass correlation coefficient (ICC) showed that all measurements (ICC>0.96 for all studying parameters: Z, R_e, R_i, and R_e/R_i) had good reliability and validity. Significant differences were found on Z between LBP patient''s and healthy subject''s LPM at all studying frequencies, with p<0.05 for all frequencies. It was also found that R_e (p<0.05) and R_e/R_i (p<0.05) of LBP patient''s LPM was significant smaller than that of healthy subjects while R_i (p<0.05) of LBP patient''s LPM was significant greater than that of healthy subjects. No statistical significant difference was found between the left and right LPM of LBP patients and healthy subjects on the four studying parameters.

Conclusion

EIM is a promising technique for assessing muscle-strained acute LBP.     

Oxygenation and Hemodynamics Do Not Underlie Early Muscle Fatigue for Patients with Work-Related Muscle Pain

Patients suffering from work-related muscle pain (WRMP) fatigue earlier during exercise than healthy controls. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. However, it remains unknown if oxygenation and hemodynamics are associated with early fatigue in muscles of WRMP patients. In the present study we applied near-infrared spectroscopy (NIRS) on the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP (n = 18) and healthy controls (n = 17). Our objective was to determine if there were group differences in endurance times for a low-level contraction of 15% maximal voluntary contraction (MVC) – sustained for 12–13 min, and to see if these differences were associated with differences in muscle oxygenation and hemodynamics. At baseline, oxygen saturation (StO₂%) was similar between groups for the ECR, but StO₂% was significantly lower for TD for the WRMP patients (76%) compared to controls (85%) (P<0.01). Also, baseline ECR blood flow was similar in the two groups. For both muscles there were a larger number of patients, compared to controls, that did not maintain the 15% MVC for the allotted time. Consequently, the endurance times were significantly shorter for the WRMP patients than controls (medians, ECR: 347 s vs. 582 s; TD: 430 s vs. 723 s respectively). Responses in StO₂% during the contractions were not significantly different between groups for either muscle, i.e. no apparent difference in oxygen consumption. Overall, we interpret our findings to indicate that the early fatigue for our WRMP patients was not associated with muscle oxygenation and hemodynamics.     

腰腹肌运动联合超声波对非特异性下腰痛的治疗效果及机制

为了解腰腹肌运动联合超声波治疗的效果,本研究对腰腹肌运动联合超声波治疗非特异性下腰痛进行了探讨。研究显示,治疗4周后,腰腹肌运动+超声波治疗组的疼痛评分(0.73)显著低于超声波治疗组(1.22)(p<0.05)。腰腹肌运动+超声波治疗组的立位体前屈活动幅度(2.35 cm)显著低于超声波治疗组(6.23 cm)(p<0.05)。腰腹肌运动+超声波治疗组的屈伸肌总功和屈伸肌峰值力矩比显著高于超声波治疗组(p<0.05)。腰腹肌运动+超声波治疗组的Oswestry功能障碍指数问卷表(ODI)评分显著低于超声波治疗组(p<0.05)。治疗4周后,腰腹肌运动+超声波治疗组的血清超氧化物歧化酶(SOD)和过氧化氢酶(CAT)水平显著高于超声波治疗组,而丙二醛(MDA)水平显著低于超声波治疗组(p<0.05)。为了进一步考察运动联合超声波疗法对下腰痛的治疗机制,本研究建立了完全弗氏佐剂诱导的腰椎间盘退变大鼠模型。采用阿利新蓝染色检测大鼠椎间盘纤维环区和髓核区蛋白多糖的水平,并采用免疫组化染色检测蛋白聚糖和Ⅱ型胶原的表达,发现运动联合超声波治疗可明显提高大鼠蛋白多糖、Ⅱ型胶原和蛋白聚糖水平。本研究表明,与超声波治疗相比,腰腹肌运动联合超声波治疗可更大程度地降低非特异性下腰痛患者的疼痛,提高肌肉功能和腰椎功能,增强血清抗氧化能力,并减少氧化应激损伤。此外,该联合疗法可明显提高腰椎间盘退变大鼠椎间盘中的蛋白多糖、Ⅱ型胶原和蛋白聚糖水平。     

Effects of Quadriceps Muscle Fatigue on Stiff-Knee Gait in Patients with Hemiparesis

The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.     

Psychometric Properties of the Japanese Version of the STarT Back Tool in Patients with Low Back Pain

Background and Objective

The STarT Back Tool uses prognostic indicators to classify patients with low back pain into three risk groups to guide early secondary prevention in primary care. The present study aimed to evaluate the psychometric properties of the Japanese version of the tool (STarT-J).

Methods

An online survey was conducted among Japanese patients with low back pain aged 20–64 years. Reliability was assessed by examining the internal consistency of the overall and psychosocial subscales using Cronbach’s alpha coefficients. Spearman’s correlation coefficients were used to evaluate the concurrent validity between the STarT-J total score/psychosocial subscore and standard reference questionnaires. Discriminant validity was evaluated by calculating the area under the curves (AUCs) for the total and psychosocial subscale scores against standard reference cases. Known-groups validity was assessed by examining the relationship between low back pain-related disability and STarT-J scores.

Results

The analysis included data for 2000 Japanese patients with low back pain; the mean (standard deviation [SD]) age was 47.7 (9.3) years, and 54.1% were male. The mean (SD) STarT-J score was 2.2 (2.1). The Cronbach’s alpha coefficient was 0.75 for the overall scale and 0.66 for the psychosocial subscale. Spearman’s correlation coefficients ranged from 0.30 to 0.59, demonstrating moderate to strong concurrent validity. The AUCs for the total score ranged from 0.65 to 0.83, mostly demonstrating acceptable discriminative ability. For known-groups validity, participants with more somatic symptoms had higher total scores. Those in higher STarT-J risk groups had experienced more low back pain-related absences.

Conclusions

The overall STarT-J scale was internally consistent and had acceptable concurrent, discriminant, and known-groups validity. The STarT-J can be used with Japanese patients with low back pain.     

Potential Risk Factors of Persistent Low Back Pain Developing from Mild Low Back Pain in Urban Japanese Workers

Study Design

Two-year, prospective cohort data from the Japan epidemiological research of occupation-related back pain study in urban settings were used for this analysis.

Objective

To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain.

Summary of Background Data

Although psychosocial factors are strongly indicated as yellow flags of low back pain (LBP) leading to disability, the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers.

Methods

At baseline, 5,310 participants responded to a self-administered questionnaire including questions about individual characteristics, ergonomic work demands, and work-related psychosocial factors (response rate: 86.5%), with 3,811 respondents completing the 1-year follow-up questionnaire. The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period. Incidence was calculated for the participants with mild LBP during the past year at baseline. Logistic regression was used to explore risk factors associated with persistent LBP.

Results

Of 1,675 participants who had mild LBP during the preceding year, 43 (2.6%) developed persistent LBP during the follow-up year. Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP: interpersonal stress at work [adjusted odds ratio (OR): 1.96 and 95% confidence interval (95%CI): 1.00–3.82], job satisfaction (OR: 2.34, 95%CI: 1.21–4.54), depression (OR: 1.92, 95%CI: 1.00–3.69), somatic symptoms (OR: 2.78, 95%CI: 1.44–5.40), support from supervisors (OR: 2.01, 95%CI: 1.05–3.85), previous sick-leave due to LBP (OR: 1.94, 95%CI: 0.98–3.86) and family history of LBP with disability (OR: 1.98, 95%CI: 1.04–3.78).

Conclusions

Psychosocial factors are important risk factors for persistent LBP in urban Japanese workers. It may be necessary to take psychosocial factors into account, along with physical work demands, to reduce LBP related disability.     

Assessing the Perception of Trunk Movements in Military Personnel with Chronic Non-Specific Low Back Pain Using a Virtual Mirror

Chronic pain, including chronic non-specific low back pain (CNSLBP), is often associated with body perception disturbances, but these have generally been assessed under static conditions. The objective of this study was to use a “virtual mirror” that scaled visual movement feedback to assess body perception during active movement in military personnel with CNSLBP (n = 15) as compared to military healthy control subjects (n = 15). Subjects performed a trunk flexion task while sitting and standing in front of a large screen displaying a full-body virtual mirror-image (avatar) in real-time. Avatar movements were scaled to appear greater, identical, or smaller than the subjects’ actual movements. A total of 126 trials with 11 different scaling factors were pseudo-randomized across 6 blocks. After each trial, subjects had to decide whether the avatar’s movements were “greater” or “smaller” than their own movements. Based on this two-alternative forced choice paradigm, a psychophysical curve was fitted to the data for each subject, and several metrics were derived from this curve. In addition, task adherence (kinematics) and virtual reality immersion were assessed. Groups displayed a similar ability to discriminate between different levels of movement scaling. Still, subjects with CNSLBP showed an abnormal performance and tended to overestimate their own movements (a right-shifted psychophysical curve). Subjects showed adequate task adherence, and on average virtual reality immersion was reported to be very good. In conclusion, these results extend previous work in patients with CNSLBP, and denote an important relationship between body perception, movement and pain. As such, the assessment of body perception during active movement can offer new avenues for understanding and managing body perception disturbances and abnormal movement patterns in patients with pain.     

Low Back Pain in Men Receiving Workmen's Compensation

In Ontario, only about 10% of compensation patients with low back pain are disabled more than six weeks and hence tend to have chronic complaints. Six hundred and twenty-three such patients were studied to determine the distribution of diagnoses and to test the effectiveness of various programs of conservative therapy.Two hundred and thirteen patients were assigned in rotation to one of four treatments. The results were inconclusive. In 70% of these, the pain was due to intervertebral disc degeneration with added trauma.Two hundred and sixteen patients were assigned randomly to a treatment involving mild exercise, or one with vigorous exercise. Neither was found to be superior. In 76% of these, the pain was due to disc degeneration with added trauma.Using 194 patients, the results of treatment in the Compensation Board Rehabilitation Centre were compared with those obtained by treatment at home. Satisfactory improvement was achieved in 15 of 95 treated at home, and in 42 of 99 in the Centre. The failure of treatment in six of each 10 cases indicates that present-day methods of management of such patients are unsatisfactory.     

Decompressive Laminectomy for Low Back and Sciatic Pain

A proportion of patients with lumbar disc syndromes have little in the way of disc protrusion, but have spinal canals, either congenitally narrow, or else narrowed by degenerative changes. These patients require myelography for their assessment and decompression by complete laminectomy for their treatment, as opposed to the more usual practice of discectomy via partial laminectomy and/or fusion. Five such cases with myelographic findings are presented.