[논문]요추부 안정성 운동이 요통 환자의 척추 불안정성에 미치는 영향: 문헌고찰

정연태

문제 정의

For the purpose of the results section , the research studies mainly focus on the efficacy of specific stabilizing exercise. The studies that focused on efficacy of specific stabilizing exercise unanimously agreed that it decreases pain and increased functional disability level (Hides et al, 1996; Hides et al, 1994; O'Sullivan .
Further understanding of the effects of spinal stabilization exercise and motor control are necessary for the effective treatment of LBP. The purpose of this study was to determine the effects of spinal stabilization exercise, which strengthens local muscle system and decreases pain in patients with LBP. It is hypothesized that lumbar spinal stabilization ex ercises will increase spinal stability, and decrease pain responses.
The specific exercise approach used in O' Sullivan and Hides studies was very different from general exercise approaches commonly advocated in the rehabilitation of patients with chronic low back pain. This approach was aimed to specifically train the isometric co- contraction of the deep abdominal muscles and lumbar mutlifidus with minimal co- activation of global system muscles. Once this pattern of co - contraction was achieved, it was immediately incorporated into static postures (such as sitting, standing, and sustained flexion), functional activities (such as bending, twisting, and lifting), and aerobic activities (such as walking, swimming, or running).

가설 설정

The concept of different trunk muscles playing different roles in the provision of dynamic stability to the spine was proposed by Begmark (1989). He hypothesized the presence of two muscle systems in the maintenance of spinal stability. The global muscle system con - sists of large and torque producing muscles that act on the trunk and spine without being directly attached to it.
The purpose of this study was to determine the effects of spinal stabilization exercise, which strengthens local muscle system and decreases pain in patients with LBP. It is hypothesized that lumbar spinal stabilization ex ercises will increase spinal stability, and decrease pain responses.

제안 방법

1. Repeated measures analysis of var - iance was used:1) to assess for group differences at entry to the trial on the baseline data ;2) to assess change within each group after the intervention period;3) to assess differences between the two groups after the intervention period on the change scores (the difference between the follow - up score and the baseline score for each individual) of each measure.
2. Two- way repeated measures analysis of variance was carried out on the questionnaire data to assess differences within and between the groups after the inter - vention and at the 3, 6, and 30 month follow - up. The level for statistical significance was set at the 95% confidence limit.
A randomized, controlled clinical trial, test- retest design with two treatment groups and a blind investigation were used. After completion of the initial testing, the patients were randomly assigned to either the specific exercise group (SEG) or a control group (CG). During the following four month period, they were allocated to either group.
All subjects were assessed initially to provide baseline data and then reassessed weekly for 4 weeks. Patients who did not attain full pain- free function were removed from the study at 4 weeks.
Measurement of multifidus cross sectional area was measured using real -time ultrasound imaging. All ultrasound imaging was performed by the blinded ultrasonographer using real-time ultrasound apparatus (T oshiba Sonolayer V SSA - 100A, T oshiba Medical Systems, Japan) equipped with a 5 ㎒ convex array transducer.
Experimental group performed an isometric spinal stabilization exercise program twice a week for 15 minutes. Subjects was asked to complete exercise sheet to monitor their compliance.
Another limitation of this study was the lack of exercise supervision, which decreased internal validity . Second, this study measured pain and functional disability using the short form of questionnaire. This measurement was quite subjective.
At the completion of the intervention period, patients were again tested by the same investigator blinded to group allocation. Subjects were then reassessed by postal questionnaire for a 3, 6, and 30 month follow - up. The SEG underwent a 10 week treatment program on a weekly basis by one of four manipulative physical therapists.
Subjects were then reassessed by postal questionnaire for a 3, 6, and 30 month follow - up. The SEG underwent a 10 week treatment program on a weekly basis by one of four manipulative physical therapists. The exercises were designed to:1) train the specific contrac- tion of the deep abdominal muscles without substitution from large torque producing muscles such as rectus abdominis and external oblique using the abdominal draw - ing in maneuver; and2) train specific contraction of deep abdominal muscles with 10 activation of lumbar multifidus proximal to the pars defect.
The SEG underwent a 10 week treatment program on a weekly basis by one of four manipulative physical therapists. The exercises were designed to:1) train the specific contrac- tion of the deep abdominal muscles without substitution from large torque producing muscles such as rectus abdominis and external oblique using the abdominal draw - ing in maneuver; and2) train specific contraction of deep abdominal muscles with 10 activation of lumbar multifidus proximal to the pars defect.
This study used a Cybex Electronic Digital Inclinometer to evaluate lumbar spine and hip sagittal range of motion in standing. The repeatability of the inclinometer for measuring lumbar curvature in the population with chronic low back pain has been established and validated against lumbar spine radiographs.

대상 데이터

Forty - four patients were assigned randomly to two treatment groups. According to inclusion criteria, the sample consisted of 44 patients of either gender between the ages of 16 and 49 whose LBP symptoms (with or without pain extension into the lower limbs) were recurrent and had persisted longer than 3 months with no sign of abating . Patients were excluded from entry to the trial if they had: a clinical presentation considered not attributable to the presence of the spondylolysis or spondylolisthesis by the treating medical specialist ; a diagnosed psychological illness; difficulty understanding English, precluding them from answering the questionnaires; previous spinal surgery ; or an inflammatory joint disease or displayed overt neurological signs (sensory or motor paralysis).

데이터처리

Comparability of baseline measurements between the groups was assessed using one- way analysis of variance (ANOVA) to examine differences in all baseline measurements. Analysis of variance also was used to examine differences between groups over time for all outcome measures used.

성능/효과

3. In sitting and upright standing, subject draw abdominal wall up and in to facilitate the contraction of the pelvic floor and lower and middle fibers of transversus abdominis with gentle controlled lateral costal diaphragm breathing without global muscle substitution.
Analysis of differences within each group after the intervention period revealed significant differences in the specific exer - cise group after the intervention period (p<.05) with a decrease in pain intensity (F =75.5, df=1.20, p< .0001), pain descriptor scores (F =35.8, df=1.20, p<.0001), and a reduction in functional disability level (F =49.1, df=1.20, p< .0001).
Analysis of the follow - up data revealed significant differences between the specific exercise group and control group on the basis of pain intensity (F =14.4, df=1.32, p=.0006).
Assumptions of the study was that localized physical training, which can re store muscle size at the segmental level, may be a necessary at the first stage of rehabilitation before more generalized stabilization training, therefore, muscle control at the segmental level might be better assured. It was assumed that asymmetry between each side of the lumbar spine has to be greater than 11% for patients to be considered for study .
A number of factors were combined to limit the generalizability of this study . First, small sample size limited the generalizability of results because: small groups tended to be less representative of target populations; random assignment to conditions can be less successful; and the statistical power of the analytical procedures was limited. Another limitation of this study was the lack of exercise supervision, which decreased internal validity .

후속연구

A challenge for further research will be to further investigate the potentials of this form of exercise intervention to alter automatic patterns of muscle recruitment within the trunk musculature in low back pain population. More research is needed to understand the nature of these motor - control problems in the deep muscles in patients with low back pain and particularly their implications for persistent and recurrent low back pain.
More research is needed to understand the nature of these motor - control problems in the deep muscles in patients with low back pain and particularly their implications for persistent and recurrent low back pain. Further clinical studies need to be undertaken to test the effectiveness of the specific stabilization program.
A challenge for further research will be to further investigate the potentials of this form of exercise intervention to alter automatic patterns of muscle recruitment within the trunk musculature in low back pain population. More research is needed to understand the nature of these motor - control problems in the deep muscles in patients with low back pain and particularly their implications for persistent and recurrent low back pain. Further clinical studies need to be undertaken to test the effectiveness of the specific stabilization program.

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요추부 안정성 운동이 요통 환자의 척추 불안정성에 미치는 영향: 문헌고찰
Effect of Lumbar Stabilization Exercise on Spinal In stability in Patients With Low Back Pain : A Literature Review 원문보기

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요추부 안정성 운동이 요통 환자의 척추 불안정성에 미치는 영향: 문헌고찰 Effect of Lumbar Stabilization Exercise on Spinal In stability in Patients With Low Back Pain : A Literature Review 원문보기

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