Noh, Dong-koog
(Department of Physical Medicine and Rehabilitation, Seoul Hyu Hospital)
,
Cha, Young-joo
(Sports.Movement.Artificial Robotics.Techology (SMART) Institute, Department of Physical Therapy, Yonsei University)
,
Kim, Dae-hun
(Department of Physical Therapy, School of Medical & Public Health, Kyungdong University)
,
You, Joshua (Sung) H.
(Sports.Movement.Artificial Robotics.Techology (SMART) Institute, Department of Physical Therapy, Yonsei University)
Background: We developed a novel integrative lumbar stabilization technique that combines lumbar extension (LE) exercise with abdominal drawing-in maneuver (ADIM) to ameliorate low back pain (LBP) associated with neuromuscular imbalance and instability, based on the collective evidence of contempora...
Background: We developed a novel integrative lumbar stabilization technique that combines lumbar extension (LE) exercise with abdominal drawing-in maneuver (ADIM) to ameliorate low back pain (LBP) associated with neuromuscular imbalance and instability, based on the collective evidence of contemporary spinal rehabilitation. Objects: The specific aim of the present study was to investigate the effects of LE exercise with and without ADIM on core muscle strength, lumbar spinal instability, and pain, as well as functional characteristics in individuals with LBP using advanced radiographic imaging techniques. Methods: patients with mechanical LBP (N = 40, 6 males; $35.1{\pm}7.6years$) were recruited and randomly assigned either to the combined LE and ADIM (experimental group) or the LE alone (control group). Outcome measures included the visual analog scale, the modified Oswestry Disability Index, muscle strength imbalance (MSI), and radiographic imaging. The lumbar intervertebral displacement (LID), intervertebral (IV) and total lumbar extension (TLE) angles were calculated to evaluate the lumbar segmental instability. Results: The experimental group showed significant differences in the L3-L4, L5-S1 LIDs, L4-L5 and L5-S1 IV angles, and TLE angle as compared to the controls (p<.05). Immediate pain reduction and muscle strength imbalance ratio were significantly different between the groups (p<.05). Conclusion: These results suggest that the addition of ADIM significantly increased lumbar spinal stabilization in individuals with LBP, thereby reducing pain associated with functional lumbar flexion during daily activities.
Background: We developed a novel integrative lumbar stabilization technique that combines lumbar extension (LE) exercise with abdominal drawing-in maneuver (ADIM) to ameliorate low back pain (LBP) associated with neuromuscular imbalance and instability, based on the collective evidence of contemporary spinal rehabilitation. Objects: The specific aim of the present study was to investigate the effects of LE exercise with and without ADIM on core muscle strength, lumbar spinal instability, and pain, as well as functional characteristics in individuals with LBP using advanced radiographic imaging techniques. Methods: patients with mechanical LBP (N = 40, 6 males; $35.1{\pm}7.6years$) were recruited and randomly assigned either to the combined LE and ADIM (experimental group) or the LE alone (control group). Outcome measures included the visual analog scale, the modified Oswestry Disability Index, muscle strength imbalance (MSI), and radiographic imaging. The lumbar intervertebral displacement (LID), intervertebral (IV) and total lumbar extension (TLE) angles were calculated to evaluate the lumbar segmental instability. Results: The experimental group showed significant differences in the L3-L4, L5-S1 LIDs, L4-L5 and L5-S1 IV angles, and TLE angle as compared to the controls (p<.05). Immediate pain reduction and muscle strength imbalance ratio were significantly different between the groups (p<.05). Conclusion: These results suggest that the addition of ADIM significantly increased lumbar spinal stabilization in individuals with LBP, thereby reducing pain associated with functional lumbar flexion during daily activities.
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문제 정의
In this investigation, we demonstrated the superior effects of combined LE with ADIM on pain, spinal stability, and associated functional movement in patients with muscular strength imbalance and instability when compared to the conventional lumbar extension exercise alone. Most importantly, the combined intervention rapidly ameliorated pain and improved lumbar spinal stability and overall spinal mobility.
This is the first study to demonstrate the effects of lumbar stabilization with an ADIM technique during LE in individuals with chronic LBP. As hypothesized, the experimental group, which received a combination of LE and ADIM, showed greater reduction in LIDs (L3-L4 and L5-S1) and IV angles of the lumbosacral segment (L5-S1) than did patients in the control group who received only LE exercise.
This study was based on a longitudinal single-blind randomized controlled study. visual analog scale, the modified Oswestry disability index were used to measure the pain and function.
가설 설정
The participant was asked to lie prone with hands palms down and aligned under the shoulders while maintaining the core stabilization. 2. The participant then raised the upper body using the arms, but the pelvis and lower legs remained stable. 3.
The participant then raised the upper body using the arms, but the pelvis and lower legs remained stable. 3. The participant maintained this position for one to two seconds and then returned to the neutral prone position. 4.
제안 방법
All experimental procedures were implemented by the same investigator. A randomization sequence was created with Microsoft Excel (Microsoft corp., Roselle, IL, USA) to assign patients randomly to either the experimental group or the control group for a 2-week course of treatment. To standardize tests and interventions, the certified and experienced physical therapists were trained in the standardized clinical tests, ADIM training and/or lumbar extension technique (Clare et al, 2007; Mckenzie and May, 2003).
The use of the “force progressions” concept in the LE method was applied via dynamic patient-generated force progression to improve the centralization of the symptoms and lumbar extension movement. After the participant successfully performed repeated LE, patients progressed to end-range with patient overpressure, which involved the patient locking the elbows straight and exhaling while allowing the pelvis to sag. Applications of force progressions and force alternatives were conducted according to the clinical reasoning and attentive interpretation of symptomatic and mechanical responses described in the LE method (Clare et al, 2007; Mckenzie and May, 2003).
For the erector spinae muscle test, the participant was asked to lie prone with hands resting on the buttocks while the pelvis was stabilized with a strap and then asked to extend the trunk (off of the umbilicus) and push against a dynamometer applied at the thoracic spine (T6-8). All patients performed 3 consecutive trials, with each test lasting for 5 seconds and a resting interval of 3 minutes between tests. The reliability and validity of the strength test used in this study is considered good to excellent (Abizanda et al, 2012).
Clinical radiographic imaging was performed with AccuRay-525R (Dong Kang Medical Systems Co., Ltd., Seoul, Korea) to determine lumbar spine movement characteristics. Each participant was instructed to lie prone with the pelvis stabilized and to extend his or her lumbar spine within pain-free maximal extension for 5 seconds.
For the ADIM exercise, the participant was asked to lie in the prone position, and a PBU was placed under the anterior superior iliac spine (ASIS) and inflated to 70 ㎜Hg. The participant was then asked to inhale and stabilize the lumbar spine by coordinated and balanced co-activation of deep and superficial core muscles while maintaining pressure within the target pressure range of 4-10 ㎜Hg (Figure 3).
To assess the abdominal muscles, each participant was positioned supine with the hip and knee at 90˚ of flexion and asked to raise his or her trunk from the table (off of the inferior scapula border) and push against a hand-held dynamometer applied at the sternum (Kendall et al, 1973). For the erector spinae muscle test, the participant was asked to lie prone with hands resting on the buttocks while the pelvis was stabilized with a strap and then asked to extend the trunk (off of the umbilicus) and push against a dynamometer applied at the thoracic spine (T6-8). All patients performed 3 consecutive trials, with each test lasting for 5 seconds and a resting interval of 3 minutes between tests.
MSI ratio was determined by measuring maximal voluntary isometric muscle contraction (MVIC) for the abdominal and erector spinae muscles using hand-held dynamometry (HHD) (JTech Medical, Salt Lake City, USA) measurements. The MSI ratio was expressed as erector spinae MVIC/abdominal MVIC.
The MODI consists of 10 items (pain intensity, personal care-washing and dressing, lifting, walking, sitting, standing, sleeping, sex life-if applicable, social life, and traveling) on a scoring scale ranging from 0 (“no pain”) to 5 (“worst pain”).
The experimental group underwent ADIM exercises during LE intervention while the control group underwent LE intervention alone. The interventions were consistently provided 30 minutes per day, 3 times per week, over a 2-week period.
The experimental group underwent ADIM exercises during LE intervention while the control group underwent LE intervention alone. The interventions were consistently provided 30 minutes per day, 3 times per week, over a 2-week period.
For the ADIM exercise, the participant was asked to lie in the prone position, and a PBU was placed under the anterior superior iliac spine (ASIS) and inflated to 70 ㎜Hg. The participant was then asked to inhale and stabilize the lumbar spine by coordinated and balanced co-activation of deep and superficial core muscles while maintaining pressure within the target pressure range of 4-10 ㎜Hg (Figure 3). The coordinated co-activation of deep and superficial core muscles and lumbar core stability were concurrently monitored by real-time ultrasound imaging and PBU, respectively.
Our combined exercise would be effective not only mechanical pain but also lumbopelvic stability. The specific aim of the present study was to investigate the effects of LE exercise with and without ADIM on core muscle strength, lumbar spinal instability, and pain, as well as functional characteristics in individuals with LBP using advanced radiographic imaging techniques.
This study is a single-blind randomized controlled design in which the two investigators who performed the radiographic examinations and the patients were blinded to group allocation and the intervention provided. All experimental procedures were implemented by the same investigator.
visual analog scale, the modified Oswestry disability index were used to measure the pain and function. Trunk muscle strength, and radiographic imaging, lumbar intervertebral displacement (LID), IV and TLE angles were calculated to evaluate the lumbar segmental instability in patients with mechanical LBP.
데이터처리
test was used to determine whether there were between group differences of gender. A independent t-test was used to compare intervention-related changes in VAS, MODI, trunk strength, LID, IV, and TLE angles within and between groups. A paired t-test was used to investigate pre-posttest within group.
A independent t-test was used to compare intervention-related changes in VAS, MODI, trunk strength, LID, IV, and TLE angles within and between groups. A paired t-test was used to investigate pre-posttest within group. The level of significance was set at p<.
Descriptive and standard statistical analyses included mean, standard deviation, and computations of the independent t-test was used to determine group difference of age, height, and weight, χ 2 test was used to determine whether there were between group differences of gender.
이론/모형
The PDS was evaluated by a physical therapist that was specialized in the McKenzie method. The experimental protocol was approved by the Ministry of Health and Welfare Institutional Review Board, and informed consent was obtained from all patients.
성능/효과
This is the first study to demonstrate the effects of lumbar stabilization with an ADIM technique during LE in individuals with chronic LBP. As hypothesized, the experimental group, which received a combination of LE and ADIM, showed greater reduction in LIDs (L3-L4 and L5-S1) and IV angles of the lumbosacral segment (L5-S1) than did patients in the control group who received only LE exercise. These results suggest that the addition of ADIM significantly increased lumbar spinal stabilization in individuals with LBP, thereby reducing pain associated with functional lumbar flexion during daily activities.
1%, within group changes), suggesting that the combined method was more effective for lumbosacral stabilization. The total lumbar extension angle was greater in the experimental group (15%, within group changes) than the control (6%, within group changes) group, indicating that a superior stabilization effect was achieved with the combined ADIM and LE technique. Such improvements in lumbar extension movement after LE combined with ADIM were similar to ranges of improvement reported previously (15-17%) in patients with LBP who participated in press-up and other specific core stabilization exercises (O’sullivan et al, 1997; Powers et al, 2008).
참고문헌 (38)
Abizanda P, Navarro JL, Garcia-Tomas MI, et al. Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons. Arch Gerontol Geriatr. 2012;54(1):21-27. http://doi.org/10.1016/j.archger.2011.02.006
Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil 2004;85:86-92. http://doi.org/10.1053/j.apmr.2003.12.005
Berlemann U, Jeszenszky DJ, Buhler DW, et al. The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord. 1999;12(1):68-73.
Boonstra AM, Schiphorst Preuper HR, Reneman MF, et al. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabili Res. 2008;31(2):165-169. http://doi.org/10.1097/MRR.0b013e3282fc0f93
Browder DA, Childs JD, Cleland JA, et al. Effectiveness of an extension-oriented treatment approach in a subgroup of subjects with low back pain: a randomized clinical trial. Phys Ther. 2007;87(12):1608-1618. http://doi.org/10.2522/ptj.20060297
Clare HA, Adams R, Maher CG. Construct validity of lumbar extension measures in McKenzie's derangement syndrome. Man Ther. 2007;12(4):328-334. http://doi.org/10.1016/j.math.2006.07.006
Cresswell AG, Grundstrom H, Thorstensson A. Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand. 1992;144(4):409-418. http://doi.org/10.1111/j.1748-1716.1992.tb09314.x
Donelson R, Aprill C, Medcalf R, et al. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence. Spine (phila Pa 1976). 1997;22(10):1115-1122.
Franca FR, Burke TN, Hanada ES, et al. Segmental stabilization and muscular strengthening in chronic low back pain: A comparative study. Clinics (Sao Paulo). 2010;65(10):1013-1017.
Fredericson M, Lee SU, Welsh J, et al. Changes in posterior disc bulging and intervertebral foraminal size associated with flexion-extension movement: a comparison between L4-5 and L5-S1 levels in normal subjects. Spine J. 2001;1(1):10-17.
Harris-Hayes M, Van Dillen LR, Sahrmann SA. Classification, treatment and outcomes of a patient with lumbar extension syndrome. Physiother Theory Pract. 2005;21(3):181-196.
Hicks GE, Fritz JM, Delitto A, et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753-1762. http://doi.org/10.1016/j.apmr.2005.03.033
Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil. 1999;80(9):1005-1012.
Hodges PW, Richardson CA. Transversus abdominis and the superficial abdominal muscles are controlled independently in a postural task. Neurosci Lett. 1999;265(2):91-94.
Hosseinifar M, Akbari M, Behtash H, et al. The effects of stabilization and mckenzie exercises on transverse abdominis and multifidus muscle thickness, pain, and disability: A randomized controlled trial in nonspecific chronic low back pain. J Phys Ther Sci. 2013;25(12):1541-1545. http://doi.org/10.1589/jpts.25.1541
Kong MH, Hymanson HJ, Song KY, et al. Kinetic magnetic resonance imaging analysis of abdominal segmental motion of the functional spine unit. J Neurosurg Spine. 2009;10(4);357-365.
Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: A randomized placebo controlled crossover study. N Am J Med Sci. 2011;3(10):456-461. http://doi.org/10.4297/najms.2011.3456
Marshall P, Murphy B. Delayed abdominal muscle onsets and self-report measures of pain and disability in chronic low back pain. J Electromyogr Kinesiol. 2010;20(5):833-839. http://doi.org/10.1016/j.jelekin.2009.09.005
McKenzie RA, May S. Mechanical diagnosis and therapy: The lumbar spine. Waikanae, New Zealand: Spinal Publications. 2003.
Miller ER, Schenk RJ, Karnes JL, et al. A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. J Man Manip Ther. 2005;13(2):103-112. http://doi.org/10.1179/106698105790824996
O'Sullivan PB, Phyty GD, Twomey LT, et al. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. 1997;22(24):2959-2967.
Powers CM, Beneck GJ, Kulig K, et al. Effects of a single session of posterior-to-anterior spinal mobilization and press-up exercise on pain response and lumbar spine extension in people with nonspecific low back pain. Phys Ther. 2008;88(4):485-493. http://doi.org/10.2522/ptj.20070069
Richardson CA, Snijders CJ, Hides JA, et al. The relation between the transversus abdominis muscles, sacroiliac joint mechanics, and low back pain. Spine (Phila Pa 1976). 2002;27(4):399-405.
Shaffer WO1, Spratt KF, Weinstein J, et al. 1990 Volvo Award in clinical sciences. The consistency and accuracy of roentgenograms for measuring sagittal translation in the lumbar vertebral motion segment. An experimental model. Spine (Phila Pa 1976). 1990;15(8):741-750.
Shirazi-Adl A, El-Rich M, Pop DG, et al. Spinal muscle forces, internal loads and stability in standing under various postures and loads application of kinematics-based algorithm. Eur Spine J. 2005;14(4)381-392. http://doi.org/10.1007/s00586-004-0779-0
Smith D, Bissell G, Bruce-Low S, et al. The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain. J Back Musculoskelet Rehabil. 2011;24(4):241-249. http://doi.org/10.3233/BMR-2011-0301
Stanton T, Kawchuk G. The effect of abdominal stabilization contractions on posteroanterior spinal stiffness. Spine (Phila Pa 1976). 2008;33(6):694-701. http://doi.org/10.1097/BRS.0b013e318166e034
Teyhen DS, Rieger JL, Westrick RB, et al. Changes in deep abdominal muscle thickness during common trunk-strengthening exercises using ultrasound imaging. J Orthop Sports Phys Ther. 2008;38(10):596-605. http://doi.org/10.2519/jospt.2008.2897
Van Dieen JH, Cholewicki J, Radebold A. Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine (Phila Pa 1976). 2003;28(8):834-841.
Van Dillen LR, Sahrmann SA, Norton BJ, et al. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: A preliminary report. Arch Phys Med Rehabil. 2003;84(3):313-322.
Vasseljen O, Unsgaard-Tondel M, Westad C, et al. Effect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: A randomized controlled trial. Spine (Phila Pa 1976). 2012;37(13):1101-1108. http://doi.org/10.1097/BRS.0b013e318241377c
Whittaker JL. Ultrasound imaging of the lateral abdominal wall muscles in individuals with lumbopelvic pain and signs of concurrent hypocapnia. Man Ther. 2008;13(5):404-410. http://doi.org/10.1016/j.math.2007.03.008
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