Park, Dae-sung
(Department of Physical Therapy, Konyang University)
,
Jung, Seung-hwa
(Department of Physical Therapy, The Graduate School of Medical Science, Konyang University)
Objective: The purpose of this study was to examine the effectiveness of pelvic displacement when self-hamstring muscle stretches were applied to persons with low back pain. Design: Three-group pretest-posttest design. Methods: Forty persons with low back pain participated in this study. Pelvic tilt...
Objective: The purpose of this study was to examine the effectiveness of pelvic displacement when self-hamstring muscle stretches were applied to persons with low back pain. Design: Three-group pretest-posttest design. Methods: Forty persons with low back pain participated in this study. Pelvic tilt angle, hamstring flexibility, Quadruple Visual Analogue Scale (QVAS), Fear Avoidance Beliefs Questionnaire (FABQ), Korea version of the Oswestry Disability Index (KODI) and pelvic mobility were measured at pre-post. All participants were divided into either the pevic anterior tilt group (PAT group, n=12), pelvic midrange group (PMR group, n=18), or the pelvic posterior tilt group (PPT group, n=10). Self-stretching was performed using the pilates ring three times a week for a total of four weeks and the post-test was conducted and compared with the pre-test. Results: Hamstring flexibility, QVAS, KODI scores were significantly different compared to before the intervention (p<0.05). The changes in hamstring flexibility of the three groups were significantly different (p<0.05). Changes in KODI and FABQ results of the three groups were not significant. The pelvic posterior tilt range were significantly different in the PMR and PPT groups (p<0.05). The pelvic anterior tilt ranges showed significant differences after stretching in the PPT group (p<0.05). Conclusions: A large amount of change of hamstring flexibility, pelvic mobility of anterior and posterior tilt test in the PPT group was observed. Furthermore, therapists should consider pelvic displacement of the participant when applying intervention, which may, accordingly, have different effectiveness.
Objective: The purpose of this study was to examine the effectiveness of pelvic displacement when self-hamstring muscle stretches were applied to persons with low back pain. Design: Three-group pretest-posttest design. Methods: Forty persons with low back pain participated in this study. Pelvic tilt angle, hamstring flexibility, Quadruple Visual Analogue Scale (QVAS), Fear Avoidance Beliefs Questionnaire (FABQ), Korea version of the Oswestry Disability Index (KODI) and pelvic mobility were measured at pre-post. All participants were divided into either the pevic anterior tilt group (PAT group, n=12), pelvic midrange group (PMR group, n=18), or the pelvic posterior tilt group (PPT group, n=10). Self-stretching was performed using the pilates ring three times a week for a total of four weeks and the post-test was conducted and compared with the pre-test. Results: Hamstring flexibility, QVAS, KODI scores were significantly different compared to before the intervention (p<0.05). The changes in hamstring flexibility of the three groups were significantly different (p<0.05). Changes in KODI and FABQ results of the three groups were not significant. The pelvic posterior tilt range were significantly different in the PMR and PPT groups (p<0.05). The pelvic anterior tilt ranges showed significant differences after stretching in the PPT group (p<0.05). Conclusions: A large amount of change of hamstring flexibility, pelvic mobility of anterior and posterior tilt test in the PPT group was observed. Furthermore, therapists should consider pelvic displacement of the participant when applying intervention, which may, accordingly, have different effectiveness.
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문제 정의
In conclusion, this study was conducted to investigate for the effect of self-stretching of the hamstring muscles according to the pelvic inclination of patients with low back pain.
제안 방법
While stretching the knee, the ankle was in neutral position. For the measurement, a smartphone goniometer application (Clinometer + bubble level; Plaincode, Stephanskirchen, Germany) was used, and it was fixed with a strap 2 cm above the malleolus of the ankle. With the goniometer set at 0°, the maximum active knee extension angle was measured 3 times and the average value was recorded (Figure 3).
In order to group all participants according to the pelvic tilt measurements, the angle between the line connecting the right upper ASIS and the PSIS and the horizontal line was measured.
In this study, after placing the STC on a flat chair, the participant was instructed to sit comfortably, and a wooden box with an appropriate height was placed on the sole of the foot so that the leg could be bent 90°.
In order to selectively stretch the hamstrings, the stretches were performed for 3 sets of 5 times per leg in 3 directions of adduction, neutral, and abduction, and a rest period of 10 seconds was provided between each exercise set (Figure 1). Intervention was conducted three times a week for a total of 4 weeks, and post-tests were performed. Prior to the experiment, all participants fully understood the contents of this study and provided their informed consent.
Next, in order to measure the range of motion of the pelvis, the inclination of the pelvis in the front, back, left and right direction was instructed.
The FABQ level test used to evaluate the psychosocial level of the study participants. The FABQ is a questionnaire that evaluates the effect of fear related to pain on physical and occupational activities.
This study included 40 patients who visited the physical therapy room department of Phil hospital of Korean medicine located in Daejeon Metropolitan City through outpatient treatment for chronic low back pain. The criteria for selection of the study participants were those who had experienced back pain for the first time and had been experiencing for more than 3 months, those who had a Quadruple Visual Analogue Scale (QVAS) of 40 or more for their current low back pain, and those without radiating pain. Those who had experienced or currently fractured a vertebrae, those who had surgical experience of the vertebrae, those who had experienced or currently fractured their hip joint, and those diagnosed with lumbar disc herniation and stenosis were excluded from the study.
The participants pelvic tilt (Anterior superior iliac spinePosterior superior iliac spine, ASIS-PSIS), hamstrings flexibility test using an inclinometer, the 4 items QVAS, psychosocial level test (FABQ), and the low back pain dysfunction level test (KODI) was used to determine the degree of back pain, and pelvic mobility was measured using a Sensbalance Therapy Cushion (STC).
Therefore, it should be considered that even patients with low back pain with the same symptoms may have different pelvic displacements. Therefore, this study was conducted to compare the effectiveness of hamstring strentching on low back pain between the neutral pelvic, anterior pelvic and posterior pelvic groups.
This study was a comparative study based on three groups before and after 4 weeks of intervention. The participants’ pelvic inclination was compared and classified into ≤5° posterior inclination, 6°-10° neutral, and ≥11° anterior inclination.
The participants’ pelvic inclination was compared and classified into ≤5° posterior inclination, 6°-10° neutral, and ≥11° anterior inclination. This subjects were classified into three groups based on the pelvic incidence, which is a representative anatomical index of the spine and pelvis, and the measured values of the previous studies were used to analyze the difference between the sagittal spine indices [19].
대상 데이터
A total of 40 participants were classified into 12 pelvic anterior tilt group, 18 pelvic midrange (PMR) group, and 10 pelvic posterior tilt (PPT) group. Among the general medical characteristics of the participants, there was a significant difference between the three groups in mean pelvic inclination (p<0.
This study included 40 patients who visited the physical therapy room department of Phil hospital of Korean medicine located in Daejeon Metropolitan City through outpatient treatment for chronic low back pain. The criteria for selection of the study participants were those who had experienced back pain for the first time and had been experiencing for more than 3 months, those who had a Quadruple Visual Analogue Scale (QVAS) of 40 or more for their current low back pain, and those without radiating pain.
성능/효과
As a result of analyzing the difference between the groups in anterior pelvic tilt range, there was a difference between groups in the amount of change, but the post-test results were not statistically significant.
As a result of analyzing the differences at each point of measurement of the QVAS, there was no significant difference between the three groups, and in the analysis of changes within the group before and after the intervention, all three groups showed a significant decrease (p<0.05).
01; Table 1). As a result of analyzing the differences in hamstring flexibility, there was a difference in the amount of change between the groups, but the post-test results were not statistically significant. The changes in hamstring flexibility before and after the intervention were significantly increased in all three groups (p<0.
Based on these contents, in this study, it is thought that increasing flexibility through stretching the hamstring muscles had an effect on the increase in the range of the anterior and posterior pelvic tilt.
As a result, although not statistically significant, there was a difference in the amount of change between the three groups. In particular, it was confirmed that the PPT group showed a relatively large amount of change in hamstring flexibility, QVAS, and pelvic anterior and posterior inclination variables.
According to previous studies, the V-sit and reach test was suggested as a representative assessment method for hamstring flexibility [38], and it was confirmed that the range of the sit-and reach test was significantly increased as an immediate effect of stretching the hamstrings [39]. In this study, it was confirmed that hamstring flexibilty was increased through stretching, and the results of previous studies were reflected, and it is thought that the KODI score was significantly reduced. As a result of this study, there was a clear difference in the amount of change in pain levels and hamstring flexibility in the pelvic posterior inclination group.
The Wilcoxon signed rank test was used to determine the pre- and post-intervention changes in the measurement variables for each group, and it was judged that there was a statistically significant difference when the p-value was 0.05. The Kruskal-Wallis test was used to compare the outcome variables between each group, and when the p-value was 0.
This study was conducted to compare the effectiveness of the hamstring muscle stretching according to the characteristics of pelvic displacement, and it was found that hamstring flexibility was significantly increased in all three groups.
When the results of this study were combined, there was no statistically significant difference between the three groups in hamstring flexibility, QVAS, and pelvic anterior and posterior inclination variables, but a larger amount of change in the posterior pelvic inclination group was confirmed. This is thought that there was a larger change in the PPT group because the hamstring muscle shortening was strong due to the coupling action in the pelvis.
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