下肢負重測試中腰髂穩定度和前外側腹肌收縮厚度的表現與慢性下背痛的影響

Lumbopelvic Stability and Anterolateral Abdominal Muscle Contraction Thickness during Leg Loading Test in People with and without Chronic Low Back Pain

郭晉源(Chin-Yuan Kuo) ； 蔡永裕(Yung-Yuh Tsai) ； 施怡芬(Yi-Fen Shih) ； 陳文英(Wen-Yin Chen)

《物理治療》 41卷2期 (2016/06) Pp. 96-105

https://doi.org/10.6215/FJPT.PTS1432191297

摘要

背景與目的：下肢負重測試可評估腰髂穩定能力和腹肌表現，但缺乏量化標準，且未知腹部肌群參與情形。本研究目的為瞭解教導腹部內縮動作後，執行此測試時前外側腹部肌群參與程度與下背痛對這些肌群收縮程度的影響。實驗設計：橫斷面病例對照研究。方法：選取下背痛與健康受試者各20位。使用壓力生物回饋儀與超音波影像收取單腳下降在髖屈曲90~15度時腰椎下壓力值與前外側腹部肌群的收縮厚度比。以重複測試變分析不同角度和有無下背痛的影響。結果：隨著髖屈曲角度減少，兩組腹內斜肌的收縮明顯上升，但在髖關節屈曲小於45度時下背痛組比健康組的腹橫肌收縮程度顯著較小(p ＜ .01)。結論：在單腳下降時，腹橫肌負責基本的腰髂穩定，腹內斜肌則可增加收縮以應付負荷挑戰。隨著負荷上升，健康受試組能維持腹橫肌收縮程度，而下背痛組腹橫肌收縮程度則在髖屈曲45度以下明顯降低。臨床應用：建議下背痛者使用單腳下降運動訓練腹橫肌，在負荷增加時應避免使用其他肌群代償。

關鍵字

前外腹部肌群 ； 腰髂穩定度 ； 下背痛 ； 下肢負重測試

並列摘要

Background: Leg loading test may be used to assess lumbopelvic stability as well as the performance of abdominal muscles. However, the test lacks quantification standards, and the participation of the anterolateral abdominal muscles was not clear. Objectives: The study aimed to investigate if the roles of the anterolateral abdominal muscles were different during the leg loading test and if the contraction pattern of the anterolateral abdominal muscles would differ between those with or without low back pain (LBP) after the subjects learned the abdominal drawnin maneuvers. Study design: Cross-sectional, case-comparison study. Procedures and measurement: 20 subjects with low back pain and 20 asymptomatic age-and-sex matched control subjects participated in the study. The subjects performed leg loading test with one leg lowered to 90° ~ 15° of hip flexion. Lumbopelvic pressure on the pressure biofeedback unit and thickness of the anterolateral abdominal wall were collected with real-time ultrasound imaging. Data analysis: Analyses of variance with repeated measures were performed to determine if lumbopelvic pressure or contraction ratios of the anterolateral abdominal muscles differed in different hip angles between those with or without LBP during the leg loading test. Results: The contraction ratio of internal oblique abdominis (IO) increased with decreasing hip angles in both groups, while the contraction thickness of transverse abdominis (TrA) decreased only in subjects with LBP at 45°, 30°, and 15° of hip flexion (p ＜ .01). Conclusion & clinical relevance: During the leg loading test, TrA in healthy subjects could maintain a constant level of contraction when the lumbopelvic stability was maintained, while IO would increase contraction to adapt to the challenge of increasing loads. On the other hand, the ability of TrA to maintain a constant level of contraction was impaired in subjects with LBP, especially at hip angles smaller than 45°. We suggest that when training TrA with the leg lowering maneuvers, care must be taken as the load increases (e.g., below 45° of hip flexion) to avoid compensation from other muscles.

並列關鍵字

anterolateral abdominal muscles ； lumbopelvic stability ； low back pain ； leg loading test