【論文摘要】Effect of Pilates-based Core Muscle Strengthening Exercises on Muscle Recruitments During Forward Bending Movement in Patients With Chronic Nonspecific Low Back Pain: A Pilot Study

【論文摘要】以皮拉提斯為基礎之核心肌群訓練運動對慢性非特異性下背痛患者前彎動作改善的前驅研究

李姍渏(Celline Shan-Ee Lee) ； 胡丞緯(Cheng-Wei Hu) ； 謝爾倩(Er-Qian Hsieh) ； 端木和頤(Ho-Yi Tuan-Mu)

《物理治療》 45卷4期 (2020/12) Pp. 356-357

https://doi.org/10.6215/FJPT.202012.P54

摘要

Background and Purpose: Pilates-based core muscle strengthening exercises have been considered as an effective intervention for patients with chronic nonspecific low back pain (LBP). However, seldom of previous publications have described the muscle recruitments during specific tasks or the comparison to the healthy subjects after interventions. Thus, the purposes of this study were to evaluate the effectiveness of Pilates-based exercises on the muscle recruitments during forward bending movements in patients with chronic non-specific LBP and to compare the muscle recruitments with healthy controls. Methods: Six students of Tzu Chi university, 3 for healthy controls and 3 patients with non-specific LBP, aged from 18 to 25 year were recruited in this study with inform consent. Healthy subjects were those without any experience of pain in the spinal region. The inclusion criterion in the LBP group was having pain in the lower back region in recent 3 months. The exclusion criteria were musculoskeletal pain of any other part of human body in recent 3 months or any other diagnostic musculoskeletal diseases. Pilates-based strengthening exercises were applied to the participants in the LBP group by a senior physiotherapy student under the supervision of a licensed physical therapist for 4 weeks with 2 sessions of 1-hour intervention per week. Wireless electromyography (EMG) system was used to exam the muscle activities of the erector spinae at the level of first lumbar spine (L1) and the multifidus just lateral to the fifth spinous process of lumbar spine. Minimal cross talk EMG signal was found from erector spinae on the multifidus based on this method in previous publications. The EMG signals were collected while forward bending movement with the set speed. All EMG data was normalized by the signals of maximal voluntary isometric contraction (MVIC) of the target muscle which produced by trunk extension. A force gauge was used to measure the pressure pain threshold (PPT) on the erector spinae muscle. The comparison among healthy control, baseline data of LBP group and LBP group after intervention were determined by Mann-Whitney U test and Wilcoxon single rank test. The significant level was set at p ＜ 0.025. Results: The LBP group demonstrated lower PPT comparing to the healthy control (4.15 ± 0.71 vs. 9.70 ± 0.59 kg/cm^2, p ＜ 0.001) and the PPT was significantly increased (4.15 ± 0.71 vs. 5.88 ± 0.74 kg/cm^2, p = 0.023) after 4 weeks' intervention. Regarding to the muscle recruitments, the LBP group demonstrated higher level of muscle recruitment at erector spinae and lower level of multifidus muscle recruitment compared to healthy subjects during forward bending (56.33 ± 6.18 vs. 43.02 ± 3.35 % of MVIC, p = 0.011 and 21.33 ± 6.55 vs. 57.67 ± 7.59 % of MVIC, p ＜ 0.001). The muscle activation was significantly changed in the multifidus after 4 weeks' intervention (21.33 ± 6.55 vs. 43.21 ± 7.30 % of MVIC, p = 0.009). Conclusion: Four weeks of Pilates-based intervention could significantly change the muscle recruitments and PPT status for patients with non-specific LBP. Clinical Relevance: Our results suggested that muscle recruitment strategies could be re-educated by Pilates-based core muscle strengthening.