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Volume 44 Issue 12
Dec.  2019
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Analysis on the effect of core muscle force training in the treatment of chronic non-specific low back pain of athletes

  • Received Date: 2019-05-30
    Accepted Date: 2019-11-15
  • ObjectiveTo study the therapeutic effects of core muscle force training on chronic non-specific low back pain(CNLBP) in athletes.MethodsSixty athletes with CNLBP were randomly divided into the control group and observation group.The control group was treated with conventional physical therapy(including short-wave and electrical interference), and the observation group was treated with core muscle force training on the basis of conventional physical therapy, 3 times a week, for 2 months.The lumbar spine disease(JOA) score, pain visual analogue(VAS) score and Roland-Morris dysfunction(RDQ) score in two groups were compared between before and after treatment.The changes in total lumbar lordosis(TLL), sacral tilt angle(SI) and lumbosacral angle(LSA) in two groups before and after treatment were recorded.The comprehensive therapeutic effects in two groups were evaluated after 2 months of treatment.ResultsAfter treatment, the VAS score and RDQ score in two groups significantly decreased compared with before treatment, and the JOA score significantly increased, and the difference of the change range of score in observation group was larger than that in control group(P < 0.01).After treatment, the TLL and SI, and LSA in observation group were higher and lower than those in control group, respectively(P < 0.01 and P < 0.05).The difference of the total effective rate between observation group(93.33%) and control group(83.33%) was not statistically significant(P>0.05).ConclusionsThe core muscle force training can significantly reduce the symptoms of low back pain in athletes with CNLBP, improve dysfunction and lumbosacral structure, help to restore the normal training of professional athletes, and is suitable for the rehabilitation of athletes with CNLBP.
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  • [1] HEIDARI J, MIERSWA T, HASENBRING M, et al.Low back pain in athletes and non-athletes:a group comparison of basic pain parameters and impact on sports activity[J].Sport Sci Health, 2016, 12(3):1.
    [2] SAIRYO K, NAGAMACHI A.State-of-the-art management of low back pain in athletes:instructional lecture.[J].J Orthop Sci, 2016, 21(3):263. doi: 10.1016/j.jos.2015.12.021
    [3] CHEVIDIKUNNAN MF, SAIF AA, GAOWGZEH RA, et al.Effectiveness of core muscle strengthening for improving pain and dynamic balance among female patients with patellofemoral pain syndrome[J].J Phys Ther Sci, 2016, 28(5):1518. doi: 10.1589/jpts.28.1518
    [4] 中国康复医学会脊柱脊髓专业委员会专家组.中国急/慢性非特异性腰背痛诊疗专家共识[J].中国脊柱脊髓杂志, 2016, 26(12):1134. doi: 10.3969/j.issn.1004-406X.2016.12.16
    [5] FINITSIS DJ, PELLOWSKI JA, HUEDO-MEDINA TB, et al.Visual analogue scale (VAS) measurement of antiretroviral adherence in people living with HIV (PLWH):a meta-analysis[J].J Behav Med, 2016, 39(6):1043. doi: 10.1007/s10865-016-9770-6
    [6] ZENCIR G, ESER I.Effects of Cold Therapy on Pain and Breathing Exercises Among Median Sternotomy Patients[J].Pain Manag Nurs, 2016, 17(6):401. doi: 10.1016/j.pmn.2016.05.006
    [7] KI C.The effects of forced breathing exercise on the lumbar stabilization in chronic low back pain patients[J].J Phys Ther Sci, 2016, 28(12):3380. doi: 10.1589/jpts.28.3380
    [8] MALLIAROPOULOS N, BIKOS G, MEKE M, et al.Mechanical low back pain in elite track and field athletes:an observational cohort study[J].J Back Musculoskelet Rehabil, 2017, 30(4):1.
    [9] FARAHBAKHSH F, AKBARIFAKHRABADI M, SHARIAT A, et al.Neck pain and low back pain in relation to functional disability in different sport activities[J].J Exerc Rehabil, 2018, 14(3):509. doi: 10.12965/jer.1836220.110
    [10] MENDIS MD, HIDES JA.Effect of motor control training on hip muscles in elite football players with and without low back pain[J].J Sci Med Sport, 2016, 19(11):866. doi: 10.1016/j.jsams.2016.02.008
    [11] 田有粮, 班东林, 胡菲菲, 等.体外冲击波与脉冲短波治疗肱骨外上髁炎的对照研究[J].颈腰痛杂志, 2018, 39(2):158.
    [12] OREN J, GALLINA J.Pars Injuries in Athletes[J].Bull Hosp Jt Dis, 2016, 74(1):73.
    [13] GADIA A, SHAH K, NENE A.Outcomes of various treatment modalities for lumbar spinal ailments in elite athletes:a literature review[J].Asian Spine J, 2018, 12(4):754. doi: 10.31616/asj.2018.12.4.754
    [14] MA X, SUN W, LU A, et al.The improvement of suspension training for trunk muscle power in Sanda athletes.[J].J Exerc Sci Fit, 2017, 15(2):81. doi: 10.1016/j.jesf.2017.09.002
    [15] HAMMAMI R, CHAOUACHI A, MAKHLOUF I, et al.Associations between balance and muscle strength, power performance in male youth athletes of different maturity status[J].Pediatr Exerc Sci, 2016, 28(4):1.
    [16] KSIAẐEK A, ZAGRODNA A, DZIUBEK W, et al.25(OH)D3 levels relative to muscle strength and maximum oxygen uptake in athletes[J].J Human Kinet, 2016, 50(1):71. doi: 10.1515/hukin-2015-0144
    [17] CUFF AR, SPARKES EL, RANDAU M, et al.The scaling of postcranial muscles in cats(Felidae) Ⅱ:hindlimb and lumbosacral muscles[J].J Anat, 2016, 229(1):128. doi: 10.1111/joa.12477
    [18] KO KJ, HA GC, YOOK YS, et al.Effects of 12-week lumbar stabilization exercise and sling exercise on lumbosacral region angle, lumbar muscle strength, and pain scale of patients with chronic low back pain[J].J Phys Ther Sci, 2018, 30(1):18. doi: 10.1589/jpts.30.18
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Analysis on the effect of core muscle force training in the treatment of chronic non-specific low back pain of athletes

  • Department of Rehabilitation Medicine, Nanjing Hospital Affiliated to Nanjing Medical University, The First Hospital of Nanjing, Nanjing Jiangsu 210000, China

Abstract: ObjectiveTo study the therapeutic effects of core muscle force training on chronic non-specific low back pain(CNLBP) in athletes.MethodsSixty athletes with CNLBP were randomly divided into the control group and observation group.The control group was treated with conventional physical therapy(including short-wave and electrical interference), and the observation group was treated with core muscle force training on the basis of conventional physical therapy, 3 times a week, for 2 months.The lumbar spine disease(JOA) score, pain visual analogue(VAS) score and Roland-Morris dysfunction(RDQ) score in two groups were compared between before and after treatment.The changes in total lumbar lordosis(TLL), sacral tilt angle(SI) and lumbosacral angle(LSA) in two groups before and after treatment were recorded.The comprehensive therapeutic effects in two groups were evaluated after 2 months of treatment.ResultsAfter treatment, the VAS score and RDQ score in two groups significantly decreased compared with before treatment, and the JOA score significantly increased, and the difference of the change range of score in observation group was larger than that in control group(P < 0.01).After treatment, the TLL and SI, and LSA in observation group were higher and lower than those in control group, respectively(P < 0.01 and P < 0.05).The difference of the total effective rate between observation group(93.33%) and control group(83.33%) was not statistically significant(P>0.05).ConclusionsThe core muscle force training can significantly reduce the symptoms of low back pain in athletes with CNLBP, improve dysfunction and lumbosacral structure, help to restore the normal training of professional athletes, and is suitable for the rehabilitation of athletes with CNLBP.

  • 腰痛(LBP)是专业运动员最常见的疾病之一, 有报道[1]称国内青年运动员LBP患病率为20%~40%, 其中超过85%为排除明确病理解剖病因的非特异性腰痛(NLBP)。慢性非特异性腰痛(CNLBP)表现为慢性腰骶、臀部疼痛, 对运动员的日常训练、比赛均产生影响, CNLBP的治疗已成为运动康复领域面临的重要问题[1]。CNLBP治疗方式众多, 包括短波、干扰电等物理治疗方式均具有一定治疗效果。近年来有观点认为, 神经、软组织功能变化引起腰骶部稳定性降低在NLBP的发生中具有十分的作用, 一项研究[2]称NLBP病人均出现不同程度的腰部核心肌肉肌力、稳定性下降以及骨盆侧倾、腰椎变直。核心肌力训练能够显著提升腰骶部核心肌肉肌力, 以提高腰骶部稳定性、协调性以及抗干扰性, 在NLBP的治疗中具有一定优势。但国内关于其用于专业运动员CNLBP康复治疗的报道较为缺乏, 专业运动员具有良好的训练、运动习惯, 对治疗内容掌握度更高, 其进行核心肌力训练能获得更佳的临床疗效[3]。因此本研究采用前瞻性对照实验, 旨在进一步明确核心肌力训练对运动员CNLBP的治疗作用及机制。现作报道。

1.   资料与方法
  • 纳入标准:(1)均符合中国康复医学会脊柱脊髓专业委员会专家组《中国急/慢性非特异性腰背痛诊疗专家共识》[4]诊断标准; (2)无脊椎器质性损伤或手术治疗史; (3)病情持续3个月以上且疼痛明显; (4)病人对治疗知情并积极配合。排除标准:(1)急性撞击、扭伤出现疼痛者; (2)合并腰椎间盘突出、肿瘤等器质性疾病; (3)病情严重或因其他原因无法完成训练动作者。本研究纳入对象为2016年6月至2018年6月我中心治疗的60例运动员CNLBP病人, 随机均分为对照组与观察组。对照组病人采用常规治疗, 观察组在此基础上采用核心肌力训练。2组一般资料比较差异无统计学意义(P>0.05)(见表 1), 具有可比性。

    分组 n 年龄/岁 病程/月
    观察组 30 25.56±3.56 18 12 6.52±1.27
    对照组 30 26.07±3.41 20 10 6.87±1.12
    t - 0.57 0.29* 1.13
    P - >0.05 >0.05 >0.05
    *示χ2
  • 对照组病人采用常规物理治疗。(1)短波治疗。治疗方法:将超短波治疗仪探头分别置于肩关节前方、后方, 空气间隙1.0~2.0 cm, 电流量80~100 mA, 以病人感觉到温热感为度, 持续15 min, 每天一次, 每周治疗5次, 休息2 d, 4周为一疗程。注意事项:病人取舒适体位, 治疗部位无需暴露, 可将所着衣服的厚度计算在间隙内; 选用适当电极, 对准治疗部位, 并根据病变深浅和病情需要确定垫物(间隙)厚度。(2)干扰电治疗。治疗方法:选用日产米纳多型干扰电治疗仪。配合3组四通道吸引治疗头, 正旋电流频率为50 000 Hz, 差额选择1~100 Hz之间的固定值, 病人俯卧于床上, 将每组通道的四个电极交叉置于腰骶部疼痛区域, 电流强度以病人有舒适感以及肌肉收缩为准。治疗时间每次20 min, 每日一次, 每周治疗5次, 休息2 d, 4周为一疗程。

    观察组在对照组治疗基础上采用核心肌力训练。(1)双桥运动:取仰卧位, 双手水平置于两侧, 双小腿并拢并置于瑞士球上, 臀部抬起, 使瑞士球保持平衡且保证肩、骨盆与双足成直线状态, 维持30 s, 每组10次; (2)单桥运动:在双桥运动基础上缓慢将一侧下肢抬起, 维持15 s, 再换另一侧下肢完成相同动作, 每组10次; (3)双膝屈曲双桥运动:在双桥运动基础上用双足将瑞士球拉向臀部, 膝关节屈曲并使肩部、臀部、膝关节保持同一直线, 维持15 s, 每组10次; (4)反桥运动:仰卧于瑞士球上, 平放双足与肩同宽, 膝关节屈曲并保持90°, 维持约1 min, 每组10次; (5)髋膝关节屈曲反桥运动:在反桥运动的基础上单侧髋关节屈曲90°, 维持10 s后另一侧下肢重复动作, 每组10次; (6)单腿伸直反桥运动:在反桥运动基础上单侧膝关节伸直, 保持10 s后另一侧下肢完成相同动作, 每组10次。每日各动作训练1组, 连续训练2个月。

  • 疼痛视觉模拟评分法(VAS)[5]:病人根据疼痛严重程度在视觉模拟卡移动评分卡游标, 共10个刻度, 0 cm代表无疼痛, 10 cm代表无法忍受; Roland-Morris功能障碍(RDQ)评分[6]:包括提物、行走、郊游等12个基本动作, 总分24分, 分数越高功能障碍越严重; 腰椎疾患(JOA)评分[7]:参考日本矫形外科学会JOA评分(29分制), 分值越高提示功能状态越好; 总腰椎前凸角(TLL)、骶骨倾斜角(SI)、腰骶角(LSA)测量见图 1; 临床疗效:参照《中国急/慢性非特异性腰背痛诊疗专家共识》, 痊愈:腰部无疼痛、按压痛及功能障碍; 显效:疼痛明显缓解, 有轻微压痛, 运动、生活正常; 有效:症状有所缓解, 存在轻微功能障碍, 但生活不受影响; 前三项为治疗总有效人数; 无效:疼痛症状、功能障碍无明显改善甚至加重。

  • 采用χ2检验和t检验。

2.   结果
  • 治疗前, 2组VAS评分、RDQ评分和JOA评分差异均无统计学意义(P>0.05);治疗后, 2组VAS评分、RDQ评分较治疗前均明显降低(P < 0.01), JOA评分均明显升高(P < 0.01), 且观察组治疗后3指标的变化幅度均大于对照组(P < 0.01)(见表 2)。

    分组 n VAS评分 RDQ评分 JOA评分
    治疗前
    观察组 30 6.56±0.98 15.02±2.32 16.34±2.23
    对照组 30 6.60±1.00 14.97±2.25 16.37±2.20
    t - 0.16 0.08 0.05
    P - >0.05 >0.05 >0.05
    治疗后
    观察组 30 1.32±0.28** 4.01±0.67** 24.12±2.61**
    对照组 30 1.70±0.30** 5.43±0.70** 22.02±2.32**
    t - 5.07 8.03 3.29
    P - < 0.01 < 0.01 < .01
    组内配对t检验:**P < 0.01
  • 治疗前, 2组TLL、SI和LSA差异均无统计学意义(P>0.05);治疗后, 观察组TLL、SI均明显高于对照组(P < 0.01), LSA低于对照组(P < 0.05)(见表 3)。

    分组 n TLL SI LSA
    治疗前
    观察组 30 42.34±3.03 37.02±2.11 137.24±12.12
    对照组 30 42.30±3.05 36.96±2.14 137.30±12.20
    t - 0.05 0.11 0.02
    P - >0.05 >0.05 >0.05
    治疗后
    观察组 30 46.23±3.18* 39.98±2.62* 131.11±10.21*
    对照组 30 43.10±3.07 37.26±2.30 136.32±12.32
    t - 3.88 4.27 2.08
    P - < 0.01 < 0.01 < 0.05
    组内配对t检验:*P < 0.05
  • 观察组治疗总有效率93.33%, 与对照组83.33%比较差异无统计学意义(P>0.05)(见表 4)。

    分组 n 痊愈 显效 有效 无效 有效率/% χ2 P
    观察组 30 12(40.00) 13(43.00) 3(10.00) 2(6.67) 93.33
    对照组 30 8(26.67) 12(40.00) 5(16.67) 2(6.06) 83.33 0.65 >0.05
    合计 60 20(33.33) 25(41.67) 8(13.33) 4(0.67) 88.33
3.   讨论
  • 专业运动员每次训练课时间基本上都在2 h以上, 上肢力量练习、弯腰训练、腰部活动超生理范围等动作难以避免, 因此容易出现LBP。在我中心就诊的运动员LBP病人, 大多无明确的器质性损伤, 多为CNLBP, 典型症状为超过3个月的慢性腰骶、臀部疼痛, 训练强度增加时腰痛加重, 训练量降低时减轻, 对运动员正常训练及比赛造成持续影响[8]。而CNLBP常见的短波、干扰电等理疗方法虽然能获得一定的效果, 但治疗周期长, 部分项目往往需要停止训练, 且复发率较高, CNLBP已成为困扰运动医学康复治疗的难题之一[9]。欧、美学者最早于20世纪90年代运用核心肌力训练治疗慢性腰痛, 经过多年的改进及优化, 其在NLBP的治疗获得了显著的进步[10]。专业运动员病人更容易掌握训练技巧、治疗依从性高, 我中心近年开展核心肌力训练治疗运动员CNLBP获得了满意效果。

    本研究给予对照组病人常规治疗, 干扰电能够作用于深部组织, 对组织产生电刺激, 对感觉神经起抑制作用, 升高痛阈; 能对组织产生不同角度、方向、形状的低频动态立体刺激, 产生血管扩张效应, 有助于促进腰部深层组织血液、淋巴液循环, 加快渗出物吸收, 减轻疼痛症状。短波的温热效应能到达人体深部组织, 改善组织血液及淋巴循环, 同时促进疼痛部位炎性物质吸收, 促进水肿消除, 从而发挥肿止痛、消除炎症的功效[11]。本研究对照组治疗总有效率为83.33%, 但无论比较总有效率还是VAS评分、RDQ评分、JOA评分等功能症状指标, 观察组治疗效果均更优, 这与观察组加用核心肌力训练具有直接的关系。随着NLBP研究的逐渐加深, 研究[12]认为慢性LBP与腰骶部稳定性降低具有直接关系, 其主要原因又在于腰部核心肌群肌力降低及稳定性下降。本研究核心肌力训练借助运动员日常训练常用的瑞士球, 经双桥运动、单桥运动、双膝屈曲双桥运动、反桥运动等增加腰部核心肌群肌力, 增加伸肌、屈肌和共收缩的协调性, 提升多裂肌运动能力, 提高腰骶部结构的稳定性[13]。开展基于瑞士球的核心肌力训练时病人身体始终保持高度不稳定状态, 能够迫使机体激活并募集核心肌群运动单位, 增加腰骶部本体感觉输入, 并经神经肌肉功能调整以恢复腰骶部肌肉的稳定性[14]

    关于腰骶结构对CNLBP等报道称, CNLBP病人较正常体检人群骶骨倾斜度以及L4~5曲度均有下降趋势, 具有明显的腰骶、骨盆侧倾[15]。本研究结果显示观察组治疗后TLL、SI高于对照组, LSA低于对照组, 与KSIAẐEK等[16]报道结果一致, 而对照组治疗前后腰骶结构无显著性变化, 说明核心肌力训练提升运动员CNLBP康复治疗效果还与改善腰骶结构有关。额状面腰骶、骨盆侧倾与周围的肌肉紧张度、力量、肉柔韧性均具有直接联系[17]。核心肌力训练能够有效改善腰骶部肌肉僵硬及痉挛, 调整腰部肌肉柔韧性及紧张度, 纠正腰骶、骨盆侧倾。本研究核心肌力训练治疗运动员CNLBP病人较既往报道效果稍好, 这可能与运动员训练动作掌握度更高, 训练效果更好有关[18]

    综上所述, 核心肌力训练能显著降低运动员CNLBP病人腰痛症状, 改善功能障碍及腰骶、骨盆侧倾程度, 有助于恢复专业运动员正常的训练, 适用于运动员CNLBP的康复治疗。

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