训练性下腰痛躯干肌功能变化特点及防治干预

The change in trunk muscle performance in recruits with low back pain caused by military training and its prevention

为探讨训练性下腰痛患者躯干肌功能变化 ,分别应用CYBEX 6 0 0 0型等速测试训练系统、彩超、肌电图、立位腰椎侧位X线片测试腰痛组(n=4 0 )和正常组 (n =4 0 )的躯干肌力指标、骶棘肌横截面积、腰背肌肌电指标及腰椎曲度。结果显示 ,在腰痛组与正常组 ,除躯干屈肌PT/BW、ER及骶棘肌横截面积差异无统计学意义 (P >0 0 5 )外 ,其他指标相比差异均有统计学意义(P <0 0 5 )。提示由于缺乏有效的腰背肌锻炼 ,训练性下腰痛患者存在明显的躯干肌肌力失衡 ,其主要由腰背肌肌力下降引起 ;同时腰背肌肌爆发力以及腰背肌静态耐力也明显下降 ,腰椎生理曲度变小 ,但不伴随有明显的椎旁肌萎缩 ;耐力比ER(动态耐力)与下腰痛关系并不密切。同时在此基础上设计了预防训练性下腰痛的现场干预实验 ,结果显示训练性下腰痛发生率明显降低 (锻炼组 8 93% ,对照组 17 0 1% ,P <0 0 1)。提示腰背肌锻炼可降低训练性下腰痛的发生率。

To elucidate the change in trunk muscle performance in patients with low back pain caused by military training. The indices of trunk muscle strength (PT/BW, TAE, F/E, ER), the cross-sectional area of sacrospinalis, the amplitude and the duration of EMG, and the lumbar curvature were measured in recruits with low back pain after military training (n=40)and healthy subjects(n=40).All of the indices were compared between two groups. It was found that except PT/BW and ER of flexors and cross-sectional area of sacrospinalis, there were significant differences between other indices of the patients compared with healthy subjects(P<0.05). In recruits with low back pain caused by military training, strength of the trunk extensors was significantly weaker, resulting in imbalance of the trunk muscle strength. At the same time, explosive force and static endurance of trunk extensors were lowered, accompanied by a decrease in the lumbar curvature. However, there was no significant atrophy of the acrospinalis mussle. ER (dynamic endurance) of trunk extensors did not seem to be related to LBP. Based on these findings, a plan of back muscles exercises was devised, and a group of recruits were subjected to this plan prior to military training. The result of this intervention was positive, as evidenced by a significant reduction in the incidence of back pain (exercise group 8.93%, control group 17.01%, P<0.01). The results suggested that a planned precedent exercises of the trunk extensors to increase their strength could reduce the rate of low back pain caused by military training.