下腰痛患者肌肉力量和神经—肌肉活动研究现状

Research Status of the Muscle Strength and Neuromuscular Activity of Patients with Low Back Pain

DOI：

英文关键词:lower back pain muscle strength neuromuscular activity EMG

基金项目:

作者	单位
李男	上海体育科学研究所

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中文摘要:

下腰痛（Low Back Pain,LBP）是一种常见的临床症状，有60%~80%的成年人生活中有LBP发作的经历，严重地影响了患者的生活质量。肌肉力量和神经肌肉活动不平衡现象常常存在于LBP患者中，被认为同LBP的产生以及LBP的反复发作相关。研究目的：探讨LBP患者中出现的肌肉力量和神经肌肉活动的异常改变，并初步探讨其同LBP发作之间的关系。研究方法：通过文献资料法，对近年来国内外对LBP患者中肌肉力量、神经肌肉控制和与其它运动环节之间关系的研究进行分析。研究结果：（1）多数研究表明慢性LBP患者存在背伸肌力的下降、屈伸峰力矩（F/E）比值的上升、背伸肌耐力下降等现象。结果反应了LBP患者肌力平衡受到了破坏，可能是引起LBP反复发作的原因。而躯干旋转力量不平衡同LBP发作的关联则尚无定论。（2）通过表面肌电图技术观察LBP患者腰背神经肌肉活动的异常。研究发现，LBP患者存在腰背肌静止状态下激活增强、椎旁肌活动不对称、屈曲放松反应（Flexion- Relaxtion ratio, FRR）缺失、腰背肌肉耐力下降等肌电的异常现象。（3） LBP不仅仅会引起腰背肌力和神经肌肉活动的改变，也会引起相关运动环节的异常。已有研究证实臀肌肌电活动异常、腹肌激活模式改变、下肢肌肉活动异常同LBP发作相关联。结论：肌肉力量及激活的异常，躯干屈/伸比值的改变，背伸肌肌肉耐力下降，椎旁肌激活不对称性，伸肌容易疲劳以及屈曲松弛，臀肌、腹肌、下肢肌肉激活的异常等都同LBP存在一定的关联。这些因素，在康复训练过程中应引起足够的重视。

英文摘要:

Low Back Pain (LBP) is a common clinical symptom. 60%-80% adults have suffered from LBP in their lives, which seriously affects the living quality of patients. The imbalance of muscle strength and neuromuscular activity is commonly seen in LBP patients, which is considered to correlate with the attack and recurrence of LBP. Objective: To explore the abnormal changes of muscle strength and neuromuscular activity in LBP patients so as to tentatively find out the relations between the changes and LBP attacks. Method: Through the way of literature study, the author analyzed the researches on the relations between the muscle strength, neuromuscular control and other exercise links of LBP patients at home and abroad in the recent years. Result: 1) Most of the researches have revealed the phenomena in chronic LBP patients such as the decline of back extensor strength, rise of stretch peak torque ratio (F/E), decline of back extensor endurance, etc. These phenomena demonstrate the break of LBP patients’ muscle strength balance, which might be the cause of LBP recurrence. There is no conclusion of the relations between the imbalance of trunk rotation strength and LBP attack. 2) LBP patients’ abnormal back neuromuscular activities have been observed with SEMG. This has uncovered the abnormal phenomena of back muscle activation in static state, asymmetry of paravertebral muscle activities, deficiency of flexion-relaxation ratio (FRR), decline of back muscle endurance, etc. 3) LBP will not only change the back muscle strength and neuromuscular activities, but also cause abnormality of relative exercise links. Researches prove that the abnormal myoelectrical activities of gluteus, changes of the activation model of abdominal muscle and the abnormal activities of lower limb activities correlate with attack of LBP. Conclusion: LBP, to some extent, correlates with the abnormality of muscle strength and activation, the changes of trunk stretch ratio decline of back extensor endurance, the asymmetry of paravertebral muscle activation, the easy fatigue of extensors as well as the flabby bending and the abnormal activation of gluteus, abdominal muscle and lower limb muscles. These factors should be seriously taken into account in the course of rehabilitation.

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