关节松动术与麦肯基技术对非特异性下腰痛的对比研究

PowersCM,BeneckGJ,KuligK,etal.EffectsofaSingleSessionofPosterior-to-AnteriorSpinalMobilizationandPress-upExerciseonPainResponseandLumbarSpineExtensioninPeopleWithNonspecificLowBackPain.PhysTher.Apr;88(4):485-93.qiang897文献阅读1背景及目的（BackgroundandPurpose）Posterior-to-anterior(PA)mobilizationandpress-upexercisesarecommonphysicaltherapyinterventionsusedtotreatlowbackpain.（后向前滑动和俯卧撑练习是治疗下腰痛常用的物理治疗方式）ThepurposeofthisstudywastoexaminetheimmediateeffectsofPAmobilizationandapress-upexerciseonpainwithstandingextensionandlumbarextensioninpeoplewithnonspecificlowbackpain.（这篇论文研究的目的是检测，后向前滑动和俯卧撑练习对非特异性下腰痛患者的疼痛以及站立位伸展的即刻效果）press-upexercisesPosterior-to-anterior(PA)mobilization2Lumbarsegmentalextensionduringapress-upmaneuverwasmeasuredbydynamicmagneticresonanceimagingpriortoandimmediatelyfollowingasinglesessionofeitherPAspinalmobilizationorapress-upexercise.Apr;88(4):485-93.Whenmotionislimited,spinalextensionisfrequentlymorerestrictedthanflexion.EffectsofaSingleSessionofPosterior-to-AnteriorSpinalMobilizationandPress-upExerciseonPainResponseandLumbarSpineExtensioninPeopleWithNonspecificLowBackPain.ThepurposeofthisstudywastoassesstheimmediateeffectsofasinglesessionofPAspinalmobilizationandapress-upexerciseonpainwithstandingextensionandlumbarsegmentalextension(asquantifiedbydynamicimagingtechniques)inpeoplewithlowbackpain.（在PA滑动和俯卧撑练习前后进行俯卧位的腰椎伸展测试，测试用于动态MRI）press-upexercisesHowever,onetreatmentwasnotmoreeffectivethantheotherinachievingoverallpainrelieforincreasingmotion.Peoplewhoreportlowbackpainoftenhavereducedspinalmotion.Thestudyparticipantswere30adults(19womenand11men)whowere18to45yearsofageandhadadiagnosisofnonspecificlowbackpain.ThepurposeofthisstudywastoexaminetheimmediateeffectsofPAmobilizationandapress-upexerciseonpainwithstandingextensionandlumbarextensioninpeoplewithnonspecificlowbackpain.Thestudyparticipantswere30adults(19womenand11men)whowere18to45yearsofageandhadadiagnosisofnonspecificlowbackpain.TheANOVAresultsforaveragepainscoresrevealedasignificantmaineffectfortime(F=23.Painscoresbeforeandafterinterventionwererecordedwithavisualanalogscale.（改善脊柱伸展通常的两种方法是脊柱松动术和麦肯基中的俯卧伸展练习）Posterior-to-anterior(PA)mobilizationandpress-upexercisesarecommonphysicaltherapyinterventionsusedtotreatlowbackpain.IntroductionPeoplewhoreportlowbackpainoftenhavereducedspinalmotion.Whenmotionislimited,spinalextensionisfrequentlymorerestrictedthanflexion.（经历腰痛的人常常会导致脊柱活动度下降，而脊柱的伸展比屈曲更容易受限。）3IntroductionTwocommonlyusedmethodsforimprovingspinalextensionarepassivesegmentalmobilizationandpress-upexercises.（改善脊柱伸展通常的两种方法是脊柱松动术和麦肯基中的俯卧伸展练习）Maitlandadvocatedtheuseofasegment-specificapproach(ie,posterior-to-anterior[PA]mobilization)（Maitland提倡使用特殊节段方法，例如：前向后的滑动）Incontrast,McKenzieadvocatedamoregeneralapproach,inwhichapress-upexerciseisusedasameansofdecreasingpainandincreasingspinalmotion.（然而，麦肯基提倡使用整体方案，俯卧伸展练习能减少疼痛和增加脊柱的活动度）4IntroductionThepurposeofthisstudywastoassesstheimmediateeffectsofasinglesessionofPAspinalmobilizationandapress-upexerciseonpainwithstandingextensionandlumbarsegmentalextension(asquantifiedbydynamicimagingtechniques)inpeoplewithlowbackpain.5SubjectsThestudyparticipantswere30adults(19womenand11men)whowere18to45yearsofageandhadadiagnosisofnonspecificlowbackpain.（受试对象为30名非特异性下腰痛成年人，19名女性和11名男性，年龄18岁-45岁）6MethodsLumbarsegmentalextensionduringapress-upmaneuverwasmeasuredbydynamicmagneticresonanceimagingpriortoandimmediatelyfollowingasinglesessionofeitherPAspinalmobilizationorapress-upexercise.（在PA滑动和俯卧撑练习前后进行俯卧位的腰椎伸展测试，测试用于动态MRI）Painscoresbeforeandafterinterventionwererecordedwithavisualanalogscale.（干预前后进行VAS评分）Differencesbetweenthetreatmentgroupsinpainandtotallumbarextensionwerecomparedovertimebyuseofa2-wayanalysisofvariance.（不同治疗组的疼痛与腰椎伸展的结果进行2次单因素方差分析）7（改善脊柱伸展通常的两种方法是脊柱松动术和麦肯基中的俯卧伸展练习）IntroductionTherewerenosignificantdifferencesinpainandlumbarextensionbetweenthe2interventionsstudied.干预方式（Intervention）274;df=1,14;P=.TheANOVAresultsforaveragepainscoresrevealedasignificantmaineffectfortime(F=23.Differencesbetweenthetreatmentgroupsinpainandtotallumbarextensionwerecomparedovertimebyuseofa2-wayanalysisofvariance.Twocommonlyusedmethodsforimprovingspinalextensionarepassivesegmentalmobilizationandpress-upexercises.ThefindingsofthisstudysupporttheuseofPAmobilizationandapress-upexerciseforimprovinglumbarextensioninpeoplewithnonspecificlowbackpain.measuredintherestingposition(left)（本研究主要以青年人及运动水平较积极为主，不同年龄和运动水平不一样的受试者是否也是这样的效果？）试验设计技术路线8Introduction（本研究发现P-A滑动和俯卧撑练习能提高非特异性下腰痛患者的腰椎伸展度）ThefindingsofthisstudysupporttheuseofPAmobilizationandapress-upexerciseforimprovinglumbarextensioninpeoplewithnonspecificlowbackpain.However,onetreatmentwasnotmoreeffectivethantheotherinachievingoverallpainrelieforincreasingmotion.Long-termresultsstillneedtobeinvestigated.（本研究发现P-A滑动和俯卧撑练习能提高非特异性下腰痛患者的腰椎伸展度）Painscoresbeforeandafterinterventionwererecordedwithavisualanalogscale.（改善脊柱伸展通常的两种方法是脊柱松动术和麦肯基中的俯卧伸展练习）EffectsofaSingleSessionofPosterior-to-AnteriorSpinalMobilizationandPress-upExerciseonPainResponseandLumbarSpineExtensioninPeopleWithNonspecificLowBackPain.PhysTher.Incontrast,McKenzieadvocatedamoregeneralapproach,inwhichapress-upexerciseisusedasameansofdecreasingpainandincreasingspinalmotion.Whenmotionislimited,spinalextensionisfrequentlymorerestrictedthanflexion.（两组干预手段都由一个具有18年手法治疗经验的物理治疗师完成，并且具有物理治疗专业委员会颁发的临床Orthopaedic专家）（脊柱松动术比麦肯基有较轻微的改善，但是两种方法没有显著差异）IntersegmentallumbarmotionwasPosterior-to-anterior(PA)mobilizationandpress-upexercisesarecommonphysicaltherapyinterventionsusedtotreatlowbackpain.Lumbarsegmentalextensionduringapress-upmaneuverwasmeasuredbydynamicmagneticresonanceimagingpriortoandimmediatelyfollowingasinglesessionofeitherPAspinalmobilizationorapress-upexercise.Twocommonlyusedmethodsforimprovingspinalextensionarepassivesegmentalmobilizationandpress-upexercises.干预方式（Intervention）两组受试者基本资料9干预方式（Intervention）Bothinterventionswereadministeredbyaphysicaltherapistwith18yearsofmanualtherapyexperienceandcertificationasanOrthopaedicClinicalSpecialistbytheAmericanBoardofPhysicalTherapySpecialties.（两组干预手段都由一个具有18年手法治疗经验的物理治疗师完成，并且具有物理治疗专业委员会颁发的临床Orthopaedic专家）10动态MRI监测的方式Intersegmentallumbarmotionwasmeasuredintherestingposition(left)Intersegmentallumbarmotionwasmeasuredontheend-rangeimage(right)11结果——疼痛评分TheANOVAresultsforaveragepainscoresrevealedasignificantmaineffectfortime(F=23.274;df=1,14;P=.001).12结果——腰椎伸展度TheANOVAresultsforaveragetotallumbarextensionrevealedasignificantmaineffectfortime(F=11.764;df=1,14;P=0.004;).13DiscussionTherewasaslightlygreateramountofmotionimprovementinthemobilizationgroup.However,onetreatm