A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction
A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction
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DOI：
10.1007/s00586-005-0925-3
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发表时间：
2006-05-01
影响因子：
2.8
通讯作者：
Panjabi, Manohar M.
中科院分区：
文献类型：
--
作者：
Panjabi, Manohar M.
临床报告和研究已经记录了慢性下背部和颈部疼痛患者的行为。一些假说试图解释这些不同的临床和研究结果。一个新的假设，基于亚失效损伤的韧带（脊柱韧带，椎间盘环和小关节囊）的概念，可能会导致慢性背痛，由于肌肉控制功能障碍，提出。该假设有以下顺序步骤。单一创伤或累积性微创伤可导致韧带和嵌入的机械感受器的亚失效损伤。受损的机械感受器产生损坏的换能器信号，这导致由神经肌肉控制单元产生的损坏的肌肉反应模式。肌肉协调和个体肌肉力量特征，即起始、大小和关闭，被破坏。这会导致韧带、机械感受器和肌肉的异常应力和应变，以及小关节的过度负荷。由于脊柱韧带的固有愈合不良，可能会发生椎间盘和小关节的加速退化。异常状况可能持续存在，并且随着时间的推移，可能通过神经组织的炎症导致慢性背痛。该假说解释了许多关于背痛患者的临床观察和研究结果。这一假设可能有助于更好地了解慢性下背痛和颈部疼痛患者，并改善临床管理。
Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit. Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.