Improved activation of lumbar multifidus following spinal manipulation: A case report applying rehabilitative ultrasound imaging
Improved activation of lumbar multifidus following spinal manipulation: A case report applying rehabilitative ultrasound imaging
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DOI：
10.2519/jospt.2007.2470
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发表时间：
2007-10-01
影响因子：
6.1
通讯作者：
Kiesel, Kyle
中科院分区：
文献类型：
--
作者：
Brenner, Alexander K.;Gill, Norman W.;Kiesel, Kyle
圆点背景：使用脊柱推拿作为一种治疗方法，以促进神经肌肉控制的椎旁肌肉组织没有很好的描述在文献中。使用康复超声成像（RUSI）可能提供一种方便的方法来调查和记录可能发生的变化，在腰椎多裂肌与操作intervention.circle.病例描述：患者是一名33岁的男性，有21年的腰痛和左大腿后疼痛的病史，表现为腰椎活动度低，符合以前发表的脊柱操作的临床预测规则。检查期间，要求患者执行俯卧上肢抬起任务，以评估自动任务期间腰椎多裂肌的激活。通过触诊，检查者注意到与右侧相比，L4-S1之间的左侧多裂肌收缩减少。为了进一步探索这一点，决定用RUST评估多裂肌，这证实了触诊期间观察到的激活缺陷。进行腰椎区域操作，目的是减少脊柱活动力低下和评估多裂肌激活的变化。在操作前、操作后即刻和操作后1天获得L4-5和L5-S1节段的多裂肌成像manipulation.circle。在操作后立即和1天，在俯卧上肢提升任务中观察到多裂肌的能力增加。在L4-5和L5-S1节段，俯卧臂上举的平均厚度变化百分比在操作前为3.6%，操作后即刻为17.2%，操作后约24小时为20.6%。上肢提升任务中多裂肌增厚的改善大于测量的3个标准误差。其他变化包括上肢提升任务期间多裂肌收缩立即明显改善，沿着患者报告增加了lifting.circle.讨论：在该病例报告中，我们使用RUSI量化了脊柱手法对多裂肌肌肉激活的短期影响。没有因果关系的说法，但结果提供了初步证据表明，脊柱操作可能会影响多裂肌功能。RUST提供了一种方便的方法来调查和记录这些更改。
circle dot BACKGROUND: The use of spinal manipulation as a treatment to facilitate neuromuscular control of the paraspinal musculature is not well described in the literature. The use of rehabilitative ultrasound imaging (RUSI) may offer a convenient way to investigate and document possible changes occurring in the lumbar multifidus associated with manipulation intervention.circle dot CASE DESCRIPTION: The patient was a 33-year-old male with a 21-year history of low back pain and left posterior thigh pain who presented with lumbar hypomobility and met a previously published clinical prediction rule for spinal manipulation. During examination, the patient was asked to perform a prone upper extremity lifting task to assess activation in the lumbar multifidus during an automatic task. Through palpation the examiner noted a decreased contraction of the left multifidus between L4-Sl compared to the right. To explore this further, a decision was made to assess the multifidus with RUST, which confirmed the activation deficit noted during palpation. A lumbar regional manipulation was performed with the intention of reducing spinal hypomobility and of assessing changes in multifidus activation. Imaging of the multifidus muscles at the L4-5 and L5-S1 levels were obtained premanipulation, immediately postmanipulation, and 1 day after manipulation.circle dot OUTCOMES: An increased ability to thicken the multifidus during a prone upper extremity lifting task was noted immediately and 1 day after manipulation. Average percent change in thickness at the L4-5 and L5-S1 levels with the prone arm lift was 3.6% premanipulation, 17.2% immediately postmanipulation, and 20.6% approximately 24 hours postmanipulation. Improvements in the thickening of the multifidus muscle during the upper extremity lifting task were greater than 3 standard errors of the measurement. Other changes included immediate palpable improvement in the contraction of the multifidus during the upper extremity lifting task, along with the patient report of increased ease of lifting.circle dot DISCUSSION: In this case report we quantified the short-term influence of spinal manipulation on multifidus muscular activation using RUSI. No cause-and-effect claims can be made; however, the results provide preliminary evidence to suggest that spinal manipulation may influence multifidus muscle function. RUST offers a convenient way to investigate and document these changes.