Efficacy of Therapeutic Exercise for Recurrent Back Pain

描述（由申请人提供）：下背部疾病是活动受限的主要原因，影响高达47%的受伤工人。虽然大多数（80%至90%）急性腰痛（LBP）患者在受伤后四周内恢复，但其中60%至86%的患者在急性发作后的一年内会出现复发性背痛。腰椎稳定练习通常用于LBP的康复计划，其理论基础是疼痛和复发性损伤的来源是由于肌肉损伤、虚弱、肌肉共激活模式改变和延迟反应导致的脊柱神经肌肉控制不足。因此，有必要确定是否可以通过治疗性运动来改善稳定性，并确定治疗所针对的神经肌肉控制因素是否有助于稳定性。特定稳定运动（SSE）涉及一系列训练，最初强调与脊柱相连的深层肌肉（多裂肌和腹横肌）的募集和共同激活，以进行局部腰椎节段控制。之后，练习的重点是在中性姿势中招募较大的躯干肌肉，以控制躯干平衡。一小批患者的新证据表明，SSE训练可减轻疼痛，改善功能，并降低治疗后3年内腰痛复发的风险。在拟议的研究中，51名符合稳定运动疗法适应症的急性复发性LBP患者将接受10周的SSE培训。将在第5周和第11周评价临床结局（疼痛和功能）和生物力学测量（运动控制的局部和整体指数）。统计分析将比较SSE训练随时间的变化，并将比较LBP受试者与51名无LBP受试者。本研究的目的是确定局部和全局神经肌肉控制因素，有助于一个国家的潜在不稳定的个人与复发性腰痛。我们将确定SSE培训是否以及何时改善复发性LBP患者的这些因素。我们将研究神经肌肉控制的局部和整体因素的改善与疼痛和功能状态的临床重要改善之间的关系，拟议的研究将启动该研究计划，并开发初步统计数据，以促进大规模、前瞻性、随机对照试验的设计。

DESCRIPTION (provided by applicant): Low back disorders are the leading cause of activity limitation and affect up to 47% of injured workers. While the majority (80% to 90%) of individuals with acute low back pain (LBP) recover by four weeks post injury, 60% to 86% of these patients will experience recurrent back pain during the year after the acute episode. Lumbar stabilization exercises are commonly used in rehabilitation programs for LBP, based on the theory that a source of pain and recurrent injury is inadequate neuromuscular control of the spine resulting from muscle damage, weakness, altered muscle coactivation patterns, and delayed responses. Therefore, it is necessary to determine whether stability can be improved by therapeutic exercise and determine whether neuromuscular control factors targeted by treatment contribute to stability. Specific Stabilization Exercise (SSE) involves a progression of training which initially emphasizes recruitment and coactivation of the deep muscles attached to the spine (multifidus and transverse abdominis) for local, lumbar segmental control. Later, exercises focus on recruitment of larger trunk muscles in neutral postures for trunk equilibrium control. Emerging evidence on a small cohort of patients indicates that SSE training reduces pain, improves function, and reduces the risk of low back pain recurrence up to 3 years post treatment. In the proposed investigation, 51 persons with acute, recurrent LBP who meet indications for stabilization exercise therapy will undergo 10-weeks of SSE training. Clinical outcomes (pain and function) and biomechanical measurements (local and global indices of motor control) will be evaluated at weeks 5 and 11. Statistical analyses will compare the change over time with SSE training and will compare the subjects with LBP to 51 subjects without LBP. The goal of this study is to identify local and global neuromuscular control factors that contribute to a state of potential instability in individuals with recurrent LBP. We will determine if and when SSE training improves these factors in persons with recurrent LBP. We will investigate the relationships between improvements in local and global factors of neuromuscular control and clinically important improvements in pain and functional status, The proposed study will initiate this research program and develop pilot statistics to facilitate the design of a large scale, prospective, randomized controlled trial.