대한물리의학회지 (Journal of the Korean Society of Physical Medicine)

  • 제11권4호
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  • Pages.115-125
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  • 2016
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  • 1975-311X(pISSN)
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  • 2287-7215(eISSN)
대한물리의학회 (The Korean Society of Physical Medicine)
권호 표지
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요추부 불안정성을 가진 요통환자에게 요부안정화운동과 신경가동술의 치료적 효과

The Effect of Lumbar Stabilization Exercise and The Neurodynamic Technique on Patients with Low Back Pain and Lumbar Instability

  • Jeong, Eui-Young (Department of Physical Therapy, Asan Chungmu Hospital) ;
  • Kim, Suhn-Yeop (Department of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 투고 : 2016.09.22
  • 심사 : 2016.10.12
  • 발행 : 2016.11.30
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초록

PURPOSE: This study aimed to compare the effects of lumbar stabilization exercise with those of the neurodynamic technique on low back pain in patients with lumbar instability. METHODS: The subjects included those with more than three tests with positive results for lumbar instability and those with a positive sign during the neurodynamic test, all of whom had low back pain. For the lumbar stabilization exercise group (n=15), lumbar stabilization exercise was performed using a sling system, while the neurodynamic technique group (n=15) performed the neurodynamic technique. The intervention was performed 5 days a week for 4 weeks. All measurement of each subject were measure at pre-intervention and post-intervention (after 4 weeks). SPSS/PC ver. 18.0 program was used to compile results. RESULTS: There was no significant difference in general characteristics of subjects between both groups (p>.05). Assessed items included the visual analog scale score (VAS), Korean version of the Oswestry Disability Index (KODI), lumbar instability test positive response counter (LIC) and Fear-Avoidance Beliefs Questionnaire score (FABQ), and a significant reduction was observed post-intervention compared to pre-intervention values in both groups (p<.01). Other assessed items such as trunk flexibility and lumbar extensor endurance and lumbar flexor endurance were significantly increased post-intervention in both groups compared to pre-intervention values (p<.01). There was no significant difference in all parameters between both groups (p>.05). CONCLUSION: Our results indicate that the neurodynamic technique may be useful for improving low back pain in patients with lumbar instability.

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참고문헌

  1. Akuthota V, Nadler SF. Core Strengthening. Arch Phys Med Rehabil. 2004;85(3 Suppl 1):s86-92.
  2. Bang HS. The effects of lumbar stabilization exercise on muscle activity and isokinetic muscle strength of female patients with chronic low back pain. J Korean Soc Phys Med. 2015;10(2):63-71. https://doi.org/10.13066/kspm.2015.10.2.63
  3. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153-7. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x
  4. Cha HG, Oh DW. Effects of sciatic nerve mobilization technique on perceived pain and knee strength in patient with chronic low back pain. Phys Ther Korea. 2010;17(3):31-9.
  5. Christie HJ, Kumar S, Warren SA. Postural aberrations in low back pain. Arch Phys Med Rehabil. 1995;76(3):218-24. https://doi.org/10.1016/S0003-9993(95)80604-0
  6. Coleman JL, Straker LM, Cambell A, et al. Biering-Sorensen test performance of Japanese young males: comparison with other ethnicities and relationship to electromyography, near-infrared spectroscopy and exertion ratings. Ergonomics. 2011;54(7):636-55. https://doi.org/10.1080/00140139.2011.586062
  7. Deville WL, van der Windt DA, Dzaferagic A, et al. The test of lasegue: systematic review of the accuracy in diagnosing herniated. Spine. 2000;25(9):1140-7. https://doi.org/10.1097/00007632-200005010-00016
  8. Ellis RF, Hing WA. Neural mobilization: A systematic review of randomized controlled trials with an analysis of terapeutic efficacy. J Man Manip Ther. 2008;16(1):8-22. https://doi.org/10.1179/106698108790818594
  9. Gill KP, Callaghan MJ. The measurement of lumbar proprioception in individuals with and without low back pain. Spine. 1998;23(3):371-7. https://doi.org/10.1097/00007632-199802010-00017
  10. Hebert JJ, Koppenhaver SL, Magel JS, et al. The relationship of transversus abdominis and lumbar multifidus activation and prognostic factors for clinical success with a stabilization exercise program: A crosssectional study. Arch Phys Med Rehabil. 2010;91(1):78-85. https://doi.org/10.1016/j.apmr.2009.08.146
  11. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measure for identification of lumbar segmental instability. Arch Phys Med Rehabil. 2003;84(12):1858-64. https://doi.org/10.1016/S0003-9993(03)00365-4
  12. Hicks GE, Fritz JM, Delitto A, et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005;86(9):1753-62. https://doi.org/10.1016/j.apmr.2005.03.033
  13. Jang KR. Effect of neurodynamics on pain and paresthesia on lumbar hernia operated patient. Master's Degree. Daegu Catholic University. 2013.
  14. Johansson JA. Psychosocial work factors, physical work load and associated musculoskeletal symptoms among home care workers. Scand Psychol. 1995;36(2):113-29. https://doi.org/10.1111/j.1467-9450.1995.tb00973.x
  15. Joo MK, Kim TY, Kim JT, et al. Reliability and validity of the Korean version of the Fear-Avoidance Beliefs Questionnaire. Phys Ther Korea. 2009;16(2):24-30.
  16. Kasai Y, Morishita K, Kawakita E, et al. A new evaluation method for lumbar spinal instability: Passive lumbar extension test. Phys Ther. 2006;86(12):1661-7. https://doi.org/10.2522/ptj.20050281
  17. Kim DY, Lee SH, Lee HY, et al. Validation of the Korean version of the Oswestry disability index. Spine. 2005;30(5):123-7. https://doi.org/10.1097/01.brs.0000148999.21492.53
  18. Kim HH. The effects of spinal stabilization exercise on lumbar paraspinal and abdorminal muscles function for patients with the chronic low back pain. Korea Sport Research. 2007;18(4):135-45.
  19. Kim SY, Kim TY, Park SJ. A clinical application with the principle of hanging point in the sling exercise therapy. Journal of Korean Academy of Orthopaedic Manual Therapy. 2003;9(2):25-45.
  20. Kim SY, Kwon JH. Lumbar stabilization exercise using the sling system. Journal of Korean Academy of Orthopedic Manual Therapy. 2001;7(2):23-39.
  21. Kim TY. The effects of spinal stability exercise using the sling and mat. Korea Sport Research. 2005;16(6):273-80.
  22. Landel R, Kulig K, Fredericson M, et al. Intertester reliability and validity of motion assessments during lumbar spine accessory motion testing. Phys Ther. 2008;88(1):43-9. https://doi.org/10.2522/ptj.20060179
  23. Lee HO. Activation of trunk muscle during stabilization exercise in four-point kneeling. J Kore Phys Ther. 2010;22(5):33-8.
  24. Lee HJ, Kim SY. Comparison of the effects of abdominal draw-in and expansion maneuvers on trunk stabilization in patients with low back pain and lumbar spine instability. Phys Ther Korea. 2015;22(1):33-48. https://doi.org/10.12674/ptk.2015.22.3.033
  25. Lee KH, Son KH, Bang JH. The effects of neurodynamics and PNF on pain, flexibility, balance and gait of patients received a lumbar herniated intervertebral disc surgery. Journal of the Korea Entertainment Industry Association. 2016;10(2):253-60.
  26. Lee MK, Kim BK. Comparison of abdominal muscle activity after sling and swiss-ball exercises in asymptomatic adults. J Korean Soc Phys Med. 2014;9(3):333-8. https://doi.org/10.13066/kspm.2014.9.3.333
  27. Lee SJ, Kim YM. The effects of gluteal muscle exercises combined lumbar stabilization on lumbar stability in chronic low back pain patients with lumbar instability. J Korean Soc Phys Med. 2013;8(1):29-39. https://doi.org/10.13066/kspm.2013.8.1.029
  28. Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit. A preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg Br. 1973;55(2):390-401.
  29. Maitland GD. The slump test: examination and treatment. Aust J Physiother. 1985;31(6):215-9. https://doi.org/10.1016/S0004-9514(14)60634-6
  30. McLellan DL, Swash M. Longitudinal sliding of the median nerve during movements of the upper limb. J Neurol Neurosurg Psychiatry. 1976;39(6):566-70. https://doi.org/10.1136/jnnp.39.6.566
  31. Mo MS, Park HS. The effect of lumbar stabilization exercises with neurodynamic techniques on lumbar muscular strength and Oswestry disability index in lumbar disc herniation patient's. Journal of Korean Academy of Orthopedic Manual Therapy. 2016;22(1):1-7.
  32. Park GD, Lee WJ, Park SJ. The effect of sling exercise on lumbar back strength stabilization for lumbar hernia operation patients. Journal of Sport and Leisure Studies. 2005;25:339-52.
  33. Seo JK, Kim SY. The relationship between hip abductor muscle strength and lumbar instability in patients with chronic low back pain. J Kor Phys Ther. 2011;23(4):15-22.
  34. Scrimshaw SV, Maher CG. Randomized controlled trial of neural mobilization after spinal surgery. Spine. 2001;26(24):2647-52. https://doi.org/10.1097/00007632-200112150-00002
  35. Shacklock M. Improving application of neurodynamic(neural tension) testing and treatments: A message to researchers and clinicians. Man Ther. 2005;10(3):175-9. https://doi.org/10.1016/j.math.2005.03.001
  36. Sin IH. The effect of back pain program on pain, functional disability, back pain management behavior, muscle strength and flexibility for chronic low back pain patient. Master's Degree. Kyung-won University. 2012.
  37. Son HH. Trunk muscle activation during bridging exercise with various shoulder supporting surfaces. J Korean Soc Phys Med. 2015;10(3):299-304.
  38. Talebi GA, Taghipour-Darzi M, Norouzi-Fashkhami A. Treatment of chronic radiculopathy of the first sacral nerve root using neuromobilization techniques. J Back Musculoskeletal Rehabil. 2010;23(3):151-9. https://doi.org/10.3233/BMR-2010-0260
  39. Topp KS, Boyd BS. Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice. Phys Ther. 2006;86(1):92-109. https://doi.org/10.1093/ptj/86.1.92
  40. Waddell G, Somerville D, Henderson I, et al. Objective clinical evaluation of physical impairment in chronic low back pain. Spine. 1992;17:617-28. https://doi.org/10.1097/00007632-199206000-00001
  41. Webright WG, Randolph BJ, Perrin DH. Comparison of nonballistic active knee extension in neural slump position and static stretch techniques on hamstring flexibility. J Orthop Sports Phys Ther. 1997;26(1):7-13. https://doi.org/10.2519/jospt.1997.26.1.7
  42. Wiltse L, Rothman S. Spondylolisthesis: Classification diagnosis and natural history. Semin Spine Surg. 1989;1(1):78-94.
  43. Yu CW, Kim SY. Comparison of lumbopelvic rotation angle during active straight leg raise in patients with chronic low back pain and without lumbar segmental instability. J Korean Soc Phys Med. 2015;10(4):39-48. https://doi.org/10.13066/kspm.2015.10.4.39
  44. Yu JH, Hur JG, Ko TS. The effect of management of neurodynamic and mechanical interface in low back related leg pain. The Journal of Korean Academy of Physical Therapy Science. 2013;5(1):69-77.