肌肉能量技术对非特异性腰痛患者动态姿势控制和腰神经肌肉功能效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.09.013

Abstract

Abstract:

Objective To explore the effect of muscle energy technique (MET) on dynamic posture control and lumbar neuromuscular function in patients with non-specific low back pain.
Methods From March to June, 2022, 30 college students with non-specific low back pain from Shandong Sport University were randomly divided into control group (n = 15) and intervention group (n = 15). The control group received health education, and the intervention group received MET, for four weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Oswestry Disability Index (ODI), Y-balance test and trunk flexion-relaxation test before and after intervention.
Results VAS scores decreased in both groups after intervention (|t| > 2.449, P < 0.05), and it was less in the intervention group than in the control group (t = -5.068, P < 0.001); while ODI score decreased in the intervention group (t = 4.785, P < 0.001), and it was less in the intervention group than in the control group (t = -2.895, P = 0.007); the performance of Y-balance test increased (t = -3.662, P = 0.003) in the intervention group, as well as flexion-relaxation ratio of multifidus (t = -2.460, P = 0.029).
Conclusion MET is effective on alleviating pain and lumbar dysfunction, improving dynamic posture control and enhancing the function of the multifidus during flexion in patients with non-specific low back pain.

Key words: non-specific low back pain, muscle energy technique, dynamic posture control, flexion-relaxation phenomenon, randomized controlled trial

CLC Number:

R685

ZHAO Jianbin, YAO Yingce, WU Jing, XUE Boshi, YANG Xiaowei, ZHOU Zhipeng, ZHENG Liangliang. Effect of muscle energy technique on dynamic postural control and lumbar neuromuscular function in patients with non-specific low back pain: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1092-1098.

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References 38

[1]	MAHER C, UNDERWOOD M, BUCHBINDER R. Non-specific low back pain[J]. Lancet, 2017, 389(10070): 736-747. doi: S0140-6736(16)30970-9 pmid: 27745712
[2]	ZAINA F, COTE P, CANCELLIERE C, et al. A systematic review of clinical practice guidelines for persons with non-specific low back pain with and without radiculopathy: identification of best evidence for rehabilitation to develop the WHO's package of interventions for rehabilitation[J]. Arch Phys Med Rehabil, 2023, 104(11): 1913-1927. doi: 10.1016/j.apmr.2023.02.022
[3]	IJZELENBERG W, OOSTERHUIS T, HAYDEN J A, et al. Exercise therapy for treatment of acute non-specific low back pain[J]. Cochrane Database Syst Rev, 2023, 8(8): CD009365.
[4]	SANTAMARIA G, RODRIGUEZ I, RODRIGUEZ-PEREZ V, et al. Effect of hip muscle strengthening exercises on pain and disability in patients with non-specific low back pain: a systematic review[J]. Sports (Basel), 2023, 11(9): 167.
[5]	CAO Q, PENG B, WANG L, et al. Expert consensus on the diagnosis and treatment of myofascial pain syndrome[J]. World J Clin Cases, 2021, 9(9): 2077-2089.
[6]	HOOPER T L, JAMES C R, BRISMEE J M, et al. Dynamic balance as measured by the Y-balance test is reduced in individuals with low back pain: a cross-sectional comparative study[J]. Phys Ther Sport, 2016, 22: 29-34. doi: S1466-853X(16)30023-2 pmid: 27579805
[7]	ALSHEHRE Y, ALKHATHAMI K, BRIZZOLARA K, et al. Reliability and validity of the Y-balance test in young adults with chronic low back pain[J]. Int J Sports Phys Ther, 2021, 16(3): 628-635. doi: 10.26603/001c.23430 pmid: 34123515
[8]	GOUTERON A, TABARD-FOUGERE A, BOURREDJEM A, et al. The flexion relaxation phenomenon in nonspecific chronic low back pain: prevalence, reproducibility and flexion-extension ratios. A systematic review and meta-analysis[J]. Eur Spine J, 2022, 31(1): 136-151.
[9]	曹奔, 周鑫, 姚重界, 等. 慢性非特异性腰痛腰椎屈伸生物力学特征研究进展[J]. 医用生物力学, 2023, 38(6): 1260-1266.
	CAO B, ZHOU X, YAO C J, et al. Research progress on biomechanical characteristics of nonspecific chronic low back pain during lumbar flexion and extension[J]. J Med Biomechanics, 2023, 38(6): 1260-1266.
[10]	蒋闻蔚, 袁奚佳, 曹震宇. 肌肉能量技术在康复医学领域的研究进展[J]. 中国医药科学, 2021, 11(17): 38-41.
	JIANG W W, YUAN X J, CAO Z Y. Research progress of muscle energy technology in the field of rehabilitation medicine[J]. Chin Med And Pharm, 2021, 11(17): 38-41.
[11]	SANTOS G K, GONÇALVES DE OLIVEIRA R, CAMPOS DE OLIVEIRA L, et al. Effectiveness of muscle energy technique in patients with nonspecific low back pain: a systematic review with meta-analysis[J]. Eur J Phys Rehabil Med, 2022, 58(6): 827-837.
[12]	WAXENBAUM J A, WOO M J, LU M. Physiology, muscle energy[M]. Treasure Island, FL: StatPearls Publishing, 2024: 1-6.
[13]	ELDEMIRE F, GOTO K K. Osteopathic manipulative treatment: muscle energy and counterstrain procedure-psoas muscle procedures[M]. Treasure Island, FL: StatPearls Publishing, 2022: 1-5.
[14]	中国康复医学会脊柱脊髓专业委员会专家组. 中国急/慢性非特异性腰背痛诊疗专家共识[J]. 中国脊柱脊髓杂志, 2016, 26(12): 1134-1138.
	Expert Group of the Spinal Cord Professional Committee of the Chinese Rehabilitation Medicine Association. Expert Consensus on Acute/Chronic Nonspecific Low Back Pain in China[J]. Chin J Spine and Spinal Cord, 2016, 26(12): 1134-1138.
[15]	约翰·吉本斯. 肌肉能量技术:精准、无痛的物理治疗方案[M]. 王华健,译. 北京: 科学技术文献出版社, 2021: 24-155.
	GIBBONS J. Muscle energy techniques: a practical guide for physical therapists[M]. WANG H J, trans trans. Beijing: Scientific and Technical Documents Publishing House, 2021: 24-155.
[16]	BAGG M K, WAND B M, CASHIN A G, et al. Effect of graded sensorimotor retraining on pain intensity in patients with chronic low back pain: a randomized clinical trial[J]. JAMA, 2022, 328(5): 430-439. doi: 10.1001/jama.2022.9930 pmid: 35916848
[17]	AHMED U A, MAHARAJ S S, VAN OOSTERWIJCK J. Effects of dynamic stabilization exercises and muscle energy technique on selected biopsychosocial outcomes for patients with chronic non-specific low back pain: a double-blind randomized controlled trial[J]. Scand J Pain, 2021, 21(3): 495-511.
[18]	ZHENG S, FU T, YAN J, et al. Repetitive temporal interference stimulation improves jump performance but not the postural stability in young healthy males: a randomized controlled trial[J]. J Neuroeng Rehabil, 2024, 21(1): 38. doi: 10.1186/s12984-024-01336-7 pmid: 38509563
[19]	甘晓鹏, 陆耀飞, 陈正权, 等. 肌筋膜放松训练对正常人腰部神经肌肉功能影响的研究[J]. 中国康复医学杂志, 2019, 34(11): 1316-1322.
	GAN X P, LU Y F, CHEN Z Q, et al. The effect of self-myofascial release on neuromuscular responses of lumber in healthy subjects during trunk flexion-extension[J]. Chin J Rehabilit Med, 2019, 34(11): 1316-1322.
[20]	JIN S, NING X, MIRKA G A. An algorithm for defining the onset and cessation of the flexion-relaxation phenomenon in the low back musculature[J]. J Electromyogr Kinesiol, 2012, 22(3): 376-382.
[21]	NEBLETT R, BREDE E, MAYER T G, et al. What is the best surface EMG measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls?[J]. Clin J Pain, 2013, 29(4): 334-340. doi: 10.1097/AJP.0b013e318267252d pmid: 23328325
[22]	ULGER O, DEMIREL A, OZ M, et al. The effect of manual therapy and exercise in patients with chronic low back pain: double blind randomized controlled trial[J]. J Back Musculoskelet Rehabil, 2017, 30(6): 1303-1309. doi: 10.3233/BMR-169673 pmid: 28946522
[23]	许元娇, 赵友屠, 夏云, 等. 隔姜灸联合肌肉能量技术治疗寒湿型慢性非特异性下腰痛的临床观察[J]. 浙江中医药大学学报, 2018, 42(10): 867-869.
	XU Y J, ZHAO Y T, XIA Y, et al. Ginger moxibustion combined with muscle energy in the treatment of cold-dampness syndrome chronic nonspecific low back pain[J]. J Zhejiang Chin Med University, 2018, 42(10): 867-869.
[24]	SBARDELLA S, LA RUSSA C, BERNETTI A, et al. Muscle energy technique in the rehabilitative treatment for acute and chronic non-specific neck pain: a systematic review[J]. Healthcare, 2021, 9(6): 746.
[25]	PINTO E M, NEVES J R, LARANJEIRA M, et al. The importance of inflammatory biomarkers in non-specific acute and chronic low back pain: a systematic review[J]. Eur Spine J, 2023, 32(9): 3230-3244. doi: 10.1007/s00586-023-07717-1 pmid: 37195364
[26]	FRYER G. Muscle energy technique: an evidence-informed approach[J]. Int J Osteopath Med, 2010, 14(1): 3-9.
[27]	ZAIDI F, AHMED I. Effectiveness of muscle energy technique as compared to Maitland mobilisation for the treatment of chronic sacroiliac joint dysfunction[J]. J Pak Med Assoc, 2020, 70(10): 1693-1697. doi: 10.5455/JPMA.43722 pmid: 33159735
[28]	苏婵娟, 陈述荣, 陈昕, 等. 肌肉能量技术联合常规康复训练在老年膝骨性关节炎患者康复中的应用[J]. 中国临床研究, 2020, 33(12): 1631-1634.
	SU C J, CHEN S R, CHEN X, et al. Muscle energy technology combined with routine rehabilitation training in elderly patients with knee osteoarthritis[J]. Chin J Clinical Res, 2020, 33(12): 1631-1634.
[29]	刘灏, 李宗涛, 蔡言伟. 功能性踝关节不稳患者单脚静立平衡能力与踝关节肌力和位置觉的关系[J]. 中国康复理论与实践, 2024, 30(2): 243-248. doi: 10.3969/j.issn.1006-9771.2024.02.016
	LIU H, LI Z T, CAI Y W. Relationship of balance in static single-leg stance to muscle strength and position sense of ankle in individuals with functional ankle instability[J]. Chin J Rehabil Theory Pract, 2024, 30(2): 243-248.
[30]	LAFANS K, TRONCOSO V. Osteopathic manipulative treatment: muscle energy procedure: lumbar vertebrae[M]. Treasure Island (FL): StatPearls Publishing, 2022: 1-5.
[31]	OSAMA M. Effects of autogenic and reciprocal inhibition muscle energy techniques on isometric muscle strength in neck pain: a randomized controlled trial[J]. J Back Musculoskelet Rehabil, 2021, 34(4): 555-564. doi: 10.3233/BMR-200002 pmid: 33523036
[32]	RUSSO M, DECKERS K, ELDABE S, et al. Muscle control and non-specific chronic low back pain[J]. Neuromodulation, 2018, 21(1): 1-9. doi: 10.1111/ner.12738 pmid: 29230905
[33]	李圣节, 李飞, 王瑞, 等. 视觉反馈下肌肉能量技术对膝骨关节炎和髌骨骨折患者功能的影响[J]. 中国康复医学杂志, 2016, 31(6): 670-673.
	LI S J, LI F, WANG R, et al. Effects of muscle energy technique with visual feedback on the function in patients with knee osteoarthritis and patella fracture[J]. Chin J Rehabil Med, 2016, 31(6): 670-673.
[34]	MCGOORY R W, LIN J H. Flexion relaxation and its relation to pain and function over the duration of a back pain episode[J]. PLoS One, 2012, 7(6): e39207.
[35]	SHAMSI M, AHMADI A, MIRZAEI M, et al. Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: a randomized clinical trial[J]. J Bodyw Mov Ther, 2022, 30: 196-202. doi: 10.1016/j.jbmt.2022.02.023 pmid: 35500971
[36]	XIA T, LONG C R, VINING R D, et al. Association of lumbar spine stiffness and flexion-relaxation phenomenon with patient-reported outcomes in adults with chronic low back pain: a single-arm clinical trial investigating the effects of thrust spinal manipulation[J]. BMC Complement Altern Med, 2017, 17(1): 303.
[37]	吴雪娇, 彭广卫, 沈小花, 等. 本体感觉神经肌肉促进技术和下肢机器人对脑卒中后下肢运动和自动态平衡功能的影响[J]. 中国康复医学杂志, 2023, 38(12): 1677-1682.
	WU X J, PENG G W, SHEN X H, et al. Comparison of effects of proprioceptive neuromuscular facilitation technique and lower limb robotics on lower limb motor function and automatic balance function in post-stroke patients[J]. Chin J Rehabilit Med, 2023, 38(12): 1677-1682.
[38]	张冠聪, 黄秋晨, 顾蕊, 等. 不同神经肌肉训练方法对早期膝骨关节炎患者疼痛和运动功能效果的比较[J]. 中国康复理论与实践, 2023, 29(9): 1090-1097. doi: 10.3969/j.issn.1006-9771.2023.09.013
	ZHANG G C, HUANG Q C, GU R, et al. Comparative effect of different neuromuscular exercises on pain and motor function of knee in patients with early knee osteoarthritis[J]. Chin J Rehabil Theory Pract, 2023, 29(9): 1090-1097.

组别	n	性别(男/女)/n	年龄/岁	身高/m	体质量/kg	体质量指数/(kg·m^-2)
干预组	15	10/5	21.9±2.0	1.72±0.09	67.3±14.0	22.6±3.1
对照组	15	8/7	20.9±1.2	1.73±0.09	65.0±9.6	21.7±2.0
χ²/t值		0.733	1.743	0.338	0.529	1.026
P值		0.464	0.092	0.738	0.601	0.314

变量	组别	n	测试	$\bar{x}±s$	t值	P值
VAS	对照组	15	前测	5.67±0.90	2.449	0.028
			后测	4.87±1.55
	干预组	15	前测	5.07±1.39	5.891	< 0.001
			后测	2.20±1.32
	治疗前两组均值差			-0.60±0.43	-1.406	0.171
	治疗后两组均值差			-2.67±0.53	-5.068	< 0.001
ODI	对照组	15	前测	19.20±5.65	0.897	0.385
			后测	17.80±6.12
	干预组	15	前测	18.53±5.83	4.785	< 0.001
			后测	10.00±8.45
	治疗前两组均值差			-0.67±2.10	-0.318	0.753
	治疗后两组均值差			-7.80±2.69	-2.895	0.007

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	15	前测	95.36±7.47	1.245	0.234
		后测	94.19±7.51
干预组	15	前测	95.08±4.76	-3.662	0.003
		后测	98.62±5.17
治疗前两组均值差			-0.28±2.29	-0.124	0.902
治疗后两组均值差			4.43±2.35	1.882	0.070

变量	组别	n	测试	$\bar{x}±s$	t值	P值
竖脊肌FRR	对照组	15	前测	17.30±4.19	2.034	0.065
			后测	14.92±4.47
	干预组	15	前测	15.00±5.91	-1.977	0.070
			后测	16.89±5.65
	治疗前两组均值差			-2.30±1.87	-1.159	0.257
	治疗后两组均值差			1.97±1.86	0.998	0.328
竖脊肌ERR	对照组	15	前测	30.74±9.44	0.920	0.376
			后测	29.06±9.74
	干预组	15	前测	26.06±10.69	-1.444	0.172
			后测	31.21±10.44
	治疗前两组均值差			-4.68±3.68	-1.201	0.241
	治疗后两组均值差			2.15±3.69	0.553	0.585
多裂肌FRR	对照组	15	前测	16.10±6.11	0.621	0.546
			后测	15.20±5.86
	干预组	15	前测	11.72±5.73	-2.460	0.029
			后测	14.79±6.52
	治疗前两组均值差			-4.37±2.16	-1.916	0.067
	治疗后两组均值差			-0.41±2.26	-0.173	0.864
多裂肌ERR	对照组	15	前测	26.53±11.12	-0.117	0.909
			后测	26.77±11.13
	干预组	15	前测	20.64±10.66	-2.130	0.053
			后测	24.71±11.25
	治疗前两组均值差			-5.90±3.98	-1.405	0.172
	治疗后两组均值差			-2.06±4.09	0.479	0.636

Effect of muscle energy technique on dynamic postural control and lumbar neuromuscular function in patients with non-specific low back pain: a randomized controlled trial

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