Ref: https://www.southeasttexasspine.com/blog/
Low back pain (LBP) is one of the most common musculoskeletal problems in many ages both of male and female. Presently, we have seen LBP in younger populations such as university students. Digital lifestyle is always mentioned as the cause of LBP.
LBP refers to pain, muscle tension or stiffness below the costal border and over the lower gluteal fold, with or without sciatica. It can be classified according to its duration in acute low back pain (ALBP), less than six weeks, or chronic low back pain (CLBP) when the pain persists for more than three months. By the way, It can be divided into 2 groups by cause of pain including non-specific LBP (NSLBP) and anatomical LBP.
An anatomical source of pain (e.g, Epidural abscess, compression fracture, spondyloarthropathy, malignancy or cauda equina syndrome) is known by clear causes from pathological or trauma. 90% of LBP cannot identify specific causes, so it is denominated non-specific LBP (NSLBP). However, multiple factors have been associated with the occurrence of NSLBP, among them the alteration of the neuromuscular response of the trunk, the deconditioning (or decrease in the function) of the lumbar musculature, the reduction in the muscular mass of the trunk, and the reduction in the muscular strength of the trunk.
 |
| Spine and disc degenerative (Ref: https://www.sandiegospinefoundation.org/) |
577 million people suffered from LBP in 2017. It is among the three leading causes of years lived with disability.
The LBP is closely related to instability in the lumbar spine segment from both mechanical and degenerative. The spine needs to be mechanically stable at all times to avoid injuries that can eventually lead to pain. Maintaining this stability is the role of the active neuromuscular system, and thus the trunk strength plays an important role in different aspects related to health and sport.
Stability of the lumbar and pelvic complex is defined as the ability to keep balance and firmness in their structures while performing body movements, and the improvement of segmental stability and trunk neuromuscular control can provide a solid foundation not only for the segment, but also for the whole body, as it prepares the body to deal with external disturbances, such as traction, torsion, and shear, which can cause injuries to the segment or other body parts.
 |
| Soft tissue force vector to balance and stabilize spine (Ref: https://chiro.org/Low_Back_Pain/Stability_From_Biomechanical.shtm) |
Trunk strength has been related to injury prevention, which is why it plays an important role in the functional evaluation of people or athletes. Muscular strength refers to the “maximal force (measured in newtons or pounds) that can be generated by a specific muscle or muscle group“.
Stability needs not only trunk strength but also trunk endurance. Endurance or fatigue of the trunk is important because it has been widely reported that patients with low back pain develop a deconditioning syndrome that particularly influences the strength and function of the back muscles, with such patients being much weaker than healthy controls. Lack of endurance has also been highlighted as a key factor for predicting low back pain, and this suggests that the assessment of fatigue warrants further investigation.
 |
| The progression of low back degenerative develops pathology and instability (Ref: https://content.iospress.com/articles/journal-of-back-and-musculoskeletal-rehabilitation/bmr210097) |
Muscle endurance refers to “the ability of a muscle group to perform repeated contractions over a period of time sufficient to cause muscular fatigue, or to maintain a specific percentage of maximum voluntary contraction for a prolonged period of time”. Muscle fatigue is a complex and multifaceted process involving physiological, biomechanical, and psychological elements. It is an important phenomenon, as there are numerous proven relations with work related musculoskeletal injuries.
The ways for assessing lumbar and pelvic stability range from simple palpation of local muscles and isometric endurance tests to use of equipment such as electromyography, ultrasound imaging device, and isokinetic dynamometer.
Prospective studies have shown trunk assessments that specifically isometric and isokinetic of trunk flexors and lumbar extensors muscles. By practicality in the clinic, core endurance was assessed by using the Mcgill Core Endurance Tests including.
(1) The anterior core endurance was assessed by using the flexor endurance test. The test was initiated with the participant’s hands crossed at the shoulder; the knee and hip joints at 90˚ flexion; the feet stabilized by the research assistant physiotherapist. The participant’s body was flexed until the lower end of the scapula rose from the bed and the duration of maintaining this position was recorded by using a stopwatch.
 |
| The anterior core endurance test (Ref: https://www.e-jer.org/journal/view.php?number=2013600519) |
(2) The extensor endurance test was used to test the erector spinae and multifidus. During this test, the participant’s body was hanging down from the table as the ASIS aligned with the table edge, the hands were crossed at the shoulders and the feet were in the supported position. The test was initiated when horizontality was achieved and the duration to maintain this position was recorded by using a stopwatch.
 |
| The extensor endurance test (Ref: https://www.researchgate.net/figure/Summary-of-correlations-between-core-stability-functional-movement-screen-and_tbl1_41548703) |
(3) The lateral bridge test was performed to test lateral core muscles. This test was performed in a side-lying position with the legs extended with one foot in front of the other foot and the body in a straight line by lifting on the front arm of the lying side. The duration to maintain this position was recorded by using a stopwatch. This test was assessed for the dominant side first and then for the nondominant side.
 |
| The lateral bridge test (Ref: https://www.e-jer.org/journal/view.php?number=2013600519) |
Isokinetic dynamometry is a machine which provides resistance to control speed motion.
In the term “Isokinetic” was referred to angular velocity consistency. For example, the machine was set for low angular velocity, if you push high power and speed, the machine will generate high resistance to you to control your motion at the setting.
"The most 2 popular isokinetic dynamometry brands which I have seen are Biodex and Humac norm".
Isokinetic dynamometry is a well-accepted tool for assessing strength of the upper and lower extremities as well as trunk muscles, and isokinetic strength testing is a useful approach to assess trunk extension and flexion in healthy individuals as well as in patients with low back pain.
 |
| Brand Biodex (Ref: https://ssrc.ac.ir/) |
Isokinetic assessment relates to LBP that determines the muscle torque of flexor and extensor groups, analyzing the agonist/antagonist balance for better treatment planning and injury prevention in reducing an athlete’s risk of injury, providing criteria for discharging the patient. isokinetic measurements can be used to identify strength deficits in individuals with and without pathologies. Moreover, it is used to define deficits in specific pathologies, as well as to evaluate effectiveness of training and therapy.
This measurement is based on the principle of testing strength capacity under constant rotational or linear motion velocities and is considered the ‘gold standard’ for assessing strength capacity. Current dynamometers are capable of measuring isometric, concentric and eccentric contraction modes for clinical, performance and scientific applications.
 |
| Brand Humac Norm (Ref: https://www.humac.com.au/) |
The assessment of fatigue and endurance in the trunk is important because it has been widely reported that patients with low back pain develop a deconditioning syndrome that particularly influences the strength and function of the back muscles, with such patients being much weaker than healthy controls. Lack of endurance has also been highlighted as a key factor for predicting low back pain, and this suggests that the assessment of fatigue warrants further investigation.
In the field of sports, it is thought that increases in the ability to exert the maximum trunk muscle force (trunk muscle strength), as well as the ability to exert trunk muscle force repeatedly or continuously over a long period of time (trunk muscle endurance), can improve athletic performance and help prevent and treat back disorders in individuals with trunk muscle weakness. These positions may produce dissimilar levels of peak torque, work, and power of isokinetic concentric trunk extension and flexion at 60°/s and 120°/s in the sitting and standing positions.
The 60°/s represents strength assessment, whereas the 120°/s is used for endurance or fatigue assessment. The range of motion in assessment varies that is possible to be -10˚ of hyperextension to 80˚ flexion.
Isokinetic dynamometry assessment has limitations. Although it is commonly used in clinical practice for testing of the extremities, only a few findings regarding the reproducibility of trunk strength testing exist. Unfortunately, it is not universally accessible and is rarely used clinically owing to its high cost, requirement for considerable user expertise, and protracted testing time.
“The product price is greater than a million THB”.
Moreover, there is a lack of normative data of trunk flexors and extensors muscle strength in the literature. Particularly, there is a lack of normative data from asymptomatic adolescent and adult athletes, unlike the arms and legs. In this way, the comparison of the trunk strength of an individual always will need to be compared with population normative data or parameters of normality.
 |
| Isokinetic dynamometry evaluation result sheet (Ref: https://www.pbscentre.com/en/biodex-dijagnostika/) |
The functional applicability of isokinetic measurement still remains questionable. Some scientists agree that isokinetic movements are “unnatural” and the motion involved is not related to that which occurs during sporting performance”. In addition, it has to be emphasized that what is being measured is not internal muscle tension but the torque/force output of complex muscle systems especially when assessing the spine.
It is nice to have a trunk isokinetic dynamometry assessment if you can afford the bill and can access the machine. If not, you can have a manual assessment as above. As far as I know, one health service place where this machine is located is the Bangkok Academy of Sports And Exercise Medicine in Bangkok hospital.
Reference:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967351/
https://www.scielo.br/j/fm/a/BgHgg3ywrynZkkMcQftPBDm/?format=pdf&lang=en
https://bjsm.bmj.com/content/bjsports/39/10/731.full.pdf
https://zaguan.unizar.es/record/71215/files/texto_completo.pdf
https://www.e-jer.org/upload/jer-14-3-413.pdf
https://sciendo.com/pdf/10.2478/hukin-2019-0035
https://core.ac.uk/download/pdf/82354186.pdf
https://pdfs.semanticscholar.org/fd1e/8eb99caab68a5f20321b1e2f0f07c2a81f7f.pdf
https://gexinonline.com/uploads/articles/article-jrpr-121.pdf
ไม่มีความคิดเห็น:
แสดงความคิดเห็น