Qualität grundlegender Bewegungsmuster bei Patienten mit chronischen lumbalen Rückenschmerzen

Zusammenfassung

Hintergrund: Chronische Rückenschmerzen können mit Änderungen der motorischen Kontrolle und einem modifizierten Bewegungsverhalten einhergehen. Zur systematisierten Überprüfung alltagsrelevanter Bewegungen bei Rückenpatienten existieren jedoch kaum Testverfahren. Die vorliegende Studie untersucht mittels einer neuen funktionellen Bewegungsanalyse, ob sich die grundlegenden Bewegungsmuster von Personen mit chronisch unspezifischen Rückenschmerzen und Gesunden unterscheiden sowie ob Schmerzpatienten häufiger asymmetrisch ausgeprägte Muster aufweisen.

Probanden/Methoden: Zwanzig Personen mit chronisch unspezifischen Rückenschmerzen im LWS-Bereich (♀ = 8, ♂ = 12; 49,4 ± 11,3 J.) und 20 beschwerdefreie Probanden (♀ = 12, ♂ = 8; 47,7 ± 10,7 J.) absolvierten die Bewegungsanalyse. Diese besteht aus elf standardisierten motorischen Aufgaben, die alltagsrelevante Bewegungen testen und jeweils anhand einer sechsstufigen Skala bewertet werden. Acht der elf Items sind beidseitig durchzuführen. Als Outcomes fungierten der Gesamtscore sowie die Anzahl der Asymmetrien (unterschiedliches Ergebnis bei den acht beidseitig durchzuführenden Items). Eine pilotartige Reliabilitätsanalyse (vier Probanden und vier Rater) erfolgte per Intraklassen-Korrelation (ICC). Die Mittelwerte beider Gruppen wurden mithilfe des t-Tests für unabhängige Stichproben (α = 0,05) verglichen. Im Falle signifikanter Unterschiede schloss sich die Berechnung der Effektstärke (Cohen’s d) an.

Ergebnisse: Bei der Reliabilitätsanalyse ergab sich ein ICC (2,1) von 0,82 (95 % KI: 0,72 − 0,90). Die Probanden mit Rückenschmerzen (31,95 ± 5,82 Punkte) erreichten einen deutlich niedrigeren Gesamtscore als die Gesunden (44,01 ± 5,27; p < 0,001; d = 2,17). Mit 3,8 ± 1,28 Asymmetrien wiesen sie bei den getesteten Bewegungsmustern gegenüber den Gesunden (1,4 ± 0,94) zudem mehr Ungleichgewichte auf (p < 0,001; d = 2,14).

Schlussfolgerung: Unphysiologische und asymmetrisch ausgeprägte Bewegungsmuster scheinen mit chronischen unspezifischen lumbalen Rückenschmerzen in Verbindung zu stehen. Ob sie jedoch Ursache oder Folge der Beschwerden sind, bleibt zu untersuchen. Weitere Studien zur Reliabilität der eingesetzten Bewegungsanalyse sind notwendig.

Abstract

Background: Chronic back pain may be associated with alterations of motor control and maladaptive movement. However, instruments that systematically screen fundamental movement patterns are rare. Using a newly developed functional movement analysis, this study aims to examine whether persons with chronic unspecific low back pain display altered quality of fundamental movement patterns and whether asymmetry exists between body sides.

Subjects/Methods: 20 patients with chronic back pain (♀ = 8, ♂ = 12; 49.4 ± 11.3 years) and 20 healthy controls (♀ = 12, ♂ = 8; 47.7 ± 10.7 years) completed the functional movement analysis. It consists of 11 items screening movements of daily life. Eight of them were to complete left and right. The overall score and the number of observed asymmetries (in items to complete left and right) constituted the primary outcomes. A preliminary analysis of reliability (four raters, four subjects) with pilot character was conducted using intraclass correlation (ICC). To compare differences in means, independent t-tests were performed. In case of significance, we calculated the effect size (Cohen’s d).

Results: The reliability analysis showed an ICC (2.1) of 0.82 (95 % CI: 0.72 − 0.90). Patients with chronic low back pain (31.95 ± 5.82) scored significantly lower than healthy subjects (44.01 ± 5.27; p < 0.001, d = 2.17). Additionally, patients averaged 3.8 ± 1.28 asymmetries while pain-free participants only demonstrated 1.4 ± 0.94 (p < 0.001; d = 2.14).

Conclusion: Faulty and dysbalanced movement patterns appear to be linked to chronic low back pain. Nonetheless, given an existing relation, it remains unclear whether the detected deficiencies are causes or consequences of pain. Further studies about the reliability of the presented screening tool are needed.

Schlüsselwörter

funktionelle Bewegungsanalyse - Asymmetrie - motorische Kontrolle

Key words

functional movement screening - asymmetry - motor control

• Literatur

• 1 Bender R, Lange S. Adjusting for multiple testing--when and how?. J Clin Epidemiol 2001; 54: 343-349
• 2 Burnett AF, Cornelius MW, Dankaerts W et al. Spinal kinematics and trunk muscle activity in cyclists: a comparison between healthy controls and non-specific chronic low back pain subjects-a pilot investigation. Man Ther 2004; 9: 211-219
• 3 Butler RJ, Contreras M, Burton ML et al. Modifiable risk factors predict injuries in firefighters during training academies. Work 2013; Epub ahead of print
• 4 Chek P. Movement that matters. 1. Aufl. Encinitas: CHEK Institute; 2001
• 5 Chorba RS, Chorba DJ, Bouillon LE et al. Use of a functional movement screening tool to determine injury risk in female collegiate athletes. N Am J Sports Phys Ther 2010; 5: 47-54
• 6 Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function – part 1. N Am J Sports Phys Ther 2006; 1: 62-72
• 7 Cook G, Burton L, Hoogenboom B. Pre-participation screening: the use of fundamental movements as an assessment of function – part 2. N Am J Sports Phys Ther 2006; 1: 132-139
• 8 Freburger JK, Holmes GM, Agans RP et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169: 251-258
• 9 Göbel H. Epidemiologie und Kosten chronischer Schmerzen. Der Schmerz 2001; 15: 92-98
• 10 Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 1996; 21: 2763-2769
• 11 Hides J, Gilmore C, Stanton W et al. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther 2008; 13: 43-49
• 12 Himmelreich H, Vogt L, Banzer W et al. Gluteal muscle recruitment during level, incline and stair ambulation in healthy subjects and chronic low back pain patients. J Back Musculoskelet Rehabil 2008; 21: 193-199
• 13 Hodges PW, Richardson CA. Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord 1998; 11: 46-56
• 14 Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil 1999; 80: 1005-1012
• 15 Horst R, Hesse S. Motorisches Strategietraining und PNF. 1. Aufl. Stuttgart: Thieme; 2005
• 16 Kiesel K, Plisky PJ, Voight ML. Can Serious Injury in Professional Football be Predicted by a Preseason Functional Movement Screen?. N Am J Sports Phys Ther 2007; 2: 147-158
• 17 Kim WH, Lee S, Lee DY. Changes in the cross-sectional area of multifidus and psoas in unilateral sciatica caused by lumbar disc herniation. J Korean Neurosurg Soc 2011; 50: 201-204
• 18 Lee JH, Ooi Y, Nakamura K. Measurement of muscle strength of the trunk and the lower extremities in subjects with history of low back pain. Spine 1995; 20: 1994-1996
• 19 Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol 2005; 17: 134-140
• 20 Nachemson A. Recent advances in the treatment of low back pain. Int Orthop 1985; 9: 1-10
• 21 Niemeläinen R, Briand M, Battié MC. Substantial asymmetry in paraspinal muscle cross-sectional area in healthy adults questions its value as a marker of low back pain and pathology. Spine 2011; 36: 2152-2157
• 22 O’Connor FG, Deuster PA, Davis J et al. Functional movement screening: predicting injuries in officer candidates. Med Sci Sports Exerc 2011; 43: 2224-2230
• 23 O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005; 10: 242-255
• 24 O'Sullivan PB, Mitchell T, Bulich P et al. The relationship between posture and back muscle endurance in industrial workers with flexion-related low back pain. Man Ther 2006; 11: 264-271
• 25 Page P, Frank CC, Lardner R. Assessment and treatment of muscle imbalance. 1. Aufl. Champaign: Human Kinetics; 2010
• 26 Perneger TV. What's wrong with Bonferroni adjustments. BMJ 1998; 316: 1236-1238
• 27 Piper A. Korrelation zwischen lumbalen Rückenschmerzen und dem M. glutaeus maximus. Manuelle Therapie 2005; 9: 65-74
• 28 Schochet PZ. Technical Methods Report: Guidelines for Multiple Testing in Impact Evaluations (NCEE 2008-4018). National Center for Education Evaluation and Regional Assistance, Institute of Education Sciences, U. S. Department of Education, Washington DC; 2008
• 29 Shum GLK, Crosbie J, Lee RYW. Symptomatic and asymptomatic movement coordination of the lumbar spine and hip during an everyday activity. Spine 2005; 30: E697-E702
• 30 Shum GLK, Crosbie J, Lee RYW. Movement coordination of the lumbar spine and hip during a picking up activity in low back pain subjects. Eur Spine J 2007; 16: 749-758
• 31 Shum GLK, Crosbie J, Lee RYW. Three-dimensional kinetics of the lumbar spine and hips in low back pain patients during sit-to-stand and stand-to-sit. Spine 2007; 32: E211-E219
• 32 Smith CA, Chimera NJ, Wright N et al. Interrater and Intrarater Reliability of the Functional Movement Screen. J Strength Cond Res 2012; Epub ahead of print
• 33 Suter E, Lindsay D. Back muscle fatigability is associated with knee extensor inhibition in subjects with low back pain. Spine 2001; 26: E361-E366
• 34 Teyhen DS, Shaffer SW, Lorenson CL et al. The Functional Movement Screen: a reliability study. J Orthop Sports Phys Ther 2012; 42: 530-540
• 35 van Hoof W, Volkaerts K, O'Sullivan K et al. Comparing lower lumbar kinematics in cyclists with low back pain (flexion pattern) versus asymptomatic controls – field study using a wireless posture monitoring system. Man Ther 2012; 17: 312-317
• 36 Vogt L, Pfeifer K, Banzer W. Neuromuscular control of walking with chronic low-back pain. Man Ther 2003; 8: 21-28
• 37 Vogt L, Pfeifer K, Portscher M et al. Influences of nonspecific low back pain on three-dimensional lumbar spine kinematics in locomotion. Spine 2001; 26: 1910-1919
• 38 Waddell G. Biopsychosocial analysis of low back pain. Baillieres Clin Rheumatol 1992; 6: 523-557