Comparison of Ranges of Motion in The Thoracolumbar Region for Clinical Diagnoses of Patients with Chronic Low Back Pain

만성요통 환자의 질환명에 따른 흉요추부의 관절가동범위 비교

  • Lee, Sang-Wook (Department of Physical Therapy, Dasarang Union Clinic) ;
  • Kim, Suhn-Yeop (Department of Physical Therapy, College of Health Sport Science, Daejeon University)
  • 이상욱 (다사랑연합의원 물리치료실) ;
  • 김선엽 (대전대학교 보건스포츠과학대학 물리치료학과)
  • Received : 2010.06.08
  • Accepted : 2010.08.25
  • Published : 2010.08.31

Abstract

Purpose : The purpose of this study was to compare differences in thoracolumbar ranges of motions by comparing ratios among 4 type diagnosis for patient with chronic low back pain. Methods : The subjects were 58 chronic low back pain patients. A motion analysis program (Global Postural System) was used after photography for posture measurement. To analyze differences in mobility percentages and ratios of thoracolumbar ranges of motion, one-way ANOVA was used. Results : Regional difference spinal posture and movement were found to diagnosis patients with chronic low back pain. Comparison of thoracolumbar ranges of motion revealed significant differences in the thoracic region during forward-bending of the trunk (p<.05). In the upper thoracic region, the herniated intervertebral lumbar disc (HILD) group was significantly larger than the spinal stenosis/herniated intervertebral lumbar disc (SS/HILD) group (p<.05). In the lower thoracic region, chronic sprains (CS) were significantly greater than in the spinal stenosis (SS) group and in the (SS/HJLD) group (p<.05). Comparative analysis of thoracic/lumbar mobility ratio showed the CS group's ratio during forward bending was largest: 1.66, while the HILD group's ratio was smallest: 84 a significant difference between the two groups (p<.01). Diagnosis was not associated with difference in thoracolumbar backward-bending range of motion (p>.05). Conclusion : Theses results indicate the clinical efficacy of diagnosing for chronic low back pain by evaluating spinal mobility.

References

  1. 고동현. 요추간판탈출증 환자의 요천각, 요추중력중심선 및 요추전만각의 통계적 관찰. 척추신경추나학회지 2007;2(2):17-32.
  2. 김근우, 김용훈, 이필구 등. 정상인과 요통환자에서의 요추 전만각 비교. 대한정형외과학회지 1995, 30(1):83-8.
  3. 김민석, 정석원, 황창주 등. 측면 방사선 촬영 자세의 표준화를 위한 정상 척추의 시상면 정렬의 분석. 대한정형외과학회지. 2005;40(7):861-7.
  4. 김병곤, 이승주, 강점덕 등. 일부 요통환자와 대조군의 요추전만도 차이. 대한물리치료학회지 2000;12(2): 185-90.
  5. 김환정, 강종원, 염진섭 등. 젊은층과 노인층에서의 시상면 정렬의 비교분석. 대한척추외과학회지 2003,10(4):327-34.
  6. 대한정형도수치료학회. 정형도수치료진단학. 4판. 현문사. 서울. 2004;443-578.
  7. 대한신경외과학회. 산경외과학. 개정판. 중앙문화진수출판사. 서울. 1996;393-414.
  8. 석세일. 정형외과학 제4판. 최신의학사. 서울. 1993; 375-386.
  9. 오덕원. 만성요통 여성환자들에서 발생되는 자세의 변화. 한국전문물리치료학회지. 2000;7(4): 1-7.
  10. 정연태. 요추부 안정성 운동이 요통환자의 척추불안 정성에 미치는 영향: 문헌고찰, 한국전문물리치료학회. 2000;21(2):368-75.
  11. 주명규, 김택연, 김진택 등. 한국판 공포-회피 반응 설문지의 신뢰도와 타당도. 한국전문물리치료학회지. 2009;16(2);24-30.
  12. Adams M, Bogduk N, Burton K, et al. Mechanical function of the lumbosacral spine. In The Biomechanics of Back Pain. Edinburgh, Churchill Livingston; 2002.
  13. Burdett RG, Brown KE, Fall MP. Reliability and validity of four instruments for measuring lumbar spine and pelvic positions. Phys Ther. 1986;66 (5):677-84.
  14. Cholewicki J, Crisco JJ, Oxland TR, et al. Effects of posture and structure on three-dimensinal coupled rotations in the lumbar spine: A biomechanical analysis. spine (phila Pa 1976). 1996;21(21): 2421-8.
  15. Dickey JP, Pierryniwski MR, Bedner DA, et al. Relationship between pain and vertebral motion in chronic low-back pain subjects. Clin Biomech (Bristol, Avon). 2002;17(5):345-52. https://doi.org/10.1016/S0268-0033(02)00032-3
  16. Dvorak: J, Panjabi MM, Chang DG, et al. Functional radiographic diagnosis of the lumbar spine. Flexion-extension and lateral bending. Spine (phila Pa 1976). 1991;16(5):562-71. https://doi.org/10.1097/00007632-199105000-00014
  17. Fotoohabadi MR, Tully EA, Galea MP. Kinematics of rising from a chair: Image-based analysis of the sagittal hip-spine movement pattern in elderly people who are healthy. Phys Ther. 2010;90(4): 561-71. https://doi.org/10.2522/ptj.20090093
  18. Hodges PW, Richardson. CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. Spine. 1996;21:2640-50. https://doi.org/10.1097/00007632-199611150-00014
  19. ltoi E. Roentgenographic analysis of posture in spinal osteoporotics. Spine (Phila Pa 1976). 1991; 16(7):750-6. https://doi.org/10.1097/00007632-199107000-00011
  20. Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine (phila Pa 1976). 199415;19(14):1611-8.
  21. Kim DY, Lee SH, Lee HY. Validation of the Korean version of oswestry disability index. Spine. 2005; 30: 123-736. https://doi.org/10.1097/01.brs.0000157172.00635.3a
  22. Lim TH, Eck JC, An HS, et al. A noninvasive, three-dimensional spinal motion analysis method. Spine. 1997;22(17):1996-2000. https://doi.org/10.1097/00007632-199709010-00011
  23. Lund T, Nydegger T, Schlenzka D, et al. Threedimensional motion patterns during active bending in patients with chronic low back pain. Spine. 2002;27(17): 1865-74 https://doi.org/10.1097/00007632-200209010-00012
  24. Magora A. Investigation of the relation between low back pain and occupation. VII. Neurologic and orthopedic condition. Scand J Rehabil Med. 1975; 7(4): 146-51.
  25. McConnell J. Recalcitrant chronic low back pain and leg pain. Manual Therapy 2002,7(4):183-92.
  26. Schenkman ML, Clark K, Xie T, et al. Spinal movement and performance of a standing reach task in participants with and without parkinson disease. Phys Ther. 2001;85(4):1400-11.
  27. Shirley FR, O'Connor P, Robinson ME, et al. Comparison of lumbar range of motion using three measurement devices in patients with chronic low back pain. Spine (phila Pa 1976). 1994;19(7): 779-83. https://doi.org/10.1097/00007632-199404000-00009
  28. Shumway-Cook A, Gruber W, Baldwin M, et al. The effect of multidimensional exercise on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther. 1997;77(1):46-57.
  29. Siebenga J, Leferink VJ, Segers MJ, et al. A prospective cohort study comparing the VAS spine score and Roland-Morris disability questionnaire in patients with a type A traumatic thomcolumbar spinal fracture. Eur Spine J. 2008;17(8):1096- 1100. https://doi.org/10.1007/s00586-008-0705-y
  30. Stokes lA. Analysis of symmetry of vertebral body loading consequent to lateral spinal curvature. Spine. 1997;22(21):2495-503. https://doi.org/10.1097/00007632-199711010-00006
  31. Waddell G. The Problem. In The Back Pain Revolution 2nd edition. Edinburgh. Churchill Livingston. 2004:1-7.