Mulligan의 Sustained Natural Apophyseal Glides Mobilization이 만성 요통 환자의 요부근 활성도에 미치는 효과

Effects of Mulligan's Mobilization with Sustained Natural Apophyseal Glides on the Paraspinal Muscle Activity of Subjects with Chronic Low Back Pain

  • 김세윤 (부산가톨릭대학교 일반대학원 물리치료학과) ;
  • 김난수 (부산가톨릭대학교 보건과학대학 물리치료학과)
  • Kim, Se-Yoon (Department of Physical Therapy, Graduate School, Catholic University of Pusan) ;
  • Kim, Nan-Soo (Department of Physical Therapy, College of Health Science, Catholic University of Pusan)
  • 투고 : 2013.01.07
  • 심사 : 2013.02.08
  • 발행 : 2013.02.25

초록

Purpose: Low back pain occurs and frequently recurs in many people. An imbalance of paraspinal muscle activity can cause low back pain. Mulligan's concept of mobilizations with sustained natural apophyseal glides (SNAG) is a common method for treating low back pain. The purpose of this study was to investigate the effects of this method on paraspinal muscle activity in patients with chronic low back pain. Methods: Twenty-one patients with low back pain participated in this study. Patients were classified using the Oswestry disability index. The subjects' paraspinal muscles were measured by surface electromyography both before and after the SNAG mobilization. We measured the root mean square value of the paraspinal muscles during lumbar flexion and extension. Results: Paraspinal muscle activity in patients with chronic low back pain was different between the right and left sides. Importantly, paraspinal muscle activity significantly decreased after using the SNAG mobilization method. Conclusion: This study shows a difference between paraspinal muscle activity in chronic low back pain patients and finds that the Mulligan's concept of SNAG mobilization is effective at reducing imbalances in paraspinal muscle activity in low back pain patients.

참고문헌

  1. Kent P, Kjaer P. The efficacy of targeted interventions for modifiable psychosocial risk factors of persistent nonspecific low back pain - a systematic review. Man Ther. 2012;17(5):385-401. https://doi.org/10.1016/j.math.2012.02.008
  2. Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther. 2004;27(4):238-44. https://doi.org/10.1016/j.jmpt.2004.02.002
  3. Liddle SD, Gracey JH, Baxter GD. Advice for the management of low back pain: a systematic review of randomised controlled trials. Man Ther. 2007;12(4):310-27. https://doi.org/10.1016/j.math.2006.12.009
  4. Yoon JY, Jang MG, Hyun SJ et al. Influence of the application to hyperbaric oxygen therapy and physical therapy on chronic low back pain in elderly. J Korean Soc Phys Ther. 2011;23(4):23-8.
  5. Kim DD, Han DU. The effects of sports on the general features of low back pain. J Korean Soc Phys Ther. 2003;15(1):185-95.
  6. Kim SY. Changes in cross-sectional area of lumbar muscle in patients with chronic back pain. J Korean Soc Phys Ther. 2010;22(5):39-47.
  7. Finneran MT, Mazanec D, Marsolais ME et al. Large-array surface electromyography in low back pain: a pilot study. Spine (Phila Pa 1976). 2003;28(13):1447-54.
  8. Neblett R, Mayer TG, Gatchel RJ et al. Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications. Spine (Phila Pa 1976). 2003;28(13):1435-46.
  9. Roy SH, De Luca CJ, Emley M et al. Classification of back muscle impairment based on the surface electromyographic signal. J Rehabil Res Dev. 1997;34(4):405-14.
  10. Liu A, Wang ZJ, Hu Y. Network modeling and analysis of lumbar muscle surface EMG signals during flexion-extension in individuals with and without low back pain. J Electromyogr Kinesiol. 2011;21(6):913-21. https://doi.org/10.1016/j.jelekin.2011.08.012
  11. Foster NE, Thompson KA, Baxter GD et al. Management of nonspecific low back pain by physiotherapists in Britain and Ireland. A descriptive questionnaire of current clinical practice. Spine (Phila Pa 1976). 1999;24(13):1332-42. https://doi.org/10.1097/00007632-199907010-00011
  12. Mulligan BR. Manual therapy: "Nags,""Snags,""MWMS" etc. 4th ed. Wellington, Plane View Services Ltd., 1999.
  13. Konstantinou K, Foster N, Rushton A et al. The use and reported effects of mobilization with movement techniques in low back pain management; a cross-sectional descriptive survey of physiotherapists in Britain. Man Ther. 2002;7(4):206-14. https://doi.org/10.1054/math.2002.0469
  14. Hall T, Hardt S, Schäfer A et al. Mulligan bent leg raise technique--a preliminary randomized trial of immediate effects after a single intervention. Man Ther. 2006;11(2):130-5. https://doi.org/10.1016/j.math.2005.04.009
  15. Bicalho E, Setti JA, Macagnan J et al. Immediate effects of a highvelocity spine manipulation in paraspinal muscles activity of nonspecific chronic low-back pain subjects. Man Ther. 2010;15(5):469-75. https://doi.org/10.1016/j.math.2010.03.012
  16. Keller TS, Colloca CJ. Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial. J Manipulative Physiol Ther. 2000;23(9):585-95. https://doi.org/10.1067/mmt.2000.110947
  17. Lehman GJ, McGill SM. Spinal manipulation causes variable spine kinematic and trunk muscle electromyographic responses. Clin Biomech (Bristol, Avon). 2001;16(4):293-9. https://doi.org/10.1016/S0268-0033(00)00085-1
  18. Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976). 2000;25(24):3100-3. https://doi.org/10.1097/00007632-200012150-00003
  19. Kim GM, Park SY, Yi CH. A rasch analysis of the Korean version of Oswestry disability questionnaire according to general characteristics of patients with low back pain. Phys Ther Kor. 2011;18(2):35-42.
  20. Jeon CH, Kim DJ, Kim DJ et al. Cross-cultural adaptation of the Korean version of the Oswestry disability index (ODI). J Korean Soc Spine Surg. 2005;12(2):146-52. https://doi.org/10.4184/jkss.2005.12.2.146
  21. Moutzouri M, Billis E, Strimpakos N et al. The effects of the Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3-D motion analysis system. BMC Musculoskelet Disord. 2008;9:131. https://doi.org/10.1186/1471-2474-9-131
  22. Oddsson LI, De Luca CJ. Activation imbalances in lumbar spine muscles in the presence of chronic low back pain. J Appl Physiol. 2003;94(4):1410-20. https://doi.org/10.1152/japplphysiol.01183.2001
  23. Neblett R, Mayer TG, Brede E et al. Correcting abnormal flexionrelaxation in chronic lumbar pain: responsiveness to a new biofeedback training protocol. Clin J Pain. 2010;26(5):403-9. https://doi.org/10.1097/AJP.0b013e3181d2bd8c
  24. DeVocht JW, Pickar JG, Wilder DG. Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study. J Manipulative Physiol Ther. 2005;28(7):465-71. https://doi.org/10.1016/j.jmpt.2005.07.002
  25. Lehman G. Kinesiological research: the use of surface electromyography for assessing the effects of spinal manipulation. J Electromyogr Kinesiol. 2012;22(5):692-6. https://doi.org/10.1016/j.jelekin.2012.02.010