Journal of Digital Convergence (디지털융복합연구)

The Society of Digital Policy and Management (한국디지털정책학회)
권호 표지
DOI QR코드

DOI QR Code

A Qualitative Analysis on Paraspinal Muscles in Patients with Acute Low Back Pain and Chronic Low Back Pain

급성 요통환자와 만성 요통환자에서 척추주변근육의 정량적 분석

  • Jeong, Dae-Keun (Dept. of Physical Therapy, Graduate School, Sehan University)
  • Received : 2013.10.02
  • Accepted : 2013.11.20
  • Published : 2013.11.28
Download PDF
⟨ Previous Next ⟩

Abstract

This study was conducted to measure and analyze the changes in paraspinal muscles of acute and chronic low back pain patients using MRI, and to provide clinical basic data for diagnosis and treatment for low back pain. For this purpose, 20 patients with acute low back pain frome August 2012 to January 2013 which occurred within 12 weeks, and 20 patients with chronic low back pain that progressed over 12 weeks, were chosen as subjects, and their MRI measurements were compared with one another. As a result, in relation to in the fatty degeneration ratio of the left spine and right spine, there were significant differences in erector spinae and multifidus(p<.001), and in relation to the Fat Infiltration ratio between all the groups, there were significant differences in psoas major, erector spinae and multifidus between the acute low back pain patient group and the chronic low back pain patient group(p<.001). In the post-hoc test, multifidus and erector spinae in the acute low back pain group and chronic low back pain group showed the highest Fat Infiltration ratio. The serious Fat Infiltration of multifidus and erector spinae in the chronic low back pain group led to weakened strength of muscles that stabilize the spine. In conclusion, it is considered that this study would present important data and basis in making acute and chronic low back pain patients pay more attention to multifidus and psoas major during rehabilitation exercise, and selecting a rehabilitation exercise program.

본 연구는 MRI를 사용하여 급성 및 만성 요통환자들의 척추주변근육에 나타나는 변화를 정량적으로 측정 및 분석하고 이를 토대로 요통에 대한 진단 및 치료에 임상적 기초자료를 제공하고자 2012년 8월부터 2013년 1월까지 내원한 환자로 요통이 발생한지 12주 이내의 급성요통환자 20명과 요통이 발생한지 12주 이상 경과된 만성 요통 환자 20명을 대상자로 선정하여 MRI를 촬영한 후 측정하여 비교하였다. 왼쪽과 오른쪽의 지방변성율에서는 척추세움근과 뭇갈래근에서 유의한 차이가 있었고(p<.001), 전체 집단 간 지방변성율 비교에서도 급성요통군과 만성요통군간의 큰허리근, 척추세움근, 뭇갈래근에서 유의한 차이가 있었다(p<.001). 사후검정에서는 급성요통군과 만성요통군에서 각각 다열근과 척추세움근의 지방변성율이 가장 높은 것으로 나타났다. 만성 요통군에서 다열근과 척추기립근의 심한 지방율의 변성은 척추의 안정성을 유지하는 근육의 근력 약화로 나타나는데 본 연구결과를 토대로 급성 만성요통환자들의 재활운동과정에 있어서 뭇갈래근, 급성 요통군은 뭇갈래근과 큰허리근에 더 주의를 기울이고 재활운동 선정 과정에서 중요한 자료와 근거를 제시 할 수 있으라고 사료된다.

Keywords

References

  1. Deyo RA, Rainville J, Kent DL, What can the history and physical examination tell us about low back pain?. The journal of the American Medical Association, Vol. 268, No. 6, pp. 760-5, 1992. https://doi.org/10.1001/jama.1992.03490060092030
  2. S. Y. Jeong, Z. W. Park, J. M. Shin et al, The comparative study of effectiveness between acupuncture and its cotreatment with calculus Bovis . Fel Ursi . Moschus pharmacopuncture on the treatment of acute low back pain. The Journal of Korean Acupuncture & Moxibustion Society, Vol. 28, No. 4, pp. 105-10, 2011.
  3. Meerding WJ, Bonneux L, Polder JJ et al, Demographic and epidemiological determinants of healthcare costs in Netherlands: cost of illness study. Clinical research ed, Vol. 317, No. 7151, pp. 111-5, 1998. https://doi.org/10.1136/bmj.317.7151.111
  4. Udermann BE, Graves JE, Donelson RG et al, Pelvic restraint effecton lumbar gluteal and hamstring muscle electromyographic activation. Archives of physical medicine and rehabilitation, Vol. 80, No. 4, pp.428-431, 1999. https://doi.org/10.1016/S0003-9993(99)90280-0
  5. Gill KP, Callaghan MJ, The measurement of lumbar proprioception in individuals with and without low back pain. Spine(Phila Pa 1976), Vol. 23, No. 3, pp. 371-377, 1998. https://doi.org/10.1097/00007632-199802010-00017
  6. Bilodeau M, Schindler-Ivens S, Williams DM et al, EMG frequency content changes with increasing force and during fatigue in the quadriceps femoris muscle of men and women. Journal of electromyography and kinesiology, Vol. 13, No. 1, pp. 83-92, 2003. https://doi.org/10.1016/S1050-6411(02)00050-0
  7. Moore BD, Drouin J, Gansneder BM et al, The differential effects of fatigue on reflex response timing and amplitude in males and females. Journal of electromyography and kinesiology, Vol. 12, No. 5, pp. 351-60, 2002. https://doi.org/10.1016/S1050-6411(02)00032-9
  8. Lonn L, Starck G, Alpsten M et al, Determination of tissue volumes. A comparison between CT and MR imaging. Acta radiologica, Vol. 40, No. 3, pp. 314-21, 1999. https://doi.org/10.3109/02841859909175560
  9. Mitsiopoulos N, Baumgartner RN, Heymsfield SB et al, Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. Journal of applied physiology, Vol. 85, No. 1, pp. 115-22, 1998. https://doi.org/10.1152/jappl.1998.85.1.115
  10. Phoenix J, Betal D, Roberts N et al, Objective quantification of muscle and fat in human dystrophic muscle by magnetic resonance image analysis. Muscle & Nerve, Vol. 19, No. 3, pp. 302-10, 1996. https://doi.org/10.1002/(SICI)1097-4598(199603)19:3<302::AID-MUS4>3.0.CO;2-H
  11. Kjaer P, Bendix T, Sorensen JS et al, Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?. BMC medicine, Vol. 25, 2007.
  12. D. J. Yang, Quantitative analysis of lumbar multifidus atrophy with low back pain patients using Magnetic Resonance Image. The journal of Korean Society of Physical Therapy, Vol. 5, No. 4, pp. 615-21, 2010.
  13. Kamaz M, Kiresi D, Oguz H et al, CT measurement of trunk muscle areas in patients with chronic low back pain. Diagnostic and Interventional radiology, Vol. 13, No. 3, pp. 144-8, 2007.
  14. Chan ST, Fung PK, Ng NY et al, Dynamic changes of elasticity, cross-sectional area, and fat infiltration of multifidus at different postures in men with chronic low back pain. The spine journal, Vol. 12, No. 5, pp. 381-88, 2011.
  15. H. S. Park, B. Y. Lee, The Clinical Study on the Efficacy of the Dong-Si Acupuncture Treatment. The Journal of Korean Acupuncture & Moxibustion Society, Vol. 14, No. 2, pp. 15-34, 1997.
  16. Videman T, Nurminen M, Troup JD, Lumbar spinal pathology in cadaveric material in relation to history of back pain, occupation, and physical loading. Spine, Vol. 15, No. 8, pp. 728-40, 1990.
  17. Takemitsu Y, Harada Y, Iwahara T et al, Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine, Vol. 13, No. 11, pp. 1317-26, 1988. https://doi.org/10.1097/00007632-198811000-00019
  18. Nakamura T, Kurosawa H, Kawahara H et al, Muscle fiber atrophy in the quadriceps in knee-joint disorders. Histochemical studies on 112 cases. Archives of Orthopaedic and Thaumatic Surgery, Vol. 105, No. 3, pp. 163-9, 1986. https://doi.org/10.1007/BF00433935
  19. J. H. Bae, J. K. Na, J. Y. Yu et al, Atrophy of multifidus muscle on low back pain patients. The Journal of Korean Academy of Rehabilitation Medicine, Vol. 25, No. 4, pp. 684-691, 2001.
  20. J. Y. Kwon, K. W. Lee, H. S. Kim et al, Correlation between Cross-sectional Areas of Paraspinal Muscles and Isometric Lumbar Extension Strength. The Journal of Korean Academy of Rehabilitation Medicine, Vol. 24, No. 2, pp. 275-280, 2000.
  21. T. R. Han, J. H. Kim, S. G. Chung et al, Correlation of ultrasonographic measure of lumbar multifidus muscles with isometric torque of low back. The Journal of Korean Academy of Rehabilitation Medicine, Vol. 23, No. 4, pp. 809-814, 1999.
  22. Lamminen AE, Magnetic resonance imaging of primary skeletal muscle disease; patterns of distribution and severity of involvement. The British journal of radiology, Vol. 63, No. 756, pp. 946-50, 1990. https://doi.org/10.1259/0007-1285-63-756-946
  23. Kader DF, Wardlow D, Smith FW, Correlation between the MRI changes in the lumbar multifidus muscle and leg pain. Clinical radiology, Vol. 55, No. 2, pp. 145-9, 2000. https://doi.org/10.1053/crad.1999.0340
  24. Cooper RG, St Clair Forbes W, Jayson MI. Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. British journal of rheumatology, Vol. 31, No. 6, pp. 1247-53, 1992.
  25. Gibbons LE, Latikka P, Videman T et al, The association of trunk muscle cross-sectional area and magnetic resonance image parameters with isokinetic and psychophysical lifting strength and static back muscle endurance in men. Journal of spinal disorders, Vol. 10, No. 5, pp. 398-403, 1997.
  26. Ebenbichler GR, Oddsson LI, Kollmitzer J et al, Sensory-motor control of the lower back: implications for rehabilitation. Medicine and Science in Sports and Exercise, Vol. 33, No. 11, pp. 1889-98, 2001. https://doi.org/10.1097/00005768-200111000-00014
  27. Parkkola R, Rytokoski U, Kormano M, Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine(Phila Pa 1976), Vol. 18, No. 7, pp. 830-6, 1993. https://doi.org/10.1097/00007632-199306000-00004
  28. Parkkola R, Kormano M, Lumbar disc and back muscle degeneration on MRI: correlation to age and body mass. Journal of spinal disorder, Vol. 5, No. 1, pp. 86-92, 1992. https://doi.org/10.1097/00002517-199203000-00011
  29. McGill SM, The biomechanics of low back injury: implications on current practice in industry and the clinic. Journal of biomechanics, Vol. 30, No. 5, pp. 465-75, 1997. https://doi.org/10.1016/S0021-9290(96)00172-8
  30. O'Sullivan PB, Phyty GD, Twomey LT et al, Evaluation of specific stabilising exercise in the treatment of chronic low back pain with radiological diagnosis of spondylolysis and spondylolisthesis. Spine(Phila Pa 1976), Vol. 15, No. 24, pp. 2959-67, 1997.
  31. S. Y. Kim, J. H. Kwon. Lumbar stablization exercise using the sling system. The Journal of Korean Academy of Orthopedic Manual Therapy, Vol. 7, No. 2, pp. 23-39, 2001.
  32. Kil-Joon Lee, Study on the correlation between the multifidus muscle atrophy on low back pain patients and the magnetic resonance image. Donnuk University Graduate School. Dissertation of Master's Degree, 2009.
  33. Hides JA, Richardson CA, Jull GA, Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine(PhilaPa1976), Vol. 21, No. 23, pp. 2763-9, 1996.
  34. S. I. Park, W. Y. Lee, H. S. Kim et al, Quantitative correlations of trunk muscle in young and middle-aged men with chronic low back pain by magnetic resonance imaging. The Journal of Korean Academy of Rehabilitation Medicine, Vol. 31, No. 1, pp. 1-5, 2007.

Cited by

  1. The Convergence Study on the Effects of Three Pelvic Floor Muscle Excercise on Thickness of Pelvic Floor Muscle and Abdominal Muscles vol.7, pp.1, 2016, https://doi.org/10.15207/JKCS.2016.7.1.105
  2. Clinical and cost-effectiveness of collaborative traditional Korean and Western medicine treatment for low back pain vol.97, pp.39, 2018, https://doi.org/10.1097/MD.0000000000012595