背部疼痛先兆能否预示脊柱损伤?

作     者：Moseley G.L. Nicholas M.K. Hodges P.W. 江山 

作者机构：School of Physiotherapy University of Sydney PO Box 170 Lidco mbe NSW 1825 Australia 

出 版 物：《世界核心医学期刊文摘（神经病学分册）》 (Digest of the World Core Medical Journals:Clinical Neurology)

年 卷 期：2005年第1卷第3期

页      面：35-35页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：脊柱损伤 躯干肌肉 肢体运动 间歇期 背痛 健康受试者 重复运动 中枢神经系统 臂运动 深部肌肉 

摘      要：Limb movement imparts a perturbation to the body. The impact of that perturbat ion is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pai n, even when they are pain free. The altered postural strategy probably serves t o protect the spine in the short term, but it is associated with a cost and is t hought to predispose spinal structures to injury in the long term. It is not kno wn why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscl es during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, f or single arm movements there was delayed activation of the deep trunk muscles a nd augmentation of at least one superficial trunk muscle. For repetitive arm mov ements, there was decreased activity and a shift from biphasic to monophasic act ivation of the deep trunk muscles and increased activity of superficial trunk mu scles during anticipation of back pain. In both instances, the changes were cons istent with adoption of an altered strategy for postural control and were simila r to those observed in patients with recurrent back pain. We conclude that antic ipation of experimental back pain evokes a protective postural strategy that sti ffens the spine. This protective strategy is associated with compressive cost an d is thought to predispose to spinal injury if maintained long term.