مقایسه اثر تمرینات کنترل حرکتی، تمرین در آب و تمرینات ترکیبی بر حس عمقی، دقت حسی و درد بیماران مبتلا به کمردرد مکانیکی مزمن

نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشجوی دکترای آسیب‌شناسی ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه خوارزمی، تهران، ایران

2 استادیار گروه حرکات اصلاحی و بیومکانیک ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه خوارزمی، تهران، ایران

3 دانشیار گروه حرکات اصلاحی و بیومکانیک ورزشی، دانشکده تربیت بدنی و علوم ورزشی، دانشگاه خوارزمی، تهران، ایران

4 استادیار بیومکانیک ورزشی، بخش علوم ورزشی، دانشکده علوم تربیتی و روانشناسی، دانشگاه شیراز،شیراز،ایران

چکیده

مقدمه و اهداف
بیماران مبتلا به کمردرد مکانیکی مزمن دچار اختلال در حس عمقی و دقت حسی می­باشند و این اختلالات با میزان درد این بیماران ارتباط دارد. هدف از مطالعه حاضر مقایسه اثربخشی تمرینات کنترل حرکتی، تمرین در آب و تمرینات ترکیبی بر حس عمقی، دقت حسی و درد بیماران مبتلا به کمردرد مکانیکی مزمن می­باشد.
مواد و روش­ ها
چهل و هشت بیمار مبتلا به کمردرد مکانیکی با استفاده از پرسش­نامه استوری انتخاب شدند و به طور تصادفی به چهار گروه تمرینات کنترل حرکتی (12 نفر)، تمرین در آب (12 نفر)، تمرینات ترکیبی (11 نفر) و گروه کنترل (13 نفر) تقسیم شدند. هر سه گروه تمرینی هشت هفته تمرین تعیین­شده را انجام دادند و گروه کنترل هیچ تمرینی انجام نداد. برای سنجش حس عمقی، دقت حسی و درد بیماران به ترتیب از گونیامتر، کالیپر و مقیاس آنالوگ بصری استفاده شد. برای مقایسه­های درون گروهی بین متغیرها از آزمون t زوجی و برای مقایسه­های بین گروهی متغیرها از آزمون تحلیل واریانس یک­طرفه استفاده شد (05/0≥آلفا).
یافته­ ها
نتایج تحقیق نشان داد تفاوت معناداری بین پیش­آزمون و پس­آزمون گروه­های تمرینی در مقایسه با گروه کنترل در متغیر درد (007/0=P)، حس عمقی (005/0=P) و دقت حسی (008/0=P) وجود دارد، اما بین سه گروه تفاوت معناداری مشاهده نشد.
نتیجه ­گیری
تمرین در آب، تمرینات کنترل حرکتی و تمرینات ترکیبی بر کاهش درد و افزایش حس عمقی و دقت حسی بیماران مبتلا به کمردرد مکانیکی اثرگذار بوده و هر سه روش تمرینی بر درمان کمردرد مزمن غیراختصاصی اثرگذار می­باشد.

کلیدواژه‌ها

موضوعات


عنوان مقاله [English]

Comparative Effect of Motor Control and Water Exercise on Proprioception, Sensory Acuity, and Pain in Patients with Nonspecific Chronic Low Back Pain

نویسندگان [English]

  • Seyedeh Yasaman Asadi 1
  • Amir Letafatkar2 Letafatkar 2
  • Sadrodin Shojaedin 3
  • Ali Abbasi 2
  • fereshteh eftekhari 4
1 PhD Student of Corrective Exercise and Sport Injury, Faculty of Sport Education, Kharazmi University, Tehran, Iran
2 Assistant Professor of Corrective Exercise and Sport Biomechanic, Faculty of Sport Education, Kharazmi University, Tehran, Iran
3 Associate Professor of Corrective Exercise and Sport Biomechanic, Faculty of Sport Education, Kharazmi University, Tehran, Iran
4 Assistant Professor of Sport biomechanics,Department of Sport sciences, School of Education and psychology, Shiraz University, Shiraz,Iran
چکیده [English]

Background and Aim: Patients with chronic mechanical low back pain experience disorder in proprioception and sensory acuity and these disorders are associated with pain in these patients. The aim of the present study was to compare the effectiveness of motor control exercises, exercise in water, and combined exercises on proprioception, sensory acuity, and pain in patients with chronic mechanical low back pain.
Materials and Methods: In the current study, patients with mechanical low back pain were selected using Oswestry Questionnaire. They were randomly assigned into four groups of motor control exercises (n=12), exercise in water (n=12), combined exercises (n=11), and control group (n=13). All three exercise groups performed eight weeks of determined exercise but the control group did not perform any exercise. To assess proprioception, sensory acuity, and pain in the patients, goniometer, caliper, and the Visual Analog Scale were used, respectively. For intra-group comparison of pre-test and post-test variables, paired t-test was used, and for inter-group comparison of variables, ANOVA test was used (Alpha ≤ 0.05).
Results: The results of the present study showed a significant difference between the pre-test and post-test of exercise groups compared with those of the control group in the variables of pain (p=0.007), proprioception (p=0.005), and sensory acuity (p=0.008). However, no significant difference was found among the three groups.
Conclusion: As a result, exercise in water, motor control exercises, and combined exercises were effective in alleviating the pain and increasing proprioception and sensory acuity of patients with mechanical low back pain, and all the three exercise methods were effective in the treatment of non-specific chronic low back pain.
 

کلیدواژه‌ها [English]

  • Motor Control Exercise
  • Exercise in Water
  • Proprioception
  • Sensory Acuity
  1. Hirata RP, Salomoni SE, Christensen SW, Graven-Nielsen T. Reorganized motor control strategies of trunk muscles due to acute low back pain. Human Movement Science, 2015; 41: 282-294.##
  2. Nazarzadeh M, Letaftkar A, Saboonchi R. The effect of Sensory-motor training in proprioceptive and Neuromuscular cooperation in nonspecific low back patients. Sport Medicine Studies Journal, 2014;14:77-81. [In Persian] ##
  3. O'Sullivan P. B. Diagnosis and classification of chronic low back pain disorders: Maladaptive movement and motor control impairments as underlying mechanism. Manual Therapy. 2005; 10(4): 242-255. ##
  4. O'Sullivan P. B. Masterclass. Lumbar segmental 'instability': Clinical presentation and specific stabilizing exercise management. Manual Therapy, 2000; 5(1), 2-12. ##
  5. Saner J, Kool J, Sieben J, Luomajoki H. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomized controlled trial with one-year follow up. Manual Therapy ,2015; 1-8. ##
  6. Macedo L, Latimer J, Maher C, Hodges P, McAuley J, Nicholas M, Tonkin L, Stanton C, Stanton T, Stafford R. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: A randomized controlled trial. Journal of American Physical Therapy Association, 2015; 92( 3):363-631. ##
  7. Silfies SP, Squillante D, Maurer P, Westcott S, Karduna AR. Trunk muscle recruitment patterns in specific chronic low back pain populations. Clin Biomech (Bristol, Avon), 2005 ; 20(5):465-73. ##
  8. Braga A.B, Rodrigues A.C, Lima G.V, Melo L.R, Carvalho A.R, Bertolini G.R. Comparison of static postural balance between healthy subjects and those with low back pain. Acta Ortop Bras, 2012;20(4): 210-212##
  9. Madigan ML, Davidson BS, Nussbaum MA. Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue. Hum Mov Sci, 2006; 25(6):788-99. ##

10. Wand B.M, Catley M.J, Luomajoki H.A, O'Sullivan, Pietro F.D, O'Connell N.E, Moseley G.L. Lumbar tactile acuity is near identical between sides in healthy pain-free participants. Manual Therapy, 2014;3:1-4. ##

11. Louw A, Farrell K, Wettach L, Uhl J, Majkowski k, Welding M. Immediate effects of sensory discrimination for chronic low back pain: a case series. New Zealand Journal of Physiotherapy, 2015;43(2):58-63. ##

12. Wand B.M, Abbaszadeh S, Smith A.J, Catley M.J, Mosely G.L. Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patient with chronic low back pain more than acupuncture alone: a randomized cross-over experiment. Br.J.Med, 2013;47:1085-1089. ##

13. Gutknecht M, Manning A, Waldvogel A, Luomajoki H. The effect of motor control and tactile acuity training on patient with non-specific low back pain and movement control impairment. Journal of Bodywork & movement Therapies, 2015 ;1-10. ##

14. Flahertty M, Connolly M. A Preliminary Investigation of Lumbar Tactile Acuity in Yoga Practitioners. International Journal of Yoga Therapy, 2014;24: 43-50##

15. Kerr, C. E., Shaw, J. R., Wasserman, R. H., Chen, V. W., Kanojia, A., Bayer, T., & Kelley, J. M. Tactile acuity in experienced Tai Chi practitioners: evidence for use dependent plasticity as an effect of sensory-attentional training. Experimental Brain Research, 2008;188(2): 317-322. ##

16. Halliday M.H, Ferreira P.A , Hancock M.J , Clare H.A. A randomized controlled trial comparing McKenzie therapy and motor control exercises on the recruitment of trunk muscles in people with chronic low back pain; a trial protocol. Physiotherapy, 2015;101: 232-238. ##

17. Wenig C.M, Schmidt C.O, Kohlmann T, Schweikert B. Costs of back pain in Germany. Eur. J. Pain , 2009; 13, 280-286. ##

18. Barker k.L, Dawes H, Hansford P, Shamley .Perceived and measured level of exertion of patient with chronic back pain exercising in a hydrotherapy pool. Arch Physs Med Rehabil, 2003; 84: 1319-1323. ##

19. Resende S.M, Rassi C.M, Viana F.P. Effects of hydrotherapy in balance and prevention of falls among elderly women. Rev Bras Fisioter ,São Carlos, 2008:12(1);57-63. ##

20. B.Beato P, Fernandez M, Gotto-Cardia M, Artero E. Effects of different frequencies (2-3`days/week) of aquatic therapy program in adults with chronic low back pain. A non-randomized comparison trial. Pain Medicine,2013;14: 145-158. ##

21.  Luomajoki H, & Moseley G. L. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. BritishJournal of Sports Medicine,2011; 45: 437-440. ##

22. Tondel U.M, Fladmark A, Salvesen O, Vasseljen O. Motor control exercises, Sling exercises, and general exercises for patient with chronic low back pain: A randomized controlled trial with 1-year follow up. Journal of the American Physical Therapy Association ,2010 ; 90:10:1426-1440. ##

23. Bystrom M, Rasmussen-Bar E, Grooten W. Motor control exercises reduces pain and disability in chronic and recurrent low back pain a meta-analysis. Spine, 2013; 38 (6): 350-358. ##

24. Kendall K, Emery C, Wiley J, Ferber Y. The effect of the addition of hip strengthening exercises to a lumbopelvice exercise programme for the treatment of non-specific low back pain: A randomized controlled trial. Journal of Science and Medicine in Sport, 2015;18(6):626-31##

25. lawand P, Lombardi Junior I, Jones A, Sardin C, Helena Ribeiro L, Natour J . Effect of muscle stretching program using the global postural reeducation method for patients with chronic low back pain: A randomized control trial. Joint Bone Spine, 2015;18: 272-277. ##

26. Hodges P. Which exercise for chronic low back pain? Motor control training interventional manual. Spinal Pain, Injury and Health, 2007;3-10. 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. ##

27. Costa L, Maher C, Latimer J, Hodges P, Herbert R, Refshauge K, McAuley J, Jennings M. Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial. Physical Therapy;2009;89(12):1-12. ##

28. Waller B, Lambeck J, Daly D. Treatment aquatic exercise the treatment of low back pain: A systematic review. Clin Rehabil, 2009;23(1):3-14. ##

29. Newcomer K, Laskowski E, Yu B, Johnson J. Differences in Repositioning Error Among Patients With Low Back Pain Compared With Control Subjects. Spine, 2000; 25(19): 2488-93. ##

30. Wand B.M, Pietro F.D, George P, O'Connell N.E. Tactile thresholds are preserved yet complex sensory function is impaired over the lumbar spine of chronic non-specific low back pain patients: a preliminary investigation. Physiotherapy, 2010;96;317-323. ##

31. Streicher H, Matzold F, Hamilton D, Wagner P. Comparison of group motor control training versus individual training for people suffering from back pain. Journal of Bodywork & Movement Therapies,2014;18:489-496. ##

32. Esbati N, Fallah Mohamadi Z, Sadeghpour B. The effect of one selected exercise therapy in water on pain and function of low back pain patients. Applied Sport Physiology Journal, 2009;5(9):7-17. [In Persian] ##

33. Sami S, Seyedebrahimi S, Veisi A. the comparison of hydrotherapy, relaxation therapy and Viliams exercises in improvement of athletic low back pain. Sport Medicine Studies Journal, 2011;10:23-44. [In Persian] ##

34.  Bello A, Kalu N, Adegoke B, Agyepong-Badu S. Hydrotherapy versus land-based exercise in the management of low back pain. Journal of Musculoskeletal Research, 2010; 13(4) :159-165. ##

35.  Han S, KiM M, SiK C. Comparison of Effects of a Proprioceptive Exercise Program in Water and on Land the Balance of Chronic Stroke Patient. J. Phys. Ther. Sci. 2013;25: 1219–1222. ##

36. Wright BA, Sabin AT . Perceptual learning: how much daily training is enough? Exp Brain Res,2007; 180(4):727–736. ##

37. Moseley, G. L., & Flor, H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation and Neural Repair,2012;26(6): 646-652.ر

38. Puta C, Schuls B, Schoeler S, Magert W, Gabriel B, Gabriel H, Miltner Wweisiss T. Somatosensory abnormalities for painful and innocuous stimuli at the back and at site distinct from the region of pain in chronic back pain patient. PloS One , 2013; e 58885. ##

39. Moseley G.l, Gsllagher L, Gallace A. Neglect like tactile dysfunction in chronic back pain. Neurology, 2012;79:327-332##

40. Shumway-Cook, A., & Woollacott, M.H. Motor Control, Translating Research in Clinical Practice (3rd ed.). Philadelphia: Lippincott Williams and Wilkins, 2007; 141-158. ##

دوره 7، شماره 1
فروردین و اردیبهشت 1397
صفحه 170-182
  • تاریخ دریافت: 29 فروردین 1396
  • تاریخ بازنگری: 17 خرداد 1396
  • تاریخ پذیرش: 03 تیر 1396
  • تاریخ اولین انتشار: 01 فروردین 1397