The pain intensity decreased significantly under the post–intervention compared with the pre–intervention (ADIM training: pre = 55.90 ± 8.31 mm, post = 18.18 ± 6.03 mm, t (10) = 11.57, p < 0.01, d = 3.49; ADIM training plus TFL–ITB self–
stretching: pre = 54.54 ± 10.11 mm, post = 21.36 ± 9.51 mm, t (10) = 11.21, p < 0.01, d = 3.37). The pain intensity rating was lower in the ADIM training plus TFL–ITB
self–stretching group than in the ADIM training group; however, the difference was not statistically significant (ADIM training: mean difference = 37.72 ± 10.80 mm;
ADIM training plus TFL–ITB self–stretching: mean difference = 33.18 ± 9.81 mm, t (20) = 1.03, p = 0.31, d = 0.44, Figure 7).
- 20 -
Figure 4. Lumbopelvic rotation angle between–
group differences (A: Abdominal drawing–in maneuver training group, B: Abdominal drawing–in maneuver training plus tensor fasciae latae–
iliotibial band self–stretching group)
*p = 0.01.
Figure 5. Lumbopelvic rotation movement onset between–group differences (A: Ab-dominal drawing–in maneuver train-ing group, B: Abdominal drawtrain-ing–in maneuver training plus tensor fasciae latae–iliotibial band self–stretching group) *p = 0.03.
Figure 6. Tensor fasciae latae–iliotibial band length between–group differences (A:
Abdominal drawing–in maneuver training group, B: Abdominal drawing–in maneuver training plus tensor fasciae latae–iliotibial band self–stretching group) *p < 0.01.
Figure 7. Pain intensity between–group differences (A: Abdominal drawing–in maneuver training group, B: Abdominal drawing–
in maneuver training plus tensor fasciae latae–iliotibial band self–stretching group).
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Discussion
The purpose of the present study was to compare the effect of a 2–week intervention with ADIM training or ADIM training plus TFL–ITB self–stretching on lumbopelvic rotation angle, lumbopelvic rotation movement onset, TFL–ITB length, and pain intensity during active prone HLR in people with lumbar extension rotation syndrome accompanying shortened TFL–ITB.
The pre–intervention lumbopelvic rotation angle during HLR was 4.94 ± 1.18° in the ADIM training group and 5.48 ± 0.92° in the ADIM training plus TFL–ITB self–
stretching group. These results agree with previous reports of excessive lumbopelvic motion in people with lumbar extension rotation syndrome (Gombatto et al. 2006;
Harris–Hayes, Van Dillen, and Sahrmann 2005; Hoffman et al. 2011; Scholtes et al.
2010; Van Dillen et al. 2007). Following the intervention in our study, lumbopelvic rotation was reduced to 1.82 ± 0.52° and 1.53 ± 0.26° in the ADIM training and ADIM training plus TFL–ITB self–stretching groups, respectively. Our results indicate that the lumbopelvic rotation angle decreased significantly following both interventions. Lumbopelvic rotation angle between–group differences were 3.12 ± 0.73° in ADIM training and 3.95 ± 0.66° in ADIM training plus TFL–ITB self–
stretching. Our results indicate that the ADIM training plus TFL–ITB self–stretching decreased the lumbopelvic rotation angle significantly more than the ADIM training alone, although the difference was minimal. Our results suggest that an improved abdominal control and an elongated TFL–ITB could play a greater role in minimizing
the lumbopelvic rotation angle. Our findings are consistent with previous research showing that insufficient abdominal control and shortened TFL–ITB could contribute to increased lumbopelvic rotation during active HLR (Sahrmann 2002).
The pre–intervention lumbopelvic rotation movement onset during HLR was 1.53
± 0.38 s in the ADIM training group and 1.58 ± 0.22 s in the ADIM training plus TFL–ITB self–stretching group. This implies that the early lumbopelvic rotation movement onset could be attributed to the lack of control by the abdominal muscles and the shortened TFL–ITB. This finding concurs with the results of previous studies reporting that LBP is associated with early lumbopelvic rotation during active limb movement (Sahrmann 2002; Van Dillen et al. 2007; Van Dillen, Maluf, and Sahrmann 2009; Van Dillen, and Sahrmann 2006). The results of the present study showed that the lumbopelvic rotation movement onset was significantly delayed following both interventions, suggesting that both abdominal control and stretching of the TFL–ITB contribute to the delayed lumbopelvic rotation movement onset.
Moreover, our results showed that ADIM training plus TFL–ITB self–stretching delayed the lumbopelvic rotation movement onset significantly more than the ADIM training alone, although the difference was minimal. The current study suggests that treatment may require not only training of the abdominal control, but also stretching of the TFL–ITB to delay the lumbopelvic rotation movement onset during the HLR.
The ADIM training plus TFL–ITB self–stretching group showed a significantly greater increase in the hip horizontal adduction angle than did the ADIM training alone group. The present study showed that ADIM training plus self–stretching the
- 24 -
TFL–ITB elongated the TFL–ITB. Shortening of the TFL increases ITB tension resulting in excessive lumbopelvic movement to compensate. Our results are consistent with those of a previous study showing that stretching in an upright standing position with arms extended overhead is an effective method for increasing TFL–ITB length (Fredericson et al. 2002).
The level of pain intensity determined using a VAS was significantly reduced following both interventions. The level of pain intensity was lower in the ADIM training plus TFL–ITB self–stretching group than in the ADIM training group;
however, the difference was not statistically significant. Our results suggest that the reduction in pain may be associated with a reduction compressive stress induced by restricted lumbopelvic rotation during HLR. Previous studies reported that people with lumbar extension rotation syndrome have a tendency to extend and rotate the lumbar spine during lower–extremity movements. Furthemore, repetitive movement in a specific direction contributes to cumulative microtrauma of the lumbar tissue and eventually results in LBP (Maluf, Sahrmann, and Van Dillen 2000; Mueller, and Maluf, 2002).
The present study has several limitations. First, we studied the effect of the ADIM training and self–stretching the TFL–ITB using a standardized movement test, and it is not clear whether our results can be generalized to other functional activities in subjects with lumbar extension rotation syndrome. Second, in our measurement of the lumbopelvic rotation motion, the angle was calculated based on movement of the level of posterior superior iliac spine marker and did not account for motion of the
upper trunk that may have contributed to lumbopelvic rotation. Third, the present study used surface markers to index bone movement; thus, artifacts resulting from skin movement were present. Because the lumbopelvic rotation movement was small, skin movement artifacts may have had an impact on our outcome measure. Finally, the 2–week test period was a short–term intervention. Further research is needed to determine the long–term effect of ADIM training and self–stretching the TFL–ITB on lumbopelvic kinematics during HLR in subjects with lumbar extension rotation syndrome.
- 26 -
Conclusion
The present study compared the effect of a 2–week intervention with ADIM training or ADIM training plus TFL–ITB self–stretching on lumbopelvic rotation angle, lumbopelvic rotation movement onset, TFL–ITB length, and pain intensity during active prone HLR in people with lumbar extension rotation syndrome accompanying shortened TFL–ITB. The results indicate that compared with ADIM training alone, ADIM training plus TFL–ITB self–stretching significantly decreased the lumbopelvic rotation angle, delayed the lumbopelvic rotation movement onset, and elongated the TFL–ITB. The reported decrease in pain intensity was greater in the ADIM training plus TFL–ITB self–stretching group than in the ADIM training group; however, the difference was not significant. In conclusion, ADIM training plus TFL–ITB self–stretching performed for a period of 2 weeks may be an effective treatment for modifying lumbopelvic motion and reducing LBP.
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- 36 - 국문 요약
요추 신전 회전 증후군을 가진 대상자에게 복부 당기기 방법과 대퇴 근막 긴장근-장경인대 자가신장
운동이 요추골반 운동형상학에 미치는 영향
연세대학교 대학원 물리치료학과
임 원 빈
본 연구의 목적은 대퇴 근막 긴장근-장경인대가 짧은 요추 신전 회전 증후군 대상자에게 엎드린 자세에서 능동 고관절 외회전 시 복부 당기기 방법과 대퇴 근막 긴장근-장경인대 자가신장 운동이 요추골반 회전 각도, 요추골반 회전 움직임 개시시간, 대퇴 근막 긴장근-장경인대 길이, 통증 강도에 미치는 영향을 비교하는 것이다. 본 연구를 위해 대퇴 근막 긴장근-장경인대가 짧은 요추 신전 회전 증후군이 있는 22명의 대상자(남자 16명과 여자 6명)가 참여하였다. 대상자들은 2주간 집에서
수행될 복부 당기기 방법과 대퇴 근막 긴장근-장경인대 자가신장 운동 수행 방법을 교육받았다. 3차원 초음파 동작 분석기는 요추골반 회전 각도,
요추골반 회전 움직임 개시시간을 측정하는데 사용하였다. 독립 t-검정은
결과분석(요추골반 회전 각도, 요추골반 회전 움직임 개시시간, 대퇴 근막 긴장근-장경인대 길이, 통증 강도)에 대한 집단 간 차이를 알아보기 위해
사용하였다. 통계학적 유의수준 α = 0.05로 하였다. 연구 결과 복부
당기기 방법만 적용하였을 때보다 복부 당기기 방법과 대퇴 근막 긴장근-장경인대 자가신장 운동을 함께 적용하였을 때, 요추골반 회전 각도는 유의하게 감소하였고, 요추골반 회전 움직임 개시시간은 유의하게 지연되었으며, 대퇴 근막 긴장근-장경인대 길이는 유의하게 신장되었고, 통증 강도는 감소하였지만 유의미한 차이는 보이지 않았다. 결론적으로, 2주간 복부 당기기 방법과 대퇴 근막 긴장근-장경인대 자가신장 운동을 함께 적용한 중재방법이 요추골반 움직임을 교정하고 요통을 감소시키는데 효과적인 중재방법으로 사료된다.
핵심 되는 말: 대퇴 근막 긴장근-장경인대, 복부 당기기 방법, 요추 신전 회전 증후군, 요추골반 운동형상학.