만성요통환자와 정상인의 요부신전근력과 주관적 통증정도의 차이에 의한 재활치료 목표치 설정

지용석;윤진환;임재형

  • Published : 20030000

Abstract

Jee, Y.S., Yoon, J.H., Im, J.H. Establishment of rehabilitative object through the differences of lumbar extension strength & subjective pain degrees between chronic low back pain patients and normal group. Exercise Science, 12(2): 319-330, 2003. The purpose of this study was to manifest the differences of lumbar extension strength and subjective pain degrees between chronic low back pain patients and normal group. The subjects were total 94. They were 44 patients(male 24, female 20) and 50 comparative healthy men (male 23, female 27). We got the results of subjective pain degree using the modified visual analogue scale(MVAS) and measured the maximal isometric lumbar strength of all subjects using MedX lumbar extension machine(Ocala, FL). Results were as followed: The chronic low back pain patients' groups included males and females had lower lumbar extension strength than that of normal control groups included males and females. The statistical significant(p<.01) differences were manifested in $0^{\circ}$, $12^{\circ}$, $24^{\circ}$, $36^{\circ}$, $48^{\circ}$, $60^{\circ}$ and $72^{\circ}$angles. The chronic low back pain patients' groups included males and females had higher subjective pain degree than that of normal control groups included males and females. The statistical significant(p<.01, p<.05) differences were manifested in 15 questionnaires. As a conclusions, when planning the lumbar rehabilitation program for LBP patients, it should be favorable to measure the lumbar extension strength and MVAS. Also if the program is progressing, the improvement objective of lumbar extension strength should be 27$\%$~48$\%$ in male and 31$\%$~44$\%$ in female.

지용석, 윤진환, 임재형. 만성요통환자와 정상인에 있어 요부 신전근력과 주관적 통증정도의 차이 관찰 후 재활치료시 목표치 설정. 운동과학. 제12권 제2호, 319-330, 2003. 본 연구는 1998년 12월 24일부터 1999년 3월 25일 사이에 S병원에 내원한 환자들 중에서 본원 운동처방과에 참여한 만성요통환자 44명(남 24, 여 20)과 요부에 문제가 없는 정상인 50명(남 23, 여 27)을 대상으로 요부신전근력과 주관적 통증정도에 어떠한 차이가 있는지를 밝혀 재활치료시 목표치를 구하는데 목적이 있었다. 이러한 연구 목적을 토대로 일련의 실험과정을 마친 결과 다음과 같은 결론을 얻었다. 첫째, 만성요통환자들은 정상인들에 비해 남녀 모두 낮은 요부신전근력을 가지고 있었는데, 구체적으로 요부굴곡/신전비가 환자군 남성의 경우 2.49:1, 여성의 경우 2.29:1이었다. 둘째, 만성요통환자들은 정상인들에 비해 남녀 모두 각도별 낮은 요부신전근력을 가지고 있었는데, 구체적으로 $0^{\circ}$에서 남성 48$\%$, 여성 44$\%$, $12^{\circ}$에서 남성 34$\%$, 여성 31$\%$, $24^{\circ}$에서 남성 31$\%$, 여성 32$\%$, $36^{\circ}$에서 남성 30$\%$, 여성 32$\%$, $48^{\circ}$에서 남성 27$\%$, 여성 33$\%$, $60^{\circ}$에서 남성 29$\%$, 여성 34$\%$, $72^{\circ}$에서는 남성 32$\%$, 여성 36$\%$ 낮았으며, 통계적으로 유의한(p<.01) 차이를 나타내었다. 셋째, 만성요통환자들은 정상인들에 비해 남녀 모두 높은 주관적 통증정도를 나타내었는데, 구체적으로 남성 환자의 경우 요통정도(back pain)부터 직무형태 수정정도(work modification)에 이르기까지 95~98$\%$ 높았고, 여성 환자의 경우는 15문항을 종합하여 최소 92~99$\%$까지 높았다. 결론적으로 만성요통환자들은 정상인에 비해 낮은 요부신전근력과 높은 통증정도를 가지고 있었으므로, 요통환자들을 대상으로 재활치료프로그램을 구성할 경우에는 각 요부굴곡 각도별 부족한 비율의 요부신전근력을 강화하는 것이 주관적 통증정도를 낮출 수 있는 과학적인 방법으로 생각된다.

Keywords

References

  1. 왕진만, 김동준(1995). Visual Analogue Scale(VAS)을 이용한 동통평가의 유용성, 대한척추외과학회지, 2(2): 177-184
  2. 정형외과학(1998). 대한정형외과학회, 최신의학사, 360-391
  3. 지용석, 유병규, 이완희(2002). 척추전방전위증 환자와 추간판탈출증 환자의 요부근 기능과 굴곡.신전근 비율에 관한 비교연구. 대한물리치료학회지, 14(3): 133-141
  4. 최희남, 유재현, 김명화, 지용석(2000). 8주간 등장성 운동이 요부근력과 주관적 통증정도에 미치는 영향, 운동과학회지, 9(1): 101-113
  5. Addison, R., & Schultz, A.(1980). Trunk strengths in patients seeking hospitalization for chronic low back disorders, Spine, 5: 539 https://doi.org/10.1097/00007632-198011000-00009
  6. Carpenter, D. M., Graves, J. E., Pollock, M. L., Leggett, S. H., Dan Foster, Bryon H., & Fulton, M. N.(1991). Effect of 12 and 20 weeks of resistance training on lumbar extension torque production, Physical Therapy, 71(8): 585-588
  7. Chaffin, D. B., Herrin, G. D., & Keyserling, W. M.(1978). Preemployment Strength Test, J. Occup. Med., 67: 403-406
  8. Donelson, R.(1990). The McKenzie approach to evaluating and treating low back pain, Orthop. Rev., 19: 681-686
  9. Framer, J. W.(1988). Back pain and sciatica, N. Engl. J. Med., 318: 291-300 https://doi.org/10.1056/NEJM198802043180506
  10. Graves, J. E., Pollock, M. L., Foster, D., Leggett, S. H., Carpenter, D. M., Rosemaria V., & Jones, A.(1990a). Effect of training frequency and specificity on isometric lumbar extension strength, Spine, 15: 504 https://doi.org/10.1097/00007632-199006000-00014
  11. Graves, J. E., Pollock, M. L., Carpenter, D. M., Leggett, S. H., Jones, A., & MacMillan, M.(1990b). Quantitative assessment of full range-of-motion isometric lumbar extension strength, Spine, 15(4): 289-294 https://doi.org/10.1097/00007632-199004000-00008
  12. Harvey, J., & Tanner, S.(1991). Low back pain in young athletes, Sports Med., 12(6): 394-406 https://doi.org/10.2165/00007256-199112060-00005
  13. Huskisson, E. C.(1974). Measurement of pain, Lancet, 2(7889): 1127-1131 https://doi.org/10.1016/S0140-6736(74)90884-8
  14. Jackson, C. P., & Brown, M. D.(1983). Is there a role for exercise in the treatment of patients with low back pain?, Clin. Ortho. Rel. Res., 179: 39-45 https://doi.org/10.1097/00003086-198310000-00007
  15. Japanese Orthopedic Association Committee(1984). Assesment of surgical treatment of low back pain, J. Jpn. Orthop. Asso., 58(10): 1183-1187
  16. Kraus, H., & Nagler, W.(1983). Evaluation an exercise program for back pain, Am. Family Phys., 28: 153-158
  17. Lawlis, G. F., Cuencas, R., Selby, D., & McCoy, C. E.(1989). The development of the Dallas pain questionnaire - an assesment of the impact of spinal pain on behavior, Spine, 14: 511-516 https://doi.org/10.1097/00007632-198905000-00007
  18. Mayer, T., Smith, S., Keeley, J., & Mooney, V. (1985). Quantification of lumbar function part 2: sagittal plane trunk strength in chronic low-back pain. Spine, 10: 765-772 https://doi.org/10.1097/00007632-198510000-00012
  19. Mayer, T., Gatchel, R., Mayer, H., Kishino, N., Keeley, J., & Mooney, V.(1987). A prospective two-year study of functional restoration in industrial low back injury, JAMA, 258: 1763-1767 https://doi.org/10.1001/jama.258.13.1763
  20. McKenzie, R. A.(1979). Prophylaxis in recurrent low back pain, N. Z. Med. J., 89: 22-23
  21. Million, R., Hall, W., Nilsen, K., Baker, R. D., & Jayson, M. I. V.(1982). Assesment of the progress of the back pain patients, Spine, 7: 204-212 https://doi.org/10.1097/00007632-198205000-00004
  22. Mooney, V.(1983). The syndromes of low back pain, Orthopedic Clinics North Am., 14(3): 505-515
  23. Nachemson, A. L.(1985). Advances in low back pain, Clinical Orthopedics, 193: 266-277
  24. Nelson, B. W.(1993). A rational approach to the treatment of low back pain, J. Musculoskeletal Med.., 67-82
  25. Nelson, B., O'Reilly, E., Miller, M., Hogan, M., Wegner, J., &. Kelly, C.(1995). The clinical effects of intensive, specific exercise on chronic back pain: a controlled study of 895 consecutive patients with 1-year follow-up. Orthopedics, 18: 971-981
  26. Peterson, C., Amundsen, L., & Schendel, M. (1987). Comparison of the effectiveness of two pelvic movement during maximal isometric trunk extension and flexion muscle contractions. Physical Therapy, 67: 534-539
  27. Pollock, M. L., Leggett, S. H., & Graves, J. E., et al.(1989). Effect of resistance training on lumbar extension strength, Am. J. Sports Med., 17: 624-629 https://doi.org/10.1177/036354658901700506
  28. Risch, S., Norvell, N., & Pollock, M.(1993). Lumbar strengthening in chronic low back pain patient: physiologic and psychological benefits. Spine, 18: 232-238 https://doi.org/10.1097/00007632-199302000-00010
  29. Rissanen, A., Alaranta, H., Sanio, P., & Harkonen, H.(1994). Isokinetic and non dynamometric tests in low back pain patients related to pain and disability index, Spine, 19: 1887-1896 https://doi.org/10.1097/00007632-199409000-00017
  30. Williams, P. C.(1965). The lumbosacral spine, emphasizing conservative management, McGraw-Hill, New York, 80-93
  31. Wyke, B.(1976). Neurological aspects of low back pain, in "The lumbar spine and back pain" Ed Jayson, M., Pitman Medical Pub. Co. 4-83