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系統識別號 U0026-1701201112060200
論文名稱(中文) 髂腰肌鬆動術於運動員背痛之療效研究:從促進背部功能、動作控制策略、與止痛效果談起
論文名稱(英文) The effects of iliopsoas release treatment for athletes with non-specific backache: focusing on pain reduction and the improvement in back function and motor control strategies
校院名稱 成功大學
系所名稱(中) 物理治療研究所
系所名稱(英) Department of Physical Therapy
學年度 99
學期 1
出版年 100
研究生(中文) 李建興
研究生(英文) Chien-Hsing Li
學號 t6697104
學位類別 碩士
語文別 中文
論文頁數 121頁
口試委員 指導教授-陳文玲
口試委員-林啟禎
口試委員-蔡一如
中文關鍵字 髂腰肌緊縮  下背痛  腰椎前凸 
英文關鍵字 iliopsoas tightness  low back pain  lumbar lordosis 
學科別分類
中文摘要 研究背景: 髂腰肌緊縮是導致運動員姿勢性相關背痛常見的原因之一。許多文獻指出髂腰肌緊縮將導致腰椎前凸加劇,而衍生出包括疼痛、腰椎失穩、以及骨盆周圍相關肌群之柔軟度與肌力不足等相關臨床症狀。此外,就動作策略而言,於俯臥姿下,進行髖伸直動作會呈現上腰椎背肌群代償性過度用力的現象;再則,過去研究指出下背痛患者普遍會於腰椎完全彎曲動作期間出現背部肌肉之平均活動強度偏高無法完全放鬆的現象,然而,至今仍未有文獻針對此類罹患髂腰肌緊縮性背痛的運動員,探討髂腰肌相關治療在相關臨床表徵與彎曲放鬆現象方面的療效。目的:本研究主要是要探討徒手治療技巧與髂腰肌相關治療計畫在罹患髂腰肌緊縮性背痛的運動員身上之療效。方法:本研究共徵召24位具兩年以上固定運動習慣,於髂腰肌有明顯壓痛點之非特定性背痛運動員,包括治療組15人及控制組9人。所有受試者均於治療前接受物理檢查與生物力學測量,包括疼痛狀態評估、背痛功能問卷評估、相關柔軟度評估、局部肌力評估、薦椎傾斜角評估、腰椎最大活動度評估以及背部肌肉活動模式評估(含俯臥姿髖伸直動作以及軀幹屈曲動作)。治療組於首次評估後,接受約 20 分鐘的髂腰肌徒手治療並立即進行再次評估,以檢定髂腰肌徒手治療技巧之立即性療效,而後繼續接受每週二回且為期三週之髂腰肌徒手治療計畫;控制組則於三週期間未接受任何治療介入。所有受試者均於三週後接受最後之評估。 結果:在單回治療之立即性效應方面,受試者經單次髂腰肌徒手治療技巧後,均立即呈現疼痛顯著減輕,彎曲放鬆過程之角度位移顯著增加(p<0.05)。至於三週之短期療效方面,治療組經治療後,於疼痛狀態、Oswestry背部功能量表、髂腰肌柔軟度、局部肌力 (髖伸肌、髖屈肌、軀伸肌)、薦椎傾斜角等方面均呈現顯著進步(p<0.05)。此外於俯臥姿進行髖伸直動作過程中,上腰椎最大肌電訊號相對下腰椎 (對側邊) 呈現顯著下降的現象(p<0.05)。而在腰椎彎曲動作過程中,於靜止站立期(左側背直肌、右側背直肌)與完全彎曲期間(左側背直肌、右側多裂肌)之平均肌電訊號亦呈顯著降低(p<0.05);在彎曲放鬆過程之角度位移顯著增加((右側背直肌)(p<0.05),而呈現彎曲放鬆現象的人數比例亦從60%提高至73%。反觀對照組於三週後,僅於疼痛狀態及背部肌力方面呈現顯著改善(p<0.05),然而在其它臨床評估參數方面則未呈現顯著差異,且控制組之彎曲放鬆現象的人數比例則從67%減少至55%。結論:本研究之受試者經髂腰肌相關治療後,不僅有效改善疼痛及背部功能,同時,軀幹伸直肌力於疼痛顯著改善後有明顯地進步,且於腰椎完全彎曲期間之背肌高張現象亦相對降低。因此,本研究結果顯示,經髂腰肌相關治療後,可有效降低背部疼痛,且因疼痛而受抑制的背伸肌肌力能發揮其最佳表現,並有效改善因疼痛刺激所產生之肌肉痙攣現象(自主性保護反應)。此外,本研究經治療後,於髂腰肌柔軟度及薦椎傾斜角亦均獲得顯著療效。本研究除能提供證據支持髂腰肌治療理念能有效減輕下交叉症候群中肌肉失衡所引發之腰椎前凸問題與背痛源頭。另一方面,有關於俯臥姿髖伸直動作期間因腰椎過度前凸所衍生之上腰椎背肌群代償性過度收縮,或臀大肌肌力受抑制無法有效收縮等異常現象亦有改善,本研究顯示經矯正腰椎前凸後,明顯降低上腰椎背肌群之高肌電訊號強度,且髖伸肌肌力亦呈現顯著進步。綜上所述,本研究乃首次提出直接證據支持髂腰肌治療可有效改善背痛、背部功能、以及腰椎前凸姿者。顯見髂腰肌治療可廣泛應用於合併髂腰肌緊縮問題之背痛運動員來改善其背痛症狀或異常動作模式。
英文摘要 Background:Iliopsoas tightness is a common cause of lordotic posture-related backache in athletes. The iliopsoas tightness has been reported to demonstrate aggravated lumbar lordosis, which will result indirectly in other symptoms including pain, lumbar instability, decreased muscle strength and flexibility around pelvic region, overactivity of muscles in the upper lumbar area instead of the lower lumbar area during prone hip extension. In addition, the absence of flexion relaxation phenomenon (FRP) had been reported in low back pain patients, possibly indicating greater back muscle activities in the full flexed position resulting from painful stimulus (volitional guarding response). However, no studies have investigated the effects of iliopsoas treatment focusing on clinical symptoms or flexion relaxation phenomenon for athletes with iliopsoas-related back pain. Purpose: This study aimed to investigate the effects of iliopsoas treatment on clinical symptoms and motor control strategies in athletes with iliopsoas-related back pain. Methods: Twenty-four athletes with chronic low back pain and local tenderness on iliopsoas were assigned to treatment group (n=15) and control group (n=9). The treatment group participated a iliopsoas release treatment program focusing on twice a week and home stretching exercises for 3 weeks, whereas the control group didn’t accept any intervention. Clinical assessments and biomechanical measurements were arranged for both groups before and after completing the treatment program 3 weeks later, focusing on the assessment of pain status, back function assessment (Oswestry Disability Index), the degree of sacral inclination , the flexibility of iliopsoas and erector spinae , strength tests for both trunk and hip muscles, and muscle activation patterns for paravertebral muscles at both upper and lower lumbar regions during prone hip extension and standing lumbar flexion movement. The immediate effect was also examined for treatment group after completing iliopsoas release treatment on the first day when initial evaluation was performed. Results: The results showed significantly reduced pain, significantly increased difference in angular displacement during fullflexion phase during standing lumbar flexion after completing the first session of iliopsoas release maneuvers (p<0.05). Moreover, the results of short term effect showed significantly pain reduction, significantly improved back function and ilipsoas flexibility, significantly increased muscle strength for hip (extensors, flexors) and trunk extensors, and significantly reduced angle of sacral inclination after completing 3 weeks iliopsoas release treatment program (p<0.05). In addition, EMGU/L ratio referring to the ratio of maximal paravertebral muscle activities collected in upper lumbar region relative to those collected in lower lumbar region during prone hip extension test was found to decrease significantly after iliopsoas release treatment program (p<0.05). Furthermore, significantly decreased muscle activities in both resting and full flexion phase and significantly increased difference in angular displacement during fullflexion phase were also found during standing lumbar flexion (p<0.05). In contrast, no significant improvement was found in the control group 3 weeks later except fo pain status and back function.. Conclusion: This study not only proved pain reduction and the improvement of back function, but found increased trunk extensor muscle strength and decreased muscle activities in full flexion phase during lumbar flexion after completing iliopsoas release treatment program. The result of this study might imply that the pain related inhibition of back extensor muscles and the absence of flexion relaxation phenomenon or volitional guarding response due to painful stimulus were improved after pain reduction by iliopsoas release treatment program. In addition, significantly increased iliopsoas flexibility and significantly decreased angle of sacral inclination indicating reduced lumbar lordosis were also found after treatment. These results have provided hard evidence to support the importance of iliopsoas in the treating lower crossed syndrome proposed by Jull and Janda, especially for young athletes that existing muscle imbalance was commonly reported. With significantly decreased EMGU/L ratio found in the contralateral paravertebral muscles during hip extension test and increased hip extensor muscle strength after treatment, we have further proved that altered spinal movement patterns in athletes with lower crossed syndrome could be improved by simply releasing iliopsos tightness. Our findings might suggest that upper lumbar spine had not worked excessively to real excessive lumbar lordosis during hip extension test and inhibition of gluteus muscle due to excessive pelvic anterior tilt had been improved after correcting the lumbar lordosis by iliopsoas release treatment program. In conclusion, this study was the first research to provide evidence to support the effects of iliopsoas release treatment in athletes with non-specific backache with iliopsoas tightness in reducing pain, improving back function and the absence of flexion relaxation phenomenon, correcting lumbar lordosis and which induced gluteus muscle weakness and overactivity of muscles in the upper lumbar area during hip extension . Iliopsoas release treatment might be recommended as a routine maneuver in treating athletes with non-specific backache with iliopsoas tightness.
論文目次 中文摘要 2
英文摘要 4
誌 謝 7
目錄 8
表目錄 12
圖目錄 13
第一章文獻回顧 14
1.1運動員腰椎前凸姿之成因 15
1.2髂腰肌緊縮對於運動員背痛之影響 17
1.3運動員之髂腰肌緊縮問題 19
1.4髂腰肌在腰椎上所扮演的解剖角色 20
1.4.1髂腰肌解剖介紹 20
1.4.2髂腰肌對腰椎動作上的貢獻 21
1.4.3髂腰肌於腰椎生物力學上之影響 22
1.5髂腰肌緊縮導致下背痛之致病機轉 23
1.6髂腰肌過緊相關下背痛的臨床表徵 23
1.6.1痛腰肌緊縮之背痛特徵 24
1.6.2腰椎失穩(lumbar instability) 24
1.6.3周邊柔軟度缺失 24
1.6.4骨盆局部肌力不足 25
1.6.5異常背部肌肉控制模式 26
1.6.5.1下背痛患者之異常肌肉活動表現 27
1. 7髂腰肌過緊相關背痛之常見治療方式 32
1.8研究動機 33
1.9研究目的 34
1.10研究假說 35
第二章 研究方法 36
2.1.研究對象 36
2.2.研究儀器與設備 37
2.2.1超音波動作分析系統 (Ultrasound-based motion analysis system) 37
2.2.2軀幹等長肌力測量系統 38
2.2.3使用手持式肌力檢測儀 (Hand-held dynamometer) 39
2.2.4 傾斜式量角器 ( Inclinometer ) 40
2.2.5皮尺(Measuring tap) 40
2.3 實驗流程 41
2.4.評估項目 43
2.4.1 疼痛狀態評估 43
2.4.2 背部功能評估 44
2.4.3腰椎穩定度評估 45
2.4.4 局部肌力評估 46
2.4.5相關柔軟度評估 48
2.4.6薦椎傾斜角評估 51
2.4.7腰椎最大活動度評估 52
2.4.7.1動作測量前的準備工作 52
2.4.7.2 測量程序 53
2.4.8背部肌肉活動模式評估 53
2. 4.8.1背部肌肉肌電圖之定位 53
2. 4.8.2軀幹彎曲動作 54
2. 4.8.3俯臥姿髖伸直動作 55
2. 4.8.4最大自主收縮肌電訊號之量測 56
2.5髂腰肌相關治療計畫 56
2.5.1髂腰肌相關徒手治療計劃 57
2.5.2居家拉筋運動 60
2.6資料處理與分析 61
2.6.1腰椎動作學資料分析 62
2.6.1.1腰椎前彎動作分期之判定 62
2.6.2肌電訊號分析 63
2.6.2.1 基本處理程序 63
2.6.2.2軀幹彎曲動作之肌電訊號分析 64
2.6.2.3俯臥姿髖伸直動作之肌電訊號分析 66
2.7統計分析 67
第三章 研究結果 69
3.1受試者基本資料 69
3.2背痛狀態評估 70
3.2.1日常背痛強度 70
3.2.2.腰椎誘痛強度 71
3.3背部功能 72
3.4腰椎穩定度 73
3.5髂腰肌壓痛強度 74
3.6相關柔軟度 75
3.6.1髂腰肌柔軟度 75
3.6.2背直肌柔軟度 76
3.6.3膕旁肌與股四頭肌柔軟度 76
3.7局部肌力評估 77
3.7.1髖部肌力 77
3.7.2軀幹肌力 78
3.8 薦椎傾斜角度 79
3.9腰椎最大活動度 80
3.10肌電訊號評估 81
3.10.1俯臥姿髖伸直動作 81
3.11軀幹前彎動作 82
3.11.1 靜止站立時之背部平均肌電訊號電壓值 82
3.11.2 軀幹完全彎曲狀況下之背部肌電訊號評估 83
3.11.2.2軀幹完全彎曲時之平均電壓值 84
3.11.2.3.彎曲放鬆比值(Flexion relaxation ratio)評估 86
3.11.2.4彎曲放鬆現象起始與結束之角度變化 87
3.11.3軀幹彎曲與回復過程之背部平均肌電訊號 88
第四章 研究討論 90
4.1日常背痛強度 90
4.2腰椎誘痛強度與腰椎穩定度 91
4.3 髂腰肌壓痛強度 92
4.4背部功能 93
4.5髖部肌力 94
4.6軀幹肌力 95
4.7相關肌肉柔軟度 96
4.8薦椎傾斜角 97
4.9腰椎關節活動度 98
4.10背部肌電訊號分析 99
4.10.1髖伸直動作 99
4.10.2軀幹前彎動作 101
4.10.2.1靜止站立狀況下之背部平均肌電訊號 101
4.10.2.2軀幹彎曲狀況下之背部肌電訊號評估 102
4.10.2.2.1呈現放鬆現象人數比例與軀幹完全彎曲時之平均電壓值 102
4.10.2.2.2彎曲放鬆比值 103
4.10.2.2.3彎曲放鬆現象開始與結束之角度變化 105
4.10.2.3軀幹彎曲與回復過程之背部平均肌電訊號 106
第五章 結論 107
5.1 臨床應用 107
5.2 研究限制 108
參考文獻 109
附錄一 人體試驗同意書 118
附錄二 修訂版Oswestry失能指數評估量表 121

參考文獻 1. Bono C, Current concepts review: low-back pain in athletes J Bone Joint Surg 2:382-396 (2004).
2. Sassmannshausen G and Smith BG, BACK PAIN IN THE YOUNG ATHLETE. THE SPINE AND SPORTS 21:121-132 (2002).
3. Trainor TJ and Wiesel SW, EPIDEMIOLOGY OF BACK PAIN IN THE ATHLETE. CLINICS IN SPORTS MEDICINE 21:93-103 (2002).
4. Standaert CJ, Low Back Pain in the Adolescent Athlete. Phys Med Rehabil Clin 19:287-304 (2008).
5. Kujala UM, Taimela S, Salminen JJ and Oksanen A, Baseline anthropometry,flexibility and strength characteristics and future low-back pain in adolescent athletes and nonathletes:A prospective one-year follow-up study Scand J Med Sci Sports 4:200-205 (1994).
6. d’Hemecourt PA, Gerbino PG and Micheli LJ, BACK INJURIES IN THE YOUNG ATHLETE CLINICS IN SPORTS MEDICINE 19:663-679 (2000).
7. Micheli LJ WR, Back pain in young athletes. Significant differences from adults in causes and patterns. Arch Pediatr Adolesc Med 199:15-18 (1995).
8. Murase M, Clinical and radiological surveys of lumbar spondylolysis in young soccer players. Nippon Seikeigeka Gakkai Zasshi 63:1297-1305 (1989).
9. Norris CM, Back stability, in IL :Human Kinetics. Champaign (2000).
10. Sahrmann S, Diagnosis and treatment of movement impairment syndromes. St.Louis, MoMosby (2002).
11. Nourbakhsh MR, Arabloo AM and Salavati M, The relationship between pelvic cross syndrome and chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation 19:119-128 (2006).
12. Schendel MJ, Wood KB, Buttermann GR, Lewis JL and Ogilvie JW, Experimental measurement of ligament force, facet force, and segment motion in the human lumbar spine. J Biomech 26:427-438 (1993).
13. Wojtys EM, Ashton-Miller JA, Huston LJ and Moga PJ, The association between athletic training time and the sagittal curvature of the immature spine. Am J Sports Med 28:490-498 (2000).
14. McGregor A, Anderton L and Gedroyc W, The assessment of intersegmental motion and pelvic tilt in elite oarsmen. Med Sci Sports Exerc 34:1143-1149 (2002).
15. Watson AW, Sports injuries in footballers related to defects of posture and body mechanics. J Sports Med Phys Fitness 35:289-294 (1995).
16. Ribeiro CZP, Akashi PMH, Sacco IdCN and Pedrinelli A, Relationship between postural changes and injuries of the locomotor system in indoor soccer athletes. Rev Bras Med Esporte 9:98-103 (2003).
17. Hammer WI, Functional soft tissue examination and treatment by manual methods, ed. by Edition S. Aspen, Caithersburg, pp 417-423 (1999).
18. Link CS, Nicholson GG, Shaddeau SA, Birch R and Gossman MR, Lumbar curvature in standing and sitting in two types of chairs: relationship of hamstring and hip flexor muscle length. Phys Ther 70:611-618 (1990).
19. Jorgensson A, The iliopsoas muscle and the lumbar spine. Australian Physiotherapy 39:P125-132 (1993).
20. Glard Y, Launay F, Viehweger E, Guillaume JM, Jouve JL and Bollini G, Hip flexion contracture and lumbar spine lordosis in myelomeningocele. J Pediatr Orthop 25:476-478 (2005).
21. Van Dillen LR, McDonnell MK, Fleming DA and Sahrmann SA, Effect of knee and hip position on hip extension range of motion in individuals with and without low back pain. J Orthop Sports Phys Ther 30:307-316 (2000).
22. Ingber RS, Iliopsoas myofascial dysfunction: a treatable cause of "failed" low back syndrome. Arch Phys Med Rehabil 70:382-386 (1989).
23. Kujala UM, Salminen JJ, Taimela S, Oksanen A and Jaakkola L, Subject characteristics and low back pain in young athletes and nonathletes. Med Sci Sports Exerc 24:627-632 (1992).
24. Sajko S and Stuber K, Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications. J Can Chiropr Assoc 53:311-318 (2009).
25. Johnston CA, Wiley JP, Lindsay DM and Wiseman DA, Iliopsoas bursitis and tendinitis. A review. Sports Med 25:271-283 (1998).
26. Holmich P, Holmich LR and Bjerg AM, Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med 38:446-451 (2004).
27. Holmich P, Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients. Br J Sports Med 41:247-252; discussion 252 (2007).
28. Mozes M, Papa MZ, Zweig A, Horoszowski H and Adar R, Iliopsoas injury in soccer players. Br J Sports Med 19:168-170 (1985).
29. Watson AWS, Lumbar Lordosis and strain of the Iliopsoas muscle. Br J Sports Med 8:203-204 (1974).
30. Anderson K, Strickland SM and Warren R, Hip and groin injuries in athletes. Am J Sports Med 29:521-533 (2001).
31. McMakin CR, Microcurrent therapy: a novel treatment method for chronic low back myofascial pain. Journal of Bodywork and Movement Therapies 8:143-153 (2004).
32. Schwartz L, Studies in physical development and posture, in Public health bulletin ed. by IV. Government Printing Office, Wahintong,D.C. (1931).
33. 游祥明等合著, 解剖學, in 華杏機構叢書, ed. by 二版. 華杏, 臺北市 (2004).
34. Andersson EA, Nilsson J and Thorstensson A, Intramuscular EMG from the hip flexor muscles during human locomotion. Acta Physiol Scand 161:361-370 (1997).
35. Andersson E, Oddsson L, Grundstrom H and Thorstensson A, The role of the psoas and iliacus muscles for stability and movement of the lumbar spine, pelvis and hip. Scand J Med Sci Sports 5:10-16 (1995).
36. Yoshio M, Murakami G, Sato T, Sato S and Noriyasu S, The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers. J Orthop Sci 7:199-207 (2002).
37. Santaguida PL and McGill SM, The psoas major muscle: a three-dimensional geometric study. J Biomech 28:339-345 (1995).
38. Barker KL, Shamley DR and Jackson D, Changes in the Cross-Sectional Area of Multifidus and Psoas in Patients With Unilateral Back Pain:The Relationship to Pain and Disability. SPINE 29:E515-E519 (2004).
39. Juker D, McGill S, Kropf P and Steffen T, Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks. Med Sci Sports Exerc 30:301-310 (1998).
40. Quint U, Wilke HJ, Shirazi-Adl A, Parnianpour M, Loer F and Claes LE, Importance of the intersegmental trunk muscles for the stability of the lumbar spine. A biomechanical study in vitro. Spine (Phila Pa 1976) 23:1937-1945 (1998).
41. Bogduk N, Pearcy M and Hadfield G, Anatomy and biomechanics of psoas major Clinical biomechanics 7:109-119 (1992).
42. C. Johnson JGR, Lumbar compressive and shear force during various trunk curl-up exercises. Clinical Biomechanics 6:97-104 (1991).
43. Lee LW, Kerrigan DC and Della Croce U, Dynamic implications of hip flexion contractures. Am J Phys Med Rehabil 76:502-508 (1997).
44. Schache AG, Blanch PD and Murphy AT, Relation of anterior pelvic tilt during running to clinical and kinematic measures of hip extension. Br J Sports Med 34:279-283 (2000).
45. Janevic J, Ashton-Miller JA and Schultz AB, Large compressive preloads decrease lumbar motion segment flexibility. J Orthop Res 9:228-236 (1991).
46. Penning L, Psoas muscle and lumbar spine stability: a concept uniting existing controversies. Critical review and hypothesis. Eur Spine J 9:577-585 (2000).
47. Labelle H, Roussouly P, Berthonnaud E, Dimnet J and O'Brien M, The importance of spino-pelvic balance in L5-s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine (Phila Pa 1976) 30:S27-34 (2005).
48. Mac-Thiong JM, Wang Z, de Guise JA and Labelle H, Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis. Spine (Phila Pa 1976) 33:2316-2325 (2008).
49. Labelle H, Roussouly P, Berthonnaud E, Transfeldt E, O'Brien M, Chopin D, Hresko T and Dimnet J, Spondylolisthesis, pelvic incidence, and spinopelvic balance: a correlation study. Spine (Phila Pa 1976) 29:2049-2054 (2004).
50. Janda V, Introduction to functional pathology of the motor system., in Physiotherapy in sport, ed. by VIIth, pp 3-39 (1982).
51. Brier SR and Nyfield B, A comparison of hip and lumbopelvic inflexibility and low back pain in runners and cyclists. J Manipulative Physiol Ther 18:25-28 (1995).
52. Geisser ME, Haig AJ, Wallbom AS and Wiggert EA, Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain 20:61-69 (2004).
53. Waddell G, Newton M, Henderson I, Somerville D and Main CJ, A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157-168 (1993).
54. Kim H-J, Chung S, Kim S, Shin H, Lee J, Kim S and Song M-Y, Influences of trunk muscles on lumbar lordosis and sacral angle. Eur Spine J 15:409-414 (2006).
55. Youdas JW, Garrett TR, Egan KS and Therneau TM, Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther 80:261-275 (2000).
56. Youdas JW, Garrett TR, Harmsen S, Suman VJ and Carey JR, Lumbar lordosis and pelvic inclination of asymptomatic adults. Phys Ther 76:1066-1081 (1996).
57. Bruno PA, Bagust J, Cook J and Osborne N, An investigation into the activation patterns of back and hip muscles during prone hip extension in non-low back pain subjects: Normal vs. abnormal lumbar spine motion patterns. Clinical Chiropractic 11:4-14 (2008).
58. Norris CM, Back stability. Human Kinetics, Champaign (2000).
59. Takemasa R, Yamamoto H and Tani T, Trunk muscle strength in and effect of trunk muscle exercises for patients with chronic low back pain. The differences in patients with and without organic lumbar lesions. Spine (Phila Pa 1976) 20:2522-2530 (1995).
60. Handa N, Yamamoto H, Tani T, Kawakami T and Takemasa R, The effect of trunk muscle exercises in patients over 40 years of age with chronic low back pain. J Orthop Sci 5:210-216 (2000).
61. Keller A, Brox JI and Reikeras O, Predictors of change in trunk muscle strength for patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Pain Med 9:680-687 (2008).
62. Chaitow L and Fritz S, A massage therapists' guide to lower back and pelvic pain Churchill Livingstone Elsevier, New York (2007).
63. Fryer G, Morris T and Gibbons P, Paraspinal muscles and intervertebral dysfunction: part two. J Manipulative Physiol Ther 27:348-357 (2004).
64. Fryer G, Morris T and Gibbons P, Paraspinal muscles and intervertebral dysfunction: part one. J Manipulative Physiol Ther 27:267-274 (2004).
65. Sihvonen T, Partanen J, Hanninen O and Soimakallio S, Electric behavior of low back muscles during lumbar pelvic rhythm in low back pain patients and healthy controls. Arch Phys Med Rehabil 72:1080-1087 (1991).
66. Watson PJ, Booker CK, Main CJ and Chen AC, Surface electromyography in the identification of chronic low back pain patients: the development of the flexion relaxation ratio. Clin Biomech (Bristol, Avon) 12:165-171 (1997).
67. Travell J, Rinzter S and Herman M, Pain and disability of the shoulder and arm. JAMA 120:417-422 (1942).
68. Arena JG, Sherman RA, Bruno GM and Young TR, Electromyographic recordings of 5 types of low back pain subjects and non-pain controls in different positions. Pain 37:57-65 (1989).
69. Shirado O, Ito T, Kaneda K and Strax TE, Flexion-relaxation phenomenon in the back muscles. A comparative study between healthy subjects and patients with chronic low back pain. Am J Phys Med Rehabil 74:139-144 (1995).
70. van Dieen JH, Selen LP and Cholewicki J, Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol 13:333-351 (2003).
71. Lund JP, Donga R, Widmer CG and Stohler CS, The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 69:683-694 (1991).
72. Toussaint HM, Faber MN and Michies YM, Scaling anticipatory postural adjustments dependent on confidence of load estimation in a bimanual whole body lifting task. Exp Brain Res 120:85-94 (1998).
73. Johansson H and Sojka P, Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis. Med Hypotheses 35:196-203 (1991).
74. Lehman GJ, Vernon H and McGill SM, Effects of a mechanical pain stimulus on erector spinae activity before and after a spinal manipulation in patients with back pain: a preliminary investigation. J Manipulative Physiol Ther 24:402-406 (2001).
75. Ambroz C, Scott A, Ambroz A and Talbott EO, Chronic low back pain assessment using surface electromyography. J Occup Environ Med 42:660-669 (2000).
76. van Dieen JH, Cholewicki J and Radebold A, Trunk muscle recruitment patterns in patients with low back pain enhance the stability of the lumbar spine. Spine (Phila Pa 1976) 28:834-841 (2003).
77. Kuriyama N and Ito H, Electromyographic functional analysis of the lumbar spinal muscles with low back pain. J Nippon Med Sch 72:165-173 (2005).
78. Neblett R, Mayer TG, Gatchel RJ, Keeley J, Proctor T and Anagnostis C, Quantifying the lumbar flexion-relaxation phenomenon: theory, normative data, and clinical applications. Spine (Phila Pa 1976) 28:1435-1446 (2003).
79. Kaser L, Mannion AF, Rhyner A, Weber E, Dvorak J and Muntener M, Active therapy for chronic low back pain: part 2. Effects on paraspinal muscle cross-sectional area, fiber type size, and distribution. Spine (Phila Pa 1976) 26:909-919 (2001).
80. Zedka M, Prochazka A, Knight B, Gillard D and Gauthier M, Voluntary and reflex control of human back muscles during induced pain. J Physiol 520 Pt 2:591-604 (1999).
81. Ritvanen T, Zaproudina N, Nissen M, Leinonen V and Hanninen O, Dynamic surface electromyographic responses in chronic low back pain treated by traditional bone setting and conventional physical therapy. J Manipulative Physiol Ther 30:31-37 (2007).
82. Alschuler KN, Neblett R, Wiggert E, Haig AJ and Geisser ME, Flexion-relaxation and clinical features associated with chronic low back pain: A comparison of different methods of quantifying flexion-relaxation. Clin J Pain 25:760-766 (2009).
83. Allen C, Muscle action potentials used in the study of dynamice anatomy. Br J Phys Med 11:66-73 (1948).
84. Floyd W and Silver P, Function of erectors spinae in flexion of the trunk. Lancet 260:133-134 (1951).
85. Dickey JP, McNorton S and Potvin JR, Repeated spinal flexion modulates the flexion-relaxation phenomenon. Clin Biomech (Bristol, Avon) 18:783-789 (2003).
86. Solomonow M, Baratta RV, Banks A, Freudenberger C and Zhou BH, Flexion-relaxation response to static lumbar flexion in males and females. Clin Biomech (Bristol, Avon) 18:273-279 (2003).
87. Ahern DK, Follick MJ, Council JR, Laser-Wolston N and Litchman H, Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls. Pain 34:153-160 (1988).
88. Geisser ME, Surface electromyography and low back pain. Biofeedback 35:p. 13-16 (2007).
89. Lalanne K, Lafond D and Descarreaux M, Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study. J Manipulative Physiol Ther 32:203-209 (2009).
90. Bicalho E, Setti JA, Macagnan J, Cano JL and Manffra EF, Immediate effects of a high-velocity spine manipulation in paraspinal muscles activity of nonspecific chronic low-back pain subjects. Man Ther 15:469-475 (2010).
91. Selkow NM, Grindstaff TL, Cross KM, Pugh K, Hertel J and Saliba S, Short-term effect of muscle energy technique on pain in individuals with non-specific lumbopelvic pain: a pilot study. J Man Manip Ther 17:E14-18 (2009).
92. Moutzouri M, Billis E, Strimpakos N, Kottika P and Oldham JA, The effects of the Mulligan Sustained Natural Apophyseal Glide (SNAG) mobilisation in the lumbar flexion range of asymptomatic subjects as measured by the Zebris CMS20 3-D motion analysis system. BMC Musculoskelet Disord 9:131 (2008).
93. Cook H, Nicholson K and A. B, A revised Oswestry Disability Questionnaire, in Back pain:new approaches to rehabilitation and education, ed. by ed. s. Roland M.O.JJR.,ed., New York,U.S.A, pp P187-204 (1988).
94. Mehra A, Baker D, Disney S and Pynsent PB, Oswestry Disability Index scoring made easy. Ann R Coll Surg Engl 90:497-499 (2008).
95. Magee DJ, Orthopedic physical assessment, ed. by ed. t. Pa. :Saunders, Philadelphia (2002).
96. Clapis PA, Davis SM and Davis RO, Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test. Physiother Theory Pract 24:135-141 (2008).
97. Hamberg J, Bjorklund M, Nordgren B and Sahlstedt B, Stretchability of the rectus femoris muscle: investigation of validity and intratester reliability of two methods including X-ray analysis of pelvic tilt. Arch Phys Med Rehabil 74:263-270 (1993).
98. Keller TS and Colloca CJ, Mechanical force spinal manipulation increases trunk muscle strength assessed by electromyography: a comparative clinical trial. J Manipulative Physiol Ther 23:585-595 (2000).
99. I.cantu R and J.Grodin A, Myofascial manipulation :theory and clinical application ed. by ed. n. TX :Pro-Ed, Austin (2006).
100. Smith M, M.H.Sc., Fryer G and B.App.Sc., A comparison of two muscle energy techniques for increasing flexibility of the hamstring muscle group. Journal of Bodywork and Movement Therapies 12:312-317 (2008).
101. Lee D, The pelvic girdle :an approach to the examination and treatment of the lumbo-pelvic-hip region ed. by Edinburgh. Churchill Livingstone, Edinburgh (1999).
102. Winters MV, Blake CG, Trost JS, Marcello-Brinker TB, Lowe LM, Garber MB and Wainner RS, Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. Phys Ther 84:800-807 (2004).
103. Ferguson LW and Gerwin R, Clinical mastery in the treatment of myofascial pain Lippincott Williams & Wilkins, Philadelphia (2005).
104. Hertling D and Kessler RM, Management of common Musculoskeletal Disorders. Physical Therapy Principles and Methods, ed. by ed. t. Lippincott Williams & Wilkins, Philadelphia (2006).
105. Tokuhashi Y, Matsuzaki H and Sano S, Evaluation of clinical lumbar instability using the treadmill. Spine (Phila Pa 1976) 18:2321-2324 (1993).
106. Cook H, Nicholson K and Breen A, A revised Oswestry Disability Questionnaire in Back pain: new approaches to rehabilitation and education, ed. by ed. s. Roland M.O. JJR,ed, New York.U.S.A, pp 187-204 (1988).
107. Haas M, Goldberg B, Aickin M, Ganger B and Attwood M, A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther 27:160-169 (2004).
108. Descarreaux M, Normand MC, Laurencelle L and Dugas C, Evaluation of a specific home exercise program for low back pain. J Manipulative Physiol Ther 25:497-503 (2002).
109. Jenkins E and Borenstein D, excercise for the low back pain patients. Baillieres Clin Rheumatol 8:191-197 (1994).
110. Fulcher ML, Hanna CM and Raina Elley C, Reliability of handheld dynamometry in assessment of hip strength in adult male football players. J Sci Med Sport 13:80-84 (2010).
111. Perry J, Weiss WB, Burnfield JM and Gronley JK, The supine hip extensor manual muscle test: a reliability and validity study. Arch Phys Med Rehabil 85:1345-1350 (2004).
112. Bruno PA and Bagust J, An investigation into motor pattern differences used during prone hip extension between subjects with and without low back pain. Clinical Chiropractic 10:68-80 (2007).
113. Harvey D, Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med 32:68-70 (1998).
114. Jackson RP and McManus AC, Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine (Phila Pa 1976) 19:1611-1618 (1994).
115. Nakipoglu GF, Karagoz A and Ozgirgin N, The biomechanics of the lumbosacral region in acute and chronic low back pain patients. Pain Physician 11:505-511 (2008).
116. Evcik D and Yucel A, Lumbar lordosis in acute and chronic low back pain patients. Rheumatol Int 23:163-165 (2003).
117. Prushansky T, Ezra N, Kurse N, Man L and Schneiderman Y, Reproducibility of sagittal pelvic tilt measurements in normal subjects using digital inclinometry. Gait Posture 28:513-516 (2008).
118. Carpes FP, Reinehr FB and Mota CB, Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: a pilot study. J Bodyw Mov Ther 12:22-30 (2008).
119. Little TL and Mansoor J, Low back pain associated with internal snapping hip syndrome in a competitive cyclist. Br J Sports Med 42:308-309; discussion 309 (2008).
120. Konstantinou K, Foster N, Rushton A, Baxter D, Wright C and Breen A, Flexion mobilizations with movement techniques: the immediate effects on range of movement and pain in subjects with low back pain. J Manipulative Physiol Ther 30:178-185 (2007).
121. Elnaggar IM, Nordin M, Sheikhzadeh A, Parnianpour M and Kahanovitz N, Effects of spinal flexion and extension exercises on low-back pain and spinal mobility in chronic mechanical low-back pain patients. Spine (Phila Pa 1976) 16:967-972 (1991).
122. Oh JS, Cynn HS, Won JH, Kwon OY and Yi CH, Effects of performing an abdominal drawing-in maneuver during prone hip extension exercises on hip and back extensor muscle activity and amount of anterior pelvic tilt. J Orthop Sports Phys Ther 37:320-324 (2007).
123. Sihvonen T, Flexion relaxation of the hamstring muscles during lumbar-pelvic rhythm. Arch Phys Med Rehabil 78:486-490 (1997).
124. Mannion AF, Taimela S, Muntener M and Dvorak J, Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength. Spine (Phila Pa 1976) 26:897-908 (2001).
125. Triano JJ and Schultz AB, Correlation of objective measure of trunk motion and muscle function with low-back disability ratings. Spine (Phila Pa 1976) 12:561-565 (1987).
126. Hashemirad F, Talebian S, Hatef B and Kahlaee AH, The relationship between flexibility and EMG activity pattern of the erector spinae muscles during trunk flexion-extension. Journal of Electromyography and Kinesiology 19:746-753 (2009).
127. Descarreaux M, Lafond D, Jeffrey-Gauthier R, Centomo H and Cantin V, Changes in the flexion relaxation response induced by lumbar muscle fatigue. BMC Musculoskelet Disord 9:10 (2008).
128. Olson MW, Li L and Solomonow M, Flexion-relaxation response to cyclic lumbar flexion. Clin Biomech (Bristol, Avon) 19:769-776 (2004).
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