Qualität grundlegender Bewegungsmuster bei Patienten mit chronischen lumbalen Rückenschmerzen^[*]

Zusammenfassung

Hintergrund: Chronische Rückenschmerzen können mit Änderungen der motorischen Kontrolle und einem modifizierten Bewegungsverhalten einhergehen. Zur systematisierten Überprüfung alltagsrelevanter Bewegungen bei Rückenpatienten existieren jedoch kaum Testverfahren. Die vorliegende Studie untersucht mittels einer neuen funktionellen Bewegungsanalyse, ob sich die grundlegenden Bewegungsmuster von Personen mit chronisch unspezifischen Rückenschmerzen und Gesunden unterscheiden sowie ob Schmerzpatienten häufiger asymmetrisch ausgeprägte Muster aufweisen.

Probanden/Methoden: 20 Personen mit chronisch unspezifischen Rückenschmerzen im LWS-Bereich (♀=8, ♂=12; 49,4±11,3 J.) und 20 beschwerdefreie Probanden (♀=12, ♂=8; 47,7±10,7 J.) absolvierten die Bewegungsanalyse. Diese besteht aus 11 standardisierten motorischen Aufgaben, die alltagsrelevante Bewegungen testen und jeweils anhand einer 6-stufigen Skala bewertet werden. 8 der 11 Items sind beidseitig durchzuführen. Als Outcomes fungierten der Gesamtscore sowie die Anzahl der Asymmetrien (unterschiedliches Ergebnis bei den 8 beidseitig durchzuführenden Items). Eine pilotartige Reliabilitätsanalyse (4 Probanden und 4 Rater) erfolgte per Intraklassen-Korrelation (ICC). Die Mittelwerte beider Gruppen wurden mithilfe des t-Tests für unabhängige Stichproben (α=0,05) verglichen. Im Falle signifikanter Unterschiede schloss sich die Berechnung der Effektstärke (Cohen’s d) an.

Ergebnisse: Bei der Reliabilitätsanalyse ergab sich ein ICC (2,1) von 0,82 (95% KI: 0,72−0,90). Die Probanden mit Rückenschmerzen (31,95±5,82 Punkte) erreichten einen deutlich niedrigeren Gesamtscore als die Gesunden (44,01±5,27; p<0,001; d=2,17). Mit 3,8±1,28 Asymmetrien wiesen sie bei den getesteten Bewegungsmustern gegenüber den Gesunden (1,4±0,94) zudem mehr Ungleichgewichte auf (p<0,001; d=2,14).

Schlussfolgerung: Unphysiologische und asymmetrisch ausgeprägte Bewegungsmuster scheinen mit chronischen unspezifischen lumbalen Rückenschmerzen in Verbindung zu stehen. Ob sie jedoch Ursache oder Folge der Beschwerden sind, bleibt zu untersuchen. Weitere Studien zur Reliabilität der eingesetzten Bewegungsanalyse sind notwendig.

Abstract

Background: Chronic back pain may be associated with alterations of motor control and maladaptive movement. However, instruments that systematically screen fundamental movement patterns are rare. Using a newly developed functional movement analysis, this study aims to examine whether persons with chronic unspecific low back pain display altered quality of fundamental movement patterns and whether asymmetry exists between body sides.

Subjects/Methods: 20 patients with chronic back pain (♀=8, ♂=12; 49.4±11.3 years) and 20 healthy controls (♀=12, ♂=8; 47.7±10.7 years) completed the functional movement analysis. It consists of 11 items screening movements of daily life. 8 of them were to complete left and right. The overall score and the number of observed asymmetries (in items to complete left and right) constituted the primary outcomes. A preliminary analysis of reliability (4 raters, 4 subjects) with pilot character was conducted using intra-class correlation (ICC). To compare differences in means, independent t-tests were performed. In case of significance, we calculated the effect size (Cohen’s d).

Results:The reliability analysis showed an ICC (2.1) of 0.82 (95% CI: 0.72−0.90). Patients with chronic low back pain (31.95±5.82) scored significantly lower than healthy subjects (44.01±5.27; p<0.001, d=2.17). Additionally, patients averaged 3.8±1.28 asymmetries while pain-free participants only demonstrated 1.4±0.94 (p<0.001; d=2.14).

Conclusion: Faulty and dysbalanced movement patterns appear to be linked to chronic low back pain. Nonetheless, given an existing relation, it remains unclear whether the detected deficiencies are causes or consequences of pain. Further studies about the reliability of the presented screening tool are needed.

Schlüsselwörter

funktionelle Bewegungs­analyse - Asymmetrie - motorische Kontrolle

Key words

functional movement screening - asymmetry - motor control

^* Erstveröffentlichung des Beitrags in: Sportverl Sportschad 2013; 27: 219-225

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