背景：非特異性下背痛是由多重因素所造成，在非特異性下背痛的患者身上，相較於健康人，腿後肌群及豎脊肌的柔軟度較低而剛性較高，而在此狀況下，腰椎的關節活動度會有失能問題產生，進而增加腰椎之力矩，最終引發下背痛。過去的研究主要探討健康人及非特異性下背痛患者之間柔軟度及剛性的差異，然而無法了解是否會因為降低肌肉柔軟度及增加肌肉剛性而伴隨非特異性下背痛的症狀惡化，因此本研究目的為探討非特異性下背痛之腿後肌群及豎脊肌的柔軟度與剛性和疼痛、失能及腰椎活動度之間的關聯性。
方法：本研究納入59位非特異性下背痛的受試者，針對疼痛及失能程度，會分別利用視覺疼痛量表（Visual Analog Scale）及歐式下背痛量表（Oswestry Disability Index）評估；腿後肌群的柔軟度會利用被動直膝抬腿（passive straight leg raise test）、坐姿提前彎（sit and reach test）及站姿體前彎（finger to floor test）測試；腰椎活動度包含屈曲（flexion）、伸展（extension）、矢狀面動作範圍（ROM range in sagittal plane）及額狀面動作範圍（ROM range in frontal plane）; 肌肉剛性會利用肌張力測量儀（Myoton Pro）針對股二頭肌及半腱肌的肌肉中點、近端肌肉肌腱交接處及遠端肌肉肌腱交接處測試，而豎脊肌將在第一至第五腰椎脊突旁2公分測試。受試者將會依照視覺疼痛量表小於3分及介在3-6分之間，依序分為輕度疼痛組及中度疼痛組。雙尾皮爾森相關將會用來檢定在疼痛、失能、腿後肌群及豎脊肌柔軟度與剛性之間的關聯性。雙尾獨立t檢定用來評估輕度疼痛組及中度疼痛組的失能、腰椎關節活動度、腿後肌及豎脊肌柔軟度與剛性之間的差異性。
結果：疼痛與被動直膝抬腿（r = -0.270, p = 0.038）及腰椎額狀面動作範圍（r = -0.381, p = 0.003）有顯著的負相關，全部的腿後肌群柔軟度測試與腰椎額狀面動作範圍皆有顯著的關聯性，但與腰椎矢狀面動作皆無顯著的關聯性。然而豎脊肌的剛性與腰椎屈曲（r = -0.326, p = 0.012）及矢狀面動作範圍（r = -0.356, p = 0.006）有顯著的負相關。輕度疼痛組相較於中度疼痛組有較高的失能程度（p = 0.010 95% CI: -3.48, -0.49）；較低的被動直膝抬腿角度（p = 0.025 95% CI: 1.24, 18.18）、腰椎伸直（p =0.030 95% CI: 0.03, 0.38）以及腰椎額狀面動作範圍（p = 0.020 95% CI: 0.91, 10.71）。然而兩組之間的大腿後肌（p = 0.520 95% CI: -15.27, 29.99）及豎脊肌（p = 0.795 95% CI: -46.81, -36.04）剛性皆無顯著差異。
結論：本篇研究提供需要處理非特異性下背痛的臨床人員了解腿後肌群和豎脊肌的柔軟度降低及剛性增加可能是潛在造成下背痛症狀惡化的因子之一，因此，非特異性下背痛的復健處方或是運動訓練需要考量此兩條肌肉的特性做設計。

Background: Non-specific low back pain (NSLBP) is a multi-factor issue. Lower flexibility and higher stiffness of hamstring and erector spinae muscles have been found in NSLBP compared to healthy people. With decreasing flexibility and increasing stiffness of hamstring and erector spinae, lumbar movement may be prone to dysfunction, thus, increasing torque on lumbar and eventually cause low back pain. Previous studies investigated the difference of muscle flexibility and stiffness between NSLBP and healthy people. However, the studies cannot know whether muscle flexibility and stiffness are one of factors increase NSLBP level. Thus, the study investigated the correlation of hamstring and erector spinae mechanical properties between pain, disability level and lumbar flexibility.
Method: Fifty-nine subjects with NSLBP were recruited in the study. For pain and disability level, visual analog scale (VAS) and Oswestry disability index (ODI) were used to evaluate respectively. Hamstring flexibility was evaluated by passive straight leg raise test (PSLR), sit and reach test (SRT) and finger to floor test (FFT). Lumbar flexion, extension, ROM range in sagittal plane and ROM range in frontal plane were evaluated for lumbar flexibility. Myoton Pro (Myoton AS, Estonia and Myoton Ltd London) was used to evaluate hamstring and erector spinae stiffness. For hamstring stiffness, location of muscle belly, proximal and distal muscle-tendon junction of semitendinosus and biceps femoris were evaluated. Bilaterally 2cm away from L1-L5 spinous processes muscle stiffness were measured for erector spinae stiffness. The participants were divided into mild pain group and moderate pain group by VAS below 3 and between 3-6, respectively. Two-tailed Pearson’s correlation coefficient test was used to test correlation between VAS, ODI, flexibility and stiffness of hamstring and erector spinae. Two tailed independent-t test were used to analyze the difference, including ODI, hamstring flexibility, hamstring stiffness, erector spinae stiffness and lumbar flexibility, between mild pain group and moderate pain.
Results: Increasing pain intensity showed decreasing PSLR (r = -0.270, p = 0.038) and lumbar frontal plane ROM range (r = -0.381, p = 0.003). All of hamstring flexibility had moderate correlation with lumbar frontal plane movement; however, no significant correlation between hamstring flexibility and lumbar sagittal plane movement was found. Hamstring stiffness was found no significant correlation between hamstring flexibility, nevertheless, erector spinae stiffness was found had significant correlation between lumbar flexion (r = -0.326, p = 0.012) and sagittal plane ROM range (r = -0.356, p = 0.006). In comparison with mild pain group, moderate pain group had higher disability level (p = 0.010 95% CI: -3.48, -0.49); and had lower PSLR (p = 0.025 95% CI: 1.24, 18.18), lumbar extension (p =0.030 95% CI: 0.03, 0.38) and lumbar ROM range in frontal plane (p = 0.020 95% CI: 0.91, 10.71). However, there were not have significant difference between mild pain group and moderate pain group, including hamstring (p = 0.520 95% CI: -15.27, 29.99) and erector spinae stiffness (p = 0.795 95% CI: -46.81, -36.04).
Conclusion: This study provided clinical physical therapists or those who need to deal with non-specific low back pain that the increased stiffness and decreased flexibility of hamstring and erector spinae may be the potential risk factors to aggravate low back pain level. Increasing hamstring flexibility and decreasing erector spinae stiffness should be considered in physical evaluation and rehabilitation programs for those who suffer from non-specific LBP.

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