Kineziterapijos įtaka dubens padėties ir aplinkinių raumenų silpnumui pacientams turintiems juosmeninės stuburo dalies išvaržą

Strankauskas, Tomas

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Kineziterapijos įtaka dubens padėties ir aplinkinių raumenų silpnumui pacientams turintiems juosmeninės stuburo dalies išvaržą

Strankauskas, Tomas

URI: http://dspace.kaunokolegija.lt//handle/123456789/530

Data: 2018-06

Santrauka:

Tyrimo metu buvo siekiama įvertinti kineziterapijos įtaką dubens padėčiai ir aplinkinių raumenų silpnumui, kuomet pacientai turėjo juosmeninės stuburo dalies išvaržą. Tiriamieji buvo suskirstyti į dvi grupes po 8, pagal darbo pobūdį: sėdimas ar stovimas. Tyrimo metu vertinama skausmo intensyvumas , manualinis raumenų testavimas apatinių galūnių ir juosmens, liemens raumenų ištvermės vertinimas, juosmens paslankumas Šobero testu, liemens paslankumas į šonus, tiesios kojos kėlimo testas, apatinių galūnių dermatomai ir miotomai, laikysenos vertinimas. Rezultatai parodė, kad kineziterapija darė teigiamą poveikį tiek dubens padėčiai, tiek aplinkinių raumenų jėgai.

Description:

Relevance of the topic. Lumbar spinal hernia is a common consequence of the pain of the lower spine, which has become a modern society and a global problem (Kuai et al., 2017a). Dionne et al., (2006) argue that back pain causes the limitation of most activities, disruption and lack of labor productivity. Risk factors such as smoking, sports related to weight lifting and similar exercises are affected by hernias (Jordan et al., 2009). Barrey et al. (2007) argue that patients with musculoskeletal and skeletal disorders of the lumbar spine in the sagittal plane will also undergo various changes such as decreased lumbar lordosis and transverse vertebrae. The aim of the study was to assess the effect of physiotherapy on the pelvic position and the muscular weakness of the patients with lumbar spine hernia. Research tasks: 1. Determine the effect of physiotherapy on the pelvic position in sitting or standing patients working with lumbar spine hernia; 2. Determine the effect of physiotherapy on the functioning of the pelvic muscle weakness, sitting or standing, and having a hernia of the lumbar spine; 3. Determine the correlations between lumbar and pelvic muscle weakness in patients with lumbar spine hernia. Methods of investigation: before the study participants were divided into two groups according to the type of work: sitting or standing. Each group consisted of 8 subjects. All subjects were tested before the study of pain intensity according to a digital analog pain scale, manual muscle testing of the lower limbs and waist, trunk muscle endurance assessment, waist mobility by Schober test, mobility torso from side to side, straight leg lifting test of the lower extremities, also dermatomes and miotomes. After the tests, both groups received physiotherapy sessions lasting 30 minutes in 4 weeks. Results: After physiotherapy, improvement in pain intensity in both groups was observed. The results of the Schober test have improved minimal, but have reached the norm so it can be argued that the lumbar spine mobility is good. The waist mobility of the sides also improved overall in both groups. When assessing the torso muscle strength, the sitting work group (SIWG) has been all-powerful torso muscle compared to standing work group (STWG). However, the posture of both groups has improved, but minimal. Posture evaluations of posture according to W.W.K.Hoeger have been observed in both the sagittal and frontal plane of the torso and pelvic areas. However, evaluating the effect of the pelvic region on the lumbar hernia was an important postural change in the sagittal plane of the abdomen. SIWG prior to physiotherapy 2.5 ± 1.41, after 3 ± 1.06. STWG before 3.25 ± 1.66, after 3.75 ± 1.03. In both groups the averages improved by 0.5 points. Manual muscle testing was performed on both left and right legs and buttocks before and after physiotherapy in both groups. In the SIWG, before the physiotherapy, the weakest was in the both sides, so left was 3.3 ± 0.70 and the right was 3.8 ± 0.46 in the psoas major muscles, and the statistical significance of the left thigh and muscle strength was observed in this group (p<0.05). Both SIWG and STWG were almost similar to muscle strength before the study. The strongest improvement in the lumbar muscle was in the muscle of the direct abdominal force, which had a force of 4.5 ± 0.53 (p <0.05) and 4.9 ± 0.35 (p <0.05) prior to physiotherapy. Strong muscles in the back are seen in the STWG: quadratus lumborum muscles. Left sides before was 4.5 ± 0.53 and after 4.6 ± 0.51. Right sides before was 4.4 ± 0.51 and after 4.5 ± 0.53. The correlations between the waist and the pelvic muscle are the strongest link to physiotherapy in the SIWG on the left side between the gluteus maximus and the rectus abdominis (r = -1), between the gluteus maximus and obliques (r = -0.904), between the rectus abdominis and obliques (r = 0.904) muscle power. After physiotherapy between the right side of the psoas major and the rectus abdominis muscle strength (r = 1). The strong correlation in STWG before the physiotherapy is between the left side of the gluteus maximus and the hamstrings (r = 0.774), between the psoas major and gluteus maximus (r = 0.774), between the psoas major and rectus femoris (r = 0.788). After physiotherapy between the right side of the gluteus maximus and the hamstrings (r = 0.882) muscle strength. Findings of the research: 1. Physiotherapy has the same effect on the pelvic floor area for patients sitting or standing. 2. After the physiotherapy sitting in the work group, the left and right front and rear arm of the thigh and the buttocks muscles increased most. The strength of the working group increased the strength of the thigh muscles of the two sides. 3. The correlations between the waist and the pelvic muscle are the strongest links to physiotherapy in SIWG on the left side between the gluteus maximus and the rectus abdominis (r = -1), between the gluteus maximus and obliques (r = -0.904), between the rectus abdominis and obliques (r = 0.904) muscle power. After physiotherapy between the right side of the psoas major and the rectus abdominis muscle strength (r = 1). The strong correlation in STWG before the physiotherapy is between the left side of the gluteus maximus and the hamstrings (r = 0.774), between the psoas major and gluteus maximus (r = 0.774), between the psoas major and rectus femoris (r = 0.788). After physiotherapy between the right side of the gluteus maximus and the hamstrings (r = 0.882) muscle strength.

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