Kronik bel ağrılı hastalarda izokinetik eksentrik bir egzersiz modelinin ağrı, fonksiyonel yetmezlik ve psikososyal durum açısından sonuçlarının karşılaştırılması
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Date
2013
Authors
Özhan, Gökhan
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Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Bu çalışma ile kronik bel ağrılı hastalarda, eksentrik kasılma içerikli izokinetik bir lomber egzersiz modelinin, ağrı, fonksiyonel yetmezlik, psikososyal durum ve bazı fiziksel özellikler üzerine olan etkilerinin incelenmesi amaçlanmıştır. Çalışmaya en az üç aydır kronik bel ağrısı olan 20-42 yaşları arasında (ortalama yaş = 26.5 ± 5.8) toplam 30 hasta (15 erkek ve kadın) katıldı. Hastalar randomize olarak grup EE: eksentrik egzersiz grubu, grup KE: konsentrik egzersiz grubu ve grup K: kontrol grubu olacak şekilde üç ayrı gruba ayrılarak fiziksel özellikleri ölçüldü. Fonksiyonel yetmezlik, klinik depresyon ve ağrı durumlarını değerlendirmek için sırasıyla Oswestry ölçütü, Beck Depresyon Skalası ve görsel analog skala (Visual Analogue Scale, VAS) kullanıldı. Spinal mobilite değerlendirmesi lomber Schober ve el parmak-zemin mesafesi ölçülerek yapıldı. İzokinetik testlerde 300/sn?lik ve 600/sn?lik açısal hızlarda lomber fleksör ve ekstansör kasların konsentrik ve eksentrik pik kuvvet değerleri ölçüldü. Lomber ekstansörlere yönelik olarak, eksentrik grup izole eksentrik ve konsentrik grup izole konsentrik olacak şekilde haftada 3 gün 4 hafta boyunca çalıştırıldı. Tüm fiziksel ölçümler, değerlendirmeler ve kuvvet testleri 1 ay sonra tekrarlandı. Ağrı düzeylerinde ve fonksiyonel yetmezlikte eksentrik egzersiz grubundaki azalma konsentrik ve kontrol gruplarına göre anlamlıydı (p<0.05). Her iki egzersiz grubunda lomber ekstansör kuvvette istatistiksel anlamlı artış saptandı (p<0.01-p<0.001). Fleksör konsentrik/ekstansör eksentrik kuvvet oranları eksentrik egzersiz grubunda istatistiksel anlamı düştü (p<0.01). Diğer yandan Fleksör eksentrik/ekstansör konsentrik kuvvet oranları ise grup EE (p<0.01) ve grup KE (p<0.001) egzersiz gruplarının her ikisinde de grup K?e göre anlamlı düzeyde azaldı. Ekstansör kaslardaki eksentrik kuvvet artışı ile ağrı (30?/sn?lik açısal hız için r=-0.49, p<0.01; 60?/sn?lik açısal hız için r=-0.47, p<0.01) ve fonksiyonel yetmezlik (30?/sn?lik açısal hız için r=-0.60, p<0.01; 60?/sn?lik açısal hız için r=-0.48, p<0.01) arasında anlamlı korelasyon saptandı. Bel fleksör konsentrik/ekstansör eksentrik resiprokal kuvvet oranı da ağrı (30?/sn?lik açısal hız için r=0.31, p<0.05; 60?/sn?lik açısal hız için r=0.55, p<0.01) ve fonksiyonel yetmezlikle (30?/sn?lik açısal hız için r=0.35, p<0.01; 60?/sn?lik açısal hız için r=0.51, p<0.01) anlamlı korele idi. Bu çalışma bulgularına göre eksentrik egzersizlerin konsentrik egzersizler ve kontrol grubu ile karşılaştırıldığında; kronik bel ağrılı hastalarda bel ekstansör kuvvetini daha belirgin arttırdığı, ağrı ve fonksiyonel yetmezliği olumlu yönde etkilediği söylenebilir.
The aim of this study was to determine the effects of an isokinetic based lumbar training model including eccentric contractions on pain, disability, psychosocial conditions and some physical features in patients with chronic low back pain. Thirty patients (15 men and women) aged 20-42 years (average age = 26.5 ± 5.8) having low back pain for at least 3 months were included to the study. The patients were randomly classified into three groups; Group EE: eccentric exercise group, Group KE: concentric exercise group and Group K: control group and their physical features were measured. In order to evaluate disability, clinic depression and pain condition; the Oswestry criterion, Beck Depression Scale and visual analogue scale (VAS) was used, respectively. Spinal mobility evaluation was done by measuring lumbar Schober and fingertip to floor distance. Peak torque values of lumbar flexor and extensor muscles were measured at 30⁰/second and 60⁰/second angular velocities during isokinetic tests. Subjects in Group EE performed eccentric and in Group KE concentric contractions for the lumbar extensor muscles for 3 day/week for 4 weeks. All physical measurements, evaluations and strength tests were repeated following 1 month. The decreases in pain and disability scores in Group EE were significantly different (p<0.05) compared to Group KE and K. Lumbar extensor muscle strength represented significant increases in both the exercise groups (p<0.01-0.001). Flexor concentric/extensor eccentric strength ratios decreased significantly (p<0.01) only in the Group EE. On the other hand, flexor eccentric/extensor concentric ratios showed significantdecrease in both Group EE (p<0.01) and KE (p<0.001) compared to Group K. The increase in eccentric strength of the extensor muscles was significantly correlated with the decrease in pain (for 30⁰/second angular velocity r=-0.49, p<0.01; 60⁰/second angular velocity r=-0.47, p<0.01) and disability (for 30⁰/second angular velocity r=-0.60, p<0.01; 60⁰/second angular velocity r=-0.48, p<0.01) scores in. Flexor concentric/extensor eccentric reciprocal strength ratio was also significantly correlated with pain decrease (for 30⁰/second angular velocity r=0.31, p<0.05; 60⁰/second angular velocity r=0.55, p<0.01) and disability recovery (for 30⁰/second angular velocity r=0.35, p<0.01; 60⁰/second angular velocity r=0.51, p<0.01) scores. According to the findings of this study, eccentric exercises increase lumbar extensor strength and decrease pain and disability in patients with chronic low back pain compared to concentric exercises.
The aim of this study was to determine the effects of an isokinetic based lumbar training model including eccentric contractions on pain, disability, psychosocial conditions and some physical features in patients with chronic low back pain. Thirty patients (15 men and women) aged 20-42 years (average age = 26.5 ± 5.8) having low back pain for at least 3 months were included to the study. The patients were randomly classified into three groups; Group EE: eccentric exercise group, Group KE: concentric exercise group and Group K: control group and their physical features were measured. In order to evaluate disability, clinic depression and pain condition; the Oswestry criterion, Beck Depression Scale and visual analogue scale (VAS) was used, respectively. Spinal mobility evaluation was done by measuring lumbar Schober and fingertip to floor distance. Peak torque values of lumbar flexor and extensor muscles were measured at 30⁰/second and 60⁰/second angular velocities during isokinetic tests. Subjects in Group EE performed eccentric and in Group KE concentric contractions for the lumbar extensor muscles for 3 day/week for 4 weeks. All physical measurements, evaluations and strength tests were repeated following 1 month. The decreases in pain and disability scores in Group EE were significantly different (p<0.05) compared to Group KE and K. Lumbar extensor muscle strength represented significant increases in both the exercise groups (p<0.01-0.001). Flexor concentric/extensor eccentric strength ratios decreased significantly (p<0.01) only in the Group EE. On the other hand, flexor eccentric/extensor concentric ratios showed significantdecrease in both Group EE (p<0.01) and KE (p<0.001) compared to Group K. The increase in eccentric strength of the extensor muscles was significantly correlated with the decrease in pain (for 30⁰/second angular velocity r=-0.49, p<0.01; 60⁰/second angular velocity r=-0.47, p<0.01) and disability (for 30⁰/second angular velocity r=-0.60, p<0.01; 60⁰/second angular velocity r=-0.48, p<0.01) scores in. Flexor concentric/extensor eccentric reciprocal strength ratio was also significantly correlated with pain decrease (for 30⁰/second angular velocity r=0.31, p<0.05; 60⁰/second angular velocity r=0.55, p<0.01) and disability recovery (for 30⁰/second angular velocity r=0.35, p<0.01; 60⁰/second angular velocity r=0.51, p<0.01) scores. According to the findings of this study, eccentric exercises increase lumbar extensor strength and decrease pain and disability in patients with chronic low back pain compared to concentric exercises.
Description
Keywords
Kronik bel ağrısı, İzokinetik egzersiz, Eksentrik, Konsentrik, Fonksiyonel yetmezlik, Chronic low back pain, Isokinetic exercise, Eccentric, Concentric, Disability
Citation
Özhan, G. (2013). Kronik bel ağrılı hastalarda izokinetik eksentrik bir egzersiz modelinin ağrı, fonksiyonel yetmezlik ve psikososyal durum açısından sonuçlarının karşılaştırılması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.