(for an English version, see below)

Prevalencija bolova u slabinskom dijelu leđa je visoka u općoj populaciji, ali i u sportaša (1-3). Brojni su čimbenici odgovorni za pojavu ovog značajnog javno-zdravstvenog problema. Među njima je i poprečni presjek paraspinalne muskulature te lumbalnih multifida. Konkretno, veći broj studija je pokazalo da osobe s kroničnom boli u slabinskom dijelu leđa imaju značajno manji poprečni presjek lumbalnih multifida od zdravih vršnjaka (4). Također, pacijenti s unilateralnom lumbalnom boli imaju značajno manju debljinu lumbalnih multifida na ipsilateralnoj (bolnoj) strani u odnosu na kontralateralnu (bezbolnu stranu) (4).

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Slika 1. MR prikaz presjeka trupa na razini lumbalne kralježnice. Označeno predstavlja par mišića multifida.

Studije provedene na australskim sportašima također su pokazale dva interesantna nalaza. Prvo, lumbalni multifidi i transversus abdominis značajno (11-21%) atrofiraju tijekom natjecateljske nogometne sezone (5). Suprotno tome, autori su utvrdili da su površinski mišići trupa nogometaša, obliques externus i lumbalni erector spinae, povećali svoju veličinu tijekom sezone za 3,5-11% (5). Drugo, ista je istraživačka grupa utvrdila kako smanjena veličina lumbalnih multifida i njihova lateralna asimetrija značajno povećava rizik nastanka mišićnih ozljeda (hamstrings, kvadriceps, aduktori kuka) tijekom sezone (6). Sveukupno gledajući, ovi nalazi jasno ukazuju na potrebu specifičnog treninga dubokih stabilizatora trupa kod sportaša i nesportaša. Pritom treba naglasiti kako se navedeni mišići ne mogu učinkovito aktivirati standardnim vježbama jakosti i stabilnosti trupa. To je, između ostalog, vidljivo i iz rezultata spomenutog istraživanja na Australskim nogometašima koji su tijekom sezone provodili standardni trening jakosti koji je uključivao mišiće trupa. Umjesto toga, potrebno je naučiti vježbače aktivaciju dubokih stabilizatora trupa. Riječ je o specifičnom treningu motoričke kontrole. Utvrđeno je kako takav trening može smanjiti rizik nastanka ozljeda donjih ekstremiteta u Australskom nogometu (7).

Ukoliko vas ovo područje zanima, pratite blog jer ću se ovom temom još dosta baviti. Ukoliko želite naučiti učinkovite vježbe za dubokih stabilizatora trupa, pridružite nam se na seminaru na temu rehabilitacijebolnih sindroma kralježnice kojeg organiziramo idući vikend (http://www.motus-melior.hr/edukacija/seminari-i-radionice/raspored-seminara-2014/sadrzaj-i-satnica-2-seminara-funkcionalna-rehabilitacija/).

Literatura

  1. van Hilst J, Hilgersom NF, Kuilman MC, Kuijer PP, Frings-Dresen MH. Low back pain in young elite field hockey players, football players and speed skaters: Prevalence and risk factors. J Back Musculoskelet Rehabil. 2014 Jun 24. [Epubahead of print].
  2. Tunås P, Nilstad A, Myklebust G. Low back pain in female elite football and handball players compared with an active control group. Knee Surg Sports Traumatol Arthrosc. 2014 May 18. [Epub ahead of print].
  3. Foss IS, Holme I, Bahr R. The prevalence of low back pain among former elite cross-country skiers, rowers, orienteerers, and nonathletes: a 10-year cohort study. Am J Sports Med. 2012 Nov;40(11):2610-6.
  4. Fortin M, Macedo LG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Phys Ther. 2013 Jul;93(7):873-88.
  5. Hides J, Stanton W. Muscle imbalance among elite Australian rules football players: a longitudinal study of changes in trunk muscle size. J Athl Train. 2012 May-Jun;47(3):314-9.
  6. Hides JA, Stanton WR, Mendis MD, Franettovich MM, and Sexton MJ.Small Multifidus Size Predicts Football Injuries. Orthop J Sports Med. 2014 June; 2(6). 2325967114537588, DOI: 10.1177/2325967114537588.
  7. Hides JA, Stanton WR. Can motor control training lower the risk of injury for professional football players? Med Sci Sports Exerc. 2014 Apr;46(4):762-8.

 

English version:

Prevalence of low back pain (LBP) is high in both the general population and athletes (1-3). Numerous factors are responsible for the occurrence LBP during life, one of them being cross-sectional area of paraspinal and lumbar multifidi muscles. Specifically, numerous studies have shown that chronic LBP patients have significantly smaller size of lumbar multifidi compared with matched healthy individuals (4). Also, patients with unilateral LBP have significantly lower thickness of lumbar multifidi on ipsilateral (i.e. painful) compared with contralateral (i.e. pain-free) side (4).

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Fgure 1. MR view of cross-sectional area of trunk at the level of lumbar spine. White marks indicate lumbar multifidi muscles.

Studies performed on Australian athletes (cricket players, football players, and ballet dancers) have revealed two interesting findings. First, the authors revealed a significant atrophy of lumbar multifidus and transversus abdominis muscles (11-21%) in football players during the competitive season (5). In comparison, the cross-sectional area of the lumbar erector spine muscles increased by 3.6%, and the thickness of the obliques internus muscle increased by 11.8% compared with the start of the preseason (5). Second, the same research group reported that decreased size of the multifidus muscle at L5 consistently predicted muscle injury in the preseason and playing season in Australian football players (6). Furthermore, asymmetry of the multifidus muscle was significantly related to lower limb injuries in the preseason. Finally, seasonal change in the size of the multifidus muscle indicating a decrease in muscle mass was linked to injury (6). Taken together, these results strongly suggest that athletes and non-athletes should regularly perform specific training of deep trunk muscles.

Interestingly, regular core strength and stability training proved to be inefficient in recruiting these functionally relevant muscles. Instead, a specific motor control training that teaches an individual how to activate those muscles is necessary. It has been shown that such training reduces the incidence of lower body injuries in high-level Australian football players (7).

If you are interested in this relevant topic, please follow my blog since I will write on this theme regularly. In the meantime, if you wish to learn effective exercise for recruitment of deep trunk muscles, join us at the forthcoming seminar on spine rehabilitation next weekend vikend (http://www.motus-melior.hr/edukacija/seminari-i-radionice/raspored-seminara-2014/sadrzaj-i-satnica-2-seminara-funkcionalna-rehabilitacija/).

References

  1. van Hilst J, Hilgersom NF, Kuilman MC, Kuijer PP, Frings-Dresen MH. Low back pain in young elite field hockey players, football players and speed skaters: Prevalence and risk factors. J Back Musculoskelet Rehabil. 2014 Jun 24. [Epubahead of print].
  2. Tunås P, Nilstad A, Myklebust G. Low back pain in female elite football and handball players compared with an active control group. Knee Surg Sports Traumatol Arthrosc. 2014 May 18. [Epub ahead of print].
  3. Foss IS, Holme I, Bahr R. The prevalence of low back pain among former elite cross-country skiers, rowers, orienteerers, and nonathletes: a 10-year cohort study. Am J Sports Med. 2012 Nov;40(11):2610-6.
  4. Fortin M, Macedo LG. Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Phys Ther. 2013 Jul;93(7):873-88.
  5. Hides J, Stanton W. Muscle imbalance among elite Australian rules football players: a longitudinal study of changes in trunk muscle size. J Athl Train. 2012 May-Jun;47(3):314-9.
  6. Hides JA, Stanton WR, Mendis MD, Franettovich MM, and Sexton MJ.Small Multifidus Size Predicts Football Injuries. Orthop J Sports Med. 2014 June; 2(6). 2325967114537588, DOI: 10.1177/2325967114537588.
  7. Hides JA, Stanton WR. Can motor control training lower the risk of injury for professional football players? Med Sci Sports Exerc. 2014 Apr;46(4):762-8.