Das kinematische und elektromyographische Gangbild von Bandscheibenpatienten mit segementalen Stabilitätsstörungen: Quantifizierung von Dysfunktionen und Therapieeffekten

Dagmar Bangert

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Abstract

The kinematic and electromyographic gait pattern of patients with disc herniation and segmental stability problems: Quantitative analysis of dysfunctions and treatment effects Back pain can be caused by stability loss within the spinal segments resulting from changes in the passive structures of the spine or in the neuromuscular activity of segmental stabilizing muscles. The present work evaluates the treatability of segmental stabilizing structures by special exercise programs. Our conclusions are based on a quantitative analysis of the stabilization and movement system of patients with herniated vertebral disc in the lumbar spine. The first part of the study is a cross-sectional analysis of the extent to which patients with a herniated disc L4 / 5 and L5/S1 differ in their gait pattern from healthy probands. For all test persons we measured both, the three-dimensional kinematic hip, pelvis and lumbar spine movements and the electromyographic gait pattern (both sides: the transversus abdominis / internal oblique, and gluteus medius M. mulitifidus). We investigated the time course, the mean amplitudes and the step-by-step variability of the kinematic and electromyographic data. A detailed comparison shows significant deviations of the gait patterns of back patients from those of back healthy subjects. This allowed us to develop a deviation index as a quantitative measure of pathological deviations. In a subsequent longitudinal study, patients were treated over a period of 4 months by a physiotherapist. Half of the patients completed a stabilization and mobilization training program; the comparison group carried out a neuromuscular, three-dimensional coordination training program following the guidelines of Spiral Dynamics. After the treatment, the same kinematic and electromyographic parameters were again measured and analyzed. For both groups we observed that the gait patterns approached those of the healthy control group. However, neuromuscular coordination training resulted in significantly greater progress. For this group, we observed a significant reduction in the number of pathological movements. Overall, it was shown that training can exert a beneficial influence on the gait motion and stabilization system. The magnitude of the effect depends on the type of therapy. Keywords: segmental stabilization, motion system, hernial disc patients, gait pattern, kinematics, electromyography, variability, deviation index, therapy, spiral dynamics
Original languageGerman
Place of PublicationKöln
PublisherDeutsche Sporthochschule Köln
Number of pages365
Publication statusPublished - 2010

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