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Effects of consecutive supervised core stability training on pain and disability in women with nonspecific chronic low back pain

Authors:

Abstract

Introduction: Low back pain is a very common health care problem affecting 85% of population. Spine rehabilitation programs are very various in subjects with chronic low back pain but core stability training is often the chosen treatment. However, the aim of this study was to examine the effects of consecutive supervised core stability training on pain intensity and disability of nonspecific chronic low back pain. Materials and Methods: Twenty-four non-athletic females with chronic low back pain were participated in the study. They were randomly divided into two groups: experimental group (12 days consecutively under physical therapist supervision) and control group (no intervention). The subjects in both groups were not allowed to perform any sport activity during 12 days of study. Before and after the intervention, visual analogue scale and the ososetry disability index were used to assess pain intensity and disability, respectively. Results: The findings show that the disability and intensity pain variables were significantly decreased in the experimental group (P=0.0001 and P=0.003, respectively), while no significant changes were found with respect to those variables in the control group. Conclusions: Consecutive supervised core stability training may decrease the pain intensity and disability of the patients with chronic low back pain.
Archive of SID
ﺶﻣﻮﻛ- ﺪﻠﺟ 12هرﺎﻤﺷ ، 3) ﻲﭘﺎﻴﭘ39(،رﺎﻬﺑ 1390
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ﺛﺎﺗ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي هدﺮﺸﻓ و ﺖﺤﺗ ﺮﻈﻧ ﺮﺑ درد و ﻧاﻮﺗﺎﻧ نﺎﻧز
ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﺻﺎﺼﺘﺧا
ﻢﻨﺒﺷ ﺘﻤﻫ
1
(M.Sc)*
، ﺎﺿر ﺒﺟر
1
(Ph.D)، ﺪﻟارﻮﻧ ﺮﻛ
2
(Ph.D) ،ﻠﻋ ﺮﺒﻛا ﺪﻧﺎﻬﺟهﺪ
3
(M.Sc)
1-
هﺎﮕﺸﻧادناﺮﻬﺗ ،هﺪﻜﺸﻧاد ﺑﺮﺗ ﻧﺪﺑ
2-
هﺎﮕﺸﻧاد مﻮﻠﻋ ﺰﻬﺑﺘﺴ و اﻮﺗ ن ﺨﺑ ،هوﺮﮔ ﭘاﺮﺗﻮ
3-
ﺎﮕﺸﻧاده دازآ ﻣﻼﺳا ﺪﺣاو نﺎﭼﻮﻗ
ﻜﭼ هﺪ
فﺪﻫ و ﻪﻘﺑﺎﺳ :دردﺮﻤﻛ زا لﻮﻤﻌﻣ ﺮﺗ تﻼﻜﺸﻣ ﺘﻣﻼﺳ ﺖﺳا ﻪﻛ 85 %داﺮﻓا ار ﺖـﺤﺗ ﺛﺎـﺗ راﺮـﻗ ـﻣ ﺪـﻫد .
ﻪﻣﺎﻧﺮﺑ ﺎﻫي ناﻮﺗ ﺸﺨﺑ نﻮﺘﺳ ،تاﺮﻘﻓ اﺮﺑي داﺮﻓا ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ عﻮﻨﺘﻣ ﺪﺷﺎﺑ .هوﻼﻋ ﺮﺑ ا،ﻦ ﻪـﺑ رﻮـﻃ ـﺳﺘﻨ
ﺮﺗاﻮﺗ نﺎﻣرد ﻪﺳ رﺎﺑ رد ﻪﺘﻔﻫ و ﺮﺗ تﺎﻗوا رد لﺰﻨﻣ ﺪﺷﺎﺑ و ﻪﺘﺴﻧاد ﺎﻫي ﻛﺪﻧا رد درﻮـﻣ ﺮﻤﺗ تﺎـﻨ ﺖـﺤﺗ ﺮـﻈﻧ و
هدﺮﺸﻓ رد نﺎﻣرد نارﺎﻤ دردﺮﻤﻛي دﻮﺟو دراد .زا ا ،ور فﺪﻫ ا ﻘﺤﺗ،ﻖ ﺳرﺮﺑ تاﺮﺛا ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي
ﺖﺤﺗ ﺮﻈﻧ هدﺮﺸﻓ ﺮﺑ تﺪﺷ درد و ﻧاﻮﺗﺎﻧ نارﺎﻤ ﻼﺘﺒ ﻪﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﺻﺎﺼﺘﺧاﺮ ﻮﺑد.
شور و داﻮﻣ ﺎﻫ :24 ﻢﻧﺎﺧ رﺎﻜﺷزرو ﺎﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ رد ا ﻪﻌﻟﺎﻄﻣ ﺖﻛﺮﺷ ﺪﻧدﻮﻤﻧ .ا داﺮﻓا ﻪﺑ رﻮﻃ ﻓدﺎﺼﺗ ﻪـﺑ
ود هوﺮﮔ ﺴﻘﺗ ﺪﻧﺪﺷ :هوﺮﮔ ﺑﺮﺠﺗ، ﻪﻣﺎﻧﺮﺑ ﻧﺎﻣرد ار رد 12 زور ﻟاﻮﺘﻣ، ﺖﺤﺗ ﺮﻈﻧ ـﻳپاﺮﺗﻮ مﺎـﺠﻧا ﺪـﻧداد و رد
هوﺮﮔ ،لﺮﺘﻨﻛ ﻪﻠﺧاﺪﻣ اي ترﻮﺻ ﺖﻓﺮﮕﻧ .ﻪﻧﻮﻤﻧ ﺎﻫ رد ﺮﻫ ،هوﺮﮔ زا مﺎﺠﻧا ﻪﻧﻮﮔﺮﻫ ﻟﺎﻌﻓ ﺷزرو رد هرود مﺎﺠﻧا ﻪﻌﻟﺎﻄﻣ
راددﻮﺧي ﺪﻧدﻮﻤﻧ .ﻞﺒﻗ و ﺪﻌﺑ زا هرود ﻧﺎﻣرد، ﻘﻣسﺎ دراﺪي درد اﺮﺑي زراﺑﺎ تﺪﺷ درد و ﺺﺧﺎﺷ ﻧاﻮﺗﺎﻧ ﺮﺘـﺳﻮﺳاي
اﺮﺑي زراﺑﺎ ﻧاﻮﺗﺎﻧ هدﺎﻔﺘﺳا ﺪﻧﺪﺷ.
ﻪﺘﻓﺎﻳ ﺎﻫ: ﺎﺘﻧ نﺎﺸﻧ داد ﻪﻛ رد ناﺰ تﺪﺷ درد و ﻧاﻮﺗﺎﻧ رد هوﺮﮔ ،ﻪﻠﺧاﺪﻣ ﻞﺒﻗ و ﺪﻌﺑ زا نﺎﻣرد توﺎﻔﺗ ـﻨﻌﻣ رادي
ﻪﺘﺷاد ﺖﺳا) ﻪﺑ ﺗﺮﺗ 000/0=Pو 003/0=P .(رد ﻟﺎﺣ ﻪﻛ رد هوﺮﮔ ،لﺮﺘﻨﻛ توﺎﻔﺗ ﻨﻌﻣ رادي هﺪﻫﺎﺸﻣ دﺮﮕﻧ.
ﻪﺠﻴﺘﻧ يﺮﻴﮔ: ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي ﺖﺤﺗ ﺮﻈﻧ و ،هدﺮﺸﻓ ﺚﻋﺎﺑ ﺶﻫﺎﻛ ـﻴناﺰ درد و ﻧاﻮﺗﺎـﻧ رد نارﺎـﻤ ﺎـﺑ
دردﺮﻤﻛ ﻦﻣﺰﻣ دﻮﺷ.
هژاو يﺪﻴﻠﻛ يﺎﻫ :دردﺮﻤﻛ ﻦﻣﺰﻣ ﺻﺎﺼﺘﺧا، ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي، ﻧاﻮﺗﺎﻧ و درد
ﻪﻣﺪﻘﻣ
دردﺮﻤﻛ زا ﺖﻠﻋ ﺎﻫي ﻧاﻮﺗﺎﻧ رد ﻌﻤﺟ گرﺰﺑ نﻻﺎﺳ
ﺪﺷﺎﺑ ﻪﻛ ناﺰ عﻮ نآ رد نﺎﻣز ﮔﺪﻧز 60 ﺎﺗ 80% ﻤﺨﺗ
هدز هﺪﺷ ﺖﺳا و ﻪﺑ رﻮﻃ ﺮﻘﺗ 80 %،نارﺎﻤ ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ
ـﻴ ﺻﺎﺼـﺘﺧا (Nonspecific low back pain) ﺪﻨﺘﺴـﻫ و
دوﺪﺣ 7 ﺎﺗ 10% زا نآ ﺎﻫ ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﺻﺎﺼﺘﺧا
ــﻣ ﺪﻨــﺷﺎﺑ] 1[ .ناﺪــﻘﻓ تﺎــﺒﺛ ﺰــﻛﺮﻣي نﻮﺘــﺳ هﺮــﻬﻣ اي
(Core stabilization)ﻪﺑ ناﻮﻨﻋ ﻞﻣﺎﻋ ﺪﻌﺘﺴـﻣ هﺪـﻨﻨﻛ دردﺮـﻤﻛ
حﺮﻄﻣ هﺪﺷ ﺖﺳا] 2[ . تﺎـﺒﺛ ﺰـﻛﺮﻣي نﻮﺘـﺳ هﺮـﻬﻣ اي ﻂـﺳﻮﺗ
تﻼﻀﻋ ﺻﺎ ﻣﺎﺗ ددﺮﮔ ﻪﻛ ا ـﻳ ،تﻼﻀـﻋ تﺎـﺒﺛ ـﺑ
هﺮﻬﻣ اي ار ﻪﺑ ﻞﻜﺷ ﻌﺿﻮﻣ ﻣﺎﺗ ـﻣ ﺪـﻨﻨﻛ] 3[ . تﻼﻀـﻋ ﺎـﺑ
تﻻﺎﺼﺗا هﺮﻬﻣ اي، ﺪﻨﻧﺎﻣ ﺘﻟﻮﻣ ،سوﺪ ﺿﺮﻋ ﻢﻜﺷ و ﺎﻣ
ﻠﺧاد اﺮﺑي تﺎﺒﺛ ﻧﺎﻤﮕﺳ ﺐﺳﺎﻨﻣ ﺮﺗ ﺪﻨﺘﺴـﻫ ]4[ . ﻪﻠﻀـﻋ
ﺿﺮﻋ ﻢﻜﺷ رد داﺮﻓا ،ﻢﻟﺎـﺳ ﻞـﺒﻗ زا ﺖـﻛﺮﺣ ماﺪـﻧا ﺎـﻫ لﺎـﻌﻓ
*
،لﻮﺌﺴﻣ هﺪﻨﺴﻳﻮﻧﻦﻔﻠﺗ: 09368754699 ﺮﺑﺎﻤﻧ:09368754699 hemmati1363@gmail.com Email:
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ: 5/2/1389شﺮﻳﺬﭘ ﺦﻳرﺎﺗ : 25/7/1389 www.SID.ir
Archive of SID
ﺮﻴﺛﺎﺗ تﺎﻨﻳﺮﻤﺗ تﺎﺒﺛ هﺪﻨﻫد يﺰﻛﺮﻣ هدﺮﺸﻓ و ﺖﺤﺗ ﺮﻈﻧ... ﻲﺘﻤﻫ ﻢﻨﺒﺷ نارﺎﻜﻤﻫ و
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ﻮﺷد و تﺎﺒﺛ درﻮﻣ زﺎ نﻮﺘﺳ هﺮﻬﻣ اي ار ﻣﺎﺗ ـﻣ ﺪـﻨﻛ ﺎـﺗ
تﺎﻛﺮﺣ ماﺪﻧا ﺎﻫ وري ﺎﭘ ﺘﺑﺎﺛ مﺎﺠﻧا ،دﻮـﺷ ـﻟو رد نارﺎـﻤ
ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ ا ﻪﻠﻀﻋ ﺎﺑ ﺧﺎﺗ لﺎﻌﻓ دﻮﺷ و رد ﺘﻧ ،ﻪـﺠ
ﺖﻛﺮﺣ ماﺪﻧا ﺎﻫ نوﺪﺑ تﺎﺒﺛ ﻓﺎﻛ نﻮﺘﺳ هﺮـﻬﻣ اي مﺎـﺠﻧا هﺪـﺷ و
ﻣزﻪﻨ ار اﺮﺑي لﺎﻤﻋا ﺎﻫرﺎﺑي ﺐـﺳﺎﻨﻣﺎﻧ ﻪـﺑ نﻮﺘـﺳ هﺮـﻬﻣ ﺎـﻫ و
دردﺮﻤﻛ ﻢﻫاﺮﻓ ﺪﻨﻛ] 5[ .هوﻼﻋ ﺮﺑ ا،ﻦ ﺶﻫﺎﻛ ﻞﻤﺤﺗ تﻼﻀﻋ
ﺘﻟﻮﻣ سوﺪ لﺎﺒﻧد دردﺮﻤﻛ ﺑدﻮﺧ دﻮﺧ دﻮﺒﻬﺑ ﻤﻧ ،ﺪﺑﺎ ﺮـﮕﻣ
ا ﻪﻛ ناﻮﺗ ﺸﺨﺑ ﺻﺎﺼﺘﺧا ﺖـﻬﺟ زﻮﻣآزﺎـﺑي ا ـﻳ تﻼﻀـﻋ
مﺎﺠﻧا دﻮﺷ] 6[ .اﺮﺑﺎﻨﺑ،ﻦ شزﻮﻣآ تﻼﻀﻋ تﺎﺒﺛ هﺪﻨﻫد و ﻪﻌﺳﻮﺗ
ﺮﻤﺗ ﺎﻫ ﻪﺑ ﺖﻤﺳ ترﺎﻬﻣ ي ﻞﻤﻋ دﺮﻛي ءﺰﺟ روﺮﺿي تﺎـﺒﺛ
ﻧﻼﻀﻋ نﻮﺘﺳ هﺮﻬﻣ اي ﺖﺳا] 7[ .نﺎﻣرد دردﺮﻤﻛ و ناﻮﺗ ﺸـﺨﺑ
نآ رد هﺎﺗﻮﻛ ﺮﺗ نﺎﻣز ،ﻦﻜﻤﻣ ـﻳ وزرآي گرﺰـﺑ و ﺪـﻗ
،ﺖﺳا ﺎﻣا زﻮﻨﻫ لﺎﺒﻗا ﺑﻮﺧ اﺮﺑي ﺖﺳد نارﺎﻛرﺪـﻧا ﺖـﺷاﺪﻬﺑ و
ﺖﻣﻼﺳ ﻞﺻﺎﺣ هﺪﺸـﻧ و ـﺘﺣ زا دردﺮـﻤﻛ ﻪـﺑ ناﻮـﻨﻋ ﻪـﻌﺟﺎﻓ
ﺘﺷاﺪﻬﺑ نﺮﻗ 21 دﺎ هﺪﺷ ﺳا] 8[ .ﺮﻫ ﺪﻨﭼ ـﭘ ﺖـﻓر ﺎـﻫي
ﻧﺎﻣرد و ناﻮﺗ ﺸـﺨﺑ دردﺮـﻤﻛ ـﺑ و ـﻳهﮋ رد لﺎـﺳ ﺎـﻫي ﺧا ـﻴ
ﻘﻓﻮﻣ ﺎﻫي ﺒﺴﻧ ﻪﺘﺷاد ﺖﺳا ﻟو زﻮﻨﻫ ﻪﻣﺎﻧﺮﺑ ﺎﻫي ﻧﺎﻣرد ﺮﭘ
ﺰﻫﻪﻨ و ﻧﻻﻮـﻃ تﺪـﻣ ﺖـﺳا ]9[ . ﺮـﻤﺗ ﻧﺎـﻣرد ـﻜ زا
ار ﺮﺗ شور ﺎﻫي ﻧﺎﻣرد اﺮﺑي نارﺎـﻤ ﻼﺘـﺒﻣ ﻪـﺑ دردﺮـﻤﻛ
ﻦﻣﺰﻣ ﺪﺷﺎﺑ و فﺪﻫ ﻠﺻا نآ ﺖﺳد ندروآ ،ترﺪﻗ ﻞـﻤﺤﺗ
و فﺎﻄﻌﻧا ﺬـﭘي تﻼﻀـﻋ نﻮﺘـﺳ تاﺮـﻘﻓ ﻪـﺑ رﻮـﻈﻨﻣ دﻮـﺒﻬﺑ
ﺖﻓﺎﺑ ﺎﻫي ﺳآ دهﺪ و ﺖﺸـﮔزﺎﺑ ﻪـﺑ ﻟﺎﻌﻓ ـﻴ ﺎـﻫي ﻪـﻧازور و
ﺒﻃ ﺪﺷﺎﺑ ]10[ .هوﻼﻋ ﺮﺑ ا رد نﺎﻣرد ﺎﻫي ﺘﻨﺳ راﺮﻜﺗ
ﺮﻤﺗتﺎﻨ 3 رﺎﺑ رد ﻪﺘﻔﻫ و ﺐـﻠﻏا رد لﺰـﻨﻣ مﺎـﺠﻧا ـﻣ دﻮـﺷ و
ﻪﺘﺴﻧاد ﺎﻫي ﻛﺪﻧا رد درﻮﻣ ﺮﻤﺗتﺎﻨ هدﺮﺸـﻓ و ﺖـﺤﺗ ﺮـﻈﻧ رد
نﺎﻣرد دردﺮﻤﻛ ﻦﻣﺰﻣ دﻮﺟو دراد] 11.[
Hides و نارﺎﻜﻤﻫ )1996 (ردﺪﻨﺘﻓﺎ ﻪﻛ 4 ﻪﺘﻔﻫ ﺮﻤﺗتﺎﻨ
وــ ﻳهﮋ ﺗﺎــﺒﺛ ﺚــﻋﺎﺑ اﺰــﻓا ﺮــﺳ ﺢﻄــﺳ ﻊــﻄﻘﻣ ﻪﻠﻀــﻋ
ﺘﻟﻮﻣ ـﻴسوﺪ ـﻣ ددﺮـﮔ] 12[ .رد ﻪـﻌﻟﺎﻄﻣ د ﺮـﮕي رد لﺎـﺳ
2008، Stanton و نارﺎــﻜﻤﻫ نﺎﺸــﻧ ﺪــﻧداد ﻪــﻛ ﺮﻤﺗتﺎــﻨ
زﻮﻣآزﺎﺑي وهﮋ ﺚﻋﺎﺑ دﻮﺒﻬﺑ ﺢﻄﺳ ﻊﻄﻘﻣ ﻪﻠﻀﻋ ﺘﻟﻮﻣ ـﻴسوﺪ و
ﺶﻫﺎﻛ درد رد ﺮﻛﺖﻜ نازﺎﺑ ﻪﺒﺨﻧ ناﻮﺟ ﺎﺑ دردﺮـﻤﻛ ـﻣ ددﺮـﮔ
]13.[ Osullivan و نارﺎﻜﻤﻫ) 1997 (هﺪﻫﺎﺸﻣ ﺪﻧدﻮﻤﻧ ﻪﻛ 10
ﻪﺘﻔﻫ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد نﻮﺘﺳ تاﺮﻘﻓ ﺚﻋﺎﺑ ﺶﻫﺎﻛ ـﺑ ﺮـﺗ
ناﺰ درد و دﻮﺒﻬﺑ ﻞﻤﻋ دﺮﻛ ﺖﺒﺴﻧ ﻪﺑ ﺮﻤﺗتﺎﻨ ﻮﻤﻋ و ﺗرﺪﻗ
ـــﻣ ددﺮـــﮔ ]3[. ،ﺎـــﻣا Koumantakis نارﺎـــﻜﻤﻫو )2005 (
ﺘﻧﻪﺠ ي ﺪﻧدﻮﻤﻧ ﻪﻛ توﺎﻔﺗ ﻨﻌﻣ رادي ود ـﺷهﻮ ﺮﻤﺗ ـﻨ
)ﺘﻣﺎﻘﺘﺳا و ﺗﺎﺒﺛ (ﺮﺑ ترﺪﻗ و ﺖﻣﺎﻘﺘﺳا تﻼﻀﻋ ﺖﺸﭘ نارﺎﻤ
ارادي دردﺮﻤﻛ ﻦﻣﺰﻣ دﻮﺟو دراﺪﻧ] 14[ .ﻢﻫ ﻨﭼ رد نﺎﻤﻫ لﺎﺳ
ا ـﻘﻘﺤﻣ هﺪﻫﺎﺸـﻣ ﺪـﻧدﻮﻤﻧ ﻪـﻛ رد ـﻳ هرود 8 ﻪـﺘﻔﻫ اي،
ﺮﻤﺗتﺎﻨ ﻣﻮﻤﻋ، ﺖﺒﺴﻧ ﻪﺑ ﺮﻤﺗتﺎﻨ ﻛﺮﺗ ﺗﺎـﺒﺛ و ﻣﻮـﻤﻋ،
ﺎﺘﻧ ﺮﺗرﺎﮔﺪﻧﺎﻣي رد نارﺎـﻤ ارادي دردﺮـﻤﻛ ﺪـﻫاﻮﺧ ﺖـﺷاد
]15.[ Wallwork و نارﺎﻜﻤﻫ) 2008 (نﺎﺸﻧ ﺪﻧداد ﻪﻛ نارﺎـﻤ
ﺎﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﻢﻛ ﺮﺗ ردﺎﻗ ﺪﻨﺘﺴﻫ ﺎﺗ ﻪﺑ ترﻮﺻ ﺘﺧارﺎي ﻪﻠﻀﻋ
ﺘﻟﻮﻣ سوﺪ ار رد ﺢﻄﺳ ﺸﻣﻪﺑﺎ هﺮﻬﻣ اي رد ﺎﺟﻲﻳ ﻪﻛ ـﻓوﺮﺗآ
ترﻮــﺻ ،ﻪــﺘﻓﺮﮔ ﺾﺒــﻘﻨﻣ ﺎﻤﻧﺪــﻨ] 16.[ Cairns و نارﺎــﻜﻤﻫ
)2005 ( نﺎﺸﻧ ﺪـﻧداد ﻪـﻛ ندوﺰـﻓا ﺮﻤﺗ تﺎـﻨ تﺎـﺒﺛ هﺪـﻨﻫد
ﺼﺼﺨﺗ تاﺮﻘﻓ ﻪﺑ ﻪﻣﺎﻧﺮﺑ لواﺪـﺘﻣ ـﻳﭘاﺮﺗﻮ رد نارﺎـﻤ ﺎـﺑ
دردﺮﻤﻛ ﻪﻌﺟار ﺮﺠﻨﻣ ﻪﺑ دﻮﺒﻬﺑي ﺮـﺗ ـﻤﻧ دﻮـﺷ] 17[ . ﺎـﻣا
Goldby
و نارﺎﻜﻤﻫ) 2006 (فﻼﺧﺮﺑ ود ﻪﻌﻟﺎﻄﻣ ـﻠﺒﻗ نﺎﺸـﻧ
ﺪﻧداد ﻪﻛ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺛﺎﺗ ـﺑ ﺮـﺗي رد ﺶﻫﺎـﻛ درد
نارﺎﻤ ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﺖﺒﺴﻧ ﻪﺑ نﺎـﻣرد ﺎـﻫي ﺘـﺳد و
هوﺮـﮔ لﺮـﺘﻨﻛ ﺪـﻧراد] 18[ . ﻢـﻫ ـﻨﭼ Fonseca و نارﺎـﻜﻤﻫ
)2009 ( هﺪﻫﺎﺸﻣ ﺪﻧدﻮﻤﻧ ﻪﻛ رد هرود 15 ﻪﺴﻠﺟ اي
ﺮﻤﺗتﺎﻨ ﺰﺗﻼ، ناﺰ درد رد هار ﻦﺘﻓر نارﺎﻤ ارادي دردﺮـﻤﻛ
ﺶﻫﺎﻛ ﺪﺑﺎ] 19[.
ﺮﺑ سﺎﺳا نآ ﻪﭼ نﻮﻨﻛﺎﺗ ﻪـﺘﻔﮔ ﺪـﺷ زا ـﻳ ﻮـﺳ رد درﻮـﻣ
آرﺎﻛﻲﻳ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪـﻨﻫد فﻼﺘـﺧا ﺮـﻈﻧ دﻮـﺟو دراد و زا
ﻮﺳي دﺮﮕ رد ﻪـﻌﻟﺎﻄﻣ ﺮﮕﻧزﺎـﺑي ﻪـﻛ Standaert و نارﺎـﻜﻤﻫ
)2008 (مﺎﺠﻧا ،ﺪﻧداد نﺎ هﺪﺷ ﺖﺳا ﻪﻛ ﺮﻤﺗتﺎﻨ تﺎـﺒﺛ هﺪـﻨﻫد
ﺮﻤﻛي رد دﻮﺒﻬﺑ ﻞﻤﻋ دﺮﻛ و درد رد هوﺮﮔ ﺎﻫي عﻮﻨﺘﻣ) ﻦﮕﻤﻫﺎـﻧ (
نارﺎﻤ ﺎﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﺮﺛﻮﻣ ﺪﺷﺎﺑ .تﺎﻋﻼﻃا ﺮـﺗي رد
درﻮﻣ عﻮﻧ نارﺎﻤ درﻮﻣ ،ﻪﻌﻟﺎﻄﻣ ﺮﻤﺗ ﺎـﻫي ﺮﺗﺮﺛﻮـﻣ و راﺪـﻘﻣ
بﻮﻠﻄﻣ ﺮﻤﺗ،ﻦ تﺪﻣ و داﺪﻌﺗ ﺎﻫراﺮﻜﺗ درﻮﻣ ـﻴزﺎ ﺖـﺳا ]20[ .
ﻢﻫ ﻨﭼ ﺴـﺑرﺎي زا نارﺎـﻤ ﻪـﺑ ﻻد ـﻳ دﺎﺼـﺘﻗاي، نﺎـﻫاﻮﺧ
ﺖﺸﮔزﺎﺑ ﺮﺳ ﺮﺗ ﺋﺎﻧاﻮﺗ ﺎﻫي ﻞﻤﻋ دﺮﻛي، ﺶﻫﺎﻛ درد و اﺰﻓا
www.SID.ir
Archive of SID
ﺶﻣﻮﻛ ﺪﻠﺟ12 هرﺎﻤﺷ ،3) ﻲﭘﺎﻴﭘ39( ،رﺎﻬﺑ 1390
246
ﻞﻤﻋ دﺮﻛ ﻧﻼﻀﻋ ﺪﻨﺷﺎﺑ و زا ﻮﺳي دﺎﻋداﺮﮕ هﺪﺷ ﺖﺳا ﻪـﻛ
ترﺎﻈﻧ ﺮﮕﻧﺎﻣرد ﺪﻧاﻮﺗ هرود ﻧﺎـﻣرد ار هﺎـﺗﻮﻛ ﺮـﺗ ،ﺪـﻨﻛ ﺎـﻣا
ﺪﻫاﻮﺷي ﻪﻛ ا ﺎـﻋدا ار ﺎﺗ ـﻴﻳ ﺪـﻨﻛ دﻮـﺟو دراﺪـﻧ] 10[ . ﻪـﺑ
رﻮﻃي ،ﻪﻛ ﺮﺗ تﺎﻌﻟﺎﻄﻣ مﺎﺠﻧا ﻪﺘﻓﺮﮔ رد تﺪﻣ نﺎﻣز ﺮﺗﻻﺎﺑ زا
4 ﻪﺘﻔﻫ ترﻮﺻ ﻪﺘﻓﺮﮔ ﺖﺳا . اﺮﺑﺎـﻨﺑ هدﺎﻔﺘـﺳا زا ﻪـﻣﺎﻧﺮﺑ ﺎـﻫي
ﺷزرو هﺎﺗﻮﻛ تﺪﻣ و ﺖﺤﺗ ﺮﻈﻧ اﺮﺑي نﺎﻣرد نارﺎﻤ ﻼﺘـﺒﻣ ﻪـﺑ
دردﺮﻤﻛ ﻦﻣﺰﻣ ﺴﺑرﺎ ﺎﺑ شزرا ﺖـﺳا و لﺎـﻌﻓ ندﺮـﻛ تﻼﻀـﻋ
ﺗﺎﺒﺛ ﻪﺑ وهﮋ ﺘﻟﻮﻣ سوﺪ و ﻪﻠﻀﻋ ﺿﺮﻋ ﻢﻜـﺷ ﻞﻘﺘﺴـﻣ زا
ﺎﺳ تﻼﻀ ﺎﭙﺳارﺎﭘلﺎﻨ رد ﻞـﺣاﺮﻣ ﻟوا ـﻴ نﺎـﻣرد روﺮـﺿي
ﺖﺳا ]8[ .ﺎﺗ نآ ﺎﺟ ﻪﻛ ﺎﻣ ﺳرﺮﺑ دﻮﻤﻧ،ﻢ ﻘﺤﺗ هﺪﻫﺎﺸﻣ ﺪﺸﻧ
ﻪﻛ ﺛﺎﺗ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي ﺖﺤﺗ ﺮـﻈﻧ و هدﺮﺸـﻓ ﺮـﺑ
تﺪﺷ درد و ﻧاﻮﺗﺎﻧ ار رد نﺎـﻧز ارادي دردﺮـﻤﻛ ﻦﻣﺰـﻣ درﻮـﻣ
ﺳرﺮﺑ راﺮﻗ هداد ﺪﺷﺎﺑ .،اﺬﻟ فﺪﻫ ﻪﻌﻟﺎﻄﻣ ﺮﺿﺎﺣ ﺛﺎﺗ ﻤﺗتﺎﻨ
تﺎﺒﺛ هﺪﻨﻫد ﺰـﻛﺮﻣي ﺖـﺤﺗ ﺮـﻈﻧ و هدﺮﺸـﻓ) 12 زور ( ﺮـﺑ وري
تﺪﺷ درد و ﻧاﻮﺗﺎﻧ نارﺎـﻤ ﻼﺘـﺒﻣ ﻪـﺑ دردﺮـﻤﻛ ﻦﻣﺰـﻣ ـﻴ
ﺻﺎﺼﺘﺧا ﺪﺷﺎﺑ.
شور و داﻮﻣ ﺎﻫ
ﻦﻳا ﻪﻌﻟﺎﻄﻣ زا عﻮﻧ تﺎﻘﻴﻘﺤﺗ ﻪﻤﻴﻧ ﺮـﺠﺗ ﻲـﺑ هدﻮـﺑ و حﺮـﻃ
ﻘﺤﺗ ﻪﺑ ترﻮﺻ ﺶﻴﭘ نﻮﻣزآ و ﺲـﭘ نﻮـﻣزآ ﺎـﺑ هوﺮـﮔ ﺪﻫﺎـﺷ
ﺪـﺷﺎﺑ . داﺪـﻌﺗ 24 ﺮـﻔﻧ زا نﺎـﻧز ﻼﺘـﺒﻣ ﻪـﺑ دردﺮـﻤﻛ ﻦﻣﺰـﻣ
ﺻﺎﺼﺘﺧاﺮ ترﻮﺻ رد سﺮﺘـﺳد بﺎـﺨﺘﻧا و ﻪـﺑ ترﻮـﺻ
ﻓدﺎﺼﺗ ﺮﺑ ﺎﻨﺒﻣي هرﺎﻤﺷ ﺖﺒﺛ هﺪﺷ اﺮـﺑي ﺮـﻫ ﻧدﻮـﻣزآ رد ود
هوﺮﮔ ﺮﻤﺗ ﻧﺎﻣرد )12 ﺮﻔﻧ (و هوﺮـﮔ لﺮـﺘﻨﻛ )12 ﺮـﻔﻧ ( راﺮـﻗ
ﺪﻨﺘﻓﺮﮔ .ﻞﺒﻗ زا ﺖﻛﺮﺷ رد ﻪﻌﻟﺎﻄﻣ ﻣﺎﻤﺗ داﺮﻓا ﺖﻛﺮﺷ هﺪﻨﻨﻛ مﺮـﻓ
ﺎﺿر ﻪﻣﺎﻧ ﻪﻛ ﻪﺑ ﻮﺼ هوﺮﮔ ﺐﻃ شزرو هﺪﻜﺸـﻧاد ﺑﺮﺗ ـﻴ
ﻧﺪﺑ هﺎﮕﺸﻧاد ناﺮﻬﺗ ﺳرهﺪ دﻮﺑ ار ءﺎﻀﻣا ﺪﻧدﻮﻤﻧ .زا ﻌﻣ ﺎـﻫرﺎي
دورو ﻪﺑ ﻪﻌﻟﺎﻄﻣ ﻦﺘﺷاد ﻪﻨﻣاد ﻨﺳ 20-40 لﺎﺳ و مﺪﻋ ﻼﺘﺑا ﻪـﺑ
،ﺖﻧﻮﻔﻋ ،رﻮﻣﻮﺗ رﺎﻤي ﺎﻫي ﺋﻮﺗﺎﻣوري، ﮕﺘﺴﻜﺷ هﺮـﻬﻣ ،ﺎـﻫ
ﻛﻮﭘ ،ناﻮﺨﺘﺳا ﻣرﻮﻓد ﺪـﺷ ،لاﺮﭽـﺳﺎﭘ رﺎـﺠﻨﻫﺎﻧي ﺎـﻫي
دازردﺎــــﻣي ،تاﺮــــﻘﻓ ﺎﭙــــﺳاﺑﺎﻨ،اﺪ ﺪﻧﻮﭙــــﺳاﻟﻮﻠ،ﺰ
ﺪﻧﺎﭙﺳاﻟﻮﻠﺰﺘﺴ،ﺲ درد هﺪﻨﺸﻛﺮ ﻪﺑ ،ﺎﻫﺎﭘ درد ﺪـﺷ ،ﻪﻧﺎﺒـﺷ
ﮔدﺮﺴﻓا، رﺎﻤي ﺎﻫي رﺎﺠﻣي رارداي و ،نﺎـﻧز ﻪﻘﺑﺎـﺳ شزرو
،ﻢﻈﻨﻣ فﺮﺼﻣ ﺎﻫورادي ﺪﺿ ﺑﺎﻬﺘﻟا و ﺪﺿ درد رد هرود ﻪﻌﻟﺎﻄﻣ
ﺪﺷﺎﺑ . رﻮـﻈﻨﻣ زا دردﺮـﻤﻛ ﻦﻣﺰـﻣ ـﻴ ﺻﺎﺼـﺘﺧا رد ا ـﻳ
ﻌﻟﺎﻄﻣ،ﻪ ﻧارﺎﻤ ﺪﻨﺘﺴﻫ ﻪﻛ رد نﺎﻣز ﺖﻛﺮﺷ رد ﻖﻴﻘﺤﺗ ﻼﺘﺒﻣ ﻪـﺑ
دردﺮﻤﻛ هدﻮﺑ و ﺎﻳ ﻪﻘﺑﺎـﺳ تﻼـﻤﺣ راﺮـﻜﺗ هﺪﻧﻮـﺷ دردﺮـﻤﻛ ار
شراﺰﮔ ﺪﻨﻨﻛ. ﻢﻫ ﻦﻴﻨﭼ رد درﻮﻣ ﺖﻠﻋ درد نآ ،ﺎـﻫ ﭻﻴـﻫ ﺖـﻠﻋ
ﻲﺻﺎﺧ هﺪﻳد هﺪﺸﻧ و هرود ﻧﺎﻣز دردﺮـﻤﻛ 3 هﺎـﻣ و ـﻳ ﺮﺗﻻﺎـﺑ
ﺪﺷﺎﺑ .رد ا ﻘﺤﺗ رد درﻮﻣ دﺎﺣ ﻦﻣﺰـﻣ ندﻮـﺑ ردﺮـﻤﻛد زا
ﻌﻣرﺎ دﻮـﺧ ـﺷراﺰﮔ دردﺮـﻤﻛ ﻪـﻛ ﻂـﺳﻮﺗ Leboeuf-Yde و
نارﺎﻜﻤﻫ )1996 (حﺮﻄﻣ ،هﺪﺷ هدﺎﻔﺘﺳا ﺪﺷ] 21[ .مزﻻ ﻪﺑ ﺮـﻛذ
ﺖﺳا ﻪﻛ مﺎﻤﺗ ﺎﻌﻣتﺎﻨ ﻂﺳﻮﺗ پاﺮﺗﻮ بﺮﺠﻣ مﺎﺠﻧا ﺪﺷ و
ﻧارﺎﻤ ﻪﻛ تﺎﺴﻠﺟ ﻧﺎﻣرد ار ﻞﻣﺎﻛ هدﺮﻜﻧ و مﺎﺠﻧا ﺮﻤﺗتﺎﻨ
ﺚﻋﺎﺑ ﺪﺸﺗ درد و ﻧاﻮﺗﺎﻧ نآ ﺎـﻫ ـﻣ ﺪـﺷ زا ﻪـﻌﻟﺎﻄﻣ جرﺎـﺧ
ﺪﻧﺪﺷ.
هزاﺪــﻧا ــﻴي درد .اﺮــﺑي هزاﺪــﻧا ــﻴي درد زا ﻘﻣــﻴسﺎ
دراﺪي درد هدﺎﻔﺘﺳا ﺪﺷ .ا ﻌﻣ ـﻴرﺎ هزاﺪـﻧا ـﻴي ﻪـﻛ ﺖـﻬﺟ
ﺳرﺮﺑ تﺪﺷ درد هدﺎﻔﺘﺳا دﻮﺷ. راﻮﻧ ﻘﻓا ﻪﺑ لﻮﻃ 100
ﺮﺘﻣ 10 ﺘﻧﺎﺳ ﺮﺘﻣ ﺖﺳا ﻪﻛ ﺎـﻬﺘﻧاي نآ ﺮﻔـﺻ ـﻨﻌ
نوﺪﺑ درد و ﺎﻬﺘﻧاي دﺮﮕ نآ 10 ﻨﻌ ﺪـﺷﺮﺗﺪ درد ﻦـﻜﻤﻣ
ﺪﺷﺎﺑ .ا ﻌﻣرﺎ ﻪﺑ رﻮـﻃ هدﺮﺘﺴـﮔ رد ﻘﺤﺗ تﺎـﻘ درد درﻮـﻣ
هدﺎﻔﺘﺳا راﺮﻗ ﻪﺘﻓﺮﮔ ﺖﺳا رﺎﺒﺘﻋا و اور ﻲـﻳ ،نآ ﻟﺎـﻋ و ﺎﭘ ـﻳﻲﻳ
ﻠﺧاد نآ 91/0=ICC ار نﺎﺸﻧ هداد ﺖﺳا] 22،23[.
زراﺑﺎ ﻞﻤﻋ دﺮﻛ . ﻪﺟرد ﻧاﻮﺗﺎﻧ ﺎﺑ ﺶﺳﺮﭘ ﻪﻣﺎﻧ ﺺﺧﺎﺷ
ﻧاﻮﺗﺎـﻧ ﺮﺘـﺳﻮﺳاي
(The oswestry disability index) ﻪـﻛ
دراﺪﻧﺎﺘﺳا ﻼﻃﻲﻳ اﺮﺑي هزاﺪﻧا ي ﻞﻤﻋ دﺮﻛ رد دردﺮـﻤﻛ ﺖـﺳا
هزاﺪﻧا ي ﺪﺷ] 24[ .ا ﺶﺳﺮﭘ ﻪﻣﺎﻧ ﻞﻣﺎﺷ 10 آﻢﺘ ﺖﺳا .ﺮﻫ
آﻢﺘ 6 ﻪﺒﺗر دراد و زا ﺮﻔﺻ ﺎﺗ 5 ﻪﺒﺗر ﺪﻨﺑي دﻮـﺷ و ﺮﺜﻛاﺪـﺣ
هﺮــﻤﻧ ﺶــﺳﺮﭘ ﻪــﻣﺎﻧ 50 ــ ﻣ ﺪــﺷﺎﺑ .آــ ﻳ
ﻢﺘ لوا تﺪــﺷ درد ار
هزاﺪﻧا ي ﺪﻨﻛ و 9 آﻢﺘ دﺮﮕ رد طﺎﺒﺗرا ﺎـﺑ ﻟﺎﻌﻓ ـﻴ ﺎـﻫي
هﺮﻣزور ﺖﺳا ﻪﻛ ﺖﺤﺗ ﺛﺎـﺗ دردﺮـﻤﻛ راﺮـﻗ ـﻣ ﺪـﻧﺮ . هﺮـﻤﻧ
آﻢﺘ ﺎﻫي ﻒﻠﺘﺨﻣ ﺎﺑ ﻢﻫ ﻊﻤﺟ و ﺮﺑ دﺪـﻋ 50 ﺴـﻘﺗ و رد دﺪـﻋ
100 بﺮﺿ دﻮﺷ ﺎﺗ ﺪﺻرد ﻧاﻮﺗﺎﻧ ﺖﺳد آ] 10.[
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ﺮﻴﺛﺎﺗ تﺎﻨﻳﺮﻤﺗ تﺎﺒﺛ هﺪﻨﻫد يﺰﻛﺮﻣ هدﺮﺸﻓ و ﺖﺤﺗ ﺮﻈﻧ... ﻲﺘﻤﻫ ﻢﻨﺒﺷ نارﺎﻜﻤﻫ و
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شور نﺎﻣرد .ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي .رد ا ﻘﺤﺗ ـﻴ
نارﺎﻤ ﺖﺤﺗ ﺮﻈﻧ ﻖﻘﺤ و پاﺮﺗﻮ بﺮـﺠﻣ ﻪـﺑ تﺪـﻣ 12
ﻪﺴﻠﺟ ﺮﻫ زور ﺮﻤﺗتﺎﻨ ار مﺎﺠﻧا ﺪﻧداد و عﻮﻧ ﺮﻤﺗ تﺎـﻨ ﻪـﺑ
ﺗﺮﺗ زا هدﺎﺳ ﻪﺑ هﺪ اﺮﺟا ﺪﺷ .ﻛﺎﺗ هﺪﻤﻋ وري ﻪﻠﻀـﻋ
ﺘﻟﻮﻣ سوﺪ و ﺿﺮﻋ ﻢﻜﺷ دﻮﺑ ﻪﻛ ﻪﺑ ﻚﻤﻛ ﺲﻤﻟ ا ﻪﻠﻀـﻋ
ﻪﺑ دﺮﻓ شزﻮﻣآ هداد ﺪﺷ .شزﻮﻣآ ﺎﺑ ﺲﻤﻟ ﺪﺑ ترﻮﺻ دﻮـﺑ
ﻪﻛ ﺮﮕﻧﻮﻣزآ ﺎﺑ راﺮﻗ نداد نﺎﺘﺸـﮕﻧا دﻮـﺧ وري ﻪﻠﻀـﻋ ) ﻪﻠﻀـﻋ
ﺿﺮﻋ ﻢﻜﺷ رد ﻞﺤﻣ 2 ﺪﻨﺑ ﺖﺸﮕﻧا رد ﻞﺧاد و ﺎﭘﻴﻳ ﺎﻫرﺎﺧي
ﻣاﺪﻗ ﻧﺎﻗﻮﻓ ﻦﮕﻟ و اﺮﺑي ﺘﻟﻮـﻣ ـﻴسوﺪ رد ود فﺮـﻃ رﺎـﺧ
ﻔﻠﺧ هﺮﻬﻣ ﺎﻫي ﺮﻤﻛي وهﮋ رد تروﺎﺠﻣ ﺰﻛﺮﻣ سﻮﻗ ﺮﻤﻛ 3-
4 (L زا وا ﺖﺳاﻮﺧ نوﺪﺑ ضﺎﺒﻘﻧا دﺮﮕ تﻼﻀـﻋ ﻂـﻘﻓ ﻪـﺑ
ترﻮﺻ ﻂﺳﻮﺘﻣ ﻀﻋﻪﻠ ز ﺖﺳد ار ﺾﺒـﻘﻨﻣ ﺪـﻨﻛ و درﻮﺧزﺎـﺑ
مزﻻ ﻪــﺑ ترﻮــﺻ ــﻣﻼﻛ هداد ــﻣ ﺪــﺷ )ﻞﻜــﺷ1 .(دﺮــﻓ ﺎﺑــﻳ
ﺖﺴﻧاﻮﺗ نوﺪﺑ ﻒﻗﻮﺗ رﻢﺘ ﺲﻔﻨﺗ ا ﺖﻛﺮﺣ ار مﺎـﺠﻧا ﺪـﻫد
]25[ .شزﻮﻣآ و ﺮﻤﺗ ضﺎﺒﻘﻧا ﻧﻮﺗ ﻪﻠﻀﻋ ﺿﺮﻋ ﻢﻜـﺷ و
ﺘﻟﻮﻣ سوﺪ ﻢﻫ نﺎﻣز ﺎﺑ ﺖﻛﺮﺣ ماﺪﻧا ﺎﻫ) ﺖﺳد و ﺎﻫﺎﭘ (لوا ﻪـﺑ
ترﻮﺻ ﻪﻧﺎﮔاﺪﺟ و ﭙﺳ ﻢﻫ نﺎﻣز ود ماﺪﻧا ﻒﻟﺎﺨﻣ ﺎﺑ ﻢﻫ )ﺖﺳد
و ﺎﭘي ﻒﻟﺎـﺨﻣ ( اﺮـﺟا ـﻣ ﺪـﺷ ا ـﻳ ﺮﻤﺗ تﺎـﻨ ﻪـﺑ ﺗﺮﺗ ـﻴ رد
ﻌﺿو ﺎﻫي ز مﺎﺠﻧا ﺪﻫد.
ﻞﻜﺷ1.ﺲﻤﻟ ﻖﻳﺮﻃ زا ﻢﻜﺷ ﻲﺿﺮﻋ ﻪﻠﻀﻋ ضﺎﺒﻘﻧا شزﻮﻣآ
ﻒﻟا- قﺎﻃ زﺎﺑ ﺑاﻮﺧهﺪ :رد ﺘﻟﺎﺣ ﻪﻛ ﻧدﻮـﻣزآ ﻪـﺑ ﺖﺸـﭘ
ﺪﺑاﻮﺧ و ﺎﺑ ضﺎﺒﻘﻧا تﻼﻀﻋ ﻢﻜﺷ دﻮﺧ شﻼـﺗ ـﻣ ﺪـﻨ ﺎـﺗ
ﺣﺎﻧ ﺮﻤﻛ ار رﺎﺑ ﺪﻨﻛ )ﻞﻜﺷ 2.(
ب- ﺮــﻣد ﺑاﻮﺧــ هﺪ :اــ ﺮــﻤﺗ صﻮﺼــﺨﻣ ضﺎــﺒﻘﻧا
اﺮﺘﻣوﺰ ﻪﻠﻀﻋ ﺿﺮﻋ ﻢﻜﺷ و ﻪﻠﻀﻋ ﺘﻟﻮﻣ سوﺪ ﻢﻫ نﺎﻣز
ﺎﺑ ﺖﻛﺮﺣ ماﺪﻧا ﺎﻫ ﻪﻛ رد ﻪﺳ ﺖﻟﺎﺣ مﺎﺠﻧا دﻮﺷ .ﻪﺑ رﻮﻃي ﻪـﻛ
ﻧدﻮﻣزآ ﻪﺑ ﺖﻟﺎﺣ ﺮﻣد ﺪﺑاﻮﺧ و وزﺎﺑ ار ﻻﺎـﺑ ـﻣ ،دروآ
رد ﻪﻠﺣﺮﻣ ﺪﻌﺑ ﻂﻘﻓ ﺎﭘ ار رد ﺘﻟﺎﺣ ﻪﻛ ﺎﻫﻮﻧاز فﺎﺻ ﺖـﺳا
ﻻﺎﺑ دروآ و رد ﻪـﻠﺣﺮﻣ ﺮـﺧآ ﺖـﺳد و ﺎـﭘي ﻒﻟﺎـﺨﻣ ار ﺎـﺑ
دﺮﮕ ﺖﻛﺮﺣ ﺪﻫد.
ﻞﻜﺷ2. ﺮﮕﻳﺪﻜﻳ ﻪﺑ ﻦﺳﺎﺑ ود ﺮﻫ نﺪﺷ هدﺮﺸﻓ ، ﻦﻴﻣز ﻪﺑ ﺎﭘ ﻒﻛ ﺮﺼﺘﺨﻣ رﺎﺸﻓ
ﻢﻜﺷ ﻲﺿﺮﻋ ﻪﻠﻀﻋ ضﺎﺒﻘﻧا ﺖﻳﺎﻬﻧ رد و
ج- ﺑاﻮﺧهﺪ ﻪﺑ ﻮﻠﻬﭘ :ﻧدﻮﻣزآ ﻪﺑ ﻮﻠﻬﭘ ﺪـﺑاﻮﺧ و ـﺳد
ز ار ز ﺮﺳ دﻮﺧ راﺮﻗ ﺪﻫد و ﻒﻛ ﺖﺳد ﻻﺎﺑﻲﻳ ار ﻮﻠﺟي
ﻢﻜﺷ اﺮﺑي ﻆﻔﺣ لدﺎﻌﺗ وري ﻣز راﺮﻗ ﺪﻫد .رد ﻟﺎـﺣ ﻪـﻛ
تﻼﻀﻋ ﻢﻜﺷ ﺾﺒﻘﻨﻣ و ﺮﻤﻛ سﻮﻗ ،ﻪﺘـﺷاﺪﻧ ﺎـﻫﻮﻧاز ار فﺎـﺻ
هدﺮﻛ و ﻪﺑ ﻣارآ، لوا ﺎﭘي ﻻﺎﺑﻲﻳ و ﺲﭙﺳ ﺎﭘي زي ار ﻪﺑ ﻢـﻫ
دﺰﻧ ﺪﻨﻛ )ﻞﻜﺷ3.(
ﻞﻜﺷ3 .ندروآ ﻻﺎﺑ ﺖﻛﺮﺣ ﺎﻫﺎﭘ )ﻲﻣ هدروآ ﻻﺎﺑ ﻲﻳور يﺎﭘ اﺪﺘﺑا ﺲﭙﺳ دﻮﺷ
يﺮﻳز يﺎﭘ(
د- ﻞﭘ ندز :ﻧدﻮﻣزآ ﻪﺑ ﺖﺸﭘ ـﻣ ﺪـﺑاﻮﺧ و ﻒـﻛ ﺎـﻫﺎﭘ ار
وري ﻣز راﺮﻗ هداد و رد ﻟﺎﺣ ﻪﻛ تﻼﻀﻋ ﻢﻜﺷ و ﻦﺳﺎﺑ دﻮﺧ
ار ﺾﺒﻘﻨﻣ هدﺮﻛ و ﺎﺑ رﺎﺸﻓ ﻒﻛ ﺎﻫﺎﭘ ﺮـﺑ ـﻣز ﻪـﺑ ـﻣارآ ﻞـﭘ
ﺪﻧز .ﺲﭙﺳ ﻌﺿو ﺮﻤﻛ ار ﺖﺑﺎﺛ
ﻪﮕﻧ ﻪﺘﺷاد و ـﻳ ﺎـﭘ ار زا
ﻣز ﻪﺑ ﻣارآ ﻻﺎﺑ دروآ )ﻞﻜﺷ4.(
و- ﺖﻟﺎﺣ ﺖـﺳدرﺎﻬﭼ و ﺎـﭘ و ﻻﺎـﺑ ندروآ ﺖـﺳد و ﺎـﭘي
ﻒﻟﺎﺨﻣ :ﻧدﻮﻣزآ ﻪﺑ ﺖﻟﺎﺣ ﺖﺳدرﺎﻬﭼ و ﺎﭘ راﺮﻗ ـﻣ ـﻴ،دﺮ رد
ﻟﺎﺣ ﻪﻛ تﻼﻀﻋ ﻢﻜﺷ ار ﺾﺒﻘﻨﻣ ،ﺪـﻨﻛ ﺮـﻤﻛ ﺎﺒﻧ ـﻳ سﻮـﻗ
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ﺶﻣﻮﻛ ﺪﻠﺟ12 هرﺎﻤﺷ ،3) ﻲﭘﺎﻴﭘ39( ،رﺎﻬﺑ 1390
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ﻪﺘﺷاد ﺪﺷﺎﺑ .ﺪﻌﺑ ﻪﺑ ﻧدﻮﻣزآ ﻪﺘﻔﮔ دﻮﺷ ﻪـﺑ ـﻣارآ ﺖـﺳد و
ﺎﭘي ﻒﻟﺎﺨﻣ ار در ﻟﺎـﺣ ﻪـﻛ ﻮـﻧاز فﺎـﺻ ﺖـﺳا ﻻﺎـﺑ ـﻴدروﺎ
)ﻞﻜﺷ5.(
ﻞﻜﺷ4 .ﻦﻴﻣز ﻪﺑ ﺎﭘ ﻒﻛ ﺮﺼﺘﺨﻣ رﺎﺸﻓ،ﺮﮕﻳﺪﻜﻳ ﻪﺑ ﻦﺳﺎﺑ ود ﺮﻫ نﺪﺷ هدﺮﺸﻓ ،
ﺎﭘ ﻚﻳ ندروآ ﻻﺎﺑ و ندز ﻞﭘ ،ﻢﻜﺷ ﻲﺿﺮﻋ ﻪﻠﻀﻋ ضﺎﺒﻘﻧا
ﻞﻜﺷ5.ﻒﻟﺎﺨﻣ يﺎﭘ و ﺖﺳد ندروآ ﻻﺎﺑ و ﺎﭘ ﺖﺳد رﺎﻬﭼ ) ﻚﻳ ﻂﻘﻓ اﺪﺘﺑا
و ﺖﺳد ﺖﻳﺎﻬﻧ رد و ﺎﭘ ﻚﻳ ﻂﻘﻓ ﺲﭙﺳ ،ﺖﺳدﻒﻟﺎﺨﻣ ترﻮﺻ ﻪﺑ ﺎﭘ (
ه- اندﺎﺘﺴ وري ﻪﺘﺨﺗ لدﺎﻌﺗ : ﻧدﻮـﻣزآ وري ﻪـﺘﺨﺗ ﺎـﻫي
لدﺎﻌﺗ اﺪﺘﺴ و رد ا ﺖﻟﺎﺣ ﻌﺳ ﺪﻨﻛ ﻪﻛ لدﺎﻌﺗ دﻮـﺧ ار
ﻆﻔﺣ ﺎﻤﻧ) ﻞﻜﺷ6.(
ﻞﻜﺷ6.لدﺎﻌﺗ ﻪﺘﺨﺗ يور ﻦﻳﺮﻤﺗ
ي- ﻦﺘﺴﺸﻧ وري پﻮﺗ ﻮﺳ :ﻧدﻮﻣزآ رد ﻟﺎﺣ ﻪـﻛ ﻪـﺑ
ﻣارآ وري پﻮﺗ ﺸﻧ،ﺪﻨ ﻪﺴﻔﻗ ﻪﻨ ار رد ﺎﻀـﻓ ﺖـﺑﺎﺛ ﻪـﮕﻧ
ﻪﺘﺷاد و رد ا ﺖﻟﺎﺣ ﻦﮕﻟ ار ﻪﺑ ﻓﺮﻃ ﺖﻛﺮﺣ ﺪﻫد )ﻞﻜﺷ
7 و 8 .(ﻧدﻮﻣزآ ا ﺮﻤﺗ ار ﺎﺑ ﻢﺸﭼ زﺎﺑ و ﻪﺘﺴﺑ اﺮﺟا ﺪﻨﻛ
و رد ﺎﻬﻧــ ﻳ ضﺎــﺒﻘﻧا ﻧﻮﺗــ ﻴ اــ ﻳ ود ﻪﻠﻀــﻋ ار رد ــ ﺣ
ﻟﺎﻌﻓ ﺎﻫي هﺮﻣزور ﮔﺪﻧز ﺪﻨﻧﺎﻣ هار ﻦﺘﻓر اﺮﺟا دﻮﻤﻧ) ﻞﻜﺷ
9 .(مﺎﻤﺗ ﺮﻤﺗتﺎﻨ رد 3 ﺖﺳ و ﺮﻫ ﺖﺳ ﻪﺑ تﺪﻣ 45 ﻧﺎﺛ اﺮﺟا
ﺪﺷ] 25،26[.
ﻞﻜﺷ7. و ﻢﻜﺷ ﻲﺿﺮﻋ ﻪﻠﻀﻋ ضﺎﺒﻘﻧا ﺎﺑ هاﺮﻤﻫ ﻦﮕﻟ ﻲﻔﻠﺧ و ﻲﻣاﺪﻗ ﺖﻠﻴﺗ
ﻦﮕﻟ ﻒﻛ
ﻞﻜﺷ8.ﺖﺳد ندروآ ﻻﺎﺑ و ﻢﻜﺷ ﻲﺿﺮﻋ ﻪﻠﻀﻋ ضﺎﺒﻘﻧا ﺎﺑ هاﺮﻤﻫ ﺎﻫﺎﭘ و ﺎﻫ
ﻦﮕﻟ ﻒﻛ
ﻞﻜﺷ9.رد ﺢﻴﺤﺻ ﺮﭽﺳﺎﭘ ﻆﻔﺣ و ﻦﮕﻟ ﻒﻛ و ﻢﻜﺷ ﻲﺿﺮﻋ ﻪﻠﻀﻋ ضﺎﺒﻘﻧا
ندﺎﺘﺴﻳا هﺎﮕﻨﻫﺖﻓر هار و
مزﻻ ﻪﺑ ﺮﻛذ ﺖﺳا ﻪﻛ هوﺮﮔ لﺮﺘﻨﻛ رد مﺎﺠﻧا ﻘﺤﺗ لاور
دﺎﻋي ﮔﺪﻧز دﻮﺧ ار ـﻃ ـﻣ ﺪـﻧدﺮﻛ و ـﻫ ﻪـﻧﻮﮔ ﻪـﻠﺧاﺪﻣ
ﻧﺎﻣرد ﺮﺑ وري نآ ﺎﻫ اﺮﺟا ﻤﻧ ﺪﺷ.
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ﺮﻴﺛﺎﺗ تﺎﻨﻳﺮﻤﺗ تﺎﺒﺛ هﺪﻨﻫد يﺰﻛﺮﻣ هدﺮﺸﻓ و ﺖﺤﺗ ﺮﻈﻧ... ﻲﺘﻤﻫ ﻢﻨﺒﺷ نارﺎﻜﻤﻫ و
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اﺮﺑي ﻌﺗﻴﻴ ﺒﻃ ندﻮﺑ زﻮﺗ ﻐﺘﻣﺎﻫﺮي دﻮﺟﻮﻣ رد ﻘﺤﺗ
زا نﻮﻣزآ فاﺮﮔﻮﻤﻠﻛ ﻤـﺳافﻮﻧﺮ هدﺎﻔﺘـﺳا ﺪـﺷ .زا نﻮـﻣزآ t
ﻪﻧﻮﻤﻧ ﺎﻫي ﻞﻘﺘﺴﻣ اﺮﺑي ﻌﺗﻴﻴ فﻼﺘﺧا ﻫوﺮﮔ و نﻮـﻣزآ t
ﻢﻫ ﻪﺘﺴﺑ اﺮﺑي ﺳرﺮﺑ ﺮﺛا ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد ﺰﻛﺮﻣي ﺮﺑ ـﻴناﺰ
تﺪﺷ درد و ﻧاﻮﺗﺎﻧ رد 2 هوﺮﮔ هدﺎﻔﺘﺳا ﺪﺷ.
ﺞﻳﺎﺘﻧ
تﺎﺼﺨﺸﻣ ﻓاﺮﮔﻮﻣد ـﻴ نارﺎـﻤ ﺮـﻫ ود هوﺮـﮔ لﺮـﺘﻨﻛ و
ﺑﺮﺠﺗ رد لوﺪﺟ هرﺎﻤﺷ 1 ﻪﺋارا هﺪﺷ ﺖﺳا .مزﻻ ﻪﺑ ﺮﻛذ ﺖـﺳا
ﻪﻛ توﺎﻔﺗ ـﻨﻌﻣ رادي رد ا ـﻳ ﻐﺘﻣ ﺎـﻫﺮ ـﺑ ود هوﺮـﮔ دﻮـﺟو
ﺖﺷاﺪﻧ )لوﺪﺟ 1 .(
هرﺎﻤﺷ لوﺪﺟ1- نارﺎﻤﻴﺑ ﻚﻴﻓاﺮﮔﻮﻣد تﺎﺼﺨﺸﻣ رﺎﻴﻌﻣ فاﺮﺤﻧا و ﻦﻴﮕﻧﺎﻴﻣ
ﻲﺑﺮﺠﺗ و لﺮﺘﻨﻛ هوﺮﮔ ود
هوﺮﮔ ﻦﺳ)لﺎﺳ(
ﺪﻗ
)ﺮﺘﻤﻴﺘﻧﺎﺳ(
نزو)مﺮﮔﻮﻠﻴﻛ(
هدﻮﺗ ﺺﺧﺎﺷ
نﺪﺑ
)K/m2
(
لﺮﺘﻨﻛ 13/1±25/23 45/5±161 86/1±16/59 47/3±72/22
ﻲﺑﺮﺠﺗ 22/2±33/22 4/5±159 7/9±25/54 95/3±3/21
P-Value
56/0 55/0 18/0 07/0
ﺎﺘﻧ نﺎﺸﻧ داد ﻪﻛ ﻞﺒﻗ زا هرود ﺮﻤﺗ، توﺎﻔﺗ ـﻨﻌﻣ رادي
ﮕﻧﺎ دﺎﻘﻣ درد و ﻧاﻮﺗﺎﻧ ود هوﺮﮔ لﺮﺘﻨﻛ و ﺑﺮﺠﺗ
دﻮﺟو دراﺪﻧ ) ﺐﻴﺗﺮﺗ ﻪﺑ0,17= Pو 0,249=P .(رد ﺗرﻮﺻ ،ﻪـﻛ
ﺪـــﻌﺑ زا هرود ﺮﻤـــﻨ، توﺎـــﻔﺗ رد ـــﻴﮕﻧﺎ دﺎـــﻘﻣ درد
)0,008=P( و ﻧاﻮﺗﺎﻧ )0,039=P ( ود هوﺮﮔ ﻨﻌﻣ راد دﻮـﺑ
)لوﺪﺟ 2.(
لوﺪﺟ2. راﺪﻘﻣ
P ﻚﻴﻜﻔﺗ ﻪﺑ ﻲﻧاﻮﺗﺎﻧ و درد ﺮﻳدﺎﻘﻣ رد ﻲﻫوﺮﮔ ﻦﻴﺑ
هوﺮﮔ ﻪﻌﻟﺎﻄﻣ ﺖﺤﺗ يﺎﻫ
ﺮﻴﻐﺘﻣ هوﺮﮔ ﻦﻳﺮﻤﺗ هرود زا ﻞﺒﻗﻦﻳﺮﻤﺗ هرود زا ﺪﻌﺑ
لﺮﺘﻨﻛ
9/0 ± 91/3 16/1± 91/3
ﻲﺑﺮﺠﺗ
83/0 ± 89/3 08/1 ± 58/2
درد تﺪﺷ
P-Value
17/0 008/0
لﺮﺘﻨﻛ
5/1 ± 5/21 67/1 ± 41/20
ﻲﺑﺮﺠﺗ
1/7 ± 19 8,49 ± 13,3
ﻲﻧاﻮﺗﺎﻧ
P-Value
246/0 039/0
ﻪﺑ ،هوﻼﻋ هرود ﺮـﻤﺗ تﺎـﺒﺛ هﺪـﻨﻫد ﺰـﻛﺮﻣي ﺚـﻋﺎﺑ
ﺶﻫﺎﻛ ﻨﻌﻣ راد رد ﮕﻧﺎ دﺎﻘﻣ درد )0,018=P (و ﻧاﻮﺗﺎـﻧ
)0,000=P (رد هوﺮﮔ ﺑﺮﺠﺗ ﺪﺷ) لوﺪﺟ3.(
لوﺪﺟ3. ﺮﻳدﺎﻘﻣﺺﺧﺎﺷ ﻲﺑﺮﺠﺗ و لﺮﺘﻨﻛ هوﺮﮔ نﻮﻣزآ زا ﺲﭘ و ﺶﻴﭘ رد ﻲﻧاﻮﺗﺎﻧ و درد يرﺎﻣآ يﺎﻫ
ﺮﻴﻐﺘﻣ هوﺮﮔ رﺎﻴﻌﻣ فاﺮﺤﻧا و ﻦﻴﮕﻧﺎﻴﻣ
D P- Value t
نﻮﻣزآ ﺶﻴﭘ 9/0 ± 91/3 لﺮﺘﻨﻛ
نﻮﻣزآ ﺲﭘ
16/1± 91/3
0
63/0 53/0
ﻮﻣزآ ﺶﻴﭘن 83/0 ± 83/3 درد تﺪﺷ
ﻲﺑﺮﺠﺗ
نﻮﻣزآ ﺲﭘ
08/1 ± 58/2
25/1 018/0 89/2
نﻮﻣزآ ﺶﻴﭘ 51 ± 5/21 لﺮﺘﻨﻛ
نﻮﻣزآ ﺲﭘ
1,67 ± 20,41
09/1 33/0 01/1
نﻮﻣزآ ﺶﻴﭘ 1/7 ± 19 ﻲﻧاﻮﺗﺎﻧ
ﻲﺑﺮﺠﺗ
نﻮﻣزآ ﺲﭘ
49/8 ± 3/13
66/5 000/0 45/5
D :نﻮﻣزآ ﺶﻴﭘ و ﺲﭘ ﻦﻴﺑ فﻼﺘﺧا
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ﺶﻣﻮﻛ ﺪﻠﺟ12 هرﺎﻤﺷ ،3) ﻲﭘﺎﻴﭘ39( ،رﺎﻬﺑ 1390
250
ﻪﺠﻴﺘﻧ و ﺚﺤﺑ يﺮﻴﮔ
ا ﻪﻌﻟﺎﻄﻣ نﺎﺸـﻧ داد ﻪـﻛ 12 زور ﺮﻤﺗ تﺎـﻨ تﺎـﺒﺛ هﺪـﻨﻫد
ﺰﻛﺮﻣي ﺖﺤﺗ ﺮﻈﻧ و هدﺮﺸﻓ ﺚﻋﺎﺑ ﺶﻫﺎـﻛ تﺪـﺷ درد و دﻮـﺒﻬﺑ
ﻞﻤﻋ دﺮﻛ )ﺶﻫﺎﻛ ﻧاﻮﺗﺎﻧ( رد نﺎـﻧز ﻼﺘـﺒﻣ ﻪـﺑ دردﺮـﻤﻛ ﻦﻣﺰـﻣ
دﻮﺷ ﻪﻛ ﺎﺑ ﺎﺘﻧ تﺎﻌﻟﺎﻄﻣ O sulivan و نارﺎـﻜﻤﻫ) 1997(،
Stanton و نارﺎﻜﻤﻫ) 2008(، Goldbay و نارﺎﻜﻤﻫ) 2006 (
و Fonseca و نارﺎـــﻜﻤﻫ) 2009 (ﻢـــﻫ ﻮـــﺳ ـــﻣ ﺪـــﺷﺎﺑ
]3،13،18،19[. ،هوﻼـﻋ رد ﻪـﻌﻟﺎﻄﻣ ﺮﮕﻧزﺎـﺑي Standaert و
نارﺎﻜﻤﻫ) 2008 ( نﺎ هﺪﺷ ﺖﺳا ﻪﻛ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪـﻨﻫد
نﻮﺘﺳ تاﺮﻘﻓ رد دﻮﺒﻬﺑ ﻞﻤﻋ دﺮـﻛ و درد رد هوﺮـﮔ ﺎـﻫي عﻮـﻨﺘﻣ
)ﻦﮕﻤﻫﺎﻧ (ﺎﺑ دردﺮﻤﻛ ﻦﻣﺰﻣ ﺮﺛﻮﻣ ﺖﺳا ]20[ .،ﺎﻣا نآ ﻪـﭼ ﻞـﺑﺎﻗ
ﻮﺗﻪﺟ ،ﺪﺷﺎﺑ ا ﺖﺳا ﻪﻛ رد ﺮﺜﻛا تﺎﻌﻟﺎﻄﻣ ﺮﻛذ هﺪﺷ رد ا ـﻳ
ﺮﮕﻧزﺎﺑي و تﺎﻌﻟﺎﻄﻣ ﺮﻛذ هﺪﺷ رد ،ﻻﺎﺑ هرود ﻪﻣﺎﻧﺮﺑ ﺮﻤﺗ
زا 4 ﻪﺘﻔﻫ ﺪﺷﺎﺑ .اﺬﻟ ﻪﻌﻟﺎﻄﻣ ﺮﺿﺎﺣ ﺮﺛا ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪـﻨﻫد
ﺰﻛﺮﻣي هدﺮﺸﻓ و ﺖﺤﺗ ﺮﻈﻧ ﺮﺑ ﺶﻫﺎﻛ درد و ﻧاﻮﺗﺎـﻧ رد نﺎـﻧز
ارادي دردﺮﻤﻛ ﻦﻣﺰﻣ ار درﻮﻣ ﺎﺗﻴﻳ ﺮﻗرا ﺪﻫد .،ﺎﻣا ﺎﺘﻧ ا ـﻳ
ﻪﻌﻟﺎﻄﻣ ﺎـﺑ ﺎـﺘﻧ Arokoski و نارﺎـﻜﻤﻫ) 2004(، Carins و
نارﺎــﻜﻤﻫ) 2005( ﻢــﻫ ﻧاﻮــﺧ ﺖــﺷاﺪﻧ] 17،27[ .زا ﻻدــ ﻳ
فﻼﺘﺧا ناﻮﺗ ﻪﺑ ا ﻪﺘﻜﻧ هرﺎﺷا دﻮـﻤﻧ ﻪـﻛ ﺮﻤﺗ تﺎـﻨ درﻮـﻣ
دﺮﺑرﺎﻛ Arokoski و نارﺎـﻜﻤﻫ )2004(، ًﺎﺻﺎﺼـﺘﺧا ﺮﻤﺗ تﺎـﻨ
ﺗﺎﺒﺛ ﺎﺑ شزﻮﻣآ ﻗد هدﻮـﺒﻧ ﺖـﺳا و ًﺎـﺳﺎﺳا زا ﻧدﻮـﻣزآ ﺎـﻫ
ﻪﺘﺳاﻮﺧ هﺪﺷ دﻮﺑ ﺎﺗ ﺮﻤﺗتﺎﻨ ار رد لﺰﻨﻣ مﺎﺠﻧا ﺪﻨﻫد و هوﻼﻋ ﺮﺑ
،نآ زا هوﺮﮔ شزرو ﺎﻫي لﺎﻌﻓ ﻣﻮﻤﻋ اﺮﺑي تﻼﻀﻋ ﻤﻜـﺷ و
ﺮﻤﻛي رد ﺖﻟﺎﺣ ا،هدﺎﺘﺴ ،ﻪﺘﺴﺸﻧ ،ﺮﻣد قﺎﻃ زﺎﺑ و هﺮ هدﺎﻔﺘﺳا
هﺪﺷ دﻮﺑ .اﺮﺑﺎﻨﺑ ﺎﺑ ﻪﺟﻮﺗ ﺖﺷاد ﻪﻛ ًﻻﻮﺻا دﺮﻓ ﻤﻧ ﺪـﻧاﻮﺗ رد
ﺪﺣ مزﻻ ﺖﻛﺮﺣ و ﺮﻤﺗ ار ﻗد مﺎﺠﻧا ﺪﻫد . وهﮋ ا ﻪﻛ ﺮﻫ
ﻪﭼ تﺪﻣ رﺎﻬﻣ ﻧﻼﻀﻋ زﺮﺗدﺎ ،ﺪﺷﺎﺑ ﺷﻮﻣاﺮﻓ ﻪﻠﻀﻋ زا ﻮﮕﻟاي
تﺎﻛﺮﺣ و ﻌﺿ نﺪـﺷ نآ ـﺑ ﺮـﺗ ـﻣ دﻮـﺷ .رد ﺘﻧ ﻪـﺠ رد
ﺗرﻮﺻ ﻪﻛ ﺮﻤﺗ،تﺎﻨ ﺖﺤﺗ ﺮﻈﻧ مﺎﺠﻧا ﺪﻧﻮﺷ رد تﺪﻣ هﺎﺗﻮﻛ ﺮﺗي
ناﻮﺗ ﻪﺑ فاﺪﻫا ﻧﺎﻣرد درﻮﻣ ﺮـﻈﻧ ـﺳر ﻪـﻛ اﺮـﺑي نﺎـﻣرد
دردﺮﻤﻛ روﺮﺿي ﻪﺑ ﺮﻈﻧ ﺪﺳر .زا ـﻓﺮﻃ رد ﻘﺤﺗ ـﻴ ﺮـﺿﺎﺣ
ﻛﺎﺗــﻴ ﻠــﺻا ﺮﻤﺗتﺎــﻨ ﺮــﺑ وري تﻼﻀــﻋ ــﺿﺮﻋ ﻢﻜــﺷ و
ﺘﻟﻮﻣ سوﺪ دﻮﺑ .زاﺮ ﻪﻠﻀﻋ ﺿﺮﻋ ﻢﻜﺷ ـﻜ زا تﻼﻀـﻋ
ﻠﻛي رد ﻆﻔﺣ تﺎﺒﺛ نﻮﺘـﺳ تاﺮـﻘﻓ ـﻣ ﺪـﺷﺎﺑ و زﻮﻣآزﺎـﺑي
ﻬﺴﺗ ،نآ ﻟوا مﺎﮔ رد دﻮﺒﻬﺑ دردﺮـﻤﻛ بﻮﺴـﺤﻣ ـﻣ ددﺮـﮔ .
ﻢﻫ ﻨﭼ ﺎﺑ ﻪﺟﻮﺗ دﺮﻛ ﻪﻛ ﺢﺿاو ﺮﺗ و ﺖـﺑﺎﺛ ﺮـﺗ ﻐﺗ ـﻴﻴتاﺮ
ﻧﻼﻀﻋ دﻮﺟﻮﻣ رد نارﺎﻤ ﻼﺘـﺒﻣ ﻪـﺑ دردﺮـﻤﻛ ـﻴ رد ﻪﻠﻀـﻋ
ﺿﺮﻋ ﻢﻜﺷ ادﺎﺠ دﻮﺷ] 28[ .
هوﻼﻋ ﺮـﺑ ا ـﻳ،ﻦ ـﻜ زا تﺎـﻜﻧ ﻢـﻬﻣ رد ﺖـﺳد ـﻳﺑﺎ ﻪـﺑ
ﺖﻓر ﻟﺎﺑ ﻞﺑﺎﻗ ،ﻪﺟﻮﺗ ﮔﻮﻠﺟي زا لﺎﻤﻋا رﺎـﺑ ـﺑ زا
ﺪﺣ ﻪﺑ ﺖﻓﺎﺑ ﺎﻫ ﺪﺷﺎﺑ .زا ﻓﺮﻃ نﺎﻨﭼ ﻪﭼ ناﺰ رﺎﺑ سﺮﺘﺳا
ﻓﺎﻛ ،ﺪﺷﺎﺒﻧ ﺮﺛا ﺸﺨﺑ ﻞﺑﺎﻗ ﻬﺟﻮﺗ ﺪﻫاﻮﺨﻧ ﺖـﺷاد .ا ـﻳ ﺮـﻣا
زا توﺎﻔﺗ ﺎﻫي ﺳﺎﺳا ا ﻘﺤﺗ ﺎﺑ ﻘﺤﺗتﺎﻘ دﺮﮕ دﻮﺑ ﻪﻛ
ﻪﺑ ترﻮﺻ مواﺪﻣ و هدﺮﺸﻓ هﻮﺤﻧ زﻮﻣآزﺎﺑي تﻼﻀﻋ ﻠﻛي ﺮﻤﻛ
ﻨﻌ ﻪﻠﻀﻋ ﺿﺮﻋ ﻢﻜﺷ و ﻟافﺎ ﻘﻤﻋ ﺘﻟﻮﻣ سوﺪ ار درﻮﻣ
ﻪﺟﻮﺗ راﺮﻗ هداد ﺖﺳا .ﺎﺷ ﻬﺴﺗ ﮔدﺎي ﺖﺤﺗ ﺮﻈﻧ و راﺮﻜﺗ
مواﺪﻣ نﺎﻤﻫ ﺳﺮﺘﺳا ﺪﺷﺎﺑ ﻪﻛ ا تﻼﻀﻋ اﺮﺑي زﻮﻣآزﺎﺑي ﻪـﺑ
نآ زﺎ ﺪﻧراد.
رد ا درﻮﻣ ﻪﻛ شزرو ﺎﺑ ﺸﺨﺑ زا نﺎﻣرد نارﺎﻤ ﻼﺘﺒﻣ
ﻪﺑ دردﺮﻤﻛ ،ﺪﺷﺎﺑ ﻖﻓاﻮﺗ ﺮﻈﻧ دﻮﺟو دراد .،ﺎﻣا فﻼﺘﺧا ﺎـﻫﺮﻈﻧﻲﻳ
رد درﻮﻣ عﻮﻧ ،شزرو تﺪﻣ هرود ﺮﻤﺗ و ﻧﺎﻜﻢﺴ ﺮﺛا نآ ﺎـﻫ
دﻮﺟو دراد .ﻀﻌﺑ زا ﻘﻘﺤﻣ شزرو ﺎﻫﻲﻳ ار ﻮﺠﺗ ﺪﻨﻨﻛ ﻪﻛ
ﻣﺎﻤﺗ تﻼﻀﻋ رﺎﭘﺎﭙﺳالﺎﻨ ار ﻞﻣﺎﺷ دﻮﺷ ﺎﺗ ردﺎﻗ ﻪﺑ لﺮـﺘﻨﻛ
تﺎﻛﺮﺣ نﻮﺘﺳ تاﺮﻘﻓ ﺪﻧدﺮﮔ] 8،29،30،31[ .ا ـﻳ ـﻘﻘﺤﻣ ﺮـﺑ
ا ﻘﻋهﺪ ﺪﻧا ﻪﻛ ﺮﺛا ﺸﺨﺑ ا شزرو ،ﺎﻫ ﻪﺑ ﺖﻠﻋ اﺰﻓا ناﻮﺗ
تﻼﻀــﻋ لﺎــﺑﻮﻠﮔ و ــﻛﻮﻟلﺎ ،ﻪــﻨﺗ اﺰــﻓا ﺴــﻧﺎﺗنﻮ ــﺳﺎﻓي
،رﺎﺒﻣﻮﻟﻮﻛارﻮﺗ ﺎﻫﻓوﺮﺗﺮﭙ ﺘﻟﻮﻣ ،سوﺪ اﺰﻓا رﺎﺸﻓ ﻌﺿﻮﻣ
و ﻬﺴﺗ ضﺎﺒﻘﻧا ﻢﻫ نﺎـﻣز ﺎﻫرﻮﺴـﻜﻠﻓ و ﺎﻫرﻮﺴـﻨﺘﺴﻛاي ﻪـﻨﺗ
ﺪﺷﺎﺑ .ﺮﺑﺎﻨﺑ ﻪﻌﻟﺎﻄﻣ Karimi و نارﺎﻜﻤﻫ )2008 ( هﺪـﻋ اي زا
ﻘﻘﺤﻣ دﺎﻬﻨﺸ هدﻮﻤﻧ ﺪـﻧا ﻪـﻛ ﻪـﺑ ﺎـﺟي اﺰـﻓا ترﺪـﻗ ـﻳ
ﺎﻫﻓوﺮﺗﺮﭙ ﻪﻨﺗ، اﺰﻓا تﺎﺒﺛ نﻮﺘـﺳ تاﺮـﻘﻓ ﺎﺑ ـﻳ زا فاﺪـﻫا
ﺮﻤﺗ ﻧﺎﻣرد نارﺎﻤ ﻼﺘﺒﻣ ﻪﺑ دردﺮﻤﻛ ﺪﺷﺎﺑ] 25[ . ﺮـﺑ فﻼـﺧ
وردﺮﻜ اﺰﻓا ،ترﺪﻗ فﺪـﻫ ا ـﻳ ور دﺮـﻜ ) اﺰـﻓا تﺎـﺒﺛ
نﻮﺘﺳ تاﺮﻘﻓ(، لﺎﻌﻓ ندﺮﻛ تﻼﻀﻋ ﺗﺎﺒﺛ وهﮋ ﺘﻟﻮﻣ ـﻴوس
و ﻪﻠﻀﻋ ﺿﺮﻋ ،ﻢﻜﺷ ﻞﻘﺘﺴﻣ زا ﺎﺳ تﻼﻀﻋ ﺎﭙﺳارﺎﭘلﺎﻨ رد
ﻞﺣﺮﻣ اﻟو نﺎﻣرد ﺪﺷﺎﺑ] 8[ .
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ﺮﻴﺛﺎﺗ تﺎﻨﻳﺮﻤﺗ تﺎﺒﺛ هﺪﻨﻫد يﺰﻛﺮﻣ هدﺮﺸﻓ و ﺖﺤﺗ ﺮﻈﻧ... ﻲﺘﻤﻫ ﻢﻨﺒﺷ نارﺎﻜﻤﻫ و
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زا دوﺪﺤﻣ ﺎﻫي ﻘﺤﺗ،ﻖ ناﻮﺗ ﻪـﺑ مﺪـﻋ لﺮـﺘﻨﻛ تاﺮـﺛا
سﺮﺘــﺳا ــ ﺷ ﺎ ﻧ زا اﺮــﺷ ﺎﻣزآــ ﻳﻫﺎﮕﺸ و سﺮــﺗ زا مﺎــﺠﻧا
ﺮﻤﺗتﺎﻨ ﻪﺑ ﻟد رﻮﺼﺗ هﺎﺒﺘﺷا زا اﺰﻓا درد رد ﻞـﻜﺗوﺮﭘ
هرﺎﺷا دﻮﻤﻧ .ﻢﻫ ﻨﭼ،ﻦ دﺎﻬﻨﺸ ددﺮﮔ ﻪﻛ تﺎـﻌﻟﺎﻄﻣ ﺪـﻌﺑي رد
ﻪﻨﻣاد ﻨﺳ ،ﺮﺗﻻﺎﺑ ﻪﺑ وﻼﻋه ﺎﻘﻣﻪﺴ ﻪﻣﺎﻧﺮﺑ ﺎﻫي ﺮﻤﺗ نﻮﮔﺎﻧﻮﮔ
ﺎﺑ ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪﻨﻫد رد تﺪﻣ نﺎﻣز هﺎﺗﻮﻛ) هدﺮﺸـﻓ ( ـﺳرﺮﺑ
ددﺮﮔ.
رد عﻮﻤﺠﻣ ﺎﺑ ﻪﺑ ا ﻪﺘﻜﻧ هرﺎﺷا دﻮﻤﻧ ﻪﻛ ود ﻞﺻا ﺳﺎﺳا
مﺎﺠﻧا ﺮﻤﺗتﺎﻨ ﺗﺎﺒﺛ ا ﺖﺳا ﻪﻛ ﻟﺎﻌﻓ تﻼﻀﻋ ﻪﻨﺗ ﻪﺑ رﻮﻈﻨﻣ
لﺮﺘﻨﻛ و ﻣﺎﺗ تﺎﺒﺛ نﻮﺘﺳ تاﺮﻘﻓ روﺮﺿي ﺖﺳا و ا ﻟﺎﻌﻓ ـﻴ
ﺎﺑ رد نارﺎﻤ ﻼﺘﺒﻣ ﻪـﺑ دردﺮـﻤﻛ هﺪـﻧادﺮﮔﺮﺑ هﺪـﺷ و ﻪـﺑ ﺪـﺣ
بﻮﻠﻄﻣ ﺪﺳﺮﺑ .ﺖﺳد ﺑﺎ ﻪﺑ ا ﺮﻣا ﻢﻬﻣ ﺪﻨﻣزﺎ ﮕﻨﻫﺎﻤﻫ ـﺑ
ﺎﻫرﺎﺘﺧﺎﺳي ﺘﻛا،ﻮ ﺳﺎﭘ و ﺒﺼﻋ ﺪـﺷﺎﺑ . اﺮﺑﺎـﻨﺑ،ﻦ ﻪـﻣﺎﻧﺮﺑ
ﺮﻤﺗ ﻪﻛ وري زﻮﻣآزﺎـﺑي تﻼﻀـﻋ ﻪـﻨﺗ ﻪـﺑ رﻮـﻈﻨﻣ لﺮـﺘﻨﻛ
تﺎﻛﺮﺣ نﻮﺘﺳ تاﺮﻘﻓ فﻮﻄﻌﻣ ﺪﺷﺎﺑ ﻘﻄﻨﻣ ﻪﺑ ﺮﻈﻧ ـﻣ ﺪـﺳر و
ﺪﻧاﻮﺗ ﺚﻋﺎﺑ ﺶﻫﺎﻛ سﺮﺘـﺳا وري ﺖـﻓﺎﺑ ﺎـﻫي ﻧاﻮﺨﺘـﺳا-
ﻧﺎﻣﺎﮕ، ﺶﻫﺎﻛ درد و رد ﺘﻧﻪﺠ دﻮﺒﻬﺑ ﻞﻤﻋ دﺮﻛ نارﺎﻤ ﻼﺘـﺒﻣ
ﻪﺑ دردﺮﻤﻛ ددﺮﮔ] 8،32،33 [و ﺮﻤﺗتﺎﻨ تﺎﺒﺛ هﺪـﻨﻫد هدﺮﺸـﻓ و
ﺖﺤﺗ ﺮﻈﻧ ﺚﻋﺎﺑ ﺶﻫﺎـﻛ درد و دﻮـﺒﻬﺑ ﻞـﻤﻋ دﺮـﻛ نﺎـﻧز ارادي
دردﺮﻤﻛ ﻦﻣﺰﻣ ددﺮﮔ.
و ﺮﻜﺸﺗ ﻲﻧادرﺪﻗ
ﻮﻧنﺎﮔﺪﻨﺴ زا ﻠﻛ داﺮﻓاي ﻪـﻛ ﻪـﺑ ناﻮـﻨﻋ ﻪـﻧﻮﻤﻧ رد ا ـﻳ
ﻪﻌﻟﺎﻄﻣ ﺖﻛﺮﺷ هدﻮﻤﻧ و تﺎﺒﺟﻮﻣ مﺎﺠﻧا ﻘﺤﺗ ار ﻢﻫاﺮﻓ ﺪـﻧدﻮﻤﻧ
و ﻤﻫ رﻮﻃ نارواد ﺰﻋ ﻪﻛ ﺎﺑ ﻪﻄﻘﻧ تاﺮـﻈﻧ ﻮـﺧ ﺐـﺟﻮﻣ
اﺰﻓا ا ﻪـﻟﺎﻘﻣ ،ﺪﻧﺪـﺷ لﺎـﻤﻛ ﺮﻜﺸـﺗ و ﻧادرﺪـﻗ ار
ﺪﻧراد.
ﻊﺑﺎﻨﻣ
[1] Elbaz A, Mirovsky Y, Mor A, Enosh S, Debbi E, Segal G.
and et al. A novel biomechanical device improves gait pattern in
patient with chronic nonspecific low back pain. Spine 2009; 34:
E507-E512.
[2] George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC,
Dugan JL. and Robinson ME. Rationale, design and potocol for
the prevention of low back pain in the military (POLM) trial. BMC
Musculoskelet Disord 2007; 8: 92.
[3] O'Sullivan PB, Phyty GD, Twomey LT. and Allison GT.
Evaluation of specific stabilization exercise in the treatment of
chronic low back pain with radiologic diagnosis of spondylolysis
or spondylolisthesis. Spine 1997; 22: 2959-2967.
[4] Bergmark A. Stability of the lumbar spine: a study in
mechanical engineering. Acta Orthop Scand Suppl 1989; 230: 1-
54. [5] Hodges PW. and Richardson CA. Delayed postural
contraction of transversus abdominis in low back pain associated
with movement of the lower limb. J Spinal Disord 1998; 11: 46-56.
[6] Helewa A, Goldsmith CH, Lee P, Smythe HA. and Forwell
L. Does strengthening the abdominal muscles prevent low back
pain--a randomized controlled trial. J Rheumatol 1999; 26: 1808-
1815.
[7] Richardson C, Jull G, Hodges P, Hides J. Therapeutic
exercise for spinal segmental stabilization in low back pain:
scientific basis and clinical approach. Philadelphia: Churchill
Livingstone; 1999. p: 191.
[8] Salavati M. The effects of disfunctions of postural stability
control and effectiveness spine stability training in chronic low
back pain patients. Ph.D thesis in physical therapist, Tehran;
Tarbiat Modares University 2002. (Persian).
[9] Norris CM. Functional load abdominal training: part1.
Body Work Mov Therap 1999; 3:150-158.
[10] Kofotolis N. and Kellis E. Effects of two 4-week
proprioceptive neuromuscular facilitation programs on muscle
endurance, flexibility, and functional performance in women with
chronic low back pain. Phys Ther 2006; 86: 1001-1012.
[11] Karimi N, Ebrahimi I, Ezzati K, Kahrizi S, Torkaman G.
and Arab Am. The Effects of consecutive supervised stability
training on postural balance in patients with chronic low back pain.
Pak J Med Sci 2009; 25: 177-181.
[12] Hides JA, Richardson CA. and Jull GA. Multifidus
recovery is not automatic after resolution of acute first low back
pain. Spine 1996; 21: 2763-2769.
[13] Hides JA, Stanton WR, McMahon S, Sims K. and
Richardson CA. Effects of stabilization training on Multifidus
Muscle cross-sectional area among young elite criceters with low
back pain. J Orthop Sports Phys Ther 2008; 38: 101-108.
[14] Koumantakis GA, Watson PJ. and Oldham JA.
Supplementation of general endurance exercise with stabilisation
training versus general exercise only. Physiological and functional
outcomes of a randomised controlled trial of patients with
recurrent low back pain. Clin Biomech 2005; 20: 474-482.
[15] Koumantakis GA, Watson PJ. and Oldham JA. Trunk
muscle stabilization training plus general exercise versus general
exercise only: randomized controlled trial of patients with
recurrent low back pain. Phys Ther 2005; 85: 209-225.
[16] Wallwork TL, Stanton WR, Freke M. and Hides JA. The
effect of chronic low back pain on size and contraction of the
lumber multifidus muscle. Man Ther 2009; 14: 496-500.
[17] Cairns MC, Foster NE. and Wright C. Randomized
controlled trial of specific spinal stabilization exercise and
conventional physiotherapy for recurrent low back pain. Spine
2006; 31: E670-681.
[18] Goldby LJ, Moore AP, Doust J. and Trew ME. A
randomized controlled trial investigating the efficiency of
musculoskeletal physiotherapy on chronic low back disorder.
Spine 2006; 31: 1083-1093.
[19] da Fonseca JL, Magini M. and de Freitas TH. Laboratory
Gait Analysis in Patients with Low Back Pain before and After a
Pilates Intervention. J Sport Rehabil 2009; 18: 269-282.
[20] Standaert CJ, Weinstein SM. and Rumpeltes J. Evidence-
informed management of chronic low back pain with lumber
stabilization exercises. Spine J 2008; 8: 114-120.
[21] Leboeuf-Yde C, Klougart N. and Lauritzen T. How
common is low back pain in Nordic population? Spine 1996; 21,
1518-1526.
[22] Price DD, Mcgrath PA, Rafii A. and Buckingham B. The
validation of visual analog scales as ratio scale for chronic and
experimental. Pain 1983; 17: 45-56.
[23] Jenson MP, Karolyn P. and Braver S. The measurement
of clinical pain intensity: A comparison of six methods. Pain 1986;
27: 117-126.
[24] Radziszewski KR. Physical exercise in the treatment of
patients with lumbar discopathy. Ortop Traumatol Rehabil 2007; 9:
98-106.
www.SID.ir
Archive of SID
ﺶﻣﻮﻛ ﺪﻠﺟ12 هرﺎﻤﺷ ،3) ﻲﭘﺎﻴﭘ39( ،رﺎﻬﺑ 1390
252
[25] Karimi N. Effectiveness of controlled accelerated
functional lumber stabilization exercises on nonspesific chronic
low back pain. Ph.D thesis in physical therapist, Tehran; Tarbiat
Modares University 2008. (Persian).
[26] Akuthota V, Ferreiro A, Moore T. and Fredericson M.
Core stability exercise principles. Curr sports Med Rep 2008; 7:
39-44.
[27] Arokoski J.P, Valta T, Kankaapa M. and Airaksinen O.
Activation of lumbar paraspinal and Abdominal Muscles during
therapeutic exercises in chronic low back pain patients. Arch Phys
Med Rehabil 2004; 85: 823-832.
[28] Cholewicki J. and VanVliet JJ 4th. Relative contribution
of trunk muscles to stability of the lumbar spine during isometric
exertions. Clin Biomech (Bristol) 2002; 17: 99-105.
[29] Carpes FP, Reinehr FB. and Mota CB. Effects of a
program for trunk strength and stability on pain, low back and
pelvis kinematics and body balance: A pilot study. J Bodyw Mov
Ther 2008; 12: 22-30.
[30] Steven Vk, Coorevits PL, Bouche KG, Mahieu NN,
Vanderstraeten GG. and Danneels LA. The influence of spesific
training on trunk muscle recruitment patterns in healthy subjects
during stabilization exercises. Man Ther 2007; 12: 271-279.
[31] Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van
Wingerden JP. and Snijders CJ. The posterior layer of the
thoracolumbar fascia. Its function in load transfer from spine to
legs. Spine 1995; 20:735-738.
[32] Liebenson C. The role of the transverse abdominus in
promoting spinal stability. Body Work Mov Therap 2000; 4:109-
112.
[33] Hides JA, Jull GA. and Richardson CA. Long-term
effects of specific stabilizing exercises for first-episode low back
pain. Spine 2001; 26: E243-248.
www.SID.ir
Archive of SID
Koomesh Spring 2011, 12 (3):
34
Effects of consecutive supervised core stability training on
pain and disability in women with nonspecific chronic low
back pain
Shabnam Hemmati (M.Sc)*1, Reza Rajabi (Ph.D)1, Nooroddin Karimi (Ph.D)2, Ali akbar Jahandideh
(M.Sc)3
1 -
Faculty of Physical Education and Sport Science, University of Tehran, Tehran Iran
2 - University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3-
Islamic Azad University, Quchan Branch, Quchan, Iran
(Received: 25 Apr 2010 Accepted: 17 Oct 2010)
Introduction: Low back pain is a very common health care problem affecting 85% of population. Spine
rehabilitation programs are very various in subjects with chronic low back pain but core stability training is
often the chosen treatment. However, the aim of this study was to examine the effects of consecutive
supervised core stability training on pain intensity and disability of nonspecific chronic low back pain.
Materials and Methods: Twenty-four non-athletic females with chronic low back pain were participated
in the study. They were randomly divided into two groups: experimental group (12 days consecutively
under physical therapist supervision) and control group (no intervention). The subjects in both groups were
not allowed to perform any sport activity during 12 days of study. Before and after the intervention, visual
analogue scale and the ososetry disability index were used to assess pain intensity and disability,
respectively.
Results: The findings show that the disability and intensity pain variables were significantly decreased in
the experimental group (P=0.0001 and P=0.003, respectively), while no significant changes were found
with respect to those variables in the control group.
Conclusions: Consecutive supervised core stability training may decrease the pain intensity and disability
of the patients with chronic low back pain.
Keywords: Nonspecific chronic low back pain, Core stability training, Disability and pain
* Corresponding author: Fax: +98 9368754699 ; Tel: +98 9368754699
hemmati1363@gmail.com
244 - 252
www.SID.ir
... A controlled and randomized clinical trial by Asgari Ashtiani et al. showed that stabilization practice in 50 patients with chronic nonspecific neck pain decreased the pain, disability, and avoidant attitudes due to pain [38]. Several studies [43][44][45][46][47][48][49][50] have shown that the core stabilization practices decrease the pain in patients with chronic back pain. Rastegar argued that at least five weeks of core stabilization practices decreased chronic back pain in elderly women significantly [49]. ...
Article
Full-text available
Background: Chronic non-specific neck pain is the most prevalent neck pain with notable impacts on the quality of life in the elderly. Objective: The impacts of the neck, core, and combined stabilization practices on pain, disability, and improvement of the neck range of motion in the elderly with chronic non-specific neck pain were examined. Method: A quasi-experimental (open label) study was carried out through a cluster sampling in two phases in Tehran-Iran in 2017. Totally, 102 patients were randomly allocated to three groups of specific neck stabilization, specific core stabilization, and combined practices through envelope method. The intervention took 12 weeks. To measure the severity of pain and neck disability, the visual analog scale (VAS), neck disability index (NDI), and neck pain and disability scale (NPDS) was used. A goniometer was used to measure the range of the motion. To examine data, used SPSS (v.20). Result: The results, confirmed a significant decrease in pain over the time in the three therapeutic groups (p = 0.000). In addition, there was a significant difference between neck, core, and combined stabilization groups. Moreover, there was a significant increase in the angle of motion in all treatment groups with different treatment duration (P = 0.000). The highest increase in the angle of motion was after 12 weeks of practice in right lateral flexion (RLF) (p = 0.000). Conclusion: Twelve sessions of the neck, core, and combined stabilization practices can alleviate the pain and improve the strength in the elderly with chronic non-specific neck pain. In addition, compared to two other methods, the combined method was a more efficient way to improve the range of motion in patients.
... A controlled and randomized clinical trial by Asgari Ashtiani et al. showed that stabilization practice in 50 patients with chronic nonspecific neck pain decreased the pain, disability, and avoidant attitudes due to pain [38]. Several studies [43][44][45][46][47][48][49][50] have shown that the core stabilization practices decrease the pain in patients with chronic back pain. Rastegar argued that at least five weeks of core stabilization practices decreased chronic back pain in elderly women significantly [49]. ...
... Its reliability and validity have been excellent, and its internal consistency has been shown as ICC=0.91. 26 The validity of the VAS scale is based on Cronbach alpha that has been reported to be 0.95. 27 ...
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Full-text available
Background Due to their occupational status, military personnel are a high-risk group for low back pain (LBP). Purpose The aim of this study was to investigate the effect of neuromuscular exercises on the severity of pain, functional disability, proprioception, and balance in military personnel with LBP. Methods Military personnel with LBP were randomly assigned into two groups: intervention (n=15) and control (n=15). The intervention group performed 60 minutes of neuromuscular exercises three times per week for eight weeks while the control group continued their routine physical activities. Results The mean post-intervention pain intensity, disability, and proprioception error significantly decreased in the intervention group. Whereas their mean post-interventions static and dynamic balance scores significantly increased. Conclusions The results indicate eight weeks of neuromuscular exercise decreased pain intensity and improved functional ability, static and dynamic balance, and proprioception among military staff suffering chronic low back pain. Keywords: chronic low back pain, military personnel, proprioception, pain intensity, functional disability, balance Keywords: MOTS CLÉS: lombalgie chronique, personnel militaire, proprioception, intensité de la douleur, incapacité fonctionnelle, équilibre
... Its reliability and validity have been excellent, and its internal consistency has been shown as ICC=0.91. 26 The validity of the VAS scale is based on Cronbach alpha that has been reported to be 0.95. 27 ...
Article
Full-text available
Background: Due to their occupational status, military personnel are a high-risk group for low back pain (LBP). Purpose: The aim of this study was to investigate the effect of neuromuscular exercises on the severity of pain, functional disability, proprioception, and balance in military personnel with LBP. Methods: Military personnel with LBP were randomly assigned into two groups: intervention (n=15) and control (n=15). The intervention group performed 60 minutes of neuromuscular exercises three times per week for eight weeks while the control group continued their routine physical activities. Results: The mean post-intervention pain intensity, disability, and proprioception error significantly decreased in the intervention group. Whereas their mean post-interventions static and dynamic balance scores significantly increased. Conclusions: The results indicate eight weeks of neuromuscular exercise decreased pain intensity and improved functional ability, static and dynamic balance, and proprioception among military staff suffering chronic low back pain.
... 27 A 2011 study supported the findings of the current study, as the supervised exercise group showed more improvement and resulted in decrease in pain intensity and functional disability compared to the unsupervised group. 28 The current study has several limitations as only pre-and post-intervention evaluations were recorded. Multiparous women were more in Group II compared to Group I, and this might have affected the outcome measures. ...
Article
Objective: To determine the effects of an exercise programme for core muscle strengthening in patients with low back pain after caesarean section. Methods: The single-blind randomised controlled trail was conducted from August 2018 to January 2019 at the Helping Hand for Relief and Development Comprehensive Rehabilitation Centre, Chakwal, Pakistan, and comprised post-caesarean section women aged 25-40 years with low back pain. Patients were randomised into supervised group I and unsupervised group II using the sealed envelope method. Group I received supervised core stability exercise programme, while group II received unsupervised, home-based core stability exercise programme. Baseline and post-intervention values were compared for numeric pain rating scale, Oswestry disability index, inclinometer and core stability assessment. Data was analysed using SPSS 21. Results: Of the 30 subjects, there were 15(50%) in each of the two groups. There was no significant difference at baseline between the groups (p>0.05). Post-intervention results showed significant intra-group and inter-group differences (p<0.05) with respect to all parameters. No improvement was observed for right and left side bending (p>0.05). Conclusions: Supervised core stability exercise programme was more effective in reducing pain and disability, and improved core muscle activation than unsupervised, home-based core exercise programme.
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Abstract Introduction: The aim of this study was to investigate the effect of dynamic neuromuscular stability (DNS) training on dynamic balance and functional disability in athletes with non-specific chronic low back pain. Materials and methods: The present study is quasi-experimental, applied with pre-test and post-test design. The sample consisted of 24 male team athletes with chronic non-specific low back pain in two equal and random control groups and experimental were divided into. The control group did not participate in any treatment and rehabilitation activities during this period and was engaged in normal daily activities. The experimental group performed dynamic neuromuscular stability training for 8 weeks. Also, before and after the intervention, the Oswestry questionnaire was used to evaluate the functional disability and the Y balance test was used to evaluate the dynamic balance. The data were analyzed using analysis of covariance (ANCOVA) at the significant level of p < 0.05. Results: The results of intergroup comparison after dynamic neuromuscular stability training showed a significant difference in improving dynamic balance and functional disability in the experimental group compared to the control group (P <0.05). Conclusion: Based on the findings of this research, dynamic neuromuscular stability exercises improve functional disability and dynamic balance in athletes with non-specific chronic low back pain.
Article
Background: Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. Objectives: The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. Search methods: We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. Selection criteria: We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. Data collection and analysis: Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. Main results: We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. Authors' conclusions: We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
Article
Aims and background: According to high prevalence of nonspecific chronic low back pain and its consequences on daily activities and lifestyle, it seems to be effective to treat and prevent injury by studying about new approaches and physical therapy. However, the most effective method for performing the exercise therapy has not been identified so far. The main purpose of this study was to compare the effects of stability training alone and in combination with pain education on pain and function and proprioception in patients with non-specific chronic low back pain. Material and Methods: current study method was semi experimental. Fourty five women with non-specific chronic low back pain were divided in to 3 groups, stability training with pain education (n=15), stability training without pain education (n=15) and control (n=15). The training groups completed training 3 times a week for 6 weeks; training lasted 45 min in each session. pain, disability and lumbopelvic proprioception respectively were measured by using visual analogue scale, the Oswestry questionnaire and universal goniometer. In order to analyze the internal group differences, paired sample T-test was used and, to check the between group differences, one-way analysis of variance (ANOVA) test was applied in SPSS version 20 (α≤0.05). results: Both training interventions were affective on pain, disability, and lumbopelvic proprioception. Also, there was significant difference between groups in dependent variables, while, differences in the control group was not significant. Conclusion: Findings revealed that both (stability training alone and combination with pain education) groups has improvement on reducing pain, disability, and lumbopelvic propriception. Regarding the improvement of the measured variables in two training groups, it is suggested that a combination of these exercises be used in the treatment of patients with non-specific chronic low back pain in future. Keywords: Non-specific chronic low back pain, lumbar stabilization training, functional disability.
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زمینه و هدف: کمردرد مزمن غیر اختصاصی شایع ترین نوع کمردرد مزمن می باشد و دستیابی به یک برنامه ی درمانی و توانبخشی برای بهبود سریع تر بیماران مبتا به کمردرد مزمن همواره مورد توجه بوده است. لذا هدف از پژوهش حاضر، ارزیابی تاثیر یک دوره تمرینات بر کنترل درد، تعادل پویا و حس عمقی کمری - لگنی بیماران مبتا به کمردرد مزمن غیر اختصاصی بود. مواد و رو شها: مطالعه حاضر از نوع نیمه تجربی با طرح پیش آزمون - پس آزمون با گروه کنترل بود. به همین منظور، 30 نفر از بیماران مرد مبتا به کمر درد مزمن غیر اختصاصی به روش تصادفی در 2گروه مساوی 15 نفری انتخاب شدند. گروه تجربی به مدت هشت هفته، هر هفته سه جلسه، تمرینات ثبات مرکز