Effects of backward bending on lumbar intervertebral discs. Relevance to physical therapy treatments for low back pain.

摘要

STUDY DESIGN: Mechanical testing of cadaveric motion segments. OBJECTIVES: To test the hypothesis that backward bending of the lumbar spine can reduce compressive stresses within lumbar intervertebral discs. SUMMARY OF BACKGROUND DATA: Lumbar extension affects the distribution of compressive stress inside normal cadaveric discs, but little is known about its effect on mechanically disrupted and degenerated discs. METHODS: Nineteen lumbar motion segments (mean donor age, 48 years) were subjected to complex mechanical loading to simulate the following postures: moderate lumbar flexion, 2 degrees of extension, 4 degrees of extension, and the neutral position (no bending). The distribution of compressive stress within the disc matrix was measured in each posture by pulling a miniature pressure transducer along the midsagittal diameter of the disc. Stress profiles were repeated after a mechanical treatment that was intended to simulate severe disc degeneration in vivo. RESULTS: The "degeneration" treatment reduced pressure in the nucleus pulposus and generated stress concentrations within the anulus, in a manner similar to that found in severely degenerated discs in vivo. When all discs were considered together, 2 degrees of extension increased the maximum compressive stress within the posterior anulus by an average of 16%, compared with the neutral posture. The size of localized stress peaks within the posterior anulus was increased by 43% (P = 0.02). In 4 degrees of extension, changes observed between 0 degree and 2 degrees were usually exaggerated. In contrast, moderate flexion tended to equalize the distribution of compressive stress. In 7 of the 19 discs, 2 degrees of lumbar extension decreased maximum compressive stress in the posterior anulus relative to the neutral posture by up to 40%. Linear regression showed that lumbar extension tended to reduce stresses in the posterior anulus in those discs that exhibited the lowest compressive stresses in the neutral posture (P = 0.003; R2 = 41%). CONCLUSIONS: The posterior anulus can be stress shielded by the neural arch in extended postures, but the effect is variable. This may explain why extension exercises can relieve low back pain in some patients.