Ocena kontraktilnih lastnosti ekstenzorjev kolka in ledvene hrbtenice z uporabo tenziomiografije pri bolnikih z ankilozirajočim spondilitisom : magistrsko delo

Štuhec, Maša (author), Kacin, Alan (mentor), Grapar Žargi, Tina (reviewer)

Uvod: Ankilozirajoči spondilitis (AS) je kronična in progresivna oblika artritisa, ki prizadene aksialni skelet. V Sloveniji se diagnoza postavi v povprečju sedmih let. Posamezniki z zgodnim pojavom AS imajo pogosto slabšo funkcijo trupa in kolka, vendar ni znano koliko k temu prispevajo z boleznijo povezane spremembe v kontraktilnosti skeletnih mišic trupa, zlasti ekstenzorjev ledvene hrbtenice in kolka. Natančna ocena kontraktilnih lastnosti skeletnih mišic je metodološko zahtevna, obetavna neinvazivnia merilna metoda primerna za klinično uporabo je tenziomiografija (TMG). Namen: Namen raziskave je bil primerjati kontraktilne lastnosti in vzdržljivost ekstenzorjev ledvene hrbtenice in kolka med ljudmi z AS in zdravimi preiskovanci. Metode dela: V raziskavo je bilo vključenih 30 preiskovancev, od tega je bilo 15 preiskovancev z AS (skupina AS) in 15 zdravih preiskovancev (kontrolna skupina) starih med 18 in 39 let starosti. Meritve s TMG smo izvedli enkrat, nato je sledil še Biering-Sorensonov test vzdržljivosti. Za primerjavo osnovnih karakteristik preiskovancev in vrednosti TMG parametrov Dm, Tc, Vc, Td in ILS med skupinama smo uporabili Shapiro-Wilkov test in Mann Whitney U test za neodvisne vzorce. Rezultati: Skupina AS je imela statistično pomembno (p < 0,05) nižjo hitrost kontrakcije (Vc = -0,03 mm/ms) in nižji indeks lateralne simetrije (ILS = -14 %) kot kontrolna skupina. Nakazan je bil tudi trend statistično pomembno manjše amplitude prečnega odmika (Dm = -0,65 mm, p = 0,067) in daljši čas zakasnitve kontrakcije (Td= 2,37 ms; p = 0,095) ekstenzorjev hrbtenice v AS skupini. Za ekstenzorje kolka nismo zaznali pomembnih razlik v TMG parametrih med skupinama. Statistično značilno manjšo vzdržljivost ekstenzorjev hrbtenice in kolka smo ugotovili pri AS skupini tudi pri Biering-Sorensonovem prilagojenem testu (BS test 45° = -45 s, p = 0,019). Nakazan je bil trend statistično pomembne zmanjšane vzdržljivosti ekstenzorjev hrbtenice in kolka pri AS skupini pri Biering-Sorensonovem testu v primerjavi s kontrolno skupino (BS test = -29,2 s, p = 0,061). Razprava in zaključek: Z raziskavo smo kot prvi na svetu preučili spremembe v kontraktilnih lastnosti ekstenzorjev hrbtenice in kolka s TMG pri bolnikih z AS. Poslabšanje kontraktilnih lastnosti in vzdržljivosti je vidno na ekstenzorjh hrbtenice, kar verjetno pomembno prispeva k slabšanju funkcijskih sposobnosti bolnikov.

• Language: Slovenian
• Keywords: magistrska dela, fizioterapija, morbus Bechterew, kontraktilne lastnosti mišic, mišica gluteus maksimus, mišica erector spinae, sakroiliakalni sklep, Biering-Sorensonov test
• Work type: Master's thesis/paper
• Typology: 2.09 - Master's Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [M. Štuhec]
• Year: 2025
• Number of pages: 31 str., [6] str. pril.
• PID: 20.500.12556/RUL-174474
• UDC: 615.8
• COBISS.SI-ID: 251594499
• Publication date in RUL: 03.10.2025

Secondary language

• Language: English
• Title: Assessment of the contractile properties of the hip and lumbar spine extensors using tensiomyography in patients with ankylosing spondylitis : master thesis

Abstract

Introduction: Ankylosing spondylitis (AS) is a chronic and progressive form of arthritis that primarily affects the axial skeleton. In Slovenia, the average time to diagnosis is seven years. Individuals with early-onset AS often present with impaired trunk and hip function; however, it remains unclear to what extent disease-related alterations in the contractility of trunk skeletal muscles—particularly lumbar spine and hip extensors—contribute to these deficits. Accurate assessment of skeletal muscle contractile properties is methodologically challenging, but tensiomyography (TMG) is a promising, non-invasive measurement technique suitable for clinical application. Aim: The aim of this study was to compare the contractile properties and endurance of the lumbar spine and hip extensors between individuals with AS and healthy controls. Methods: Thirty participants were included, comprising 15 individuals with AS (AS group) and 15 healthy controls aged 18–39 years. TMG measurements were performed once, followed by the Biering-Sørensen endurance test. To compare participant characteristics and TMG parameters (Dm, Tc, Vc, Td, and ILS) between groups, the Shapiro–Wilk test and Mann–Whitney U test for independent samples were applied. Results: The AS group demonstrated significantly (p < 0.05) lower contraction velocity (Vc = –0.03 mm/ms) and a reduced index of lateral symmetry (ILS = –14%) compared to controls. A trend toward lower displacement amplitude (Dm = –0.65 mm, p = 0.067) and longer contraction delay time (Td = 2.37 ms, p = 0.095) was also observed in the spinal extensors of the AS group. No significant differences in hip extensor TMG parameters were found between groups. The AS group showed significantly lower endurance of lumbar and hip extensors in the modified Biering-Sørensen test (BS test 45° = –45 s, p = 0.019). A trend toward reduced endurance was also evident in the standard Biering-Sørensen test (BS test = –29.2 s, p = 0.061). Discussion and Conclusion: To our knowledge, this is the first study worldwide to investigate alterations in spinal and hip extensor contractile properties using TMG in individuals with AS. Impairments in contractility and endurance were evident in the lumbar extensors, which likely contribute to the functional limitations experienced by patients.

• Keywords: master's theses, physiotherapy, Bechterew's disease, muscle contractile properties, gluteus maximus, erector spinae, sacroiliac joint, Biering–Sørensen test