Ulawulo lweChiropractic lwe-Down Back Pain kunye ne-Low-Related Related: Izikhalazo zomthetho: I-Literature Synthesis

 

Ukhathalelo lweChiropractic lukhetho olwaziwayo oluncedisayo kunye nolunye unyango olusetyenziswa rhoqo ukuxilonga, ukunyanga nokuthintela ukulimala kunye neemeko zenkqubo ye-musculoskelet and nervous. Imiba yempilo yomgogodla iphakathi kwezinye zezizathu eziqhelekileyo abantu abafuna ukunakekelwa kwe-chiropractic, ngakumbi kwiintlungu ezisezantsi kunye nezikhalazo ze-sciatica. Nangona kukho iintlobo ezininzi zonyango ezifumanekayo ekuncedeni ukuphucula iintlungu ezisezantsi kunye neempawu ze-sciatica, abantu abaninzi baya kudla ngokukhetha iindlela zonyango zendalo ngaphezu kokusetyenziswa kweziyobisi / amayeza okanye ukungenelela kokuhlinzwa. Uphononongo olulandelayo lophando lubonisa uluhlu lweendlela zonyango ze-chiropractic ezisekelwe kubungqina kunye nemiphumo yazo ekuphuculeni imiba eyahlukeneyo yempilo yomgogodla.

 

Abstract

 

• Iinjongo: Injongo yale projekthi yayiyikuhlaziywa kweencwadi zokusetyenziswa kweentlungu zomgudu ngenxa yentlungu ephantsi (LBP).
• Iindlela: Uphando oluqulunqwe kwi-Cochrane Cooperation reviewLLP luqhutywe ngoluhlu olulandelayo: i-PubMed, iMantis, kunye ne-Cochrane Database. Izimemo zokuhambisa amaphepha afanelekileyo zongezelwa kumsebenzi ngokusebenzisa iindaba eziphathekayo ezisemgangathweni kunye neendaba zoshishino. IKhomishoni yeSayensi yeBhunga malunga neChropractic Guidelines kunye neParameters Parameters (CCGPP) ihlawuliswe ngokuphuhlisa i-syntheses yeencwadi, ehlelwe ngummandla we-anatomical, ukuvavanya nokunika ubungqina malunga nesiseko sobungqina bokunakekelwa kwe-chiropractic. Eli nqaku sisiphumo sale ntlawulo. Njengengxenye yenkqubo yeCCGPP, iiprojekti zokuqala zala manqaku zithunyelwe kwiWebhsayithi ye-CCGPP ethi www.ccgpp.org (2006-8) ukuvumela inkqubo evulekileyo kunye nenkqubo ebonakalayo kunazo zonke zokufakelwa kwabathintekayo.
• iziphumo: Kufunyenwe amaxwebhu omthombo we-887. Iziphumo zophando zahlenga kwiiqela ezihambelana nesihloko njengolu hlobo: izilingo ezilawulwa ngononophelo (RCTs) ze-LBP kunye nokuphathwa; izilingo ezingenakulinganiswa kwezinye iindlela zokungenelela kweLBP; khokelo; Ukuphononongwa ngokuchanekileyo kunye nokuhlaziya i-meta; yesayensi yesiseko; amanqaku anxulumene nokuxilongwa, indlela; Iingxaki zengqondo kunye neengxaki zengqondo; izifundo kunye nezisiphumo; nabanye. Iqela ngalinye lahlula ngesihloko ukuze amalungu amagosa athole amanani alinganayo amanqaku avela kwiqela ngalinye, okhethwe ngokulandelelana. Iqela likhethe ukunciphisa ingqwalasela kule ntlawulo yokuqala kwiikhokelo, ukuphononongwa ngendlela echanekileyo, ukuhlaziya i-meta-analysis, i-RCT kunye ne-coh ort. Oku kwavelisa izikhokelo ze-12, i-64 RCTs, ii-13 ukuhlaziywa okuchanekileyo / ukuhlaziywa kwemeta, kunye nezifundo ze-11.
• Izigqibo: Kukho ubungqina obuninzi okanye obuninzi bokusetyenziswa kwemigudu yokunciphisa impawu nokuphucula umsebenzi kwizigulane ezine-LBP ezingapheliyo malunga nokusetyenziswa kwi-LBP enzima kunye neyengxaki. Ukusetyenziswa kokusebenza ngokubambisana nokuphathwa kakubi kunokukhawuleza nokuphucula iziphumo kunye nokunciphisa ukuphindaphinda kweepasitidi. Kukho ubungqina obuncinane bokusetyenziswa kwezigulane ezine-LBP kunye neentlungu zentlungu, i-sciatica, okanye i-radiculopathy. (J Uluhlu lwePhysiol Ther 2008; 31: 659-674)
• Iimpawu eziPhambili zeNkcazo: Ubunzima Bokubuya; Ukunyanzelisa; Chiropractic; Isipho; Sciatica; Radiculopathy; Ukuphonononga, ukuCwangcisa

 

IBhunga leZikhokelo zeChiropractic kunye neParameters Practice (CCGPP) yasekwa kwi-1995 yiCongress of Chiropractic State Associations ngoncedo oluvela kwi-American Chiropractic Association, i-Association of Chiropractic Colleges, iBhunga kwiMfundo yeChiropractic, i-Federation of Chiropractic Licensings Ukuqhubela phambili kweSayensi yeChiropractic, iSiseko seMfundo yeChiropractic kunye noPhando, uMbutho weZizwe eziManyeneyo weeChiropractors, uMbutho weSizwe wamaGqwetha eChiropractic, kunye neZiko leSizwe loPhando lweChiropractic. Intlawulo kwi-CCGPP yayikukudala uxwebhu lwe-chiropractic �eyona ndlela ilungileyo yokusebenza”. IBhunga leZikhokelo zeChiropractic kunye neeParameters zokuSebenza zathunyelwa ukuba zihlolisise zonke izikhokelo ezikhoyo, iiparitha, iiprotocol, kunye nezenzo ezilungileyo e-United States nakwezinye iintlanga ekwakhiweni kolu xwebhu.

 

Ngaloo ndlela, iKhomishoni yeSayensi yeCCGPP yahlawuliswa ngokuphuhlisa i-syntheses yeencwadi, ehlelwe ngummandla (intamo, i-back back, i-thoracic, i-upper and lower extremity, i-soft tissue) kunye neentlobo ezingezizo zokungabikho komzimba, ukukhusela / ukukhuthaza impilo, abantu abakhethekileyo, ukuxhaswa, kunye nokucinga ngomfanekiso.

 

Injongo yalo msebenzi kukubonelela ngokucacileyo uncwadi ukuchonga ukhetho olukhuselekileyo nolunefuthe ekunyamekelweni kwezigulane ezinentlungu ephantsi (LBP) kunye neengxaki ezinxulumene nazo. Esi sishwankathelo senzelwe ukusetyenziswa njengezibonelelo kubasebenzi ukuba bancedise ekuqwalaselweni kweendlela ezahlukeneyo zokunyamekela kwezi zigulane. Akuyiyo indawo yokugwetywa kwekliniki okanye umgangatho ochanekileyo wokunyamekela izigulane ngamnye.

 

 

tindlela

 

Uphuhliso lwenkqubo lukhokelwa ngamava ngamalungu ekhomishana ngenkqubo yokubambisana kweRAND, ukubambisana kweCochrane, i-Arhente yeNkonzo yezeMpilo kunye noPhando lweMigaqo-nkqubo, kwaye ipapashwe iziphakamiso eziguqulelwe kwiimfuno zebhunga.

 

Ukuchonga kunye nokubuyisela

 

Idibansi yale ngxelo yile ye-LBP kunye neempawu zomlenze ezisezantsi. Ukusebenzisa uphando lwengqesho kunye neempapasho kwiincwadi zophicotho-zincwadi, iqela likhethile izihloko zokuhlaziywa ngolu hlobo.

 

Izihloko zakhethwa ngokusekelwe kwiintlupheko eziqhelekileyo ezibonwayo kunye neziqhelo eziqhelekileyo zonyango ezisetyenziselwa iicropractors ezisekelwe kwincwadi. Izinto zokufunda zifunyenwe ngokuphanda ngokusisesikweni kwincwadi kunye neenkcukacha zekhompyutheni, ngoncedo oluvela kwilayibrari yezobuchwephesha. Isicwangciso sophando saphuhliswa, esekelwe kwiComraneWorking Group ye-Pain Down Back Pain. Izilingo ezilawulwa ngokungahlawulwanga (RCTs), ukuphononongwa ngokuchanekileyo / uhlalutyo lweemeta, kunye nezikhokelo ezipapashwe kwi-2006 zifakiwe; zonke iindidi zezifundo zifakwe kwi-2004. Izimemo zokuhambisa amaphepha afanelekileyo zongezelwa kumsebenzi ngokusebenzisa iindaba eziphathekayo ezisemgangathweni kunye neendaba zoshishino. Ukukhangela kugxininiswe kwizikhokelo, ukuhlaziya i-meta-analysis, ukuphononongwa ngokuchanekileyo, izilingo ezinokwenziwa kweeklinikhi, izifundo eziqhelekileyo kunye neenkalo zecala.

 

Evaluation

 

Izixhobo ezisemgangathweni kunye neziqinisekisiweyo ezisetyenziswe yiNkcazo ye-Interconnected Guidelines yaseScotland yasetyenziselwa ukuvavanya i-RCT kunye nokuphononongwa ngokuchanekileyo. Izikhokelo, i-Appraisal of Guidelines for Research and Assessment instrument yasetyenziswa. Indlela echanekileyo yokubeka ubungqina bobufakazi isetyenzisiweyo, ngokufingqiweyo kwi-Figure 1. Iqela ngalinye leqela lezemfundo liqhube ukuhlaziywa nokuvavanya ubungqina.

 

 

Iziphumo zophando zihlelwe kwiqela elichaphazelekayo njengezilandelayo: I-RCT ze-LBP kunye nokuphathwa; izilingo ezingenakulinganiswa kwezinye iindlela zokungenelela kweLBP; khokelo; Ukuphononongwa ngokuchanekileyo kunye nokuhlaziya i-meta; yesayensi yesiseko; amanqaku okuxilonga; indlela; Iingxaki zengqondo kunye neengxaki zengqondo; izifundo kunye nezisiphumo; nabanye. Iqela ngalinye lahlula ngesihloko ukuze amalungu amagosa athole amanani alinganayo amanqaku avela kwiqela ngalinye, okhethwe ngokulandelelana. Ngokwe siseko seQumrhu leCCGPP yenkqubo yokwenziwa kwezinto kunye nomyinge womsebenzi okhoyo, iqela likhethe ukukhawulela ingqwalasela kule ngqungquthela yokuqala kwizikhokelo, ukuphononongwa ngokuchanekileyo, ukuhlalutya kweemeta, ii-RCT, kunye nezifundo eziphakathi.

 

Insight of Dr. Alex Jimenez

Ukhathalelo lwe-chiropractic lubanceda njani abantu abaneentlungu ezisezantsi kunye ne-sciatica? �Njenge-chiropractors abanolwazi ekulawuleni iintlobo zempilo yeengxaki zomnxeba, kubandakanywa iintlungu ezisezantsi kunye ne-sciatica, ukuguqulwa kwamagqabi kunye nokusetyenziswa kwamanyathelo, kunye nezinye iindlela zokwelapha ezingenasiphene, zingaphunyezwa ngokufanelekileyo kwaye ziphunyezwe ngempumelelo ekuphuculeni intlungu emva iimpawu. Injongo yolu lulwazi kuphando olulandelayo lubonakalisa iziphumo ezisekelwe ubungqina be-chiropractic kwonyango lweemeko kunye neemeko zesistim ne-nervous systems. Ulwazi olukule nqaku lunokufundisa izigulane ngendlela ezinye iindlela zokwenza unyango ezingakunceda ngayo ukuphucula intlungu yazo ye-back and sciatica. Njenge-chiropractor, izigulana nazo zingathunyelwa kwabanye abaqeqeshi bezempilo, njengabagqirha bezonyango, oogqirha bezonyango osebenzayo kunye noogqirha bezobugqirha, ukubanceda ukuba baphathe ukunyamezela kwabo ubuhlungu obuphantsi beempawu ze-sciatica. Ulondolozo lwe-Chiropractic lungasetyenziselwa ukuthintela ukungenelelo ngoncedo olusisigxina kwimpilo.

 

Iziphumo neengxoxo

 

Ingxelo yamaxwebhu e-887 yafunyanwa ekuqaleni. Oku kwakuquka izikhokelo ze-12, ii-RCT ze-64, ii-20 ukuhlolwa kwakhona / iimvavanyo-meta, kunye neengxelo ze-12. Itheyibhile 1 inikeza isishwankathelo esipheleleyo senani leengxelo ezivandlakanywe.

 

 

Uqinisekiso kunye neengcebiso

 

Isicwangciso sokukhangela esisetyenziswe liqela liye laphuhliswa nguVan Tulder et al, kwaye iqela lichonge izilingo ze-11. Ububungqina obuhle bubonisa ukuba izigulane ezine-LBP ezikhuselekileyo ekuphumleni kokulala ziba nobuhlungu obukhulu kunye nokubuyiswa okuncinci kunabasebenzi abahlala besebenza. Akukho ntlukwano kwiintlungu kunye nesimo sokusebenza phakathi kokuphumla kombhede nokuzilolonga. Kwiigulane ze-sciatica, ubungqina obufanelekileyo abubonakali ulwahlulo lwangempela kwiintlungu kunye nemeko esebenzayo phakathi kokuphumla kombhede nokuhlala usebenza. Kukho ubungqina obufanelekileyo bokungabi nantlukwano kwintlungu ebuhlungu phakathi kokuphumla kombhede kunye ne-physiotherapy kodwa ukuphuculwa okuncinci kwimeko yokusebenza. Ekugqibeleni, akukho umahluko omncinci kwintlungu ebuhlungu okanye kwindawo esebenzayo phakathi kwexesha elifutshane okanye ixesha lokuphumla kwexesha elide.

 

Ukuhlaziywa kwe-Cochrane nguHagen et al ubonise iingenelo ezincinci kwixesha elifutshane kunye nexesha elide lokuhlala ekhuselekileyo ekuphumleni kombhede, njengoko kwenza ukuhlaziywa okuphezulu kweDanish Society of Chiropractic kunye neCliniki Biomechanics, kubandakanywa ukuhlolwa kwe-4, i-4 eyongezelelweyo ye-RCTS kunye nezikhokelo ze-6, kwi-LBP kunye ne-sciatica. Ukuhlaziywa kweCchrane nguHilde et al kuquka iilingo ze-4 kwaye yagqiba umphumo omncinci wokuhlala esebenzayo kwi-LBP enzima, engenakunzima, kodwa akukho nzuzo kwi-sciatica. Izifundo ezisibhozo zokuhlala zisebenza kwaye i-10 ekuphumleni kwebhedlele zifakwe kuhlalutyo liqela leWaddell. Unyango oluninzi lwaluhlanganiswa neengcebiso zokuhlala zikhuthele kwaye zibandakanya amayeza e-analgesic, unyango lomzimba, isikolo esikolweni, kunye neengcebiso zokuziphatha. Ibhedi yokuphumla kwi-LBP enzima yayifana neyonyango kunye ne-placebo kwaye ingasebenzi ngaphantsi kuneyonyango. Iziphumo ezicatshangelwe kuzo zonke izifundo ziyizinga lokubuyiselwa, intlungu, amanqanaba omsebenzi kunye nokulahleka kwexesha lomsebenzi. Ukuhlala bekhuthele kwafunyanwa kuba nefuthe elihle.

 

Uphononongo lwezifundo ezi-4 ezingabandakanywanga kwenye indawo ezivavanywe ukusetyenziswa kweencwadana/iincwadana. Intsingiselo ibingeyoyantlukwano kwiziphumo zamaphecana. Enye into yaphawulwa - ukuba abo bafumana ukukhwabanisa babeneempawu ezincinci kwiiveki ze-4 kunye nokukhubazeka okuncinci kwiinyanga ze-3 kwabo bafumana incwadana ekhuthaza ukuhlala bekhuthele.

 

Isishwankathelo, ukuqinisekisa izigulane ukuba ziyakwenza kakuhle kwaye zicebise ukuba zihlale zikhuthele kwaye ziphephe ukuphumla kombhede yindlela efanelekileyo yokulawula i-LBP enzima. Ibhedi yokuphumla ixesha elifutshane linokuba luncedo kwizigulane ezineentlungu zomlenze ongenakunyameko.

 

Uhlengahlengiso / Ukunyanzelisa / Ukukhuthaza iiModels Multiple Modalities

 

Olu hlalutyo luqwalasela iincwadi eziphezulu, i-lowamplitude (HVLA) iinkqubo, ngokuqhelekileyo zibizwa ngokuba nguhlengahlengiso okanye ukuphathwa, kunye nokuhlanganiswa. Inqubo ye-HVLA isebenzise ukuhamba ngokukhawuleza kusetyenziswa ngokukhawuleza; Ukubambisana kusetyenziswa ngokulandelelana. Inkqubo yeHVLA kunye nokuhlanganiswa kunokuncediswa ngombane; Izixhobo zomshukumisi zogqirha zibhekwa njenge-HVLA, kunye neendlela zokuphazamisa i-flexion kunye nezindlela zokuqhubela phambili ezihambayo zingabandakanywa.

 

 

Iqela likhuthaza ukufumana iziphumo zokuphononongwa ngokuqhelanisiweyo yiBronfort et al, kunye nemilinganiselo esemgangathweni (i-QS) ye-88, ehambisa incwadi ukuya kwi-2002. Ku-2006, ukusebenzisana kweCochrane kuphinda kuphinde kuhlaziywe uphando (2004) lwangaphambili (i-39) yonyango lomnxeba (SMT) lweentlungu ezibuhlungu ezenziwa ngu-Assendelft et al. Oku kwaxelwa ngezifundo ze-1999 ukuya kwi-XNUMX, ehamba phambili kunye nalawo abikelwe yiBronfort et al usebenzisa iindlela ezihlukileyo kunye nohlalutyo lwenveli. Athi akukho mpahla kwiphumo elivela kwonyango kunye neendlela ezithile. Njengoko ii-RCT ezongezelelweyo ezongezelelweyo zavela ngexeshana, isisombululo sokubuyisela kwakhona ukuhlaziywa komdala ngaphandle kokuvuma izifundo ezintsha kwakungekho ngokucacileyo.

 

LBP efanelekileyo. Kwakukho ubungqina obufanelekileyo bokuthi i-HVLA ibenokusebenza kakuhle kwexesha elifutshane kunokubambisana okanye ukutyhila kunye nobungqina obuncitshisiweyo bokusebenza kancinci kwexesha elifutshane kunobungakanani bentambo, ukuzivocavoca kunye nokulungiswa kwe-ergonomic.

 

LBP engapheliyo. Inkqubo ye-HVLA edityaniswe nokuqinisa umthambo yayisebenza kakuhle ekupheliseni iintlungu njenge-nonsteroidal antiinflammatory dugs kunye nomthambo. Ubungqina obufanelekileyo bubonise ukuba ukukhohlisa kungcono kunonyango lomzimba kunye nomthambo wasekhaya wokunciphisa ukukhubazeka. Ubungqina obufanelekileyo bubonisa ukuba ukukhwabanisa kuphucula iziphumo ngaphezu kokhathalelo lwezonyango ngokubanzi okanye indawo ye-placebo kwixesha elifutshane kunye nonyango lomzimba kwixesha elide. Inkqubo ye-HVLA ibe neziphumo ezingcono kunokuzivocavoca ekhaya, i-transcutaneous-electrical nerve stimulation, i-traction, i-exercise, i-placebo kunye ne-sham manipulation, okanye i-chemonucleolysis ye-disk herniation.

 

Ezixubileyo (ezichanekileyo kunye nezingapheliyo) LBP. I-Hurwitz yafumanisa ukuba i-HVLA yayifana nokunyamekelwa kwezonyango kwiintlungu nokukhubazeka; ukongezelela unyango olwenziwe ekuphatheni kakubi aluzange luphucule iziphumo. U-Hsieh akafumananga xabiso elixabisekileyo kwi-HVLA emva kwesikolo esikolweni okanye unyango lwe-myofascial. Ixabiso elifutshane elifutshane lokusetyenziswa kwiphephancwadana kwaye akukho mmahluko phakathi kobuchule kunye neMacKenzie. Ukuqhathaniswa nokuxhatshazwa kweendlela kunye nokunyamekelwa kwezibhedlele, ukufumana uncedo olungakumbi malunga nokuphathwa kwexesha elifutshane kunye nexesha elide. UDoran noNewell bafumene ukuba i-SMT ibangele ukuphucula okukhulu kunonyango okanye kwi-corsets.

 

LBP efanelekileyo

 

Uluhlu lwezilwanyana Ukuthelekiswa. I-Seferlis ifumene ukuba izigulane ezigulayo zidweliswe ziphuculwe ngokuphawulekayo emva kwenyanga ye-1 kungakhathaliseki ukungenelela, kuquka ukuphathwa. Izigulane zazinelisekile kwaye zivakalelwa kukuba zinikezelwa iinkcazo ezingcono malunga nentlungu yabo evela kwiingcali ezisebenzise unyango olusesikweni (QS, 62.5). UWand et al uhlolisise imiphumo yokuzihlula ngokugula kwaye uqaphele ukuba iqela elifumana uvavanyo, iingcebiso kunye nokunyangwa kwonyango luphucuke kangcono kunokuba iqela lihlola uvavanyo, iingcebiso, kwaye banikwa uluhlu lokulinda kwixesha leveki le-6. Ukuphuculwa kwakubonwe ukukhubazeka, impilo jikelele, umgangatho wobomi kunye nomoya, nangona intlungu kunye nokukhubazeka kwakungeyona eyahlukileyo ekulandeleni ixesha elide (QS, 68.75).

 

I-Physiologic Iimpawu zoButhambo kunye nokuSebenza. U-Hurley kunye nabalingane bakhe bavavanyelwa imiphumo yokuxhaphaza idibene ne-anti-inferential therapy xa kuthelekiswa nokuba yindlela yokuziphatha yodwa. Iziphumo zabo zabonisa ukuba onke amaqela e-3 aphucula umsebenzi kwizinga elifanayo, zombini kwiinyanga ze-6 kunye ne-12-inyanga-emva kwe-81.25 (QS, 2). Ukusebenzisa ukucwangcisa okukodwa ukucatshulwa ukucatshulwa ukuxilisa kunye ne-electrostimulation yamanqanaba aphantsi, u-Godfrey et al akafumananga umahluko phakathi kwamaqela kwi-3 ukuya kwi-19 yeveki yexesha lokuqwalasela (QS, 94). Kwisifundo seRasmussen, iziphumo zibonise ukuba i-14% yezigulane eziphathwe kakubi ziyi-symptom-free kwiintsuku ze-25, xa kuthelekiswa ne-18% kwiqela lafumana i-short-wave diathermy. Isayizi yesampula yayincinci, nangona kunjalo, kwaye ngenxa yoko, isifundo sasilawulwa (QS, 12). Ukuhlaziywa kwe-Danish ngokuchanekileyo kuhlolisise izihlomelo ze-12 zezizwe ngezikhokelo, ukuhlolwa kwe-10 ngokuchanekileyo, kunye ne-XNUMX izilingo zonyango ngokulandelelana. Awufumani nantoni yokuzivocavoca, kungakhathaliseki ukuba luhlobo luni, oluluncedo ekwenzeni unyango lwe-LBP ngaphandle kweMcKenzie.

 

Sham kunye nenye indlela yokuLinganisa. Uphononongo lwe-Hadler olulungelelanisiweyo kwiziphumo zokuqwalaselwa komnikezeli kunye nokunxibelelana ngokomzimba kunye nomzamo wokuqala kwinkqubo yokukhohlisa. Izigulane kwiqela elingene kulingo ngokugula okukhulu ixesha elide ekuqaleni kwaxelwa ukuba zixhamle ekusebenziseni. Ngokufanayo, baphucula ngokukhawuleza kwaye kwinqanaba elikhulu (QS, 62.5). U-Hadler ubonise ukuba kukho inzuzo kwiseshoni enye yokukhwabanisa xa kuthelekiswa neseshoni yokuhlanganisa (QS, 69). U-Erhard wabika ukuba izinga lokuphendula okulungileyo kunyango lwe-manual kunye ne-hand-heel-rocking motion yayinkulu kunomsebenzi wokwandisa (QS, 25). UVon Buerger uhlolisise ukusetyenziswa kokuguqulwa kwe-LBP enzima, ethelekisa ukuguqulwa okujikelezayo kwi-massage yezicubu ezithambileyo. Ufumene ukuba iqela lokukhwabanisa liphendule bhetele kuneqela lezicubu ezithambileyo, nangona iziphumo zenzeke ngokukodwa kwixesha elifutshane. Iziphumo nazo zathintelwa bubume bokunyanzeliswa kokukhetha ukhetho oluninzi kwiifom zedatha (QS, 31). I-Gemmell iqhathanise iifom ze-2 zokukhwabanisa kwi-LBP engaphantsi kweeveki ze-6 zobude obulandelayo: Ukulungiswa kweMeric (uhlobo lwe-HVLA) kunye ne-Activator technique (uhlobo lwe-HVLA encediswa ngoomatshini). Akukho mmahluko wabonwa, kwaye zombini banceda ukunciphisa ubunzima beentlungu (QS, 37.5). I-MacDonald yabika inzuzo yexesha elifutshane kwimilinganiselo yokukhubazeka ngaphakathi kwe-1 yokuqala kwiiveki ze-2 zokuqala unyango lweqela lokukhwabanisa elanyamalala kwiiveki ze-4 kwiqela lokulawula (QS, 38). Umsebenzi kaHoehler, nangona uqulethe idatha edibeneyo yezigulane ezine-LBP enzima kunye nengapheliyo, ifakwe apha ngenxa yokuba inxalenye enkulu yezigulane ezine-LBP ezinzima zibandakanyeka kwisifundo. Izigulane zokukhwabanisa zichaze ukukhululeka ngokukhawuleza ngokukhawuleza, kodwa kwakungekho nantlukwano phakathi kwamaqela ekukhutshweni (QS, 25).

 

Amayeza. I-Coyer ibonise ukuba i-50% yeqela lokuxhaphaza yayingenazo iimpawu kwi-1 iveki kwaye i-87% yayingenasifo kwiimpawu ze-3, xa kuthelekiswa ne-27% kunye ne-60%, ngokulandelanayo, yeqela lokulawula (ukulala nokulala kunye ne-analgesics) (QS , 37.5). UDoran noNewell bafanisa ukuphathwa, i-physiotherapy, i-corset, okanye imithi yezilwanyana, ngokusebenzisa iziphumo ezihlolisise ubuhlungu nokuhamba. Kwakungekho nantlukwano phakathi kwamaqela ngokuhamba kwesikhathi (i-QS, i-25). U-Waterworth uthelekisa ukuxhaphaza kwimizimba ye-physiotherapy kunye ne-500 mg ye-diflunisal kabini ngosuku ngemini ye-10. Ukunyanzelisa akubonanga nzuzo kwizinga lokubuyisela (QS, 62.5). I-Blomberg iqhathanisa ukuphathwa kwee-injection steroid kunye neqela lokulawula elifumana unyango olusetyenziswayo oluqhelekileyo. Emva kweenyanga ze-4, iqela lokuxhaphaza lalinomda wokunciphisa ngokuncinci, isithintelo esincinci kwi-side-bending kumacala omabini, ubuncinane beentlupheko zengingqi kwandiso kunye nokunene kwebala, intlungu engapheliyo, kunye nentlungu engaphantsi xa kuphakanyiswa umlenze ochanekileyo (QS, 56.25 ). I-Bronfort ayifumananga nantlukwano yempembelelo phakathi kokunyamekela kwe-chiropractic kuthelekiswa nokunyangwa kwonyango kwiinyanga ze-1 zonyango, kodwa kukho ukuphucula okubonakalayo kwiqela le-chiropractic kwi-3 kunye ne-6-inyanga-emva kwe-31 (QS, XNUMX).

 

Ukuxhatshazwa Kwintlungu

 

Ukuhlala Usebenza. I-Grunnesjo ithelekisa imiphumo edibeneyo yonyango lwe-manual kunye neengcebiso zokuhlala zisebenza kwiingcebiso zodwa kwizigulane ezine-LBP ezibukhali kunye ne-subacute. Ukongezwa konyango lwezandla kubonakala kunciphisa iintlungu kunye nokukhubazeka ngokusebenza ngakumbi kunombono �ukuhlala usebenza wedwa (QS, 68.75).

 

I-Physiologic Iimpawu zoButhambo kunye nokuSebenza. UPapa ubonise ukuba ukukhwabanisa kunika ukuphuculwa kweentlungu ezingcono kune-transcutaneous electrical nerve stimulation (QS 38). U-Sims-Williams uthelekisa ukukhohlisa kunye �physiotherapy.� Iziphumo zibonise inzuzo yexesha elifutshane yokukhohlisa iintlungu kunye nokukwazi ukwenza umsebenzi olula. Ukwahluka phakathi kwamaqela kwancipha kwi-3 kunye ne-12-inyanga yokulandelelana (QS, 43.75, 35). U-Skargren et al wathelekisa i-chiropractic kwi-physiotherapy kwizigulane ezine-LBP ezingenalo unyango lwenyanga engaphambili. Akukho nantlukwano ekuphuculeni impilo, iindleko, okanye izinga lokuphindaphinda ziphawulwe phakathi kwamaqela e-2. Nangona kunjalo, ngokusekelwe kumanqaku e-Oswestry, i-chiropractic yenza ngcono kwizigulane ezinentlungu engaphantsi kweveki ye-1, kanti i-physiotherapy ibonakala ingcono kwabo babenentlungu engaphezulu kweeveki ze-4 (QS, 50).

 

Ukuhlaziywa kwe-Danish ngokuchanekileyo kuhlolisise izihlomelo ze-12 zezizwe ngezikhokelo, ukuhlolwa kwe-12 ngokuchanekileyo, kunye ne-10 izilingo zonyango ngokulandelelana. Iziphumo zacetyiswa ukuba ukusetyenziswa, ngokubanzi, kuxhamla izigulana ezinokubuhlungu kwintlungu. Ukusetyenziswa kweprogram eyisisiseko ekwazi ukuguqulwa ngokukhawuleza ukuhlangabezana neemfuno zesigulane ngasinye kunconywa. Imiba yamandla, ukunyamezela, ukuzinza, kunye nokulungelelaniswa ngaphandle kokulayishwa ngokugqithiseleyo konke kunokuqwalaselwa ngaphandle kokusetyenziswa kwezixhobo zobuchwepheshe. Uqeqesho olunzulu olubandakanya ngaphezulu kwe-30 kwaye ngaphantsi kweeyure ze-100 zoqeqesho zisebenza kakhulu.

 

Sham kunye nenye indlela yokuLinganisa. UHoiriis uthelekise ukusetyenziswa kolawulo lwe-chiropractic kwindawo ye-placebo / sham yokuhlukumeza i-LBP. Wonke amaqela aphuculwe kwiimvavanyo zentlungu, ukukhubazeka, ukuxinezeleka, kunye nokuPhathwa kweMhlaba yoBunzima. Ukuphathwa kwe-Chiropractic kulunge ngakumbi kune-placebo ekunciphiseni ubuhlungu kunye ne-Global Impression of Scores scores (QS, 75). UAndersson kunye nabalingane bakhe baqhathanisa ukunyanzeliswa kwe-osteopathic ukunyamekela okuqhelekileyo kwizigulane ezine-LBP, ekufumaneni ukuba amaqela amabini aphuculwe kwixesha le-12 ngeveki elilinganayo (QS, 50).

 

Ukuthelekiswa kwamachiza. Kwinkalo eyahlukileyo yonyango yokufunda iHoiriis, ukusetyenziswa kohlobo lwe-chiropractic ekusebenziseni ukuhlengahlengiswa kwemisipha yokuhlukumeza i-LBP kwafundwa. Kuzo zonke iindidi, intlungu, ukukhubazeka, ukuxinezeleka, kunye ne-Global Impression of Severity yehle. Ukuphathwa kwe-Chiropractic kwakuphumelele ngakumbi kunokuba i-muscle relaxants inciphisa i-Global Impression of Scars scores (QS, 75).

 

LBP engapheliyo

 

Ukuhlala Uthelekiso Oluqhelekileyo. I-Aure ifanisa unyango lwamayeza ukusetyenziswa kwizigulane ezine-LBP ezingapheliyo ezigulayo zidweliswe. Nangona zombini amaqela abonisa ukuphuculwa kwintlungu ebuhlungu, ukukhubazeka okusebenzayo, impilo yempilo, kunye nokubuyela emsebenzini, iqela lokunyanga lonyango libonisa ukuphucula okukhulu kakhulu kunokuba kwenziwe iqela lokusebenza kuzo zonke iziphumo. Iziphumo zazingqinelana zombini kunye nexesha elide (QS, 81.25).

 

Ugqirha Ubonise / Unonophelo lwezeMpilo / iMfundo. U-Niemisto uqhathanise ukuphathwa ngokubambisana, ukunyanzeliswa kokusebenza, kunye nodokotela ngokubonisana kunye nokubonisana kuphela. Ukungenelela okudibaniseneyo kwakunempumelelo ngakumbi ekunciphiseni ubuhlungu kunye nokukhubazeka (i-QS, i-81.25). Ii-Koes ziqhathanisa unyango oqhelekileyo wokunyanga, i-physiotherapy, kunye ne-placebo (ifunyenwe i-ultrasound). Iimvavanyo zenziwe kwi-3, i-6, kunye neeveki ze-12. Iqela lokuxhaphaza lalinokuphucula ngokukhawuleza kunye nokukhudlwana komsebenzi ngokomzimba xa kuthelekiswa nezinye iindlela zokwelapha. Ukutshintsha ukuhamba kwamagqabi kumaqela kwakuncinane kwaye akuhambelani (QS, 68). Kwimbiko yokulandelelana, i-Koes efunyenwe ngexesha lokuhlalutya kwamagqabantshintshi ukuba uphuculo lwentlungu lukhulu kunokuba lugqithise ukudlula ezinye unyango kwiinyanga ze-12 xa ucinga izigulane ezineemeko ezingapheliyo, kunye nabangaphantsi kweminyaka eyi-40 (QS, 43). Olunye uphando olwenziwa yi-Koes lubonise ukuba izigulane ezininzi kwizigulane zonyango ezingabonakali zifumene unyameko olongezelelweyo ngexesha lokulandela. Sekunjalo, ukuphuculwa kwezikhalazo eziphambili kunye nokusebenza ngokomzimba kwahlala kungcono kwiqela lokuxhaphaza (QS, 50). U-Meade waphawula ukuba unyango lwe-chiropractic lusebenza kakuhle kunokhathalelo lwezonyango, njengoko luhlolwa ngokusetyenziswa kwe-Oswestry Scale (QS, 31). I-RCT eyenziwa eYiputa nguRupert ithelekisa ukuphathwa kwe-chiropractic, emva kokuvavanywa kwezonyango kunye ne-chiropractic. Ubuhlungu, ukuhamba phambili, ukusebenza, kunye nomlenze wokunyusa ukuphakamisa konke kuphuculwe kwizinga eliphezulu kwiqela le-chiropractic; Nangona kunjalo, inkcazo yezinye unyango kunye neziphumo zazingenangqiqo (QS, 50).

 

I-Triano ifanisa unyango lwamayeza kwiinkqubo zemfundo ze-LBP ezingapheliyo. Kukho ukuphucula okukhulu kwintlungu, ukusebenza, kunye nokunyamezela komsebenzi kwiqela lokuxhaphaza, eliqhube ngaphaya kwexesha le-2 yeyonyango (i-QS, i-31).

 

I-Physiologic. Uvavanyo olubi lokukhwabanisa luchazwe nguGibson (QS, 38). I-detuned diathermy yaxelwa ukuba ifikelele kwiziphumo ezingcono phezu kokuguqulwa, nangona kukho umahluko osisiseko phakathi kwamaqela. U-Koes wafunda ukusebenza kwe-manipulation, i-physiotherapy, unyango ngugqirha jikelele, kunye ne-placebo ye-ultrasound ye-detuned. Uvavanyo lwenziwa kwi-3, 6, kunye neeveki ze-12. Iqela le-manipulation libonise ukuphuculwa okukhawulezayo kunye nokungcono kumandla okusebenza komzimba xa kuthelekiswa nolunye unyango. Ukungafani kokuguquguquka phakathi kwamaqela kwakungabalulekanga (QS, 68). Kwingxelo elandelwayo, i-Koes yafumanisa ukuba uhlalutyo lweqela elincinci lubonise ukuba ukuphuculwa kweentlungu kwakukhulu ngakumbi kulabo baphathwa ngokuphathwa, zombini izigulane ezincinci (b40) kunye nezo zineemeko ezingapheliyo kwi-12-inyanga yokulandelelana (QS, 43) . Nangona izigulane ezininzi kumaqela angabonakaliyo afumana unyango olongezelelweyo ngexesha lokulandelwa, ukuphuculwa kwahlala kubhetele kwiqela lokukhwabanisa kuneqela lonyango lomzimba (QS, 50). Kwingxelo eyahlukileyo yeqela elifanayo, kukho uphuculo kuzo zombini i-physiotherapy kunye namaqela onyango lwe-manual ngokubhekiselele kubunzima bezikhalazo kunye nesiphumo esibonwa kwihlabathi jikelele xa kuthelekiswa nokunyamekela kwabasebenzi ngokubanzi; nangona kunjalo, ukungafani phakathi kwamaqela e-2 kwakungabalulekanga (QS) , 50). UMathews et al wafumanisa ukuba ukukhwabanisa kukhawuleza ukubuyiswa kwe-LBP ngaphezu kokulawula.

 

Ukuzivocavoca. I-Hemilla yaqaphela ukuba i-SMT ikhokelela ekunciphiseni ukukhubazeka okude kwithuba elide kunye nexesha elifutshane xa kuthelekiswa nopilisi okanye umzimba (QS, 63). Iqendu lesibini ngeliqela elifanayo lafumanisa ukuba akukho ukubeka izifuba okanye ukuzivocavoca kwahluke kakhulu kumathambo angokwenyama ukulawulwa kwezonyango, nangona ukubeka amathambo kudibaniswa nokuphuculwa kwe-lateral nokuhamba-phambili komgca ngaphezu kokuzivocavoca (QS, 75). I-Coxhea ibike ukuba i-HVLA inikeze iziphumo ezingcono xa kuthelekiswa nokusebenzisa, i-corsets, i-traction, okanye akukho nzisetyenziswano xa ifundwa kwixesha elifutshane (QS, 25). Ngokwahlukileyo, u-Herzog akafumani nantlukwano phakathi kokuxhaphaza, ukuzivocavoca, kunye nemfundo emva ekunciphiseni intlungu okanye ukukhubazeka (i-QS, i-6). I-Aure ifanisa utyando lwezonyango ukusetyenziswa kwezigulane ezine-LBP ezingapheliyo eziye zigula phantsi. Nangona zombini amaqela abonisa ukuphucula kwintlungu, ukukhubazeka okusebenzayo, kunye nempilo jikelele kunye nokubuyela emsebenzini, iqela lokunyanga lonyango libonisa ukuphucula kakhulu kunokuba kwenziwe iqela lokuqhuba kuzo zonke iziphumo. Esi siphumo sagxila kwixesha elifutshane kunye nexesha elide (QS, 81.25). Kwinqaku likaNisemisto kunye noogxa, usebenziso olunxulumene nolwabiwo oluhlangeneyo, uqeqesho (iifom stabilizing), kunye noonxibelelwano nodokotela xa kuthelekiswa nokubonisana kuphela kwaphandwa. Ukungenelela okudibaniseneyo kwakunempumelelo ngakumbi ekunciphiseni ubuhlungu kunye nokukhubazeka (i-QS, i-81.25). Ucwaningo lwe-Beam Kingdom lubonise ukuba ukunyanzelisa okulandelwa ngumsebenzi kufumaneka inzuzo ephantsi kwiinyanga ze-3 kunye nenkxaso encinci kwiinyanga ze-12. Ngokufanayo, ukuxhaphaza kufumaneke inzuzo encinci kwi-3 inyanga kunye nenzuzo encinci kwiinyanga ze-12. Ukuzivocavoca kwedwa kwakunenzuzo encinci kwiinyanga ze-3 kodwa akukho nzuzo kwiinyanga ze-12. U-Lewis et al wafumana ukuphucula kwenzeka xa izigulane zonyango ziqhutywe ngokusetyenziswa kunye kunye nokunyanzeliswa kwemisipha ngokuchithwa kwe-10-esitoyisini sokuqhuba umsebenzi.

 

Ukuhlaziywa kwe-Danish ngokuchanekileyo kuhlolisise izihlomelo ze-12 zezizwe ngezikhokelo, ukuhlaziywa kwe-12 ngokuchanekileyo, kunye ne-10 izilingo zonyango ngokulandelelana. Iziphumo zacetyiswa ukuba ukusetyenziswa, ngokubanzi, kuxhamla izigulane ezine-LBP ezingapheliyo. Ayikho indlela ecacileyo eyaziwayo. Ukusetyenziswa kweprogram eyisisiseko ekwazi ukuguqulwa ngokukhawuleza ukuhlangabezana neemfuno zesigulane ngasinye kunconywa. Imiba yamandla, ukunyamezela, ukuzinza, kunye nokulungelelaniswa ngaphandle kokulayishwa ngokugqithiseleyo konke kunokuqwalaselwa ngaphandle kokusetyenziswa kwezixhobo zobuchwepheshe. Uqeqesho olunzulu olubandakanya ngaphezulu kwe-30 kwaye ngaphantsi kweeyure ze-100 zoqeqesho zisebenza kakhulu. Izigulane ezine-LBP ezingapheliyo, ezibandakanya abo bangasebenzi, zonyango ngokubhekiselele kwinkqubo yokulungiswa kwamanqanaba ahlukeneyo. Ukulungiselela ukulungiswa kokupasa, izigulane eziqala i-4 ukuya kwii-6 iiveki emva kokuhlinzwa ngediski phantsi koqeqesho olunzulu zithola inzuzo enkulu kuneenkqubo zovavanyo.

 

Sham kunye nezinye iindlela zokuLungiselela. I-Triano ibone ukuba i-SMT ivelise iziphumo ezingcono kakhulu zentlungu kunye nokukhubazeka kwexesha elifutshane, kunokuba kuqhutywe i-sham (i-QS, i-31). I-Cote ayifumananga umahluko phakathi kwexesha okanye ukuthelekiswa ngaphakathi okanye phakathi kwamaqela okuphathwa kunye nokuhlanganiswa (i-QS, i-37.5). Ababhali babonisa ukuba ukungaphumeleli kokubona ukungafani kungahle kube ngenxa yokuphendula okuphantsi kokutshintshwa kwezixhobo ezisetyenziselwa i-algometry, kunye nekhulu lesayizi yesampula. U-Hsieh akafumanekanga ixabiso elixabisekileyo kwi-HVLA emva kwesikolo esikolweni okanye unyango lwe-myofascial (QS, 63). Kuhlolisiso lwe-Licciardone, ukuthelekiswa kwenziwa phakathi kwe-osteopathic manipulation (equka ukuququzelela kunye neenkqubo eziphathekayo kunye ne-HVLA), ukuphathwa kakubi, kunye nolawulo olungenawo uncedo kwizigulane ezine-LBP ezingapheliyo. Wonke amaqela abonise ukuphuculwa. I-Sham kunye ne-osteopathic manipulation yahlanganiswa kunye nokuphucula okukhulu kunokuba kubonwe kwiqela elisebenzisayo, kodwa akukho mmahluko okwakuboniswa phakathi kwamacandelo kunye namaqela okuphatha (i-QS, i-62.5). Amanyathelo amancinane kunye neenjongo abonise ukuphucula okukhulu kwiqela lokuxhaphaza lifaniswa nokulawulwa kwe-sham, kwingxelo kaWagen (QS, 44). Ngomsebenzi weKinalski, unyango lwamacebiso luthintela ixesha lokunyanga kwezigulane ezine-LBP kunye nezilonda ze-disk intervertebral. Xa idiski yezilonda zingaphuthuki, i-hypertonia ye-muscular eyancipha kunye nokunyuka kwenyuka kwaphawulwa. Nangona kunjalo, eli nqaku lilinganiselwe ngcaciso ephosakeleyo yezigulane kunye neendlela (i-QS, i-0).

 

UHarrison et al uvakalise iilingo ezingalindelekanga zokulawula unyango lwe-LBP engapheliyo eline-3-point pointing traction eyenzelwe ukwandisa ukukhawulela kwintlambo. Iqela lokulinga lafumana i-HVLA yokulawula ubuhlungu ngexesha leeveki zokuqala ze-3 (i-9 zonyango). Iqela lolawulo alitholanga nonyango. Ukulandelelwa ngentsingiselo yeeveki ze-11 akubonanga utshintsho kwiintlungu okanye kulungelelaniso lweendawo zokulawula kodwa ukwanda okwenyukayo nokunciphisa intlungu kwiqela lokulinga. Umyinge wenani lezonyango ukuphumeza esi sibalo yi-36. Ukulandela ixesha elide kwiinyanga ezili-17 kubonisa ukugcinwa kweenzuzo. Akukho ingxelo yobudlelwane phakathi kweenguqu zenkqubela kunye nokutshintshwa kwesakhiwo kwanikwa.

 

Iinqununu kunye nabalingane bavavanya iipatheni zokuphendula umthamo we-LBP ezingapheliyo. Izigulane zanikwa izabelo eziza kumaqela athola i-1, i-2, i-3, okanye i-4 ukutyelela ngeveki kwiiveki ze-3, kunye neziphumo ezibhalwe ngentlungu ebuhlungu kunye nokukhubazeka okusebenzayo. Impembelelo ebalulekileyo nekliniki yenani lezonyango ze-chiropractic kwiintlungu zesifo kunye nokukhubazeka kwiiveki ze-4 zidibaniswe namaqela athola amazinga aphezulu okunyamekela (QS, 62.5). Descarreaux et alonge le msebenzi, unyango amaqela angama-2 kwiiveki ze-4 (amaxesha e-3 ngeveki) emva kokuvavanywa kwe-2 ekwahlulelweni ngeeveki ze-4. Elinye iqela labe liphathwa njalo kwiiveki ze-3; omnye akenzanga. Nangona zombini amaqela anamaqela aphantsi ase-Oswestry kwiiveki ze-12, kwiinyanga ze-10, ukuphuculwa kwaphela kwaqhubeka kwiqela elongezelelweyo le-SMT.

 

Amayeza. UBurton kunye noogxa babonisa ukuba i-HVLA iholele ekuphuculeni okukhulu kwexesha elifutshane kwiintlungu kunye nokukhubazeka kunokuba i-chemonucleolysis yokulawula i-disk'herniation (QS, 38). UBronfort wafunda i-SMT edityaniswe nokuzilolonga vs indibaniselwano yamachiza alwa nokudumba angasebenziyo kunye nomthambo. Iziphumo ezifanayo zifunyenwe kumaqela omabini (QS, 81). Ukunyanzeliswa okunyanzeliswayo kunye nonyango lwe-sclerosant (i-injection yesisombululo esicacileyo esihlanganiswe ne-dextrose-glycerine-phenol) yafaniswa nokunyanzeliswa kwamandla aphantsi adityaniswe nenaliti ye-saline, kuphononongo olwenziwa ngu-Ongley. Iqela elifumana ukuguqulwa okunamandla kunye ne-sclerosant liqhube ngcono kunelinye iqela, kodwa iziphumo azikwazi ukwahlula phakathi kwenkqubo ye-manual kunye ne-sclerosant (QS, 87.5). UGiles noMuller bathelekisa iinkqubo ze-HVLA kumayeza kunye ne-acupuncture. Ukukhwabanisa kubonise ukuphucuka okukhulu kwiintlungu zentlungu emva, amanqaku eentlungu, i-Oswestry, kunye ne-SF-36 xa kuthelekiswa nolunye ungenelelo lwe-2. Uphuculo lwathatha unyaka o-1. Ubuthathaka bokufunda kusetyenziswe ukuhlalutya kwe-compliers-kuphela ngenjongo yokuphatha i-Oswestry, kunye ne-Visual Analogue Scale (VAS) yayingabalulekanga.

 

I-Sciatica / I-Radicular / Radiating Pain Leg Pain

 

Ukuhlala Ukusebenza / Ukuphumla kweBhedi. I-Postacchini yafunda iqela elidibeneyo lezigulane nge-LBP, kunye nangaphandle kokugqithisa intlungu yomlenze. Izigulane zingabalwa njengeziqhamo okanye ezingapheliyo kwaye zavavanywa kwiiveki ze-3, iinyanga ze-2, kunye neenyanga ze-6 emva kwexesha. Unyango lwaluquka ukuphathwa, unyango lweziyobisi, i-physiotherapy, i-placebo kunye nokuphumla kombhede. Intlungu ebuhlungu emva ngaphandle kwemitha kunye neentlungu ezingapheliyo ziphendule kakuhle ukuphathwa; Nangona kunjalo, akukho namanye amaqela ayenze ukuphathwa kwamanye amazwe kunye namanye amanyathelo (QS, 6).

 

Ugqirha Ubonise / Unonophelo lwezeMpilo / iMfundo. UArkuszewski ubukele izigulane ezinobunzima be-lumbosacral okanye i-sciatica. Elinye iqela lafumana iziyobisi, i-physiotherapy, kunye nokuhlolwa kweencwadi, ngelixa lesi sibini songezelela ukusetyenziswa. Iqela elifumana ukuphathwa kakubi lixesha elifutshane lokunyanga kunye nokuphuculwa okuphawulekayo. Kwi-6-inyanga yokulandelelana, iqela lokuxhaphaza libonisa umsebenzi ongcono we-neuromotor kunye nokukwazi okungcono ukuqhubeka nomsebenzi. Ukukhubazeka kwakuphantsi kweqela lokuxhaphaza (i-QS, i-18.75).

 

I-Physiologic. I-Physiotherapy idibene nokuphathwa ngokunyanisekileyo kunye namayeza ahlolwe nguArkuszewski, ngokuchaseneyo nesicwangciso esifanayo kunye nokuxhaphazwa kwongeziweyo, njengoko kuchaziwe ngasentla. Iziphumo ezivela ekusebenziseni ukulungiswa zilungcono kwimisebenzi ye-neurologic kunye ne-motor kunye nokukhubazeka (i-QS, i-18.75). I-Postacchini ibhekisele kwizigulane ezineempawu ezinzima okanye ezingapheliyo zivavanywa kwiiveki ze-3, iinyanga ze-2, kunye neenyanga ze-6 emva kwexesha. Ukunyanzelisa kwakungekho ngempumelelo ekulawuleni izigulane ezineentlungu zomlenze ezinjengezinye izixhobo zonyango (QS, 6). I-Mathews kunye noogxa bavavanya unyango oluninzi oluquka ukuphathwa, ukulandelelana, ukusetyenziswa kwezilwanyana, kunye neentsholongwane ze-epidural ngenxa yentlungu emva kunye ne-sciatica. Kwizigulane ezine-LBP kwaye zithintela umlenze ophakanyisiweyo wokuphakamisa umlingo, ukuphathwa kakubi kunikwe ukukhululeka okukhulu, ngaphezu kokungenelela okunye (i-QS, i-19). I-Coxhead ne-al zibandakanya phakathi kwezifundo zabo izigulane ezaziye zenza imfucumfucu emancinci kwiindawo. Amanyathelo angenelelo afaka ukulandelelana, ukuxhaphaza, ukusetyenziswa, kunye ne-corset, usebenzisa i-designorial design. Emva kweeveki ze-4 zokunyamekela, ukuphathwa kakubi kubonisa inqanaba elithile leenzuzo kwisikali esisetyenziselwa ukuvavanya inkqubela phambili. Kwakungekho nantlukwano ekhoyo phakathi kwamaqela kwiinyanga ze-4 kunye neenyanga ze-16 emva kwe-posttherapy, nangona kunjalo (i-QS, i-25).

 

Ukuzivocavoca. Kwimeko ye-LBP emva kwe-laminectomy, uTimm uxelele ukuba ukuzivocavoca kunikwe inzuzo kokubili ukuphucula intlungu kunye neendleko-ukusebenza (QS, 25). Ukunyanzelisa kwaba nempembelelo encinci ekuphuculweni kweempawu okanye umsebenzi (i-QS, i-25). Kuhlolisiso lukaCoxhead et al, ukugqithisa ubuhlungu ubuncinane ubuncwane obubungcono emva kweeveki ze-4 zokunyamekela ukuphathwa, ngokungafani nezinye iindlela zonyango ezadlulayo kwiinyanga ze-4 kunye ne-16 yeenyanga emva kwe-posttherapy (QS, 25).

 

Sham kunye neNkqubo yokuSebenzisa indlela. U-Siehl wabheka ukusetyenziswa kwe-anesthesia kwizigulane ezine-LBP kunye neentlungu ezingabandakanyekanga okanye zomhlaba ezihamba ngeenyawo. Ukuphuculwa kweklinikhi kuphela okwethutyana kwaphawulwa xa ubungqina bendabuko be-electromyographic of involvement of root nervousness exist. Nge-electromyography engalunganga, ukuxhatshazwa kwaxelwa ukuba kunikeze uphuculo oluqhubekayo (i-QS, i-31.25) iSantilli kunye nabalingane bafanisa ne-HVLA kwi-press tissue pressing ngaphandle kokuphazamiseka ngokukhawuleza kwizigulane ezineentlungu ezilindelekileyo zokubuya nasemlenzeni. Iimigaqo ze-HVLA zenzeke kakhulu ekunciphiseni ubuhlungu, ukufikelela kwisimo esingenabuhlungu, kunye nenani leentsuku ngeentlungu. Ulwahlulo oluphawulekayo lwezonyango lubekwe Inani elipheleleyo leeseshoni zonyango lifakwe kwi-20 kumyinge wamaxesha e-5 ngeveki ngokunyamekela kuxhomekeke kwisihluthulelo seentlungu. Ukulandelelana kubonisa ukuxhaswa okuqhubekayo kwiinyanga ze-6.

 

Amayeza. Uxinzelelo oluxubileyo olungapheliyo lwentlungu kunye nokuphulukiswa kweemitha kwiphononongo usebenzisa izixhobo ezininzi zonyango lwavavanywa kwiiveki ze-3, iinyanga ze-2, kunye neenyanga ze-6 zihamba emva kweqela le-Postacchini. Ukulawulwa kwamachiza kulunge ngakumbi kunokuba kukho ukuphathwa xa ubuhlungu bentlungu bekhona (QS, 6). Ngakolunye uhlangothi, ngenxa yomsebenzi weT Mathews kunye noogxa nabo, iqela lezigulane ezine-LBP kunye nokukhawulwa kwemilenze yokuphakamisa umlenze ngokuthe ngqo kwiphendule ngakumbi ekusebenziseni ukuphathwa ngaphandle kwe-epidural steroid okanye i-sclerosants (QS, 19).

 

Disk Herniation

 

U-Nwuga wafunda izifundo ze-51 eziye zafumanisa ukuba i-disk intervertebral disk ehlanjululweyo kwaye yayithunyelwe kunyango lomzimba. Ukukhwabanisa kuchazwe ukuba kuphezulu kunonyango oluqhelekileyo (QS, 12.5). UZylbergold wafumanisa ukuba akukho mahluko wamanani phakathi kwe-3 yonyango �i-lumbar flexion exercises, ukunakekelwa kwekhaya, kunye nokuphathwa. Ukulandelwa kwexesha elifutshane kunye nesayizi encinci yesampula yenziwe ngumbhali njengesiseko sokungaphumeleli ukugatya i-null hypothesis (QS, 38).

 

Lolonga

 

Ukuzivocavoca yenye yezona ndlela zifundwe kakuhle zonyango lweengxaki ezisezantsi. Kukho iindlela ezininzi ezahlukeneyo zokuzilolonga. Kule ngxelo, kubalulekile kuphela ukwahlula ukubuyisela kwimeko yesiqhelo kwiinkalo ezininzi. Ezi nkqubo ziyilelwe izigulana ezinemeko engapheliyo enengxaki enkulu yengqondo. Zibandakanya umthambo we-trunk, ukuqeqeshwa komsebenzi osebenzayo kuquka ukulinganisa umsebenzi / uqeqesho lobugcisa, kunye nokucetyiswa kwengqondo.

 

 

Ukuhlaziywa kweCochrane kutshanje kumsebenzi wokunyanga kwe-LBP engeyiyo (QS, 82), ukuphumelela kokunyanga kwamayeza kwizigulane ezikhethiweyo, ukuxhatshazwa, kunye nokugula kunokuthelekiswa kungekho nonyango kunye nokunye unyango. Iziphumo zazibandakanya uvavanyo lweentlungu, umsebenzi, ubuyela emsebenzini, ukungabikho emsebenzini, kunye / okanye ukuphucula ihlabathi. Ekuhlaziyweni, izilingo ze-61 zidibanise imigaqo-nkqubo yokungeniswa, ininzi ekubhekiselele kwimeko engapheliyo (n = 43), kanti iinombolo ezincinci zibhekiselele kakhulu (n = 11) kunye ne-subacute (n = 6) intlungu. Izigqibo eziqhelekileyo zilandelayo:

 

• ukusetyenziswa akusebenzi kakuhle njengonyango lwe-LBP,
• ubungqina bokuthi umsebenzi wawunempumelelo kwiindawo ezingapheliyo ezinxulumene nokuthelekiswa kwezikhathi zokulandelelana,
• kuthetha ukuphuculwa kweengongoma ze-13.3 ngenxa yentlungu kunye neengcambu ze-6.9 zomsebenzi zabonwa, kwaye
• kukho ubungqina bokuba ukusetyenziswa komsebenzi oqingqiweyo kusebenza ngokuphumelelayo ukuhlukumeza i-LBP kodwa kuphela kwisimo sokusebenza

 

Ukuphonononga ukuhlolwa kwamanani kunye neendlela zokungenelela, kunye neziphumo zokufikelela kwizigqibo zayo. Ukukhupha idatha ekubuyeleni emsebenzini, ukungabikho emsebenzini kunye nokuphuculwa kwehlabathi jikelele kunzima kangangokuthi intlungu kunye nomsebenzi kuphela kunokuchazwa ngokulinganayo.

 

Izifundo ezisibhozo zifumene ngokuqinisekileyo kwiinkqubo zokubaluleka eziphambili. Ngokumalunga nokufaneleka kweklinikhi, ezininzi izilingo zinikezela ngolwazi olungonelanelekanga, kunye ne-90% yokunika ingxelo kubemi besifundo kodwa kuphela i-54% echaza ngokwaneleyo ukungenelela kokusebenza. Iziphumo ezichaphazelekayo zabikwa kwi-70% yezilingo.

 

Ukuzivocavoca kwe-LBP efanelekileyo. Kwizilingo ze-11 (inani elingu-n = 1192), i-10 yayingenakuqhathaniswa kwamaqela. Izilingo zanikezela ubungqina obuphikisanayo. Izilingo ezi-8 eziphantsi kobunzima azibonisi ukubahluko phakathi kokuzilolonga nokunyamekela okanye akukho unyango. Idatha edibeneyo yabonisa ukuba kwakungekho umahluko kwintlupheko yentlungu emfutshane phakathi kokuzivocavoca kwaye akukho unyango, akukho mvahluko ekulandeleni kwangaphambili intlungu xa kuthelekiswa namanye amanyathelo, kwaye akukho miphumo emihle yokuzivocavoca kwiziphumo zokusebenza.

 

Ukuxhathisa i-LBP. Kwizifundo ze-6 (inani elingu-n = 881), amaqela okusebenzisa i-7 ayeneqela elifanisayo lokuqhathanisa. Izilingo zanikezela iziphumo ezixutywe ngokubhekiselele kububungqina bokusebenza, ngobungqina obufanelekileyo bokusebenza kwenkqubo yokusebenza ngokuzibandakanya ngokwezinto ezibonakalayo njengeyona nto ibonwayo kuphela. Idatha edibeneyo ayizange ibonise ubungqina kwiinkxaso okanye ukuphikisa ukusetyenziswa kwemisebenzi yokuhlukumeza i-LBP, nokuba yenzelwe ukunciphisa intlungu okanye ukuphucula umsebenzi.

 

LBP engapheliyo. Kwakukho izilingo ezingama-43 ezibandakanyiweyo kweli qela (iyonke n = 3907). Amashumi amathathu anesithathu ezifundo ayengathathi amaqela. Ukuzivocavoca ubuncinci bekusebenzayo njengokungenelela kolondolozo lwe-LBP, kunye nezifundo ze-2 ezikumgangatho ophezulu kunye nezifundo ezili-9 zomgangatho osezantsi zifumene umthambo ukuze usebenze ngakumbi. Ezi zifundo zisebenzise iinkqubo zokuzilolonga ezizodwa, zijolise ikakhulu ekomelezeni okanye ekuqiniseni itraki. Kwakukho izilingo ezili-14 ezingafumananga mahluko phakathi kokuzilolonga kunye nezinye iindlela zongenelelo; kwezi, ezi-2 zilinganiswe kakhulu zaza i-12 zalinganiswa zisezantsi. Ukudibanisa idatha kubonise ukuphuculwa kokuthetha kwe-10.2 (95% yexesha lokuzithemba [CI], 1.31-19.09) amanqaku kwisikali seentlungu se-100-mm xa kuthelekiswa nokungabikho konyango kunye ne-5.93 (95% CI, 2.21- 9.65) amanqaku xa kuthelekiswa Olunye unyango olulondolozayo. Iziphumo zomsebenzi zikwabonisa ukuphuculwa ngolu hlobo lulandelayo: Amanqaku e-3.0 kulandelelo lokuqala xa kuthelekiswa nonyango (95% CI,? 0.53 ukuya ku-6.48) kunye namanqaku e-2.37 (95% CI, 1.04-3.94) xa kuthelekiswa nolunye unyango olulondolozayo.

 

Uhlalutyo lwamagqabantshintshi angangqalileyo lufumene ukuba izilingo zokuvavanya izifundo zononophelo lwezempilo zinezinga eliphezulu lokuphucula intlungu kunye nokusebenza ngokomzimba xa kuthelekiswa namaqela athelekiswayo okanye izilingo ezibekwe kumsebenzi okanye jikelele.

 

Ababhali bokuhlaziywa banikezela izigqibo ezilandelayo:

 

1. Kwi-LBP enzima, ukuzivocavoca akusebenzi ngakumbi kunezinye iindlela zokungenelela. Uhlalutyo lwama-meta alubonanga nzuzo ngaphandle kwonyango lwezentlungu kunye neziphumo ezisebenzayo ngexesha elifutshane okanye elide.
2. Kukho ubungqina obuchanekileyo bokusebenza kweprogram yovavanyo lwe-gradedactivity ekuhambiseni i-LBP kwizicwangciso zokusebenza. Ukusebenza kwezinye iintlobo zokusetyenziswa kweyeza kwezinye iindawo ezicacileyo.
3. Kwi-LBP engapheliyo, kukho ubungqina obuhle bokuthi umzimba ubuncinane usebenza njengamanye unyango olulondolozayo. Iiprogram eziqinisiweyo eziqinisiweyo okanye ezizinzileyo zibonakala zisebenza kwimimiselo yokunakekelwa kwempilo. Uhlalutyo lweemeta lufumene iziphumo zokusebenza eziphuculweyo kakhulu; nangona kunjalo, imiphumo yayincinci, ibe ne-3-point (ye-100) umahluko phakathi komsebenzi kunye nokuqhathanisa amaqela ekulandeleleni kokuqala. Iziphumo zobuhlungu ziye zaphucula kakhulu kwiiqela ezifumana izivo ezimalunga nokunye okuthelekiswayo, enentsingiselo malunga namaqondo e-7. Iimpembelelo zazifana nokulandelelwaniswa kwexesha elide, nangona ukuzithemba kwexesha kukunyuka. Kuthetha ukuphuculwa kwentlungu kunye nokusebenza kunokubaluleka ekliniki kwizifundo ezivela kwiinkonzo zempilo apho uphuculo lukhulu kakhulu kunabo ababonwa kwizifundo ezivela kubantu abaqhelekileyo okanye abaxubekileyo.

 

Uphononongo lweqela laseDanish lokuzilolonga luye lwakwazi ukuchonga ukuphononongwa okucwangcisiweyo kwe-5 kunye nezikhokelo ze-12 ezixubusha umsebenzi we-LBP enzima, ukuphononongwa kwe-1 ngokuchanekileyo kunye nezikhokelo ze-12 ze-subacute, kunye ne-7 yokuphononongwa okucwangcisiweyo kunye nezikhokelo ze-11 ezingapheliyo. Ngaphaya koko, baye bachonga uphononongo olu-1 olucwangcisiweyo olukhethelwe iimeko zasemva kotyando. Izigqibo zazifana nokuphononongwa kwe-Cochrane, ngaphandle kokuba kukho inkxaso encinci ye-McKenzie yokulawula izigulane ezineemeko ezinzima kunye neenkqubo ezinzulu zokuvuselela i-4 kwiiveki ze-6 emva kokuhlinzwa kwediski kwiinkqubo zokusebenzisa ukukhanya.

 

Umlando weNdalo kunye neMpilo yeLBP

 

Uninzi lwezifundo lubonise ukuba phantse ihafu yeLBP iya kuphucula ngeveki ye1, kanti phantse i-90% yayo iya kuhamba ngeeveki ze-12. Ngaphezu koko, uDixon wabonisa ukuba mhlawumbi i-90% ye-LBP iya kuzinyulula, ngaphandle kokungenelela nantoni na. UVon Korff wabonisa ukuba isibalo esiphezulu sezigulane ezineLBP esibi siya kuba neentlungu eziqhubekayo xa zigcinwa kwi-2 iminyaka.

 

U-Phillips ufumene ukuba malunga ne-4 yabantu be-10 baya kuba ne-LBP emva kwesiganeko kwiinyanga ze-6 ukususela ekuqaleni, nokuba intlungu yangaphambili iyanyamalala ngenxa yokuba ngaphezu kwe-6 kwi-10 kuya kuba ne-1 ephindekayo emva konyaka wokuqala emva kwesiganeko. Ezi zihlandlo zokuqala zibuyela emva kweeveki ze-8 eziqhelekileyo kwaye zingahlala zihamba ngokukhawuleza ixesha, nangona ziphantsi kweepesenti.

 

Izigulane zokulimala izigulane zabasebenzi ziye zagcinwa ngonyaka we-1 ukuhlola ubunzima bokusebenza kunye nesimo somsebenzi. Ingxenye yalabo bafundela abazange bafumane ixesha lokusebenza ngenyanga yokuqala emva kokulimala, kodwa i-30% yalahlekelwa lixesha emsebenzini ngenxa yobungozi babo ngaphezu kwe-1 ngonyaka. Kwalabo abaphosakele umsebenzi ngenyanga yokuqala ngenxa yokulimala kwabo kwaye sele bekwazi ukubuyela emsebenzini, phantse i-20% yayingabikho emva kwaloo nyaka. Oku kuthetha ukuba ukuvavanya ukubuyela emsebenzini kumyanga we-1 emva kokulimala kuya kuphelelwa ukunika ubungqina obuchanekileyo bendalo obungasigxina, i-LBP. Nangona ezininzi izigulane zibuyele emsebenzini, ziya kuba neengxaki eziqhubekayo kunye nokungabikho komsebenzi. Ukukhubazeka okwenziwe ngaphezu kweeyure ezingama-12 i-postinjury ingaba phezulu kunezinto eziye zabikwa ngaphambili kwincwadi, apho amazinga e-10% aqhelekileyo. Enyanisweni, amaxabiso angaphakama ukuya kwi-3 kumaxesha e-4 aphezulu.

 

Kuhlolisiso lukaSchiotzz-Christensen kunye nabo basebenzisana nabo, oku kulandelayo kwaqatshelwa. Ngokubhekiselele kwikhefu lokugula, i-LBP ine-prognosis efanelekileyo, kunye ne-50% yokubuyela emsebenzini kwiminyaka yokuqala ye-8 kunye ne-2% kuphela kwikhefu lokugula emva kwe-1 ngonyaka. Nangona kunjalo, i-15% yayiyekhefu lokugula ngexesha lonyaka olandelayo kwaye malunga nesiqingatha saqhubeka sikhalaza. Oku bekucebise ukuba isiqephu esicacileyo se-LBP esibalulekileyo ngokwaneleyo ukuba senze isigulane sifune ukutyelelwa kwicandelo jikelele lilandelwa lixesha elide lokukhubazeka kwezinga eliphantsi kunokuba libikwe ngaphambili. Kwakhona, kwanokuba abo babuyela emsebenzini, ukuya kwi-16% babonise ukuba abaphuculanga kakuhle. Kwesinye isifundo esibhekisele kwiziphumo emva kweeveki ze-4 emva kokuxilongwa kwonyango kunye nonyango, kuphela i-28% yezigulane azizange zenze iintlungu. Okugqithisileyo, ukuphikelela kwentlungu eyahlukileyo phakathi kwamaqela ayevezela intlungu kunye nabangenayo, kunye ne-65% yeso sihlandlo sokuqala ukuphucula kwiiveki ze-4, vs 82% yaloo mva. Iziphumo eziqhelekileyo ezivela kule sifundo zihluke kwabanye kuba i-72% yezigulane zisezintlungu ze-4 emva kweentsuku zokuxilonga.

 

I-Hestbaek kunye noogxa bahlolisise inani lamanqaku ngokuphononongwa ngokufanelekileyo. Iziphumo zibonise ukuba inani elichazwe ngezigulane ezisezintlungu emva kweenyanga ze-12 emva kokuqala kwaba ngu-62% ngokuqhelekileyo, kunye ne-16% ezibhalwe zizifo ze-6 emva kokuqala, kunye ne-60% ejongene nokuphindaphinda kokungabikho emsebenzini. Kwakhona, bafumanisa ukuba intsingiselo ebhengeziweyo ye-LBP kwizigulane ezithe zadlulayo ze-LBP ziyi-56%, xa kuthelekiswa ne-22% kuphela kwabangenayo loo mlando. I-Croft kunye noogxa benza umsebenzi oza kuhlola ukujonga kwiziphumo ze-LBP ngokwenza ngokuqhelekileyo, ekufumaneni ukuba i-90% yezigulane ezine-LBP ekunyamekelweni kweprayimari ziye zayeka ukubonisana neempawu kwiinyanga ze-3; Nangona kunjalo, uninzi lwabe lufumana uLBP kunye nokukhubazeka ngonyaka we-1 emva kokutyelela okokuqala. Kuphela i-25% yayiphinde ibuyiselwe ngokupheleleyo ngaloo nyaka.

 

Kukho iziphumo ezahlukileyo kwi-Study by Wahlgren et al. Apha, ezininzi izigulane zaqhubeka zivalelwa kwii-6 kunye ne-12 inyanga (78% kunye ne-72%, ngokulandelanayo). Kuphela i-20% yesampuli yayifumane ngokupheleleyo kwiinyanga ze-6 kwaye kuphela i-22% ngeenyanga ze-12.

 

I-Von Korff inikezele uluhlu olude lweenkcukacha ezijonga ukuba lufanelekile ukuvavanya inkqubo yeklinikhi yentlungu emva koko: ubudala, isondo, ubuhlanga / ubuzwe, iminyaka yemfundo, umsebenzi, utshintsho emsebenzini, indawo yengqesho, isimo se-inshorensi yokukhubazeka , ukukhumbula / iminyaka kwiminyaka yokuqala yokuqala intlungu, ukukhumbula / ubudala xa kwakunyanzeliswa, ukukhumbula kwakhona intlungu yesigxina, ubude bexesha elikhoyo / lwakutshanje lentsasa yokubuyela emva, inani leentsuku zentlungu emva, intlungu ekhoyo yangoku, intlungu yesantya, ubuhlungu obukhulu kunabo bonke, ukuphazamiseka kwemisebenzi, imisebenzi yokunciphisa iintsuku, ukuxilongwa kweekliniki kule ngqungquthela, iintsuku zokuphumla zokulala, iintsuku zokulahlekelwa ngumsebenzi, ukuhlaziywa kweentlungu zentlungu, kunye nobude bexesha elidlulileyo.

 

Kwisifundo esisisiseko esisekelwe ku-Haas et al malunga nezigulana eziphantse ze-3000 ezinezifo ezinzima kunye nezifo ezingapheliyo eziphathwe ngabagqirha kunye noogqirha bonyango lokuqala, iintlungu zaphawulwa kwizigulane ezinezifo ezinzima kunye nezifo ezingapheliyo kwiinyanga ze-48 emva kokubhalisa. Kwiinyanga ze-36, i-45% ukuya kwi-75% yezigulane zibike ubuncinane iintsuku eziyi-30 zentlungu ngonyaka ongaphambili, kwaye i-19% ukuya kwi-27% yezigulane ezinesifo esingapheliyo zikhumbula iintlungu zemihla ngemihla kunyaka odlulileyo.

 

Utshintsho oluchazwe kwezi zifundo kunye nezinye ezininzi lunokucaciswa ngenye inzima ngoluhlu lokulungelelanisa ngokwaneleyo, iiplani ezahlukeneyo zokuqulunqa ezisetyenziselwa ukuhlenga i-LBP, ngezixhobo ezahlukeneyo zeziphumo ezisetyenziswe kwisifundo ngasinye kunye nezinye izinto ezininzi. Kwakhona kubonisa ubunzima obunzima ekufumaneni isibambiso kwimini yemihla ngemihla kulabo abane-LBP.

 

Iimpawu eziqhelekileyo kunye nokuBaluleka kweLBP

 

Ziziphi Iimpawu zokuBaluleka eziBalulekileyo zokuHlola iNkqubo yoKhathalelo? Omnye umlinganiselo uchazwe ngasentla, ukuba yimbali yendalo. Ukuntsonkotha kunye nokwahlulwa komngcipheko kubalulekile, njengoko imiba yeendleko; nangona kunjalo, ukuphumelela kweendleko kungaphaya kwendawo yale ngxelo.

 

Kuqondwa ukuba izigulane ezinengxaki ye-LBP zithuthuka ngokukhawuleza kunezo ezineengxaki ezihlukahlukeneyo, eyona nto ibonakalayo yinkxwaleko. Zininzi izinto ezinokuchaphazela inkxalabo yokubuyela emva, kubandakanywa nokuxhatshazwa, iimeko ze-ergonomic, ubudala, izinga lomzimba wesigulane, izinto zokusingqongileyo kunye nemeko yengqondo. Olu hlobo lokufumana ingqwalasela enkulu encwadini, nangona njengoko kuphawulwe kwenye indawo kule ncwadi, loo nto ingacingelwa. Naliphi na le miba, yodwa okanye idibeneyo, inokuphazamisa okanye ibale ixesha lokubuyisela emva kokulimala.

 

Kubonakala ngathi izinto ezinobomi zidlala indima ebalulekileyo kwiimeko zeziganeko zokuqala ze-LBP kunye neengxaki zesikhombisi ezifana nokulahleka komsebenzi; Iimeko zengqondo ziza kudlala kakhulu kwii-episodes ezilandelayo ze-LBP. Iziganeko ze-biomechanical zikhokelela ekuthungeni izicubu, okwenza ubuhlungu kunye nokukwazi ukukwazi ukulandela iminyaka. Lo monakalo wethambo awubonakali kwi-imaging standard kwaye inokubonakala kuphela kwi-dissection okanye ukuhlinzwa.

 

Imiba yengozi ye-LBP ibandakanya oku kulandelayo:

 

• ubudala, isondo, ubunzima beempawu;
• ukwandisa ukuguquguquka komgudu, ukunciphisa ukunyamezela komzimba;
• ukulimala kwangaphambili okanye ukuhlinzwa;
• ukunyakaza okungaqhelekanga okanye ukunyuka komzimba;
• ukuhamba kwexesha elide okanye ukulawulwa kwemoto engafanelekanga;
• ezinxulumene nomsebenzi ezifana nokusebenza kwemoto, imithwalo eqhubekayo, ukuphatha izinto;
• imbali yengqesho kunye nokwaneliseka; kwaye
• isimo somvuzo.

 

IJzelenberg kunye noBurdorf baphando ukuba ngaba abantu bezemvelo, izinto ezinxulumene nomsebenzi, okanye iingqondo zengqondo ezichaphazelekayo kwiimeko ze-musculoskeal zichonga ukusetyenziswa kwezempilo kunye nekhefu lokugula. Bafumene ukuba kwiinyanga ze-6, malunga neyesithathu kwabasebenzi bezentengiselwano abane-LBP (okanye intamo kunye neengxaki ezisemagqabini aphezulu) babekho ukuphindwa kwekhefu lokugula kuloo ngxaki efanayo kunye nokuphindaphinda kwe-40% yokunakekelwa kwezempilo. Izinto ezinxulumene nomsebenzi ezinxulumene neempawu ze-musculoskeletal zifana nezo zidibene nokusetyenziswa kwezempilo kunye nekhefu lokugula; kodwa, i-LBP, ubudala kunye nokuhlala yedwa yenze isigqibo sokuba ngaba izigulane ezi nale ngxaki zithatha ikhefu lokugula. I-12 inyanga ye-LBP yayingu-52%, kunye nalabo abaneempawu kwisiseko, i-68% iphindaphinda i-LBP. UJarvik kunye noogxa bangezelela ukudakumba njengento ebalulekileyo ye-LBP entsha. Bafumene ukusetyenziswa kwe-MRI ukuba yinto engabalulekanga ebalulekileyo ye-LBP kunokudandatheka.

 

Ziziphi iziphumo eziPhumelayo? Izikhokelo zeCliniki zokuSebenza eziQulunqelwe yiCanadian Chiropractic Association kunye neCanada Federation of Chiropractic Regulatory Boards inqaku lokuba kukho iziphumo ezingasetyenziswa ukubonisa utshintsho ngenxa yonyango. Ezi zinto zifanele zithembeke kwaye zivumeleke. Ngokwezikhokelo zeCanada, imilinganiselo efanelekileyo iluncedo kwi-chiropractic practice ngoba bayakwazi ukwenza oku kulandelayo:

 

• ukuhlalutya ngokuqhubekayo imiphumo yokunyamekela ngexesha;
• uncedo lubonise ingongoma yokuphucula ukuphuculwa kwengqondo;
• ukufumanisa iingxaki ezinxulumene nokunakekelwa okunjengokungahambisani;
• ukuphuculwa komqulu kwisigulane, ugqirha kunye nabasithathu;
• ukuphakamisa ukuguqulwa kweenjongo zonyango xa kuyimfuneko;
• ukulinganisa amava eokliniki ogqirha;
• ukuthethelela uhlobo, umthamo, kunye nobude benkathalo;
• uncedo lokubonelela ngeenkcukacha zophando; kwaye
• ukuncedisa ekumiseni imigangatho yokonyango kweemeko ezithile.

 

Iiklasi eziqhelekileyo zeziphumo ziquka iziphumo zokusebenza, iziphumo zokujonga izigulane, iziphumo ze-physiologic, ukuhlolwa kwempilo jikelele kunye neziphumo ze-subluxation syndrome. Esi sahluko sithetha kuphela iziphumo zokujonga nokusebenza kweziphumo ezihlolwe ngababuzo kunye neziphumo ezisebenzayo ezihlolwe yinkqubo yesikhokelo.

 

Iziphumo zokusebenza. Ezi ziphumo ezilinganisa ukulinganiselwa kwesigulane ngokuphathelele imisebenzi yakhe yemihla ngemihla. Yintoni ekujongwa ngayo yimpembelelo yimeko okanye isigulane kwisigulane (oko kukuthi, i-LBP, apho ukuxilongwa okuthe ngqo kungabi khona okanye kunokwenzeka) kunye nesiphumo sokunyamekela. Zininzi izixhobo eziphambili zeziphumo. Ezinye zezona ziyaziwayo zibandakanya oku kulandelayo:

 

• Umbuzo woLwazi lokukhubazeka kaRoland Morris,
• I-Oswestry Disability Questionnaire,
• Inkcazo yokukhubazeka,
• Inkcazo yokukhubazeka kweNeck,
• Inkcazo yokukhubazeka kweWaddell, kunye
• Imibuzo Yokukhubazeka yezigidi.

 

Ezi ziphela zezixhobo ezikhoyo zokuvavanya umsebenzi.

 

Kwiincwadi ze-RCT ezikhoyo ze-LBP, iziphumo zokusebenza ziboniswe ukuba yiphumo ebonisa utshintsho olukhulu kunye nophuculo lwe-SMT. Imisebenzi yokuphila kwansuku zonke, kunye nesigulane sokuzibandezeleka kweentlungu, yizona ziphumo ze-2 eziphawulekayo zokubonisa ukuphucuka okunjalo. Ezinye iziphumo zenzeke ngaphantsi kakuhle, kubandakanywa intlobo yeendwendwe (ROM) kunye nokuphakanyiswa komlenze.

 

Kule ncwadi ye-chiropractic, iimpahla eziphambili ezisetyenziswa rhoqo kwiLBP yi-Questionnaire ye-Disability Disability Roland Morris kunye ne-Questionnaire yase-Oswestry. Kwisifundo kwi-1992, u-Hsieh wafumanisa ukuba zombini izixhobo zanikezela ngeziphumo ezihambelanayo kwimeko yokuvavanywa kwakhe, nangona iziphumo zemibuzo ye-2 zahluke.

 

IziPhumo zokuPhelelwa kweMonde. Esinye isisombululo esibalulekileyo sesiphumo siquka ukujonga isigulane sengqondo kunye nokwaneliseka kwabo ngononophelo. Iyokuqala ibandakanya ukulinganisa utshintsho kwiintlungu ezibonakalayo ngexesha lobunzima balo, ixesha, kunye nexesha. Kukho izixhobo ezikhoyo ezikhoyo ezikwazi ukufeza oku, kubandakanywa oku kulandelayo:

 

Isikali se-analog ebonakalayo�lo ngumgca we-10-cm oneenkcazo zentlungu eziphawulwe kuzo zombini iziphelo zaloo mgca obonisa ukuba akukho ntlungu kwiintlungu ezingenakunyamezeleka; isigulane sicelwa ukuba simakishe inqaku kuloo mgca obonisa ubunzima babo obubonakalayo bentlungu. Kukho inani leenguqu zesi siphumo, kubandakanywa i-Numerical Rating Scale (apho isigulane sibonelela ngenani phakathi kwe-0 kunye ne-10 ukumela inani leentlungu abanazo) kunye nokusetyenziswa kwamanqanaba eentlungu ukusuka kwi-0 ukuya kwi-10 echazwe ngemifanekiso kwiibhokisi, apho isigulane sinokujonga. Zonke ezi zibonakala zithembeke ngokulinganayo, kodwa ukuze kube lula ukusetyenziswa, nokuba i-VAS eqhelekileyo okanye i-Numerical Rating Scale isetyenziswa ngokuqhelekileyo.

 

Idayari yeentlungu-ezi zingasetyenziselwa ukunceda ukubeka iliso kwiindidi ezahlukeneyo zeentlungu ezahlukeneyo (umzekelo, ukuphindaphinda, apho i-VAS ayinakulinganisa). Iindlela ezahlukeneyo zisenokusetyenziswa ukuqokelela olu lwazi, kodwa ludla ngokuzaliswa yonke imihla.

 

I-McGill Pain Questionnaire-esi sikali sinceda ukulinganisa amacandelo amaninzi eentlungu zengqondo ngolu hlobo lulandelayo: ukuqonda-ukuvavanya, ukukhuthaza-okusebenzayo, kunye nocalucalulo lweemvakalelo. Kule sixhobo, kukho iindidi ze-20 zamagama ezichaza umgangatho weentlungu. Ukususela kwiziphumo, iinguqu ze-6 ezahlukeneyo zeentlungu zinokumiselwa.

 

Zonke izixhobo ezingentla ziye zasetyenziswa ngamaxesha athile ukuba zijonge inkqubela phambili yonyango lwentlungu emva kwe-SMT.

 

Ukwaneliseka ngesineke kusebenza kokunakekelwa kwenkathalo kunye nendlela yokufumana loo nkathalo. Kukho iindlela ezininzi zokuvavanya ukwaneliseka kwesigulane, kwaye akuzona zonke eziye zenzelwe ukusetyenziswa ngokuthe ngqo kwi-LBP okanye ukuphathwa. Nangona kunjalo, uDeyo wavelisa enye yokusetyenziswa kunye neLBP. Isixhobo sakhe sihlola ukuphumelela kweenkathalo, ulwazi kunye nokunyamekela. Kukho kwakhona i-Questionnaire Yokuneliseka kweMonde, ehlola ii-indices ze-8 ezihlukeneyo (ezifana nokuphumelela / iziphumo okanye ubuchule bezakhono, ngokomzekelo). UCherkin uqaphele ukuba umbuzo weThala leNgcaciso lokuNeliseka unokusetyenziswa kwi-chiropractic assessment assessment.

 

Umsebenzi wamva ubonise ukuba ukuzithemba ngesigulane kunye nokwaneliseka ngononophelo kuhambelana neziphumo. I-Seferlis ifumene ukuba izigulane zanelisekile kwaye zivakalelwa kukuba zinikezelwa iinkcazo ezingcono malunga nentlungu yabo evela kwiingcali ezisebenzise unyango olusesikweni. Kungakhathaliseki ukuba unyango, izigulane ezinelisekile kakhulu kwiiveki ze-4 zazininzi kunezigulane ezinganelisekanga ukuqonda ukuphuculwa okukhulu kwintlungu kwi-18-inyanga elandelelweyo ku-Hurwitz et al. I-Goldstein noMorgenstern bafumana ubudlelwane obuthathaka phakathi kokunyaniseka kwonyango kwiyeza abaye bafumana kunye nokuphucula ngakumbi kwi-LBP. Ukuqinisekiswa ngokuphindaphindiweyo kukuba iinzuzo ezibonwayo ekusebenziseni iindlela zokuxhaphaza zibangelwa ugqirha kunye nokuthintela. Izifundo ngokuzodwa zihlola le ngcamango yenziwa nguHadler et al kwizigulane ezineempawu ezinzima kunye no-Triano et al kwizigulane ezinobulunga kunye nezifo ezingapheliyo. Zomibini izifundo ziqhathanisa ukuphathwa kwe-placebo control. Kuhlolisiso lweHadler, ukulawula okulinganayo kwenkxaso yexesha kunye nobunzima, ngelixa i-Triano et al yongezelela inkqubo yezemfundo kunye neencomo zekhaya. Kuzo zombini iimeko, iziphumo zibonise ukuba nangona ingqalelo enikezelwa kwizigulane idibaniswe nokuphuculwa kwexesha, izigulane ezifumana iinkqubo zokunyanzelisa ziphuculwe ngokukhawuleza.

 

IziGqibo zeMpilo jikelele. Oku kuye kwaba ngumphumo obunzima kumlinganiselo ochanekileyo kodwa ininzi yezixhobo zakutshanje zibonisa ukuba inokwenziwa ngokuthembeka. Izixhobo ezinkulu ze-2 zokwenza njalo yiProfayili ye-Impact and SF-36. Iimvavanyo zokuqala zokuhlola ezifana nokuhamba, ukuxhamla, ukuphumla, umsebenzi, ukusebenzisana nentlalo, njalo njalo; Isibini sibheka ngokusisiseko, isimo sisebenza, kunye nempilo yonke, kunye ne-8 nezinye iingcamango zezempilo, ekugqibeleni iinqununu ze-8 ezingasetyenziselwa ukucacisa yonke imeko yezempilo. Izinto apha ziquka ukusebenza komzimba, ukusebenza kwentlalo, impilo yengqondo kunye nabanye. Esi sixhobo sisetyenziswe kwisetyenziselwano ezininzi kwaye satshintshelwe ngeefom ezincinci ngokunjalo.

 

Iziphumo zePhysiologic. Umsebenzi we-chiropractic unemiphumo ye-physiologic ekhoyo esetyenziswayo malunga nesigqibo sokwenza isigqibo. Ezi ziquka iinkqubo ezifana nokuhlolwa kwe-ROM, ukuhlolwa komzimba, ukugqithisa, i-radiography kunye nezinye iinkqubo ezingaqhelekanga (uhlalutyo lomlenze, i-thermography kunye nabanye). Esi sahluko sithetha kuphela iziphumo ze-physiologic ezihlolwe ngesandla.

 

Uhlobo lokuhamba. Le nkqubo yeemviwo isetyenziswe phantse yonke i-chiropractor kwaye isetyenziselwa ukuvavanya ukungaphumeleli ngenxa yokuba inxulumene nomsebenzi wamagxa. Kuyakwazi ukusebenzisa iROM njengendlela yokujonga ukuphuculwa komsebenzi ngexesha elide, ngoko ke, ukuphucula njengoko kuhambelana nokusetyenziswa kwe-SMT. Omnye unokujonga ukunyakaza kwesithili kunye nehlabathi jikelele, umzekelo, kwaye uyisebenzise njengommakishi omnye wokuphucula.

 

Ukuphakama kwesantya kunokulinganiswa ngeendlela ezininzi. Omnye unokusebenzisa i-goniometers ejwayelekile, i-inclinometers, kunye nezixhobo ezithe gqwa kakhulu ezifuna ukusetyenziswa kwezixhobo ezizodwa kunye neekhomputha. Xa wenza njalo, kubalulekile ukuqwalasela ukuthembeka kwendlela nganye. Izifundo ezininzi ziye zavavanya izixhobo ezahlukeneyo ngolu hlobo lulandelayo:

 

• UZachman ufumene ukusetyenziswa kwe-colorometer ngokuthe tye,
• I-Nansel ifumaneka ukuba usebenzisa ii-5 ezinyathelo eziphindaphindiweyo zentsholongwane yesibeleko kunye ne-inclinometer yokuthembeka,
• ULiebenson wafumanisa ukuba isicatshulwa seSchrober, kunye kunye neengcingo kunye nezilawuli ezinobuncwane be-spine babenenkxaso engcono kwiincwadi,
• U-Triano no-Schultz bafumene ukuba iROM kwisiqu, kunye ne-trunk poweros ratios kunye nomsebenzi wamagqabi, yayisilathisi esihle sokukhubazeka kwe-LBP, kwaye
• eziliqela zophando zifumene ukuba ukulinganisa i-REM ye-ROM yokuhamba kwamagogxa kuyathembeka.

 

Umsebenzi weMiscle. Ukuphonononga umsebenzi weesistim kunokwenziwa ngokusetyenziswa kwenkqubo yokuzenzekelayo okanye ngeendlela zendlela. Nangona uvavanyo lwemizimba yomzimba luye lusetyenziswa ngokuqhelekileyo kwisifo se-chiropractic, kukho izifundo ezimbalwa ezibonisa ukunyaniseka kweklinikhi kule nkqubo, kwaye ezi zinto zingabonwa njengobunqanaba eliphezulu.

 

Iinkqubo ezizenzekelayo zithembeke ngakumbi kwaye ziyakwazi ukuvavanya iiparitha ze-muscle ezifana namandla, amandla, ukunyamezela, kunye nomsebenzi, kunye nokuvavanya iindlela ezahlukeneyo zokuqhawula imisipha (isotonic, isometric, isokinetic). U-Hsieh wafumanisa ukuba indlela eqaliswe isigulane yayisebenza kakuhle kwimisipha ethile, kwaye ezinye izifundo zibonise i-dynamometer ukuba ithembeke kakuhle.

 

Ubude beMilo Ubude. Izifundo ezimbalwa kakhulu zobude bomlenze ziye zabonisa amanqanaba amkelekileyo okuthembeka. Izindlela ezifanelekileyo zokuvavanya ukuthembeka nokuqinisekiswa kobude bomlenze zibandakanya iindlela zendawo kunye kwaye zixhomekeke ekuboniseni imisebe ye-ionizing. Ekugqibeleni, le nkqubo ayizange ifundwe ngokubhekiselele ekuqinisekiseni, okwenza ukusetyenziswa kwalokhu kube ngumphumo ongathandabuzekiyo.

 

Ukuthobela kweTissue Compliance. Ukuthotyelwa kuhlolwe yindlela zombini kunye neendlela zokusebenzisa, usebenzisa isandla esisodwa okanye usebenzisa isixhobo esinjenge-algometer. Ngokuvavanya ukuthotyelwa, i-chiropractor ikhangele ukuhlola ithoni ye-muscle.

 

Ukuvavanywa kwangaphambili kokuthotyelwa ngu-Lawson kubonise ukuthembeka. UFisher wathola ukwandiswa kwezicubu ukuthotyelwa kwezifundo ezibandakanya unyango lomzimba. UWaldorf wafumanisa ukuba ukuthotyelwa kwamathambo okuxhaswa kwamathambo kwakumlinganiselo wokuvavanya / ukuphindaphinda kwe-10%.

 

Ukunyamezela iintlungu ezihlolwe kusetyenziswa ezi ndlela zifunyenwe zithembekile, kwaye uVernon wafumanisa ukuba ngumlinganiselo oluncedo ekuhloleni i-cervical paraspinal musculature emva kokulungiswa. Iqela lezikhokelo ezivela kwiCanadian Chiropractic Association kunye neCanadian Federation of Chiropractic Regulatory Boards ligqibe kwelokuba "uvavanyo lukhuselekile kwaye alubizi kwaye lubonakala luphendula kwiimeko kunye nonyango olubonwa ngokuqhelekileyo kwi-chiropractic practice.)

 

 

isiphelo

 

Ubungqina bokuba uphando malunga nokusetyenziswa komgudu wokuguqula umlenze / ukunyanzelisa / ukugqugquzela kubonisa oku kulandelayo:

 

1. Ubungqina obuninzi okanye obuninzi bokusetyenziswa kwe-SMT ukunciphisa iimpawu nokuphucula umsebenzi kwizigulane ezine-LBP ezingapheliyo malunga nokusetyenziswa kwi-LBP enzima kunye neyengxaki.
2. Ukusetyenziswa kokusebenza ngokubambisana nokuphathwa kakubi kunokukhawuleza nokuphucula iziphumo kunye nokunciphisa ukuphindaphinda kweepasitidi.
3. Kukho ubungqina obuncinane bokusetyenziswa kwezigulane ezine-LBP kunye neentlungu zentlungu, i-sciatica, okanye i-radiculopathy.
4. Iziganeko ezinzima kakhulu zeempawu ziya kunceda ngokudluliselwa kweempawu ngeempawu.
5. Kwakungekho ubungqina obuncinane bokusetyenziswa kwezinto ezichaphazela iimeko ezichaphazelekayo kunye namancinci amanqaku okuxhasa inkxaso ephezulu.

 

Ukuzivocavoca kunye nokuqinisekiswa kuye kwaboniswa ukuba kunexabiso ngokuyinhloko kwi-LBP engapheliyo kunye neengxaki ezisezantsi ezinxulumene neempawu ezinzulu. Iqela lezixhobo ezisemgangathweni, eziqinisekisiweyo ziyafumaneka ukunceda ukubamba uphuculo olunentsingiselo lweklinikhi ngexesha lokhathalelo oluphantsi. Ngokuqhelekileyo, ukuphuculwa komsebenzi (ngokuchasene nokunciphisa ingxelo elula kumanqanaba eentlungu) kunokuba nentsingiselo yeklinikhi yokubeka iliso kwiimpendulo zokunyamekela. Uncwadi oluphononongiweyo luhlala lulinganiselwe xa luqikelela iimpendulo kukhathalelo, ukulungelelanisa indibaniselwano ethile yerejimeni zongenelelo (nangona indibaniselwano yokulawula kunye nomthambo inokuba ngcono kunomthambo wedwa), okanye ukwenza iingcebiso ezingqamene nemeko yokuphindaphinda kunye nobude bongenelelo. Itheyibhile 2 ishwankathela iziphakamiso zeqela, ngokusekelwe ekuhlaziyweni kobungqina.

 

 

Izicelo eziSebenzayo

 

• Ubungqina bokuba kusetyenziswe ukunyanzeliswa komgudu ukunciphisa iimpawu nokuphucula umsebenzi kwizigulane ezinokugula okungapheliyo, ezilukhuni kunye ne-LBP.
• Ukuzivocavoca ngokubambisana nokuxhaphaza kusenokukhawuleza ukuphucula iziphumo nokunciphisa ukuphindaphinda

 

Ukuququmbela,Uphando olongezelelekileyo olusekwe kubungqina sele lukhona malunga nokusebenza kokhathalelo lwe-chiropractic kwiintlungu ezisezantsi kunye ne-sciatica. Eli nqaku libonise ukuba ukuzivocavoca kufuneka kusetyenziswe kunye ne-chiropractic ukunceda ukukhawuleza inkqubo yokubuyisela kunye nokuphucula ngakumbi ukubuyiswa. Kwiimeko ezininzi, ukunakekelwa kwe-chiropractic kungasetyenziselwa ulawulo lweentlungu ezisezantsi kunye ne-sciatica, ngaphandle kwesidingo songenelelo lotyando. Nangona kunjalo, ukuba utyando luyafuneka ukufezekisa ukuchacha, i-chiropractor ingathumela isigulana kwingcali elandelayo yezempilo. Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: iSciatica

 

I-Sciatica ibhekiselwa kuyo njengeqoqo leempawu kunokuba luhlobo oluthile lokulima okanye imeko. Iimpawu zibonakaliswa njenge-radiating intlungu, ukuxubha kunye nokuvakala kwintsholongwane kwi-nerve ye-sciatic kumqolo ongaphantsi, phantsi kweentsimbi kunye namathanga kunye nemilenze enye okanye zombini kunye neenyawo. I-Sciatica idla ngokubangelwa ukucaphukisa, ukuvuvukala okanye ukunyanzeliswa kwesibindi esikhulu kunazo zonke emzimbeni womntu, ngokuqhelekileyo ngenxa ye-disc okanye i-bone spur.

 

 

INGXELO EBALULEKILEYO: UKUPHATHA KWE-EXTRA: Ukunyanga i-Sciatica Pain