Intlungu yentloko yenye yezona zizathu ezigqithisileyo zokutyelela iofisi. Uninzi lwabantu lubafumana ngethuba elithile ebomini babo kwaye lunokuchaphazela nabani na, kungakhathaliseki ubudala, ubuhlanga kunye nesini. I-International Headache Society, okanye i-IHS, ikwahlula intloko njengento ephambili, xa ingabangelwa enye inzakalo kunye / okanye imeko, okanye kwesekondari, xa kukho isizathu esiphezu kwabo. Ukusuka migraines ukuqoqa intloko kunye nentloko yexinzelelo, abantu abaneziintlungu zentlungu rhoqo bangakufumana kunzima ukuthatha inxaxheba kwimisebenzi yabo yemihla ngemihla. Abaninzi bezonyango baphatha intlungu yentloko, nangona kunjalo, ukunakekelwa kwe-chiropractic kuye kwaba yindlela ekhethwa yonyango ekhethiweyo kwimicimbi eyahlukeneyo yempilo. Injongo yale nqaku ilandelayo kukubonisa izikhokelo ezisekelwe kwisiseko sokunyangwa kwe-chiropractic yabantu abadala abaneentloko.

 

Izikhokelo ezisekelwe kwiNgcebiso yeChirpractic Treatment of Adult with Headache

 

Abstract

 

• Injongo: Injongo yale ncwadi yesandla kukubonelela ngeengcebiso-zengcebiso zenkqubela ye-chiropractic unyango lwentloko kubantu abadala.
• Iindlela: Uphando lweencwadi oluchanekileyo lwezilingo zokulawulwa kweekliniki ezipapashwe ngo-Agasti 2009 ezifanelekileyo malunga nokusebenza kwe-chiropractic zenziwa ngokusetyenziswa kweenkcukacha MEDLINE; EMBASE; Ulwalamano kunye noNyango oluPheleleyo; I-Index Yoluhlu lweeNcwadi zoLondolozo kunye neZempilo zoLuntu; Umqulu, iNkqubo, kunye neNyango yoLwazi lweZonyango; Alt HealthWatch; Inkcazo yeTyhurthikhi; kunye neTranskrit Cochrane. Inombolo, umgangatho, kunye nokuhambelana kweziphumo zacatshangelwa ukuba zinike amandla obanzi obubungqina (ezinamandla, ezilinganayo, ezilinganiselweyo, ezingqinelaniyo) kunye nokwenza iziphakamiso zendlela.
• iziphumo: Amanqaku angamashumi amabini ananye adibanisa imigaqo yokufakwa kunye kwaye isetyenziselwa ukuphuhlisa iziphakamiso. Ubu bungqina abuzange budlule kwizinga elilinganayo. Ukulungiswa kwemigudu, ukuguqulwa kwemisipha kunye nokungenelela kwamanyathelo ahlukeneyo okubandakanya ukusikwa kwamathambo kunconywa ukuphathwa kwezigulane ezine-episodic okanye ezingapheliyo. Ukuxilongwa kwentloko, ukunyanzeliswa komgudu akunakunconywa kulawulo lwe-headache type-headache. Isiphakamiso asikwazi ukucwangciswa okanye ngokuchasene nokusetyenziswa komgudu wokugulisa izigulane ezinezifo zentlungu ezingapheliyo. Ukunyuka kwe-craniocervical ingabangela inzuzo yokulawula ixesha elide lwezigulane ezineentloko ze-episodic okanye ezingapheliyo. Ukunyangwa kwentloko, ukunyanzeliswa komgudu kunconywa. Ukuhlanganiswa okuhlangeneyo okanye ukunyamezela intamo ye-flexor umzimba kunokuphucula iimpawu. Akukho nzuzo eqhubekayo yokuhlanganisa ukuhlanganiswa ngokubambisana kunye nokunyaniseka kwentamo ye-flexor exercises kwizigulane ezinentloko ye-cervicogenic. Iziganeko ezimbi azizange zibhekiswe kwizilingo ezininzi zeeklinikhi; kwaye ukuba bekunjalo, kwakungekho namnye okanye bebancinane.
• Izigqibo: Ubungqina bubonisa ukuba ukunakekelwa kwe-chiropractic, kuquka ukunyanzeliswa kwempompo, kuphucula i-migraine
  kunye nentloko yomlomo. Uhlobo, ubude, umlinganiselo, kunye nobude bonyango (s) kufuneka kusekelwe kwizikhokelo zesikhokelo, amava eenkliniki kunye neziphumo. Ububungqina bokusetyenziswa kwegulana njengendlela yokungenelela kwodwa kwizigulane ezineentloko zentlobo-ntloko zihlala zilingana. (J Uluhlu lwePhysiol Ther 2011; 34: 274-289)
• Iimpawu eziPhambili zeNkcazo: Ukunyanzeliswa komgudu; Iziphazamiso zeMigraine; Intambo-Thayipha intloko; Intloko yesifo; Isikhokelo sokuSebenza; Chiropractic

 

Insight of Dr. Alex Jimenez

Intloko, okanye iintlungu zentloko, kuquka i-migraine nezinye iintlobo zeentloko, yenye yezona ntlobo eziqhelekileyo zentlungu ebhaliweyo phakathi kwabantu bonke. Ezi zinokuthi zenzeke kwelinye okanye kumacala omabini entloko, zinokuthi zixhomekeke kwindawo ethile okanye ziyakwazi ukuhamba ngaphaya kwentloko ukusuka kwindawo enye. Nangona iimpawu zentloko ziyahlukahluka ngokuxhomekeka kwintlobo yesifo se ntloko kunye nangenxa yemvelaphi yenkxalabo yempilo, iintloko zithathwa njengesingxoxwa ngokubanzi kungakhathaliseki ubunzima kunye nefom. Intloko, okanye intlungu yentloko, inokwenzeka ngenxa yesiphumo sokuguqulwa kwamagqabi, okanye i-subluxation, kunye nobude bomgudu. Ngokusebenzisa ukuguqulwa komgogodla kunye nokunyanzeliswa kwemigaqo, ukunyamekelwa kwe-chiropractic kungaphumelela kwaye kuphumelele ukulungisa umgudu, ukunciphisa uxinzelelo kunye noxinzelelo kwizakhiwo ezijikelezayo zomgudu, ekugqibeleni kukunceda ukuphucula impawu zentlungu yesifo kunye nempilo yonke kunye nokuphila kakuhle.

 

Intloko yinto eqhelekileyo kubantu abadala. Iintsholongwane eziphindaphindiweyo zichaphazela kakubi ubomi bentsapho, umsebenzi wezenhlalakahle kunye nomsebenzi womsebenzi. [1,2] Ehlabathini lonke, ngokweMpilo Yehlabathi Yehlabathi, i-migraine yedwa ngu-19th phakathi kwazo zonke izizathu zonyaka ezihlala nezikhubazo. Intloko yesithathu phakathi kwezizathu zokufuna unyango lwe-chiropractic eNyakatho Melika. [3]

 

Ukuxilongwa ngokuchanekileyo kubalulekile ekuphatheni nasekunyangeni, kwaye uluhlu olubanzi lweentlobo zeentloko zichazwe kwiSizwe soBume beZizwe eziPhephayo zeNtloko 2 (I-International Headache Society [IHS]). [4] Iindidi zenzelwe uklinikhi kunye nokusetyenziswa kophando. Iintsholongwane eziqhelekileyo, uhlobo lokuxhatshazwa kunye ne-migraine, zibhekwa njengeentloko eziphambili okanye zizifo ezingapheliyo. I-epradic migraine okanye i-head-type-headaches iyenzeka ngaphantsi kweentsuku ze-15 ngenyanga, kanti iintsuku ezingapheliyo zivela ngaphezu kwe-15 ngeenyanga ubuncinane kwi-3 (migraine) okanye kwi-6 inyanga (intloko yesifo senwele). [4] iingxaki zekliniki ezingundoqo entloko okanye entanyeni enokuthi ibe yi-episodic okanye ingapheliyo. Iintsholongwane ze-Cervicogen ziyakuthi ziphathwe ngamakhanda asekondari kwaye zibandakanya iintlungu ezibhekiswe kumthombo entanyeni kwaye zibonwe kwi-1 okanye kwimimandla engaphezulu. I-IHS iyaqaphela intloko yesifo somlomo njengengxaki ehlukileyo, [4] kunye nobungqina bokuba intloko ingabangelwa yintlungu yesifo okanye i-lesion esekelwe kwimbali kunye nempawu zekliniki (imbali yentlungu, ukunyanzeliswa kwentlungu, ukunciphisa intlobo yesondlo, Ukunyamezela kwentamo, kungabandakanyi intlungu ye-myoyedwa yedwa) kufanelekileyo ukuxilongwa kodwa akukho nxamnye nolu hlobo kwiincwadi. [4,5] Xa ubuhlungu be-myofasha kuphela yimbangela, isigulane kufuneka siphathwe njengento enentloko yokuxhaphaza. [4]

 

Iimodalities ezonyango ezisetyenziselwa izigulane zokunyamekela izigulane ezinentloko ziquka ukunyanzelisa umlenze, ukuxhobisa, ukuxhaswa kwezixhobo zomnxeba, imfundo malunga neendlela zokuphila eziguquguqukayo, iindlela zokhathaza umzimba, ukufudumala / imvula, ukusilalisa, ukunyanga kwezicubu ezincinci ezifana nokunyanga, kunye nokomeleza nokwelula. Kukho ukulindela okukhulayo kwimisebenzi yezempilo, kubandakanya i-chiropractic, ukufumana nokusebenzisa ulwazi olusekelwe kuphando, kuthatha iakhawunti eyaneleyo yobungqina bobuphando obufumanekayo ukuzisa ulwazi lwekliniki. Ngenxa yoko, injongo yeCanada Chiropractic Association (CCA) kunye neCanada Federation of Chiropractic Regulatory and Education Accrediting Boards (Project) Iprojekthi yeZikhokelo zoLwazi lweKlinikhi kukuphuhlisa izikhokelo zokusebenza ngokusekelwe kubungqina obukhoyo. Injongo yale ncwadi yesandla kukubonelela ngeengcebiso-zengcebiso zenkqubela ye-chiropractic unyango lwentloko kubantu abadala.

 

tindlela

 

IKomiti yoPhuhliso lweZikhokelo (GDC) icwangcisele kwaye ilungelelanise iinkqubo ezicwangcisiweyo zokukhangela, ukuhluza, ukuphonononga, ukuhlalutya, kunye nokutolika. Iindlela ezi zihambayo ziyangqinelana neendlela ezicetywayo �UVandlakanyo lweziKhokelo zoPhando noVavanyo� intsebenziswano (www.agreecollaboration.org). Esi sikhokelo sisixhobo esixhasayo seengcali. Akujoliswanga njengomgangatho wokhathalelo. Isikhokelo siqhagamshela ubungqina obukhoyo obupapashiweyo kunyango lwaseklinikhi kwaye lilungu le-1 kuphela lendlela enolwazi-kubungqina kukhathalelo lwezigulana.

 

Imithombo Yedatha kunye noPhando

 

Uphando oluchanekileyo kunye nokuvavanywa kweencwadi zonyango luqhutywe kusetyenziswa iindlela eziphakanyiswe yiQumrhu leCocrane Cooperation Back Review Group [6] kunye no-Oxman noGuatt. [7] Isicwangciso sophando saphuhliswa kwi-MEDLINE ngokuhlola iMeSH ngokumalunga ne-chiropractic kunye nongenelelo oluthile kwaye kamva ukuguqulwa kwezinye iinkcukacha. Isicwangciso sophando lweencwadi sasininzi ngokubanzi. Ulwaphulo lwe-Chiropractic luchazwe njengoluhlobo oluqhelekileyo lwezonyango ezisetyenziswe ngabagcisa kwaye aluzange lubekwe kumanyathelo okunyango awanikezwa kuphela ngabaphathi bezonyango. Inetha elibanzi lalingelwa ukuquka unyango olunokulawulwa kwinkathalo ye-chiropractic kunye nalawo angeniswe nakwiimeko zokunyamekelwa ngabanye abaqeqeshi bempilo kwiphando oluthile lophando (IsiHlomelo A). Ukuguqulwa kwamagqabi kuye kwachazwa njenge-high-speed velocity low-amplitude eyenzelwa intsipho. Ukungabikho kwonyango kwakuquka iinkqubo ezingummangaliso okanye iinkqubo ze-neurostimulation, i-pharmacotherapy, ii-injections ze-toxin ye-botulin, i-cognitive okanye i-behavioral treatments, kunye ne-acupuncture.

 

Uphando loncwadi lwagqitywa ukusukela ngo-Epreli ukuya kuMeyi 2006, kwahlaziywa ngo-2007 (isigaba 1), kwahlaziywa kwakhona ngo-Agasti 2009 (isigaba 2). Indawo yolwazi ekhangelwe ibandakanya iMEDLINE; ULAWULO; Amanyeneyo kunye noNyango oluDibeneyo; Isalathiso sokuQokelelwa kuNcwadi lwaBongikazi kunye neAllied Health Literature; Incwadana yemigaqo, eNye indlela, kunye neNkqubo yoLwazi lweNdalo; I-AltWatchWatch; Isalathiso kuLwazi lweChiropractic; kunye neThala leencwadi laseCochrane (Isihlomelo A). Ukukhangela kwakubandakanya amanqaku apapashwe ngesiNgesi okanye ngesiNgesi. Icebo lokukhangela lalilinganiselwe kubantu abadala (? Iminyaka eli-18); nangona izifundo zophando kunye neenqobo zokubandakanya isifundo ezibandakanya uluhlu olubanzi lweminyaka, njengabantu abadala kunye nolutsha, zafunyanwa kusetyenziswa isicwangciso sokukhangela. Uluhlu lweereferensi ezibonelelwe kuvavanyo olucwangcisiweyo (i-SRs) ziye zajongwa kwakhona yi-GDC ukunciphisa amanqaku afanelekileyo ukuba aphoswe.

 

Iingqinisiso zokuKhethwa koBungqina

 

Iziphumo zokukhangela zavavanywa ngombane, kwaye kusetyenziswa amanqanaba amaninzi (Isihlomelo B): inqanaba 1A (isihloko), 1B (abstract); Inqanaba 2A (isicatshulwa esipheleleyo), i-2B (indlela yokubhaliweyo epheleleyo, ukufaneleka); kunye nenqanaba 3 (isicatshulwa esigcwele-sokugqibela sokuvavanywa kwe-GDC njengeengcali zomxholo weklinikhi). Izicatshulwa eziphindiweyo zisusiwe, kwaye amanqaku afanelekileyo afunyenwe njenge-elektroniki kunye / okanye iikopi ezikhutshiweyo zohlalutyo oluneenkcukacha. Abavavanyi abohlukeneyo, besebenzisa iikhrayitheriya ezifanayo, bagqibezela izikrini zoncwadi ngo-2007 nango-2009 ngenxa yexesha eliphakathi kokhangelo.

 

Izilingo zonyango kuphela ezilawulwayo (i-CCTs); izilingo ezilawulwa ngokungahleliyo, ezilawulwayo (RCTs); nokuphononongwa ngokuchanekileyo (i-SRs) kukhethwe njengobungqina obunesi sikhokelo esivumelana nemigangatho ekhoyo yokutolika iziphumo zekliniki. I-GDC ayizange ifake iiphononongo zezifundo, uchungechunge lwamacandelo, okanye iingxelo zecala ngenxa yobume babo obungalawulwayo kunye nekhwalithi ebonakalayo ephantsi ye-methodological vs CCTs. Le ndlela ihambelana neendlela ezihlaziyiweyo ze-SRs ezipapashwe yiQela leComrane Review Review. [8] Ukuba ezininzi ii-SRs zapapashwa ngababhali abafanayo kwisihloko esinikeziwe, kuphela ukushicilelwa kwangoko kwabalwa kwaye kusetyenziswa ubungqina bokubambisana. Ukuphononongwa ngokuchanekileyo kwe-SRs kwachithwa ngaphandle ukuphepha ukubalwa kabini kweziphumo zophando.

 

Uvavanyo lweeNcwadi kunye nokuThetha

 

Ukulinganiswa komgangatho wee-CCTs okanye ii-RCTs kubandakanya iikhrayitheriya ze-11 eziphendulwe ngu-ewe (amanqaku 1) okanye u-hayi (amanqaku 0) / andazi (amanqaku 0) (1 Table). I-GDC ibhale i-2 eyongezelelweyo yeenqobo zomdla: (1) Ukusetyenziswa kwabaphandi kweendlela zokuqonda isifo ze-IHS kubhaliso lwezifundo kunye (2) novavanyo lweziphumo ebezingalindelekanga (1 Table, iikholamu L kunye M). Ukusetyenziswa kweekhrayitheriya ze-IHS [4] kwakufanelekile kule nkqubo yesiKhokelo sokuziQhelanisa neKlinikhi (CPG) ukuqinisekisa ubungqina bokuqonda isifo ngaphakathi nakulo lonke uphando lwezifundo. Izifundo azifakwanga ukuba iikhrayitheriya zokuqonda isifo ze-IHS khange zisetyenziswe ngabaphandi ukuze kufakwe isifundo kufundo (Isihlomelo C); kwaye ukuba ngaphambi kwe-2004, ngaphambi kokuba i-cervicogenic headache ifakwe kwi-IHS, i-criteria ye-diagnostic yeCervicogenic Headache International Study Group [9] ayizange isetyenziswe. Iziphumo ebezingalindelekanga ziye zaqwalaselwa njengommeli wobungozi obunokubakho kunyango. Akukho zinto zokulinganisa zisetyenzisiweyo kwiikhrayitheriya zomntu ngamnye, kwaye ukulinganiswa komgangatho kunokwenzeka ukusuka ku-0 kuye ku-11. Zombini iimfama zezifundo kunye nababoneleli ngononophelo babalinganiswa kumanqaku ophando yi-GDC, kuba ezi zinto zidwelisiwe kwisixhobo sokulinganisa umgangatho. [6] Iindlela ze-GDC azikhange zilungelelanise okanye zitshintshe isixhobo sokureyitha. Isizathu sale ndlela yayikukuba iindlela ezithile zonyango (umzekelo, amandla ombane akhuthazayo [i-TENS], i-ultrasound) kunye noyilo lwesilingo sinokufikelela kwisigulana kunye / okanye ugqirha ongaboniyo. [10] I-GDC ayikuthintelanga kuvavanyo lwala mabhentshi omgangatho ukuba eneneni zichazwe kwizifundo zeklinikhi zonyango lweengxaki zentloko. I-GDC ikwaqwalasele ngaphandle kobuchule bayo ukuguqula, ngaphandle kokuqinisekisa, isixhobo esisetyenziswa ngokubanzi sokuvavanya uncwadi lweklinikhi. [6] Izixhobo ezitsha zophando kuhlalutyo kunye nenqanaba loncwadi lonyango olusebenzayo, nangona kunjalo, ziyafuneka ngokungxamisekileyo kwaye ziyaqwalaselwa njengendawo yophando lwexesha elizayo kwicandelo lengxoxo elingezantsi.

 

 

Abavavanyi boncwadi babengabanikeli beprojekthi abahlukileyo kwi-GDC kwaye babengafakwanga nto ngaphandle kokufunda ababhali, amaziko, kunye nemithombo yeendaba. Amalungu amathathu e-GDC (MD, RR, kunye ne-LS) aqinisekisile iindlela zokulinganisa umgangatho ngokugqibezela uvavanyo lomgangatho kwiseti engacwangciswanga yamanqaku ali-10. [11-20] Inqanaba eliphezulu lesivumelwano laqinisekiswa kumanqanaba onke omgangatho. Ukugqitywa kwesivumelwano kuzo zonke izinto kufezekisiwe kwizifundo ezi-5: kwizinto ezili-10 kwezili-11 kwizifundo ezi-4 kunye nezinto eziyi-8 kwezili-11 kwisifundo esinye esishiyekileyo. Konke ukungangqinelani kusonjululwe ngokulula ngengxoxo kunye nokuvumelana yi-GDC (1 Table). Ngenxa ye-heterogeneity yeendlela zophando kwizilingo, akukho meta-analysis okanye i-statistical pooling yeziphumo zetyala ezenziweyo. Izilingo zokufumana amanqaku ngaphezulu kwesiqingatha senqanaba lilonke elinokubakho (okt,? 1) zithathwa njengomgangatho ophezulu. Izilingo zokufumana amanqaku ngo-6 ukuya ku-0 zithathwa njengomgangatho ophantsi. Izifundo ezineziphene ezikhulu zendlela okanye ukuphanda ngeendlela zonyango ezizodwa azifakwanga (umzekelo, unyango olungathathelwa ngqalelo njengefanelekileyo yi-GDC kukhathalelo lwe-chiropractic yezigulana ezinentloko; Isihlomelo 5.

 

Umgangatho wokuvavanywa kwee-SRs ubandakanye iikhrayitheriya ezili-9 eziphendulwe nguewe (inqaku 1) okanye hayi (amanqaku 0) / andazi (amanqaku 0) kunye nempendulo esemgangathweni yento J no iimpazamo, iziphoso ezincinci, okanye major iimpazamo Itheyibhile 2). Ukulinganiswa okunokwenzeka kususela kwi-0 kuye kwi-9. Ukuchongwa komgangatho wobunzululwazi we-SRs ngeziphene ezinkulu, iziphene ezingephi, okanye akukho ziphene, njengoko zidwelisiwe kwikholamu J (2 Table), yayisekwe kwiimpendulo zabalinganiswa boncwadi kwizinto ezili-9 zangaphambili . Ezi paramitha zilandelayo zisetyenziselwe ukufumana umgangatho wobunzululwazi we-SR: ukuba akukho / andazi ukuba impendulo isetyenzisiwe, i-SR inokuba neziphene ezincinci. Nangona kunjalo, ukuba Akukho nto yayisetyenzisiwe kwizinto B, D, F, okanye H, uphononongo lwalunokuba neziphene ezinkulu. [21] Uphengululo olucwangcisiweyo lokufumana amanqaku ngaphezulu kwesiqingatha senqanaba lilonke elinokubakho (okt,? 5) ngaphandle kweziphene okanye ezincinci zilinganisiwe njengomgangatho ophezulu. Uphengululo olucwangcisiweyo lokufumana amanqaku ama-4 okanye ngaphantsi kunye / okanye ngeziphene ezinkulu azifakwanga.

 

 

Uphengululo luchazwe njengolucwangcisiweyo ukuba zibandakanya indlela ecacileyo nephindaphindwayo yokukhangela kunye nokuhlalutya uncwadi kwaye ukuba ukubandakanywa kunye neendlela zokuthintela izifundo zichaziwe. Iindlela, iikhrayitheriya zokubandakanywa, iindlela zomgangatho wokufunda, amanqaku ezifundo ezibandakanyiweyo, iindlela zokwenza idatha, kunye neziphumo zavavanywa. IiRaters ziphumeze isivumelwano esipheleleyo sazo zonke izinto zokulinganisela ii-7 SRs [22-28] kunye nezinto ezisi-7 kwezili-9 ze-2s ezongezelelweyo ze-SRs. [29,30] Ukungangqinelani kuthathwe njengokuncinci kwaye kusonjululwa ngokulula ngovavanyo lweGDC kunye nemvumelwano (Itheyibhile 2 ).

 

Ukuphuculwa kweNcomelo zokuSebenza

 

I-GDC isichazela ubungqina obuchaphazela unyango lwe-chiropractic lwezigulane zentloko. Isishwankathelo esicacisiweyo samanqaku afanelekileyo siya kufakwa kwi-website ye-CCA / Federation Clinic Practice Guidelines.

 

Izilingo ezilawulwe ngokungaqhelekanga, ezilawulwayo kunye neziphumo zazo zafunyaniswa ukuzisa iingcebiso zonyango. Ukunika ubungqina obuninzi bobubungqina (obuqinileyo, obunokulinganisela, obunqamlekileyo, obuphikisanayo, okanye abukho ubungqina), [6] i-GDC iqwalasele inani, umgangatho, kunye nokuhambelana kweziphumo zophando (Ithebula 3). Ubungqina obuqinileyo babucingelwa kuphela xa ii-RCT ezininzi eziphezulu zixhasa ukufunyaniswa kwabanye abaphandi kwezinye izicwangciso. Kuphela ii-SRs eziphezulu zifundwa ngokumalunga nomzimba wobungqina kunye nokwazisa iingcebiso zonyango. I-GDC iqwalasele indlela yokwenza unyango ukuba incedise (s) xa ixhaswa ubuncinci bezinga lobungqina.

 

 

Iziphakamiso zokusebenza zenziwe zidibeneyo kwiintlanganiso zendibano zokusebenza.

 

iziphumo

 

 

 

 

 

Iincwadi

 

Ukususela ekuphandweni kwincwadi, ekuqaleni i-6206 icatshulwa. Amanqaku angamashumi amabini ananye adibanisa imfuno yokugqibela yokufakwa kwaye yaqwalaselwa ekuphuhliseni iziphakamiso zenkqubo (ii-16 CCT / RCTs [11-20,31-36] kunye ne-5 SRs [24-27,29]). Ukulinganiselwa komgangatho wezinto ezifakiwe kufakwe kwiiTables 1 kunye ne-2. Isihlomelo Ithebula le-3 dwelisa amanqaku angabandakanywa ekuhlolweni kokugqibela yi-GDC kunye nezizathu zokukhutshwa kwabo. Ukungabikho kweso sifundo kunye neengcali eziyimfama kunye neengcaciso ezingenelisekiso zokuqulunqwa kwemali ziqhelwaniswe ngokukhawuleza kwendlela yokulawulwa kwezilingo. Iintlobo zeentloko ezivandlakanywe kwezi zilingo zibandakanya i-migraine (Itheyibhile 4), intloko yesifo senwele (Itheyibhile 5), kunye nentloko ye-headervogen (Ithebula 6). Ngenxa yoko, ezi ntlobo zentloko kuphela zimelelwe ubungqina kunye nokwenza iziphakamiso kule CPG. Ubu bungqina bemiqulu ye-SRs banikezwa kwiThebhile 7.

 

Zenza iziNcomelo: unyango lwe-Migraine

 

• Ukunyanzeliswa komgudu kunconywa ukuba kulawulo lwezigulane ezine-episodic okanye ezingapheliyo kunye nokungahambi. Le ngcebiso isekelwe kwizifundo ezisetyenziswe ngonyango lwe-1 kumaxesha e-2 ngeveki kwii-8 iiveki (inqanaba lobubungqina, lingqinelana). Omnye we-RCT ophezulu, [20] 1 ophezulu we-RCT, [17] kunye ne-1 ephezulu ye-SR [24] ukuxhasa ukusetyenziswa kwamagulane okugulisa izigulane ezine-episodic okanye ezingapheliyo (miguel 4 ne-7).
• Ukuxilongwa kwe-weekly unyango kunconywa ukunciphisa i-episodic freraine frequency kunye nokuphucula iimpawu ezichaphazelekayo ezinokudibaniswa nentlungu yentloko (ubungqina bezinga, ubungqinelana). Omnye we-RCT ophezulu [16] uxhasa le nkcazo yezithethe (Ithebula 4). Abaphandi basebenzisa i-45-minute massage ngokugxila kwisakhelo se-neuromuscular kunye ne-trigger kwinqanaba, emagxeni, entanyeni, nasentloko.
• Ukunakekelwa kwamanqanaba ahlukeneyo (uqeqesho, ukuphumula, uxinzelelo kunye nokucebisa okunomsoco, unyango lwe-massage) Kunconywa ukulawula izigulane ezine-episodic okanye ezingapheliyo. Khangela njengoko kufanelekileyo (inqanaba lobubungqina, i-moderation). Omnye we-RCT ophezulu [32] uxhasa ukuphumelela kwe-multi-modal intervention interdisciplinary for migraine (Ithebhile 4). Ukungenelela kubeka phambili indlela yokulawula jikelele equkethe ukusetyenziswa, imfundo, utshintsho lwezinto zokuphila, kunye nokulawulwa kobuqu.
• Kukho idatha engenakwaneleyo yeklinikhi yokucebisa okanye ukusetyenziswa kokusetyenziswa komzimba kuphela okanye ukusetyenziswa ngokudibeneyo kunye nemithi yokwelapha ye-multimodal yokuphathwa kwezigulane ezine-episodic okanye ezingapheliyo imithraine (uvavanyo lwe-aerobic, intlobo yesibindi sokunyakaza [cROM], okanye ukuthambisa umzimba wonke). Iikhompyutyana ze-CCT ezisezantsi (13,33,34] zinegalelo kwesi siphelo (Itheyibhile 4).

 

Ziqhelise iziNcomelo: Intambo-Thayipha intloko

 

• Ukunyanzeliswa komthwalo ophantsi we-craniocervical (umz., I-Thera-Band, iiNkqubo zokuZilolonga eziHlukeneyo; I-Hygenic Corporation, iAkron, i-OH) iyacetyiswa ixesha elide (umz. ukumodareyitha). Elinye i-RCT ekumgangatho ophezulu [6] ibonise ukuba ukuhlanganiswa okunyanzeliswa kancinci kunciphise kakhulu iimpawu zentloko-yentloko ebuhlungu kwizigulana ngexesha elide (Itheyibhile 36).
• Ukunyanzeliswa kwemisipha akunakunconywa ukulawula izigulane ezine-headache-headache-headache (inqanaba lobubungqina, i-moderation). Kukho ubungqina obunokulinganisela ukuba ukunyanzeliswa kwemisipha emva kokuba unyango olusisigxina lonyango aluboneli ngenye inzuzo kwizigulane ezineentloko zesifo. Omnye we-RCT ophezulu [12] (Ithebhile 5) kunye nemibiko echazwe kwi-4 SRs [24-27] (Itheyibhile 7) ibonisa ukuba akukho nzuzo yokunyanzeliswa kwemigudu yezigulane ezineentloko zeentlobo zesifo se-episodic.
• Isiphakamiso asikwazi ukwenza okanye ukusetyenziswa kokusetyenziswa kwemigudu (amaxesha e-2 ngeveki kwii-6 iiveki) kwizigulane ezinezintlungu ezingapheliyo. Abalobi be-1 RCT [11] babalwa njengomgangatho ophezulu ngethuluzi lovavanyo lomgangatho [6] (Itheyibhile 1), kunye nesishwankathelo solu pho nonongo kwi-2 SRs [24,26] kukhombisa ukuba ukunyanzeliswa komgudu kunokusebenza ngokufanelekileyo kwintloko yesifo sengqondo. Nangona kunjalo, i-GDC ibona i-RCT [11] nzima ukuyichaza kwaye ayifanelekanga (iThebhile 5). Icandelo lingalawulwa ngokungahambisani ngokungalingani kwinani leenkcukacha zogqirha zezifundo phakathi kwamacandelo okufunda (umz., Ukutyelela kwe-12 kwizifundo kwi-tissue ye-tissue andrapy kunye ne-spinal manipulation group vs i-2 ukutyelela izifundo kwiqela le-amitriptyline). Ayikho indlela yokwazi ukuba iqondo elifana nelinye leenkcukacha kwiqela le-amitriptyline lingaba nefuthe kwiziphumo zophando. Ezi ngqalelo kunye nokutolika kwi-2 nezinye i-SRs [25,27] zinegalelo kule sigqibo (Itheyibhile 7).
• Kukho ubungqina obaneleyo bokucetyiswa okanye ukuchasene nokusetyenziswa kwezinto ezihamba phambili, ukuxhaphaza kwezicubu, ukuxhaswa kweCyriax, okanye ukuqeqeshwa / ukuqeqeshwa ngokomzimba kwizigulane ezineentloko zesifo se-episodic okanye esingapheliyo. Izifundo ezintathu ezingenakuthelekiswa okungafaniyo [19,31,35] (Ithebhile 5), i-1 ye-RCT engamgangatho ophezulu, i- [14] kunye ne-1 SR [25] ifake kwisiphetho (Itheyibhile 7).

 

Ziqhelise iziNcomelo: Intloko yeCervicogenic

 

• Ukunyanzeliswa komgudu kunconywa ukulawula izigulane ezineentloko zentloko. Esi siphakamiso sisekelwe kwi-1 yophando esetyenziswe ngamaxesha e-2 ngeveki kwiiveki ze-3 (inqanaba lobubungqina, i-moderation). Kwi-RCT ephezulu, uNilsson et al [18] (Itheyibhile 6) yabonisa umphumo ophezulu ophezulu wendlela yokugulisa umlenze we-stervicogenic headache. Ingqungquthela yobungqina ukusuka kwi-2 SRs [24,29] (Itheyibhile 7) isekela lo mbululo.
• Ukuhlanganiswa okuhlangeneyo kunconywa ukulawulwa kwezigulane ezineentloko ze-cervicogenic (ubungqina bezinga, ubungqinelana). I-Jull et al [15] ihlolisise imiphumo ye-Maitland yokuhlanganiswa kwe-8 kwii-12 zonyango kwii-6 iiveki kwi-RCT ephezulu (Ithebula 6). Ukuququzelela kulandelelwano oluqhelekileyo lweklinikhi, apho ukukhethwa kwezinto ezincinci kunye nobuchule obuphezulu obusekelwe kwiimvavanyo zokuqala kunye nokuqhubela phambili kwezigulane zentsholongwane yezigulane. Iziphumo ezixhamlayo zaxelwa ukuba zintlungu zentloko, ubunzima, kunye nentlungu yentlungu kunye nokukhubazeka. Ingqungquthela yobungqina ukusuka kwi-2 SRs [24,29] (Itheyibhile 7) isekela lo mbululo.
• Ukunyanzeliswa kwentamo ye-flexor umzimba kuyanconywa ukulawula izigulane ezineentloko ze-cervicogenic (ubungqina bezinga, ubungqinelana). Esi siphakamiso sisekelwe kuphando lwezihlandlo ze-2 imihla ngemihla kwiiveki ze-6. Akukho nzuzo eqhubekayo yokongeza ukuhlanganisa iminyango yomsila we-flexor kunye nokuhlanganiswa ngokubambisana kwentloko yesifo senhliziyo. Omnye we-RCT ophezulu [15] (Itheyibhile 6) kunye nokuqwalaselwa okunikeziwe kwi-2 SRs [24,29] (Itheyibhile 7) inkxaso le ngcebiso.

 

Safety

 

Iingcali zikhetha iindlela zonyango ngokubambisana nazo zonke iinkcukacha zeklinikhi ezikhoyo kwisigulana esinikiweyo. Kwii-16 ze-CCTs / i-RCTS [i-11-20,31-36] ibandakanyiwe emzimbeni wobungqina bale CPG, zifundo ezi-6 kuphela [11,12,15,20,32,36] ezivavanywe ngokwaneleyo okanye zaxoxa ngemiphumela yesigulana okanye ukhuseleko iiparameter (Itheyibhile 1, ikholamu M). Ngokubanzi, umngcipheko oxeliweyo ubuphantsi. Izilingo ezintathu zichaze ulwazi lokhuseleko lokunyanzeliswa komgogodla. [11,12,20] UBoline et al [11] uxele ukuba i-4.3% yezifundo yafumana ukuqina kwentamo emva kokuqunjelwa komqolo okuqala okwanyamalala kuwo onke amatyala emva kweeveki zokuqala ze-2 zonyango. Ukudakumba okanye ukwanda kwentloko emva kokunyanzeliswa komqolo (n = 2) yayizizizathu zokuyeka unyango olukhankanywe nguTuchin et al. [20] Akukho ziphumo ebezingalindelekanga eziye zafunyanwa zizo naziphi na izifundo ezifundwe nguBove et al [12] kusetyenziswa ukunyanzeliswa komqolo kunyango lwe-episodic tension-type headache. Uvavanyo lonyango lokuvavanya iziphumo ezinokubakho alunakubhalisa amanani afanelekileyo ezifundo ukuvavanya izehlo zeziganeko ezimbi ezinqabileyo. Ezinye iindlela zophando ziyafuneka ukuphuhlisa ukuqonda okupheleleyo kokulinganisela phakathi kwezibonelelo kunye nomngcipheko.

 

ingxoxo

 

Ukunyanzeliswa kwamagqabi kunye nezinye iindlela zokufundisa eziqhelekileyo ezisetyenziselwa kwi-chiropractic ziye zafundwa kwiiCCT eziliqela ezihambelana nokubhaliswa kwezifundo, ukucwangciswa kunye nomgangatho jikelele. Iimpawu zonyameko kunye neentloko zeentloko zimelelwe kwisiseko sobungqina be-migraine, iintlobo zeentlobo zesifo, kunye nentloko yesifo senhliziyo. Iziphumo eziphambili zezempilo zempilo zichazwe ngokuqhelekileyo ubukhulu beentloko, ubunzima, ubude, kunye nemilinganiselo yempilo. Ubungqina abukho ngaphezu kwezinga elilinganayo ngeli xesha.

 

Ubungqina buxhasa ukusetyenziswa kwe-spinal for the management of chiropractic izigulane ezine-migraine okanye iintloko zentliziyo kodwa zingabi ziintsholongwane. Ukunakekelwa kwemigraine, ukunakekelwa kwamanyathelo ahlukeneyo usebenzisa i-45-minute-massage yonyango kunye nokunakekelwa kwamaninzi (ukuzivocavoca, ukuphumula, kunye nokuxinwa kunye nokucebisa okunomsoco) kunokusebenza. Ngaphandle koko, ukuhlanganiswa ngokubambisana okanye ukunyanzelisa iminyango ye-flexor exercises kunconywa ukuba kuphuculwe iimpawu zentloko ye-cervicogenic. Kubonakala ngathi akukho nzuzo eqhubekayo yokuhlanganisa ukuhlanganiswa ngokubambisana kunye nokunyaniseka kwentamo ye-flexor exercises kwizigulane ezinentloko ye-cervicogenic. Ubungqina obuncinane buxhasa ukusetyenziswa kwe-craneocervical mobilization ephantsi kwexesha elide lolawulo lweentloko zentlungu.

 

Imida

 

Ukungaphumeleli kwesi sikhokelo kubandakanya ubungakanani kunye nomgangatho wobungqina obuxhasayo obunokufumaneka ngexesha lophando. Akukho zifundo zophando olusenyongweni olulandelayo olwenziwe ngokufanelekileyo kunye neziphumo zokufumana iziphumo zeklinikhi ezipapashwe ngokunyamekela kwezilwanyana zentloko. Izifundo ziyadingeka ukuqhubela phambili ukuqonda kwethu imigaqo ethile yesikhokelo kwintetho okanye ekudibaniseni kakuhle ukunyanga kwe-migraine, intloko yentlungu, intloko yesifo, okanye ezinye iintlobo zentloko ezinikezela kwiikliniki (umz., Iqela, i-postusumatic head-ache) . Olunye ukungahambi kwale ncwadana yenkcazo yolu xwebhu luxhomekeke kwizifundo zophando ezipapashwe ngamanqanaba amancinci amancinane (iifayile 4-6), iiprodigms zonyango zexesha elifutshane kunye nexesha lokulandelela. Izilingo zeekliniki ezenzelwe kakuhle kunye neenombolo ezaneleyo zezifundo, unyango lwexesha elide, kunye nezihlandlo zokulandelelana kufuneka zixhaswe ngemali ukunyamekela unyango lwe-chiropractic, kunye nokunyanzeliswa komgudu ngokukodwa, ekulawuleni izigulane ezineengxaki zentlungu. Njengoko naluphina uhlaziyo lweencwadi kunye nesicwangciso sezonyango zekliniki, ulwazi olusiseko kunye neencwadi ezishicilelweyo ziyavela. Izifundo ezinokuthi zazise lo msebenzi zingapapashwa emva kokupheliswa kwesi sifundo. [37-39]

 

Iingqwalasela malunga nophando lwexesha elizayo

 

Ingqiqo ye-GDC kukuba kukho isidingo sokuqhubela phambili izifundo ze-chiropractic nezigulane ezineengxaki zentlungu.

 

• Uphando olungakumbi lwekhlinikhi lufunekayo. Uphando lwexesha elizayo ludinga ukucwangciswa kocwaningo kusetyenziswa ukuthelekiswa okusebenzayo kunye nokungaxhamli kunye / okanye iqela le-placebo ukuphucula ubungqina benkxaso yesigulane. Isigulane sokuphulukiswa kwamanyathelo angenelelo ekulawuleni iziphumo zokulindela kuyadingeka kwaye ihlolwe ngabaphandi kwi-chiropractic kwezinye iimeko ezibuhlungu. [10] Ukungabikho kwezifundo ezichongiweyo zibonisa umngeni wokwenza iziphakamiso zonyango olusisiseko. Zonke iifundo ezizayo kufuneka zenziwe ngendlela echanekileyo (umz., IMigangatho yokuHlanganiswa yoLingo lweZingxelo [UKUSETSHENZISWA] kunye nokuBika ngokuPheleleyo koVavanyo ngeZakhiwo ezingekho phantsi kweNkqubo [TREND]).
• Ukunika ingxelo ngokuchanekileyo kwedata lokukhuseleko kuyadingeka kuphando lwe-chiropractic. Zonke izilingo zonyango kufuneka ziqokelele kwaye zixelile kwimiphumo emibi okanye zingonakalise nokuba akukho nanye ibonwa.
• Ukuphuhlisa izixhobo zokuvelisa izixhobo zokuvavanya uphando lwezobisi. Ukukhunjulwa kusebenza ukulawula imiphumo yokulinda kunye nemiphumo engabonakaliyo yabathengi-ntsebenziswano kumxholo kumaqela okufunda. Ngokuqhelekileyo akunakwenzeka kwizifundo ezingaboniyo kunye nababoneleli ngeengxelo eziphumelelayo zonyango. Ngaphandle kokunciphisa ubunzima, ukuphazamiseka kwezifundo kunye nabanikezeli-nkathalo babalwa kumanqaku ophando yi-GDC, ekubeni ezi zinto zifakwe kwizixhobo zokulinganisela okuphezulu. [6] Izixhobo zophando eziphambili zokuhlalutya kunye nokulinganisa okulandelayo kwincwadi yokunyanga ezifunekayo ngokukhawuleza.
• Ukuqhubela phambili uphando malunga neziphumo ezisebenzayo kwiinkqubo zokunakekelwa kweentloko ze-chiropractic. Esi sikhokelo sichaze ukuba uphando lweentloko lusetyenziso lwamanyathelo ahlukeneyo ekuhlaleni umphumo wonyango kwiziphumo zempilo. Ubuninzi beentloko, ubukhulu, kunye nobude ziphumo eziqhelekileyo ezisetyenziswayo (iifayile 4-6). Imizamo enzulu iyadingeka ukubandakanya amanyathelo okuphunyezwa okujoliswe ngesigulane kwi-chiropractic yophando ehambelanayo kunye nokuphuculwa kwimihla ngemihla kunye nokuqaliswa kweziqhelo ezibalulekileyo.
• Iindleko-mpu melelo. Akukho ziphando zophando eziye zafunyanwa kwiindleko-mpu melelo yokugulisa umlenze ukuze unyango lweengxaki zentlungu. Iimvavanyo zeklinikhi zexesha elizayo zokunyanzelisa umgudu kufuneka zihlole iindleko-mpu melelo.

 

Ezinye iindlela zophando zifuneka ukuphuhlisa ukuqonda ngokupheleleyo ukulinganisela phakathi kweenzuzo kunye nobungozi. Le CPG ayinikezeli ukuhlaziywa kwazo zonke izifo zonyango. Nasiphi na ukushiya kubonisa izikhala kwiincwadi zeklinikhi. Uhlobo, ubude, umlinganiselo, kunye nobude bonyango kufuneka busekelwe kwizikhokelo zesikhokelo, amava okliniki, nolwazi lwesigulane kude kube namazinga aphezulu obubungqina obukhoyo.

 

izigqibo

 

Kukho ubungqina obunobungqina bokuxhasa ukunakekelwa kwe-chiropractic, kubandakanywa nokunyanzeliswa kwempompo, ukuphathwa kwe-migraine kunye neentloko zentliziyo. Uhlobo, ubude, umlinganiselo, kunye nobude bonyango (s) kufuneka kusekelwe kwizikhokelo zesikhokelo, amava eenkliniki kunye nolwazi lwesigulane. Ububungqina bokusetyenziswa kwegulana njengendlela yokungenelela kwodwa kwizigulane ezineentloko zentlobo-ntloko zihlala zilingana. Kufuneka uphando olungakumbi.
Izikhokelo zokuziqhelanisa zidibanisa obona bungqina bufumanekayo kwindlela elungileyo yokusebenza kweklinikhi kwaye zizinto ezi-1 kuphela zendlela enobungqina bokunikezela ngononophelo. Esi sikhokelo senzelwe ukuba sisixhobo sonikezelo lokhathalelo lwe-chiropractic kwizigulana ezinentloko ebuhlungu. Luxwebhu "oluphilayo" kwaye luxhomekeke ekuhlaziyweni ngokuvela kwedatha entsha. Ngapha koko, ayisiyonto ethatha indawo yamava oqeqesho kunye nobungcali. Olu xwebhu alwenzelwanga ukuba lusebenze njengomgangatho wokunyamekela. Endaweni yoko, isikhokelo singqina ukuzibophelela kobungcali ekuqhubeleni phambili ukuziqhelanisa nobungqina ngokuzibandakanya kutshintshiselwano lolwazi kunye nenkqubo yokudlulisa ukuxhasa ukuhamba kolwazi kuphando.

 

Izicelo eziSebenzayo

 

• Esi sikhokelo sisisityebi sokuhanjiswa kwe-chiropractic kwizigulane ezineentloko.
• Ukunyanzeliswa komgudu kunconywa ukulawula izigulane ezinomlenze we-migraine okanye i-headervogenic headaches.
• Ukungenelela kwamanyathelo ahlukeneyo okubandakanya ukusilalisa kunokuncedisa izigulane nge-migraine.
• Ukuhlanganiswa okuhlangeneyo okanye ukunyamezela kwintamo yesimo se-flexor kungenza ngcono iimpawu zentloko ye-cervicogenic.
• Ukunyusa okuphantsi kwe-craniocervical ingabinokuphucula intloko yesifo.

 

Imibulelo

 

Ababhali bayabulela oku kulandelayo ngegalelo kwesi sikhokelo: URon Brady, DC; IGreyden Bridge, DC; UH James Duncan; UWanda Lee MacPhee, DC; UKeith Thomson, DC, ND; UDean Wright, DC; kunye noPeter Waite (aMalungu oMsebenzi oSebenza ngeZikhokelo zeKlinikhi). Ababhali bayabulela oku kulandelayo ngoncedo kuvavanyo lokuphandwa koncwadi lweSigaba XNUMX: USimon Dagenais, DC, PhD; kunye noThor Eglinton, MSc, RN. Ababhali bayabulela oku kulandelayo ngoncedo ngeSigaba II sophando loncwadi olongezelelweyo kunye nenqanaba lobungqina: Seema Bhatt, PhD; UMary-Doug Wright, uMLS. Ababhali bayabulela uKarin Sorra, PhD ngoncedo lokukhangela uncwadi, ukulinganiswa kobungqina kunye nenkxaso yokuhlela.

 

Imithombo Yenkxaso kunye Neengxabano Zomdla

 

Uxhasomali lunikezelwa yi-CCA, uMbutho woKhuselo waseCanada waseCanada, kunye nemiphondo ye-chiropractic evela kumaphondo ngaphandle kweBritish Columbia. Lo msebenzi wawuxhaswe yiCCA kunye neFree Federation. Akukho zintlukwano zomdla ezichazwe kulolu cwaningo.

 

Ukuququmbela, Intloko yesinye sezizathu eziqhelekileyo abantu bafuna unyango. Nangona abaninzi abanezonyango bezempilo banokuphatha unyango, ukunyamekelwa kwe-chiropractic yindlela ekhethwa yonyango ekhethiweyo esetyenziswa rhoqo ukuphatha imiba eyahlukahlukeneyo yempilo, kuquka iintlobo ezininzi zeentloko. Ngokwale nqaku apha ngasentla, ubungqina bubonisa ukuba ukunakekelwa kwe-chiropractic, kuquka ukulungiswa komgudu kunye nokusetyenziswa kwemigaqo, kunokuphucula intloko kunye ne-migraine. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

 

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Umqolo obuhlungu isikhalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski zeHerniated kwenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ngeengqungquthela kwijikelezo zayo zangaphandle, ukuxilisa nokucaphukisa izimpande zentliziyo. Iingxoxo ze-Disc zivame ukuqhutyelwa kwi-back back, okanye i-lumbar spine, kodwa nazo zingenzeka kunye nomlenze womlomo wesibeleko okanye intamo. Ukufakelwa kwamathambo afunyenwe kwinqanaba eliphantsi ngenxa yokulimala kunye / okanye imeko ehlaseleyo ingakhokelela kwimpawu ze-sciatica.

 

ISIQENDU ESIBALULEKILEYO ESIBALULEKILEYO: Unyango lweNhlungu zobuhlungu kwi-El Paso, TX

 

 

IINKCUKACHA EZINYE: I-EXTRA EXTRA: El Paso, Tx | Abadlali