Ngokusekelwe kwiziphumo zokufumana izibalo, Abantu abangaphezu kwezigidi ezintathu e-United States balimala kwingozi yemoto unyaka ngamnye. Enyanisweni, izingozi zeemoto zibhekwa njengenye yezizathu eziqhelekileyo zokubandezeleka okanye ukulimala. Ukulimala kwe-Neck, njenge-whiplash, ngokuqhelekileyo kubangelwa ukunyuka kwe-back-and-out kwentloko yentamo kunye nentamo evela kummandla wefuthe. Indlela efanayo yokulimala inokubangela ukulimala kwamathambo athile kwezinye iindawo zomzimba, kubandakanywa umqolo ongaphantsi kunye nemigangatho ephantsi. Intambo, umlenze, intamo kunye nokulimala kwamadolo ziqhelekileyo iintlobo zokulimala ngenxa yeengozi zengozi.

 

Abstract

 

• Injongo: Injongo yolu vavanyo olulungelelanisiweyo kukuqinisekisa ukusebenza komsebenzi wokulawula ukulimala kwezicubu ezithambileyo zomlenze, intamo kunye namadolo.
• Iindlela: Senze uhlolo olusisiseko kwaye sitshekishe iMEDLINE, i-EMBASE, i-Psycinfo, iRejista yeCochrane Central yezilingo eziLawulayo, kunye neCINAHL Plus kunye neTekisi epheleleyo ukusuka ngoJanuwari 1, 1990, ukuya ku-Ephreli 8, 2015, kwiimvavanyo ezilawulwa ngokungahleliwe (RCTs) Ucwaningo lwengxelo kunye nokuhlolwa kweengxaki ezihlola umphumo wokuzivocavoca kwiintlungu, ukubuyiswa komsebenzi, ukubuyiswa komsebenzi, imilinganiselo yezempilo, imiphumo yengqondo kunye neziganeko ezimbi. Amaqela angama-Random abahlalutyi abazimeleyo bahlolwe izihloko kunye neziqulatho kwaye bavavanya umngcipheko wokubaluleka usebenzisa i-criteria yaseScottle Intercollegiate Network Network. Ubungqina obuninzi bokusetyenziswa kwendlela yasetyenziswa.
• iziphumo: Sihlolisise izicatshulwa ezingama-9494. Ii-RCTs ezisibhozo zavavanywa ngokunzulu, kwaye i-3 yayinomngcipheko ophantsi wokhetho kwaye yafakwa kwi-synthesis yethu. Enye i-RCT ifumene ukuphuculwa okubalulekileyo kwintlungu kunye nomsebenzi othanda iklinikhi ngokubhekisele kwimithambo ehlanganisiweyo eqhubayo yokulinda kunye nokubona indlela ye-patellofemoral syndrome. I-RCT yesibini iphakamisa ukuba ukubekwa kweliso kwi-kinetic chain exercises kungakhokelela ekuphuculweni kweempawu ezinkulu kuneendlela ezivulekileyo zokuzilolonga kwe-patellofemoral syndrome. Enye i-RCT iphakamisa ukuba ukusetyenziswa kweqela elisekwe eklinikhi kunokuba nokusebenza ngakumbi kune-multimodal physiotherapy kwiimbaleki ezingamadoda ezineentlungu ezingapheliyo zokuqaqamba.
• Isiphelo: Sifumene ubungqina obuqingqiweyo obuphezulu bokuxhasa ukusetyenziswa kwemisebenzi yokulawulwa kwezilwanyana ezithambileyo ezisezantsi. Ubungqina bubonisa ukuba iinkqubo zenkqubo yokusetyenziswa kweekliniki zingaxhamla izigulane nge-patellofemoral syndrome kunye neentlungu eziqhubekayo. Uphando olongezelelweyo oluphezulu lufuneka. (J Uluhlu lwePhysiol Ther 2016; 39: 110-120.e1)
• Iimpawu eziPhambili zeNkcazo: Knee; Ukulimala Knee; I-Hip; Ukulimala kwe-Hip; Ikhuni; Ubuhlungu Bentambo; Ukuzivocavoca

 

Ukulimala kwamathambo aphantsi kwesigxina esezantsi ziqhelekileyo. EUnited States, i-36% yazo zonke ukulimala ezinikezela kumasebe aphuthumayo zihluma kunye / okanye iintlobo zomgca osezantsi. Phakathi kwabasebenzi base-Ontario, malunga ne-19% yazo zonke izibango zokuhlawulelwa kwexesha elilahlekileyo zichanekileyo zihambelana nokulimala okuphantsi. Ngaphezu koko, i-27.5% yabantu abadala baseSaskatchewan balimala kwintlungu yeengxabano zengxabano kwintsiphelelo esezantsi. Ukulimala kwamathambo omnxeba, umlenze, kunye namadolo kuxabisa kwaye kubeka umthwalo obalulekileyo woqoqosho kunye nokukhubazeka kwiindawo zokusebenza kunye neenkqubo zokuhlawulela. Ngokutsho kweSebe le-US labasebenzi be-Statistics, i-median time off work for inferior injury injuries yayingu-12 iintsuku kwi-2013. Ukulimala kwe-Knee kwakudibaniswe nomsebenzi omdala kakhulu wokungabikho emsebenzini (i-median, iintsuku ze-16).

 

Ukulimala kwamathambo amaninzi kunesigqeba esingaphantsi kulawulwa ngokuzenzekelayo, kwaye ukusetyenziswa ngokuqhelekileyo kusetyenziswa ukuphatha le nzakala. Ukuzivocavoca ijolise ukukhuthaza impilo emzimbeni kwaye ubuyisele umsebenzi oqhelekileyo wamajoyina kunye nama-tissue adibeneyo ngeengcamango ezibandakanya uluhlu lwesinyanzelo, ukunweba, ukuqiniswa, ukunyamezela, ukunyameka, kunye nokuziphatha okufanelekileyo. Nangona kunjalo, ubungqina malunga nokusebenza komsebenzi wokulawula ukulimala kwezicubu ezincinci zesalunga esingaphantsi akucaci.

 

Ukuphononongwa okucwangcisiweyo kwangaphambili kwenziwe uphando malunga nokusebenza komsebenzi wokulawulwa kwezilwanyana ezithambileyo zomzimba wezantsi. Uphononongo lubonisa ukuba umzimba usebenza kakuhle ekulawuleni i-patellofemoral syndrome kunye nokulimala kwe-groin kodwa kungekhona i-patellar tendinopathy. Kwolwazi lwethu, ukuhlaziywa kokubhaliweyo kuphela malunga nokusebenza komsebenzi wokulimala ngokukhawuleza kubone ubungqina obuncinane bokuxhasa ukulungiswa, ukuqina, kunye nokuzimela kwe-trunk.

 

 

Injongo yohlolo lwethu olufanelekileyo kukuphanda ukuphumelela kokusebenza ngokuthelekiswa namanye amanyathelo, ukungenelela kwe-placebo / sham, okanye akukho nxaxheba ekuphuculeni ukubuyiswa okuzimeleyo, ukubuyisela ukusebenza (umzekelo, ukubuyela kwimisebenzi, emsebenzini, okanye esikolweni), okanye kwiklinikhi iziphumo (umzekelo, intlungu, umgangatho obunxulumene nempilo yobomi, ukudakumba) kwezigulane ezinobungozi obunzima bokuzilimala kwintambo, intamo kunye namadolo.

 

tindlela

 

ubhaliso

 

Le protocol yokuhlaziywa ngokuchanekileyo ibhalisiwe kunye neRejista yamazwe ngamazwe eRejista yeeNkqubo eziPhononongo ngo-Matshi 28, 2014 (CRD42014009140).

 

Ulungelelwaniso olufanelekileyo

 

Lwabantu. Uphononongo lwethu lujolise kwizifundo zabantu abadala (? Iminyaka eyi-18) kunye / okanye abantwana abanokulimala kwezicubu ezithambileyo zomlenze, ithanga, okanye idolo. Ukulimala kwethishu ethambileyo kubandakanya kodwa ayikhawulelwanga kwibakala I ukuya kwi-II sprains / strains; tendonitis; tendinopathy; tendinosis; iintlungu ze-patellofemoral (syndrome); isi-band band syndrome; inyonga, ithanga, okanye iintlungu zedolo (ngaphandle kwesifo esikhulu); kunye nokunye ukonzakala kwezicubu ezithambileyo njengoko kunikwe ubungqina obukhoyo. Sichaze amanqanaba oonobumba kunye noxinzelelo ngokwendlela yokuhlelwa okucetywayo yiAmerican Academy of Orthopedic Surgeons (1 kunye 2). Izicubu ezithambileyo ezichaphazelekayo esinqeni zibandakanya iigaments ezixhasayo kunye nezihlunu eziwela ilunga le-hip ethangeni (kubandakanya i-hamstrings, i-quadriceps, kunye namaqela emisipha ye-adductor). Izicubu ezithambileyo zamadolo zibandakanya ukuxhasa i-intra-articular kunye ne-extra-articular ligaments kunye nezihlunu eziwela emadolweni zihlangene ethangeni kubandakanya i-patellar tendon. Asizibandakanyi izifundo zebakala lesi-XNUMX zokuthanjiswa okanye iintlobo, iinyembezi ze-acetabular labral, iinyembezi, i-osteoarthritis, ukwaphuka, ukusasazeka kunye nezifo zenkqubo (umzekelo, usulelo, i-neoplasm, ukuphazamiseka kwesifo).

 

 

 

Ngoncedo. Sithintele ukuhlaziywa kwethu kwizifundo ezavavanya umphumo wokuzilolonga (okt, ayikho inxalenye yenkqubo yokunakekelwa kweenkonzo ezininzi). Sichaza ukuzivocavoca nje naluphi na uchungechunge lwezithuthi ezijolise ekuqeqesheni okanye ekuphuhliseni umzimba ngomsebenzi oqhelekileyo okanye ukuqeqeshwa ngokomzimba ukukhuthaza impilo emzimbeni.

 

Maqela othelekisa. Siquka iinkalo eziqhathanisa i-1 okanye ezinye iindlela zokungenelela komnye nomnye okanye ukungenelela kokungenelela kwamanye amanyathelo, uluhlu olulindelweyo, ukungenelela kwe-placebo / sham, okanye akukho ncedo.

 

Iziphumo. Ukuze ufaneleke, uphando lufanele lufake esinye seziphumo zilandelayo: (1) ukubuyiswa okuzimeleyo; (2) ukubuyisela ukusebenza (umzekelo, ukukhubazeka, ukubuyela kwimisebenzi, umsebenzi, isikolo okanye imidlalo); (3) ubuhlungu bentlungu; (4) umgangatho wobomi obunxulumene nempilo; (5) iziphumo zengqondo ezifana nokudandatheka okanye ukwesaba; kunye (6) neziganeko ezimbi.

 

Iimpawu zoFundo. Izifundo ezifanelekileyo zihlangabezane neendlela ezilandelayo: (1) ulwimi lwesiNgesi; (2) zophando ezipapashwe phakathi kweJanuwari 1, 1990, no-Aprili 8, 2015; (I-3) izilingo ezilawulwa ngokungahleliwe (RCTs), uphando lwamaqela, okanye izifundo zokulawulwa kwamatyala ezenzelwe ukuvavanya ukusebenza nokukhuseleko kwamanyathelo; kunye (4) zibandakanya iqela lokuqala lokubamba iqela labathathi-nxaxheba be-30 nganye ngengalo yonyango kunye nemeko echaziweyo ye-RCT okanye i-100 abathathi-nxaxheba ngeqela elichaziweyo kwizifundo eziqhelekileyo okanye izifundo zokulawula iimeko. Izifundo ezibandakanya amanye amacandelo okutyumba okanye intambo emlonyeni, emthangeni, okanye emadolweni kwakufuneka zibonelele ngeziphumo ezizimeleyo kubafundi abathatha amabakala I okanye ii-II.

 

Sifake iifundo ngeziphumo ezilandelayo: (i-1), ii-editorials, iingxelo, imiqulu engashicilelwa, iingxelo, urhulumente wengxelo, iincwadi kunye nezahluko zeencwadi, iinkqubo zenkomfa, iziganeko zeentlanganiso, iintetho kunye needilesi, iingxelo zentsebenziswano, okanye iingxelo zesikhokelo; (I-2) zoyilo zophando ezibandakanya uphando lwee-pilot, uphando lwee-cross-sectional, iingxelo zecala, iifowuni zeemeko, izifundo ezifanelekileyo, ukuphononongwa okulandelelanayo (kunye okanye ngaphandle kweemeta-analysis), izikhokelo zenkcubeko, izifundo ze-biomechanical, izifundo zebhubhoratri kunye nezifundo ingxelo ngeendlela; (3) i-cadaveric okanye izifundo zezilwanyana; kunye (4) izifundo kwizigulane ezinobungozi obunzima (umzekelo, ibakala lesiGrike III / iintambo, ukuhlukana, ukuchithwa, ukuhlukana ngokupheleleyo, izifo, ukugula, i-osteoarthritis kunye nesifo sesistim).

 

Imithombo yolwazi

 

Siye saqulunqa isicwangciso sethu sokwenza uphando nge-sciences yezempilo (iSithasiselo 1). Uhlaziyo lwabahlobo lwee-Electronic Search Strategies (PRESS) Uluhlu lokuhlola luye lwasetyenziswa yilayibrari yesibini ukuphonononga isicwangciso sokukhangela ukugqiba nokuchaneka. Sifuna i-MEDLINE kunye ne-EMBASE, ebonwa njengeyona nkcazelo enkulu ye-biomedical, kunye ne-PsycinFO, ngenxa yeengqondo zengqondo nge-Ovid Technologies, Inc; I-CINAHL kunye neTekisi epheleleyo yoobuhlengikazi kunye noononophelo lwezempilo kunye ne-EBSCOhost; kunye ne-Cochrane Central Register yeeLingo eziLawulayo ngo-Ovid Technologies, Inc, nakuphi na izifundo ezingabanjwanga ngenye iinkcukacha. Isicwangciso sokukhangela sasiqala ngokuqala kwi-MEDLINE kwaye satshintsheliswa kwezinye iibliographic database. Izicwangciso zethu zokukhangela ezidibeneyo ezilawulwayo ezihambelana nesigcaziso ngasinye (umz., I-MeSH ye-MEDLINE) kunye namagama obhaliweyo afanelekileyo kunye nokunyameka kwimizimba yomlenze, intamo, okanye idolo, kubandakanywa ibanga lokuqala ukuya kwe-II okanye ukulimala koxinzelelo (iSithasiselo 1). Siphinde siphinde sifunde uludwe lweenkcukacha zengxelo ezidlulileyo zenkqubo kwanoma ziphina izifundo ezongezelelweyo ezifanelekileyo.

 

Ukhetho lo kufunda

 

Inkqubo yokuhlola inkqubo ye-2 yayisetyenziselwa ukukhetha izifundo ezifanelekileyo. Amaqela angama-Random abahlaziyileyo abazizimeleyo bahlolisise izihloko kunye neziqulatho zokuchonga ukufaneleka kwezifundo kwisigaba 1. Ukuhlolwa kwaphumela ekubeni uphando lubonakaliswe njengolufanelekileyo, mhlawumbi olufanelekileyo okanye olungenanto. Kwinqanaba le-2, iimbini ezifanayo zabahlalutyi ngokuzimeleyo ziphonononge izifundo ezifanelekileyo ezifanelekileyo ukuqinisekisa ukufaneleka. Ababuyekezi badibana ukuze bafikelele kwisivumelwano malunga nokufaneleka kwezifundo kunye nokuxazulula ukungavumelani. Umhloli wesithathu wasetyenziselwa ukuba isivumelwano singenakufikelelwa.

 

 

UkuHlola koMngcipheko weeBhasi

 

Abaphononongo abazimeleyo bebanjwe ngokungaqhelekanga ukujonga ngokuqinisekileyo ukungqinelana kwangaphakathi kwezifundo ezifanelekileyo ngokusebenzisa i-criteria yeScottlegate Guidelines Network (SIGN). Igalelo lokukhethwa kwezinto ezikhethiweyo, inkcazo yolwazi kunye nokudibanisa kwiziphumo zolu pho nonongo lwavandlakanyo luhlolwa ngokusetyenziswa kwe-SIGN criteria. Ezi ngqinisiso zazisetyenziselwa ukukhokela ababuyekezi ngokwenza isigqibo esipheleleyo soluvo malunga nokusebenza kwangaphakathi kwezifundo. Le ndlela ichazwe ngaphambili. Amanqaku amanani okanye i-cutoff iphuzu lokumisela ukusetyenziswa kwangaphakathi kwezifundo akuzange isetyenziswe kule ngxelo.

 

IINKQUBO ZOKUGQIBELA ii-RCTs zazisetyenziselwa ukuvavanya ngokunzulu le ndlela ilandelayo: (1) ukucaca kombuzo wophando, (2) indlela yokwenza izinto ngendlela engaqhelekanga, (3) ukufihlwa kolwabiwo lonyango, (4) ukungaboni ngonyango kunye neziphumo, (5) ukufana kwesiseko nempawu phakathi / phakathi kweengalo zonyango, (6) ukungqubana okungqinelanayo, (7) ukuthembeka kunye nokuthembeka kwamanyathelo eziphumo, (8) amaxabiso okulandela, (9) uhlalutyo ngokwemigaqo yokuphatha ngenjongo, kwaye ( 10) ukuthelekiswa kweziphumo kwiindawo zokufunda (apho kufanelekileyo). Imvumelwano yafikelelwa kwingxoxo yomvavanyi. Ukungavisisani kusonjululwe ngumvavanyi wesithathu ozimeleyo xa isivumelwano singafikelelwanga. Umngcipheko wokukhetha kwisifundo ngasinye esivavanyiweyo kwajongwa kwakhona ngugqirha wezifo zengqondo (PC). Ababhali kwaqhagamshelwana nabo xa kufuneka ulwazi olongezelelweyo ukugqibezela uvavanyo olubalulekileyo. Zizifundo kuphela ezinomngcipheko ophantsi wokhetho olubandakanyiweyo kubungqina bethu.

 

Ukwaziswa kwedatha kunye neSthesis yeZiphumo

 

Iinkcukacha zacatshulwa kwizifundo (DS) kunye nomngcipheko omncinci wokubakho ukudala ubungqina betafile. Umphononongi wesibini ngokuzimeleyo uhlolisise idatha ekhishiwe. Siye senza iziphumo ezixhomekeke kwixesha leemeko (ukuqala kwangoko [iinyanga ze-0-3], ziqhubekayo [iinyanga ze-N3], okanye ixesha eliguquguqukileyo [ukuqala kwangoku kunye nokuqhubekayo okuhlangeneyo]).

 

Sasebenzise amanyathelo amiselweyo ukuchonga ukubaluleka kwekliniki kwenguqu echazwe kwisilingo ngasinye kwiimpawu eziqhelekileyo zeziphumo. Ezi ziquka ukuhlula phakathi kweqela le-2 / 10 ngamanqaku kwi-Numeric Rating Scale (NRS), umehluko we-2 / 10 cm kwi-Visual Analog Scale (VAS), kunye ne-10 / 100 umahluko wendawo kwi-Kujala Patellofemoral, I-Anterior Knee Pain Scale.

 

Uhlalutyo lweSatisati

 

Isivumelwano phakathi kwabavavanyi bokuvavanywa kwamanqaku sabalwa kwaye kwaxelwa kusetyenziswa i? Inani kunye ne-95% yexesha lokuzithemba (CI). Apho ifumanekayo, sisebenzise idatha ebonelelwe kwizifundo kunye nomngcipheko ophantsi wokukhetha umlinganiso phakathi kongenelelo oluvavanyiweyo kunye neziphumo ngokubala umngcipheko (RR) kunye ne-95% CI yayo. Ngokufanayo, sibala umahluko kwiinguqu phakathi kwamaqela kunye ne-95% CI ukulinganisa ukusebenza kongenelelo. Ukubalwa kwe-95% ye-CI kwakusekwe kwinto yokuba isiseko kunye neziphumo zokulandela zilungelelaniswe kakhulu (r = 0.80).

 

Ukubika

 

Uhlolo lokuhlaziywa oluhlelekile luhlelwe kwaye lwabikwa ngokusekelwe kwizinto eziBalulekayo zokuBika kwiiNkcazo zokuHlola kunye neSitatimende seMeta-Analysis.

 

Insight of Dr. Alex Jimenez

Njengogqirha we-chiropractic, ukulimala kwengozi yemoto sesinye sezizathu eziqhelekileyo zokuba abantu bafune ukhathalelo lwe-chiropractic. Ukususela ekulimaleni kwentamo, njenge-whiplash, ukuya kwintloko kunye nentlungu yangemva, i-chiropractic ingasetyenziselwa ukukhusela ngokukhuselekileyo nangokufanelekileyo ukunyaniseka komgudu emva kokuphazamiseka kwemoto. I-chiropractor enjengam ihlala isebenzisa indibaniselwano yolungelelwaniso lomgogodla kunye neendlela zokwenza izinto ngesandla, kunye nezinye iindlela zonyango ezingenabungozi, ukulungisa ngobunono naziphi na izinto ezingalunganga zomqolo ezibangelwa kukwenzakala kwengozi yemoto. I-Whiplash kunye nezinye iintlobo zokulimala kwentamo zenzeka xa izakhiwo ezintsonkothileyo zomqolo womlomo wesibeleko zolulelwe ngaphaya kohambo lwendalo lokuhamba ngenxa yokuhamba ngesiquphe nangasemva kwentloko nentamo kumandla wempembelelo. Ukulimala komqolo, ngakumbi kumqolo osezantsi, kuqhelekile ngenxa yengozi yemoto. Xa izakhiwo ezintsonkothileyo kumqolo we-lumbar zonakele okanye zonzakele, iimpawu ze-sciatica zinokuhla zibuyele ezantsi ngasemva, ezinqeni, ezinqeni, emathangeni, emilenzeni nasezantsi ezinyaweni. Ukulimala kwamadolo kunokwenzeka nakwimpembelelo ngexesha lengozi yemoto. Ukuzivocavoca kusetyenziswa rhoqo ngononophelo lwe-chiropractic ukunceda ukukhuthaza ukubuyisela kwimeko yesiqhelo kunye nokuphucula amandla, ubhetyebhetye kunye nokuhamba. Ukuzivocavoca umzimba kunikezelwa kwizigulana ukubuyisela ngakumbi ukuthembeka komzimba wazo. Olu phando lulandelayo lubonisa ukuba umthambo, xa kuthelekiswa nonyango olungelulo olungenelelayo, yindlela yonyango ekhuselekileyo nesebenzayo yabantu abaphethwe yintamo kunye nokwenzakala okungaphantsi kwengozi yemoto.

 

iziphumo

 

Ukhetho lo kufunda

 

Sihlolisise izicatshulwa ze-9494 ngokusekelwe kwisihloko kunye ne-abstract (Umzobo 1). Kwezi, upapasho olupheleleyo lwe-60 luye lwahlolwa, kwaye amanqaku e-9 avavanywa ngokunzulu. Izizathu eziphambili zokungafaneleki ngexesha lokuvavanywa kokubhaliweyo okupheleleyo yayiyi (1) uyilo lokufunda olungafanelekanga, (2) ubungakanani besampulu encinci (nb 30 ngengalo yonyango), (3) ungenelelo lweemodemodal ezingavumeli ukubekwa bucala kokuzilolonga, (4) isifundo esingafanelekanga Inani labemi, kunye (5) nongenelelo olungafezekisi inkcazo yomthambo (Umzobo 1). Kulawo aphononongwa ngokunzulu, Izifundo ezi-3 (ezixelwe kumanqaku ama-4) zazinomngcipheko ophantsi wokukhetha icala kwaye zibandakanyiwe kulungelelwaniso lwethu. Isivumelwano sokungenelela ekuvavanyweni kwamanqaku kwaba njalo? = 0.82 (95% CI, 0.69-0.95). Isivumelwano sepesenti sovavanyo olubalulekileyo lwezifundo yayiyi-75% (yezifundo ze-6/8). Ukungavisisani kusonjululwe ngengxoxo yezifundo ezi-2. Saqhagamshelana nababhali abavela kwizifundo ezi-5 ngexesha lokuvavanya kakhulu ukucela ulwazi olongezelelweyo kwaye i-3 yaphendula.

 

 

Iimpawu zoFundo

 

Izifundo ezinobungozi obuncinci bokukhetha i-RCTs. Olunye uphononongo, olwenziwe eNetherlands, luvavanye ukusebenza kwenkqubo yokuziqhelanisa nomgangatho xa kuthelekiswa nendlela 'yokulinda kunye nokubona' kubathathi-nxaxheba abane-patellofemoral pain syndrome yexesha eliguqukayo. Isifundo sesibini, kunye neziphumo ezichazwe kumanqaku e-2, xa kuthelekiswa isibonelelo sokuvalwa kweeklinikhi ezivulekileyo zokuzivocavoca kubantu abanexesha elinokutshintshwa kwentlungu yesifo seentlungu eBelgium. Isifundo sokugqibela, esenziwa eDenmark, saphanda uqeqesho olusebenzayo xa kuthelekiswa nongenelelo lwe-multimodal physiotherapy ngoncedo lolawulo lweentlungu eziqhubekayo ezinxulumene ne-adductor.

 

Ii-RCT ezimbini zisebenzisa iinkqubo zokuzilolonga ezidibanisa uqeqesho lokuqinisa kunye nokulinganisa okanye uqeqesho lobuchule kumda ongezantsi. Ngokukodwa, imithambo eyomeleleyo ibandakanya zombini isometric kunye ne-concentric contractions ye-quadriceps, i-hip adductor, kunye nezihlunu ezinobungqabavu kulawulo lwe-patellofemoral pain46 kunye ne-hip adductors kunye nezihlunu ze-trunk kunye ne-pelvis yeentlungu ezinxulumene ne-adductor. Iinkqubo zokuzivocavoca zazisusela kwi-646 ukuya kwi-1243 yeeveki ubude kwaye zabekwa iliso kwaye iklinikhi isekwe kwimithambo eyongezelelweyo yemihla ngemihla ekhaya. Iinkqubo zokuzilolonga zathelekiswa nendlela yokulinda kunye nokubona okanye indlela yonyango ye-multimodal. I-RCT yesithathu ifanisa iiprotokholi ze-2 ezahlukeneyo zeeveki ezi-5 ezidityanisiweyo ezivaliweyo okanye ezivulekileyo zokomeleza ukhenketho kunye nokuzilolonga kwimithambo esezantsi.

 

Uhlalutyo lwe-Meta aluzange luqhutywe ngenxa yokunyuka kweengcaphephe zezifundo ezifunyenwe ngokubhekiselele kwizigulane zezigulane, ukungenelela, ukuthelekisa, kunye neziphumo. Imigaqo yobungqina bokubambisana obugqwesileyo yayisetyenziselwa ukuphuhlisa ubungqina benkcazo kunye nokwenza uququzelelo olululo lwezinto ezifunyenweyo kwiziphumo ezinobungozi obuphantsi.

 

Umngcipheko weeNkcazo kwiZifundo

 

Izifundo ezinomngcipheko ophantsi wokuba nombuzo wophando ngokucacileyo, ezisetyenziselwa iindlela ezifanelekileyo zokungaboniyo xa kunokwenzeka, zichazwe ukufana okwaneleyo neempawu ezisemgangathweni phakathi kwezonyango zonyango, kwaye zenze uhlalutyo lwenjongo ekufunekayo (iTheyibhile 3). Ama-RCT ayenamanani alandelayo aphezulu kune-85%. Nangona kunjalo, ezi zifundo zineendlela zokwehluleka kweendlela: ingcaciso engapheliyo ichaza iindlela zokufihla ukwabiwa (1 / 3), ingcaciso engapheliyo echaza indlela yokuchithwa kwezinto (1 / 3), ukusetyenziswa kwamanyathelo omphumo awazange aboniswe ukuba asemthethweni okanye athembekile ( oko kukuthi, ubude bemisipha kunye nonyango oluyimpumelelo) (2 / 3), kunye nemibono ebalulekileyo yeempawu kwiimpawu zokuqala (1 / 3).

 

 

Kwimihlathi echaphazelekayo ye-9, i-5 yabonwa ukuba neengozi ephezulu yokuxhamla. Ezi zifundo zineempompo ezilandelayo: (1) iindlela ezibi okanye ezingaziwa ngeendlela zokuhamba ngeendlela (3 / 5); (2) iindlela ezingafihlayo okanye ezingaziwayo zokufihla iindlela (5 / 5); (3) umhloli wesiphumo akaphoswanga (4 / 5); (4) ukungafani kliniki ezibalulekileyo kwimimiselo yokuqala (3 / 5); (5) ezingabonakaliyo, ingcaciso engapheliyo malunga nokuhluthwa ngeqela okanye ulwahlulo olukhulu kwimilinganiselo yokulahla phakathi kweengalo zonyango (N15%) (3 / 5); kunye (6) ukungabikho kolwazi malunga nokuba akukho naluphi uhlalutyo lokufuna unyango (5 / 5).

 

Isishwankathelo soBungqina

 

I-Patellofemoral Pain Syndrome yexesha eliguqukayo. Ubungqina obuvela kwi-1 RCT bucebisa ukuba inkqubo yovavanyo yokuqhubela phambili yeklinikhi inokubonelela ngesibonelelo sexesha elifutshane kunye nexesha elide kukhathalelo oluqhelekileyo kulawulo lwe-patellofemoral pain syndrome yexesha eliguqukayo. van Linschoten et al Abathathi-nxaxheba abangahleliyo abane-diagnostic clinical patellofemoral syndrome yeenyanga ezi-2 ukuya kwiminyaka emi-2 ubude ukuya (1) kwinkqubo yovavanyo olusekwe kwiklinikhi (9 ukutyelelwa ngaphezulu kweeveki ezi-6) ezibandakanya imithambo eqhubekayo, emileyo nenamandla okomeleza i-quadriceps, i-adductor, kunye nezihlunu ezinobungangamsha kunye nokulinganisela kunye nokuziqhelanisa nokuzilolonga, okanye (2) inkathalo yesiqhelo yokulinda ubone indlela. Omabini la maqela afumana ulwazi olusemgangathweni, iingcebiso, kunye nokuziqhelanisa ne-isometric esekwe ekhaya ye-quadriceps esekwe kwizindululo ezivela kwizikhokelo zeDatshi Jikelele zoNyango (4 Table) Kwakukho umahluko ngokwezibalo okhuthaza iqela lokuzilolongela (1) iintlungu (i-NRS) ekuphumleni kwiinyanga ezi-3 (kuthetha utshintsho umahluko 1.1 / 10 [95% CI, 0.2-1.9]) kunye neenyanga ezi-6 (kuthetha utshintsho umahluko 1.3 / 10 [95% CI, 0.4-2.2]); (2) iintlungu (i-NRS) ezinomsebenzi kwiinyanga ezi-3 (kuthetha umahluko wotshintsho 1.0 / 10 [95% CI, 0.1-1.9]) kunye neenyanga ezi-6 (kuthetha umahluko wotshintsho 1.2 / 10 [95% CI, 0.2-2.2]); kunye (3) umsebenzi (Kujala Patellofemoral Scale [KPS]) kwiinyanga ezi-3 (kuthetha utshintsho umahluko 4.9 / 100 [95% CI, 0.1-9.7]). Nangona kunjalo, akukho namnye umahluko owawubalulekile eklinikhi. Ngapha koko, kwakungekho mahluko ubonakalayo kwinani labathathi-nxaxheba abanika ingxelo yokubuyiswa (bachacha ngokupheleleyo, bafunyanwa ngamandla), kodwa iqela lokuzilolonga lalinokwenzeka ukuba linike ingxelo yokuphuculwa kokulandelwa kweenyanga ezi-3 (umlinganiso wobungakanani [OR], 4.1 [95% I-CI, 1.9-8.9]).

 

 

Ubungqina obuvela kwi-RCT yesibini bucebisa ukuba i-physiotherapist- ijongiwe imithambo ye-kinetic yeeklinikhi zomzimba ezivaliweyo (apho unyawo luhlala luqhakamshelana rhoqo nomphezulu) inokubonelela ngesibonelelo sexesha elifutshane xa kuthelekiswa novavanyo oluvulekileyo lwe-kinetic chain (apho ilungu lihamba ngokukhululekileyo) patellofemoral Iimpawu zesifo seentlungu (Itheyibhile 4). Bonke abathathi-nxaxheba baqeqeshelwe imizuzu engama-30 ukuya kwengama-45, amaxesha ama-3 ngeveki kangangeeveki ezintlanu. Omabini la maqela ayalelwa ukuba enze umlenze ongezantsi osolulekayo emva kweseshoni yoqeqesho nganye. Ezo zilungiselelwe ukuzivocavoca ngemixokelelwane evaliweyo zenziwe zongamela (5) oomatshini bokushicilela bomlenze, (1) ukugoba amadolo, (2) ukuhamba ngebhayisikile, (3) ukukhwela inqanawa, (4) ukuzilolonga okunyukayo nokunyathela, kunye (5) nokuzilolonga okuqhubekayo . Abathathi-nxaxheba abavulekileyo bezinto ezenziweyo (6) ubuncinci besikhungu, (1) ukuphakama komlenze othe ngqo, (2) ukuhamba okufutshane kwe-arc ukusuka kwi-3 ukuya kwandiswa ngamadolo, kunye (10) nokukhutshwa komlenze. Iziphumo zobukhulu azange zixelwe, kodwa ababhali baxele umahluko okhoyo ngokwezibalo othanda ukuzivocavoca ngetyathanga kwiinyanga ezi-4 ze (3) ubude bokutshixa (P = .1), (03) ukucofa uvakalelo (P = .2), (04) iintlungu ngovavanyo lwe-isokinetic (P = .3), kunye (03) nentlungu ebusuku (P = .4). Ukubaluleka kweklinikhi kwezi ziphumo akwaziwa. Kwakungekho nantlukwano ebonakalayo phakathi kwamaqela nayiphi na enye intlungu okanye amanyathelo okusebenza naliphi na ixesha lokulandelela.

 

 

 

Ukunyamezela kwe-Adductor-Related Related Pain Pain

 

Ubungqina obuvela kwi-RCT ye-1 bucebisa ukuba inkqubo yokuzivocavoca yeqela elisekelwe kwikliniki iyasebenza ngakumbi kunenkqubo ye-multimodal yokunyamekela intlungu eqhubekayo ehlobene ne-adductor. U-H�lmich et al wafunda iqela leembaleki zamadoda kunye nokuxilongwa kweklinikhi yeentlungu ze-groin ezinxulumene ne-adductor ezingaphezulu kweenyanga ze-2 ubude (ixesha eliphakathi, iiveki ze-38-41; uluhlu, iiveki ze-14-572) kunye okanye ngaphandle kwe-osteitis pubis. Abathathi-nxaxheba bahlelwe ngokungahleliwe (1) inkqubo yokuzivocavoca yeqela elisekelwe kwikliniki (iiseshoni ze-3 ngeveki kwii-8-12 iiveki) ezibandakanya i-isometric kunye ne-concentric resistance resistance exercise exercises for the adductors, trunk, and pelvis; ibhalansi kunye ne-agility exercises for the lower end; kunye nokwelula izibilini, umva, kunye nomgangatho ophantsi (ngaphandle kwemisipha ye-adductor) okanye (2) inkqubo ye-physiotherapy ye-multimodal (ukutyelelwa kwe-2 ngeveki kwii-8-12 iiveki) ezibandakanya i-laser; i-massage ye-friction transverse; transcutaneous electrical nerve stimulation (TENS); kunye nokwelula i-adductors, i-hamstrings, kunye ne-hip flexors (Itheyibhile 4). Kwiinyanga ezine emva kokungenelela, iqela lokuzivocavoca lalinokuthi lichaze ukuba imeko yabo "ingcono kakhulu" (RR, 1.7 [95% CI, 1.0-2.8]).

 

Iziganeko ezimbi

 

Akukho nanye yezifundo ezibandakanyiweyo ezichazwe kwixesha okanye ubunjani bezityalo ezimbi.

 

ingxoxo

 

Isishwankathelo soBungqina

 

Ukuphononongwa kwethu ngokucwangcisiweyo kuhlolisise ukusebenza komsebenzi wokulawula ukulimala kwezicubu ezincinci zomlenze, intamo, okanye idolo. Ubungqina obuvela kwi-1 ye-RCT lubonisa ukuba inkqubo yeprogram eqhubekayo yokuzilolonga inokuthi inikeze inzuzo eyongezelelweyo okanye ixesha elide xa kuthelekiswa nokubonelela ngolwazi kunye neengcebiso malunga nokulawulwa kweentlungu zesifo sengqondo se-patellofemoral. Kukho ubungqina bokuba ukunyanzelwa kokunyanga kwe-kinetic ye-chain inezixhobo ezinokubangela iintlungu zesifo se-patellofemoral xa zifaniswa neendlela ezivulekileyo zethambo lwe-kinetic. Ukuba ubuhlungu be-groin ehambelana ne-adductor, ubungqina obuvela kwi-1 RCT bubonisa ukuba inkqubo yeklinikhi esebenzayo yeekliniki isebenze ngakumbi kuneenkqubo ezininzi zokunakekelwa. Nangona kusetyenziswa ngokuqhelekileyo ukusetyenziswa kwemithi yokunyusa, kukho ubungqina obuncitshisiweyo obuphezulu bokuzisa ukusetyenziswa kwemisebenzi yokulawulwa kwezilwanyana ezithambileyo ezisezantsi. Ngokukodwa, asifumananga uphando oluphezulu kwiindlela zokulawula ukusetyenziswa kweemeko eziqhelekileyo ezifumanekayo ziquka i-patellar tendinopathy, i-hamstring sprain kunye noxinzelelo olunzima, i-hamstring tendinopathy, i-bursitis ye-trochanteric, okanye i-capsular injured in the hip.

 

 

Uhlolo oluPhezulu lwangaphambili

 

Iziphumo zethu ziyahambelana nokufunyenwe kuvavanyo olucwangcisiweyo lwangaphambili, kugqitywa ekubeni umthambo uyasebenza kulawulo lwe-patellofemoral syndrome kunye nentlungu yokuqaqamba. Nangona kunjalo, iziphumo ezivela kuvavanyo olucwangcisiweyo lwangaphambili oluvavanya ukusetyenziswa kwemithambo kulawulo lwe-patellar tendinopathy kunye nokulimala ngokuqatha kwe-hamstring akuhambelani. Olunye uphononongo luchaze ubungqina obomeleleyo bokusetyenziswa koqeqesho lwe-eccentric, ngelixa abanye baxela ukungaqiniseki malunga nokuba imithambo ekhethiweyo ye-eccentric iluncedo kwi-tendinopathy xa kuthelekiswa nezinye iindlela zokuzilolonga. Ngapha koko, kukho ubungqina obunqunyelweyo besiphumo esihle ukusuka ekuzoluleni, ukukhawuleza kunye nokuzilolonga komzimba, okanye ukolula ukolula ulawulo lokulimala ngokuqatha. Izigqibo ezahlukileyo phakathi kokuphononongwa okucwangcisiweyo kunye nenani eliqingqiweyo lezifundo ezithathwa njengezamkelekileyo emsebenzini wethu zinokubangelwa kukungafani kwendlela. Sivavanye uluhlu lweereferensi zovavanyo lwangaphambili lwenkqubo, kwaye uninzi lwezifundo ezibandakanyiweyo kuphononongo aluzange zihlangabezane neenqobo zokufaka. Izifundo ezininzi zamkelwe kolunye uphononongo zazinobungakanani besampulu (b30 ngengalo yonyango). Oku kunyusa umngcipheko wentsalela yokudideka ngelixa kunciphisa ubungakanani besiphumo. Ngaphaya koko, inani lophononongo olucwangcisiweyo lubandakanya uthotho lwamatyala kunye nezifundo zamatyala. Ezi ntlobo zezifundo azenzelwanga ukuvavanya ukusebenza kongenelelo. Okokugqibela, uphononongo lwangaphambili lwalubandakanya izifundo apho umthambo wawuyinxalenye yongenelelo lweemodemodal, kwaye ngenxa yoko, isiphumo sokuzilolonga sodwa asinakuqinisekiswa. Kwizifundo ezanelisa iikhrayitheriya zethu zokukhetha, zonke zavavanywa ngokunzulu kuphononongo lwethu, kwaye yi-3 kuphela eyayinomngcipheko ophantsi wokhetho kwaye yafakwa kuhlanganiso lwethu.

 

Amandla

 

Ukuhlolwa kwethu kunamandla amaninzi. Okokuqala, saqulunqa iqhinga lokukhangela ngokuzimeleyo elihlaziywa ngokuzimeleyo yilayibrari yesibini. Okwesibini, sichaza ukufakwa okucacileyo kunye neendlela zokungabikho ekukhethweni kwezifundo ezichaphazelekayo kwaye ziqwalaselwe kuphela ngezifundo kunye nobukhulu bezesampuli ezifanelekileyo. Okwesithathu, iimbini zababuyekezi abaqeqeshiwe bahlolwe kwaye bahlolisiswa ngokufanelekileyo izifundo ezifanelekileyo. Okwesine, sasebenzisa imilinganiselo evumelekileyo ye-criteria (SIGN) ukujonga ngokukhawuleza izifundo. Ekugqibeleni, siyekezela ukuqala kwethu ukuqhuba izifundo kunye nomngcipheko omncinci wokungabikho.

 

Imida kunye neNcomelo zoPhando lweHlabathi

 

Ukuphononongwa kwethu kunemida. Okokuqala, ukukhangela kwethu kwakuncinane kwizifundo ezipapashwe ngesiNgesi. Nangona kunjalo, ukuphononongwa kwangaphambili kufumene ukuba ukuthintela ukuphononongwa ngokuchanekileyo kwizifundo zolwimi zesiNgesi akuzange kubangele ukunyaniseka kwiziphumo ezichazwe. Okwesibini, nangona kukho inkcazo ebanzi yobunzima bokuzilimala kwintambo, intamo, okanye idolo, isicwangciso sethu sokukhangela singenakuthatha zonke izifundo ezifanelekileyo. Okwesithathu, ukuhlaziywa kwethu kusenokungaphumeleli izifundo ezifanelekileyo ezipapashwe phambi kwe-1990. Sijonge ukunciphisa oku ngesandla ngokukhangela uludwe lweenkcukacha zovavanyo oludlulileyo. Ekugqibeleni, uvavanyo olubalulekileyo lufuna isigwebo senzululwazi esahlukileyo phakathi kwabahlalutyi. Sanciphise le nto enokubaluleka ngabaqeqeshi ekusebenziseni i-SIGN tool kunye nokusebenzisa inkqubo yokuvumelana ukuze kuqinisekiswe ukuthotyelwa kokufunda. Ngokubanzi, ukuphononongwa kwethu ngokuchanekileyo kubonisa ukusilela kophando olunzulu kule ndawo.

 

Izifundo eziphakamileyo zezinga eliphezulu ekusebenziseni umsebenzi wokulawula ukulimala kwamathambo athambileyo kumgangatho ophantsi kufuneka. Uninzi lweengxelo ezibandakanyiweyo kwisigqibo sethu (63%) sinomngcipheko omkhulu wokubakho kwaye asikwazanga ukufakwa kwi-synthesis yethu. Uphononongo lwethu lubonakalise ikhefu ezibalulekileyo kwiincwadi. Ngokukodwa, uphando olufunekayo ukukwazisa imiphumo ethile yokuzivocavoca, imiphumo yabo yexesha elide, kunye namayeza angenelelo ngoncedo. Ukongezelela, kukho iimfuno ezifunekayo ukuchonga ukusebenza kohlobo lweentlobo ezahlukeneyo zoqeqesho kunye nokuba ukuphumelela kuyahlukahluka kwenzakaliso yezilwanyana ezithambileyo zomlenze, intamo kunye namadolo.

 

isiphelo

 

Kukho ubungqineli obuphezulu obunobungqina bokufundisa ukusetyenziswa komsebenzi wokulawulwa kwezilwanyana ezinobunzima zomlenze, intamo kunye namadolo. Ubungqina obukhoyo bubonisa ukuba inkqubo yeprogram yokuqhubekayo yokuzilolonga inokuthi iqhube ekuphuculeni ukuphucula xa idibene nolwazi kunye neengcebiso ngokuphumla nokukhusela imisebenzi evuselelayo yokulawula i-patellofemoral syndrome. Ngenxa yosizi lwe-groin eqhubekayo ye-adductor, inkqubo yeklinikhi ephantsi kwenkqubo yokusebenzisa iprojekthi yenkqubo isebenza ngokugqithiseleyo kunonophelo lwe-multimodal ekukhuthazeni ukubuyiswa.

 

Imithombo Yenkxaso kunye Neengxabano Zomdla

 

Olu phononongo luxhaswe liSebe lezeziMali lase-Ontario kunye neKhomishini yeeNkonzo zezeMali yase-Ontario (RFP no. OSS_00267175). Iarhente yenkxaso mali khange ibandakanyeke kuqokelelo lweenkcukacha, uhlalutyo lwedatha, ukutolikwa kwedatha, okanye ukuyilwa kombhalo obhaliweyo. Olu phando lwenziwe, ngokuyinxenye, enkosi kwinkxaso-mali evela kwinkqubo yoPhando lweZitulo zaseCanada. UPierre C t wayekhe wafumana inkxaso-mali kwiGrant kwiSebe lezeziMali lase-Ontario; ukubonisana noMbutho woKhuseleko lweChiropractic waseCanada; ukuthetha kunye / okanye amalungiselelo okufundisa eNational Judicial Institute nakwi-Soci t des M decins Experts du Quebec; uhambo / uhambo, uMbutho waseYurophu we-Spine; Ibhodi yabalawuli, i-European Spine Society; izibonelelo: Aviva Canada; ubudlelane ngenkxaso, Inkqubo yoSihlalo woPhando lwaseCanada Azikho ezinye iimpikiswano zomdla ezichazwe kolu phando.

 

Ulwazi loNcedo

 

• Ukuphuhliswa komxholo (unikezelwe ngcamango yophando): iDS, CB, PC, JW, HY, SV
• Uyilo (lucebise iindlela zokuvelisa iziphumo): iDS, CB, PC, HS, JW, HY, SV
• Ukulawulwa (ukubonelelwa ngongamela, uxanduva lokumisela nokuphunyezwa, ukubhala kombhalo): DS, PC
• Ukuqokelela idatha / ukucwangcisa (uxanduva lwezilingo, ukulawula isigulane, intlangano, okanye idatha yokunika ingxelo): iDS, CB, HS, JW, DeS, R, HY, KR, JC, KD, PC, PS, RM, SD
• Ukuhlalutya / ukuchazwa (uxanduva lokuhlalutya, ukuvavanya, nokunikezelwa kweziphumo): iDS, CB, PC, HS, MS, KR, LC
• Uphando lweencwadi (wenza uphando lweencwadi): I-ATV
• Ukubhala (uxanduva lokubhala inxalenye ebhaliweyo yesandla): DS, CB, PC, HS
• Ukuhlaziywa okubalulekileyo (isicatshulwa esihlaziyiweyo kwisiqulatho somqondo, oku akuhambelani nokupela ukupela nokusetyenziswa kwegrama): I-DS, i-PC, i-HS, i-JW, i-DeS, i-RS, i-MS, i-ATV, i-KY, i-JC, i-KD, i-LC, i-PS, i-SD, i- RM, SV

 

Izicelo eziSebenzayo

 

• Kukho ubungqina obubonisa ukuba ukusetyenziswa kwezikliniki ezinokusetyenziselwa izibonelelo kunokuncedisa izigulane nge-patellofemoral syndrome okanye intlungu ye-groin.
• Ukunyamekela ukuqhutyelwa kokuqhubela phambili kunokunceda inzala ye-patellofemoral ye-syndrome yexesha eliqhelekileyo lifaniswa nolwazi / iingcebiso.
• Ukulawulwa kwendlela yokucwangcisa i-kinetic chain kungabonelela ngenzuzo xa kuthelekiswa nokuvulwa kwezikhenkethi zovavanyo lwezilwanyana zesifo se-patellofemoral.
• Ukuphuculwa ngokuzimeleyo kwintlungu eqhubekayo ye-groin kuphezulu emva kweprogram ye-kliniki yokusetyenziswa kweqela eliqhathaniswa ne-physiotherapy ye-multimodal.

 

Ngaba Amanyathelo angenelelekiyo asebenzayo kuLawulo lweeNtloko ezinxulumene neNeck Pain?

 

Ngaphezu koko,Olunye ungenelelo olungenayo ungenelelo, kunye nongenelelo olungesosikhemesti, zihlala zisetyenziswa ukunceda ukunyanga iimpawu zentlungu kunye nentloko ebangelwa kukulimala kwentamo, njenge-whiplash, ebangelwa ziingozi zemoto. Njengoko kukhankanyiwe ngaphambili, i-whiplash yenye yeendlela eziqhelekileyo zokulimala kwentamo okubangelwa yingozi yemoto. Ukunyamekela kwe-Chiropractic, unyango lomzimba kunye nokuzilolonga, kunokusetyenziselwa ukuphucula iimpawu zentlungu yentamo, ngokutsho kwezi zifundo zilandelayo zophando.

 

Abstract

 

Injongo

 

Ukuhlaziya iziphumo ze-2000 2010 ye-Bone kunye ne-Joint Decade Task Force kwiNeck Pain kunye nokuphazamiseka okunxulumene nayo kunye nokuvavanya ukusebenza kongenelelo olungenasiphelo nolungelulo olwezamayeza kulawulo lwezigulana ezineentloko ezihambelana nentlungu yentamo (okt, uxinzelelo- uhlobo, i-cervicogenic, okanye iintloko ezinxulumene ne-whiplash).

 

tindlela

 

Sikhangele kwiziseko zedatha ezintlanu ukusuka kwi-1990 ukuya kwi-2015 kwizilingo ezilawulwa ngokungahleliwe (RCTs), izifundo zamaqela, kunye nezifundo zolawulo lwamatyala ngokuthelekisa ungenelelo olungenelelayo kunye nolunye ungenelelo, i-placebo / sham, okanye akukho ngenelelo. Izibini ezingahleliwe zabavavanyi abazimeleyo bavavanya izifundo ezifanelekileyo besebenzisa iikhowudi zeScotland zokuQinisekiswa kweNgcaciso yeNethiwekhi ukumisela ukwamkeleka kwesayensi. Izifundo ezinomngcipheko ophantsi wokhetho zadityaniswa emva kobungqina obusemagqabini bobungqina.

 

iziphumo

 

Sihlolisise izicatshulwa ze-17,236, izifundo ze-15 zifanelekileyo, kwaye i-10 inomngcipheko ophantsi. Ubungqina bubonisa ukuba iintloko ze-episodic-intlobo zesifo kufuneka zilawulwe ngomthwalo ophantsi wokunyamezela ukunyuka kwe-craniocervical kunye ne-cowervoscapular exercises. Izigulane ezineentloko ezingapheliyo zentlungu zingaphumelela kumthwalo ophantsi wokunyamezela ukunyamezela kwe-craniocervical kunye ne-cowervoscapular exercises; uqeqesho lokuphumula ngokunyanga kokunyamezela; okanye ukunakekelwa kwamaninzi okubandakanya ukuhlakulela umgogodla, ukuqeqeshwa kwe-craniocervical, kunye nokulungiswa kwangaphambili. Kwiintsholongwane zentliziyo, umthwalo ophantsi wokunyamezela i-craniocervical kunye ne-cowervoscapular exercises; okanye unyango olusesikweni (ukuphathwa kunye okanye ngaphandle kokubambisana) kwintambo yomlomo wesibeleko kunye nesifo se-thoracic sinokukunceda.

 

 

izigqibo

 

Ulawulo lweentloko ezinxulumene nentlungu yentamo kufuneka lubandakanye ukuzivocavoca. Izigulane ezinobulunga obungapheliyo-intloko zingaphumelela ekuqeqesheni ukuphumula ngokunyamezela unyango okanye ukunyamekelwa kwe-multimodal. Izigulane ezinentloko yesifo somlomo zingaphinda zizuze kwikhosi yeyeza.

 

Internet

 

Amanyathelo angeneliyo, ukungathinteli kwintloko, intloko yesifo, intloko yesifo sekhanda, intloko yesibalo esichengeni ukulimala kwe-whiplash, ukuhlolwa kwenkqubo

 

amaNqaku

 

Imibulelo

 

Sithanda ukubonga nokubulela bonke abantu abaye benza umrhumo obalulekileyo kule ngxelo: URobert Brison, uPoonam Cardoso, J. David Cassidy, uLaura Chang, uDouglas Gross, uMraray Krahn, uMichel Lacerte, uGail Lindsay, uPatrick Loisel, uMike Paulden, uRoger Salhany, uJohn Stapleton, u-Angela Verven noLeslie Verville. Sithanda kwakhona ukubonga uTrish Johns-Wilson kwiYunivesithi yase-Ontario Institute of Technology ukuze ahlaziye isicwangciso sakhe sokukhangela.

 

Ukuthotyelwa kweMigangatho yokuHlola

 

Ukugqubana kwemidla

 

UGqr. Pierre C t ufumene isibonelelo kurhulumente wase-Ontario, Icandelo loMphathiswa Wezimali, inkxaso-mali evela kwinkqubo yase-Canada yoPhando lweZitulo, imirhumo yobuqu kwi-National Judicial Institute yokufundisa, kunye nemirhumo yobuqu evela kwi-European Spine Society yokufundisa. UGqr. USilvano Mior noMargareta Nordin bafumene imbuyiselo yeendleko zokuhamba ukuya kwiintlanganiso zesifundo. Ababhali abaseleyo baxela akukho zibhengezo zomdla.

 

Inkxaso

 

Lo msebenzi uxhaswe liSebe lezeMali lase-Ontario kunye neKhomishini yeeNkonzo zezeMali yase-Ontario [RFP # OSS_00267175]. Iarhente yenkxaso mali khange ibandakanyeke kuyilo lokufunda, ukuqokelela, ukuhlalutya, ukutolikwa kwedatha, ukubhala umbhalo obhaliweyo okanye isigqibo sokungenisa lo mbhalo ukuze upapashwe. Uphando lwenziwe, ngokuyinxenye, ngenxa yenkxaso-mali evela kwinkqubo yoPhando lweZitulo zaseCanada kuGqirha Pierre C t , uSihlalo woPhando eCanada kuThintelo loKhubazeko kunye nokuBuyisela kwimeko yesiqhelo kwiYunivesithi yaseOntario Institute of Technology.

 

Ukuququmbela,Ukuzivocavoca okubandakanyiweyo kukhathalelo lwe-chiropractic kunye nolunye ungenelelo olungangenisiyo kufuneka lusetyenziswe njengenxalenye ebalulekileyo yonyango ukuqhubela phambili ukunceda ukuphucula iimpawu zokulimala kwentamo kunye nokulimala kwethambo, ithanga kunye namadolo. Ngokwezifundo zophando zingasentla, ukwenza umthambo, okanye ukwenza umthambo, kuluncedo ekukhawuleziseni ixesha lokubuyisela kwizigulana ezinengozi yemoto kunye nokubuyisela amandla, ubhetyebhetye kunye nokushukumiseka kwezakhiwo ezichaphazelekayo zomqolo. Ulwazi olukhankanyiweyo kwiZiko leLizwe leNgcaciso yeBiotechnology (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngomxholo, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi apha 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