Iidiski ze-Herniated yimeko ephazamisayo ebonakaliswe yintlungu, ukuphazamiseka kunye nobuthathaka kwisigxina esinye okanye ngaphezulu. Ngelixa abanye abantu basenokungabi nantlungu kwaphela, abo benzayo basenokunqwenela ukuthomalalisa iintlungu ngokukhawuleza ukuphepha ixesha elide lekhefu lokugula kwimisebenzi yabo. Uninzi lweengcali zempilo zincoma utyando kwizigulane ezine-disc eziqhubekayo kunye / okanye ezimbi ngakumbi iimpawu ze-disc ye-herniated kodwa ezinye iindlela zonyango ezingasebenzisiyo zinokunceda ukuphatha i-disc herniations. Injongo yale nqaku ilandelayo kukubonisa indlela imodeli yonyango ye-physiotherapy eyakhiweyo inokubonelela ngokukhawuleza kwizigulane ezifanelwe utyando lwe-lumbar disc.
Contents
Iimpawu ze-lumbar disc herniation ziqhelekile kuluntu jikelele, nangona izinga lokuxhaphaka lihluka ngokubanzi phakathi kwezifundo ezahlukeneyo (1). Ubunzima beempawu buyahluka kwaye, kwizigulane ezininzi, intlungu kunye nokulahlekelwa ngumsebenzi kunokukhokelela ekukhubazekeni kunye nexesha elide lekhefu lokugula (2). Isisombululo esizenzekelayo seempawu emva kwe-lumbar disc herniation kuthathwa njengento eqhelekileyo, okwenza kube nzima ukuvavanya imiphumo yonyango. Ngaphaya koko, kwizifundo ezivavanya ukuphiliswa okuzenzekelayo, unyango olwahlukeneyo lwephysiotherapy luhlala lubandakanyiwe, kunye namayeza eentlungu (3�5), nto leyo eyenza kube nzima ukumisela ubungakanani bokuphilisa kwendalo. Ngakolunye uhlangothi, kwizigulane ezine-sciatica, kodwa ngaphandle kwe-disc herniation eqinisekisiweyo kwi-imaging resonance imaging (MRI), malunga nesinye kwisithathu sezifundo zifumana iiveki ze-2 emva kokuqala kwe-sciatica kwaye malunga neekota ezintathu zibuyiselwa emva kweenyanga ze-3 (6).
Ngokungafaniyo nokuvavanya ukuphiliswa ngokuzenzekelayo, utyando lwe-lumbar disc herniation luphandwe kwizifundo ezininzi. Utyando lufaniswa neentlobo ezahlukeneyo zonyango, ezifana nemfundo, i-chiropractic, i-physiotherapy engachazwanga, i-acupuncture, i-injection kunye neyeza (7�10). Unyango olungasebenzisi utyando, nangona kunjalo, luchazwe kuphela ngamagama angacacanga, kwaye ukwahluka kunyango kusetyenzisiwe. Izifundo zangaphambili zichaze iziphumo ezithandekayo zexesha elifutshane (emva kwe-1 ngonyaka) iziphumo zokuhlinzwa, kodwa akukho mahluko mkhulu phakathi kotyando kunye nolunye unyango oluye lwaboniswa kwixesha elide (ngaphezu kweminyaka eyi-2) (7, 10, 11). Izigqibo ezithatyathwe kuthelekiso phakathi kotyando kunye nonyango olungacwangciswanga olungacwangciswanga lusenokuba lulahlekisa. Oku kuye kwaqinisekiswa kuphononongo olucwangcisiweyo, oluye lwagqiba ukuba kukho ubungqina obuphikisanayo malunga nokuba utyando lunenzuzo ngaphezu kokunyamekelwa kokungabikho kokuhlinzwa kokulandelelana kwexesha elifutshane kunye nexesha elide (12).
I-Kinesiophobia iye yahlolwa kwizigulane emva kokuhlinzwa kwe-lumbar disc, kwaye malunga ne-50% yezigulane babalwa njenge-kinesiophobia (13). Ulwazini lwethu lwe-kinesiophobia aluzange luhlolwe kwizigulane ezine-lumbar disc herniation ephathwe ngonyango olumanyelweyo lwe-physiotherapy.
Kukho iindlela ezahlukeneyo zonyango ezingenagqirha kwizigulane ezinentlungu ephantsi sciatica. Enye indlela yokulawula eqhelekileyo yi-Mechanical Diagnosis and Therapy (MDT), eyaziwa ngokuba yindlela kaMcKenzie, ejolise ekupheliseni okanye ukunciphisa intlungu (14). Uphononongo olucwangcisiweyo olusuka kwi-2004 yokusebenza kwe-MDT lubonise ukuba izigulane ezineentlungu ezisezantsi eziphathwayo) nge-MDT zichaze ukuncipha okukhulu, okukhawulezileyo kwiintlungu kunye nokukhubazeka xa kuthelekiswa neziyobisi ezingekho-steroidal anti-inflammatory (NSAIDs), iincwadana zezemfundo, umva. i-massage kunye neengcebiso zokunakekelwa ngasemva, ukuqeqeshwa kwamandla, ukuhlanganiswa komgogodla kunye nokuzivocavoca ngokubanzi (15). Kwilingo elilawulwa ngokungahleliwe kunye nokulandelwa kwe-1 ngonyaka ukusuka kwi-2008, i-Paatelma kunye nabasebenzi abasebenzisana nabo (i-16) bafumanisa ukuba indlela kaMcKenzie yayisebenza ngokukhawuleza xa kuthelekiswa nokunika iingcebiso kuphela kwizigulane ezineentlungu ezisezantsi. Kwizigulane ezineentlungu ezisezantsi, i-sciatica kunye ne-lumbar disc herniation eqinisekisiweyo, nangona kunjalo, ibonakaliswe ukuba iqela elikhethiweyo lezigulane eziphendule kwi-MDT emva kweentsuku ze-5 zonyango nazo zabika ukuba zanelisekile emva kweeveki ze-55 (17) . Izigulana ziqale unyango nje ngeentsuku ezili-12 emva kokuqalisa kweempawu kwaye iziphumo zokuphiliswa ngokuzenzekelayo azinakukhutshwa. Kuthatyathwe kunye, iziphumo zonyango lwe-MDT kwizigulane ezine-lumbar disc herniation eziqinisekisiweyo zibonakala zifuna ukuvavanywa ngakumbi.
I-Trunk stabilization exercises, ejolise ekubuyiseleni ukulawulwa kwemisipha ye-trunk ejulile, isetyenziselwe ukuthintela kunye nokubuyisela intlungu ephantsi (18). Ulingo olulawulwa ngokungahleliwe lubonakalise ukunciphisa ukuphindaphinda kweentlungu ezisezantsi emva kokuzivocavoca kwe-trunk ethile yokuzinzisa xa kuthelekiswa neqela elilawulayo elifumana iingcebiso kunye nokusetyenziswa kweyeza (19). I-Dynamic lumbar stabilization exercises ifunyenwe ukukhulula intlungu kunye nokuphucula umsebenzi kwizigulane eziye zafumana i-microdiscectomy (20). Imiphumo ye-trunk stabilization exercises kudibaniswa ne-MDT, nangona kunjalo, ayizange ifundwe kwizigulane ezine-lumbar disc herniation ezingasebenzisiyo. I-MDT ayifane ikhuthazwe kwizigulane ezine-MRI eqinisekisiweyo ye-lumbar disc herniation kunye ne-annulus yangaphandle eyaphukileyo. Kwisibhedlele sethu, nangona kunjalo, sineminyaka eliqela yamava alungileyo ezonyango indibaniselwano ye-MDT kunye ne-trunk yokuzinzisa imithambo yolu didi lwezigulane. Kulwazi lwethu, akukho sifundo sangaphambili esiye saphanda ukuba ngaba izigulane ezine-lumbar disc herniation ziqinisekiswe yi-MRI, iimpawu ubuncinane kwiiveki ze-6 (ukunciphisa imiphumo yokuphulukiswa ngokuzenzekelayo) kwaye ngubani ofanelekele utyando lwe-disc unokuphucula imodeli yonyango ye-physiotherapy equka i-MDT kunye imithambo yozinzo eqhubela phambili ngokuthe ngcembe. Injongo yolu phononongo yayikukuvavanya imodeli yonyango ye-physiotherapy ehleliweyo kwizigulana ezilungele utyando lwe-lumbar disc.
Ngethuba lexesha lokufakwa kwesifundo, izigulane ze-150, eziye zathunyelwa kwiklinikhi yamathambo kwiSibhedlele saseYunivesithi yaseSahlgrenska, eGothenburg, ukususela ngoNovemba 2003 ukuya kuJanuwari 2008, zachongwa njengabathathi-nxaxheba abanokuthi bathathe inxaxheba ekubeni i-disc herniation iqinisekisiwe nge-MRI. Iikhrayitheriya zokubandakanywa bezi: 18� iminyaka engama-65 ubudala; I-MRI eqinisekisa i-disc herniation echaza iziphumo zeklinikhi; iimpawu ubuncinane kwiiveki ze-6 (ukunciphisa imiphumo yokuphiliswa ngokuzenzekelayo) kunye nokusabalalisa intlungu kunye nokuphazamiseka kwe-neurological concomitant ehambelana nengcambu ye-nerve echaphazelekayo. Iikhrayitheriya zokukhutshwa zaziyi: i-cauda equina syndrome, utyando lwangaphambili lomgogodla, ezinye izifo zomgogodla, ezifana ne-spinal stenosis kunye ne-spondylolisthesis, kunye nomyalelo onganeleyo weSweden. Nangona kunjalo, izigulane ze-70 zazingabandakanywa ngenxa yesisombululo esizenzekelayo seentlungu kunye neempawu. Izigulane ze-80 eziseleyo zadibana neendlela zokubandakanywa kwaye zifanelekile ukuhlinzwa. Oogqirha bamathambo banqume ukuba ngaba izigulane zifanelekile ukuhlinzwa kwe-lumbar disc emva kwe-MRI kunye nokuhlolwa komzimba ngokweengcebiso ze-American Academy of Orthopedic Surgeons kwizigulane ezine-lumbar disc herniation (21).
Ekuqaleni, isifundo sasihlelwe njengolu vavanyo olulawulwa ngokungapheliyo (RCT) phakathi kwendlela yokwenza unyango lwe-physiotherapy kunye nokuhlinzwa, kodwa inani lezigulane alinelanga ukufumana amandla amkelekileyo. Izigulane ezili-18 ze-80 zaqala ukuba zithintela kwi-physiotherapy, izigulane ze-17 zazingenakulinganiswa nokuhlinzwa kwaye izigulane ze-45 zazingavumelani ukuba zenze i-randomization. Amashumi amabini anesibhozo kwezigulane ze-45 ezingavumelani nokungahambi ngokungafaniyo zivunyelwene ukuba zithathe inxaxheba kwonyango olwenziweyo lwe-physiotherapy kwaye izigulane ze-18 zavuma ukuhlinzwa. Ngoko ke isigqibo senziwe kuphela ukuveza iqela lezonyango ze-45 eziphathwe ngokwemiqathango ye-physiotherapytreatment protocol (Fig. 1). Izigulane zanikezwa ngolwazi olubhaliweyo nolubhaliweyo kwaye kwafunyanwa imvume enolwazi. Uphononongo luvunyiwe yiBhodi yokuHlola yoLungileyo.
Ngaphambi kokuba unyango lwe-physiotherapy luqaliswe, izigulane ze-4 zafumana ngokuthe xa zingenako ukuvunyelwa njengabaviwa abavotyiweyo kwaye ngenxa yoko babengabandakanywa kwisifundo. Izigulane ze-41 eziseleyo ziphathwe ngokwemodeli ye-physiotherapy ehlelwe apha kweli phepha.
Iingcali ze-physiotherapists ezintandathu ezineemviwo eziqinisekisiweyo kwi-MDT, oluluviwo ngaphakathi kwengcamango ye-MDT emva kokugqiba iikhosi ze-4 iintsuku ze-4 nganye yokuvavanya nokunyanga izigulane ezineengxaki zomgogodla. Emva kokugqitywa kwezi zifundo, uphando olubanzi lweencwadi kunye nokusebenza ekuvavanyeni nasekuphatheni izigulane kuyadingeka ngaphambi kokuba uvavanyo lugqitywe. I-physiotherapists ebandakanyekayo kwisifundo yayineminyaka eyi-5-20 yamava ekliniki yokunyanga izigulane ezineengxaki ze-back back kunye ne-herniated lumbar disc. Ukuthembeka kwe-inter-examiner yovavanyo lwe-MDT kubonakaliswe ukuba kulungile ukuba umhloli uqeqeshwe kwindlela ye-MDT (22). I-physiotherapists ihlolisise kwaye iphathe izigulane ngexesha leeveki ze-9 (Itheyibhile I). Kwiiveki zokuqala ze-2 zonyango, i-protocol ye-MDT yalandelwa, ngokusekelwe kwiimviwo zeklinikhi zomntu ngamnye kunye neempendulo zeempawu kwizikhundla kunye nokunyakaza, ngenjongo yokunciphisa intlungu kunye nokugxininisa ekulawuleni ukuzilawula (14). Ngethuba leveki yesithathu yonyango, ukuqeqeshwa kwe-trunk stabilization yongezwa kwiprotocol ye-MDT. Injongo yokuzivocavoca kwe-trunk stabilization yayikukuphucula ukulawulwa kwemisipha (23). Umthwalo ophantsi we-muscular unyamezelo wokuziqhelanisa ngokuthe ngcembe wonyuswa ngamandla kumntu ngamnye ngokubhekiselele kwizigulane ezichazwe kwintlungu yomlenze kunye nokulawulwa kwentshukumo kunye nomgangatho. Ngethuba lonyango, izigulane zakhuthazwa ukuba ziqhubeke nokuzilolonga ngokwazo kwindawo yokuzivocavoca, okanye ukwenza olunye uhlobo loqeqesho lomzimba oluzikhethelayo emva kokuba unyango olucwangcisiweyo lwe-physiotherapy luqukunjelwe. Kwiiveki ezine emva kokugqitywa kwexesha le-9-iveki yonyango lwe-physiotherapy, izigulane zaya kutyelelo lokulandelelana kunye ne-physiotherapist eyayibaphatha. Injongo yolu tyelelo ibikukukhuthaza umgangatho ophezulu wokuthotyelwa ngokubhekiselele kuqheliselo oluqhubekayo lokuzinzisa iziqu kunye ne-MDT practice (iThebhile I).
Izigulane zanikezwa ibhetri yeemibuzo zokugqiba. Abahloli abazimeleyo, ababengabandakanyekanga kunyango, bahambisa i mibuzo ngaphambi kokuba unyango (isiseko) kunye ne-3-, 12- kunye ne-24-inyanga yokulandela.
Imilinganiselo yeziphumo eziphambili yayiyintlungu ebuhlungu emlenzeni, ilinganiswe kusetyenziswa i-analogue scale scale (VAS) 0�100 mm (24) kunye ne-Oswestry Disability Index (ODI) 0�100% (25). Inqaku le-0�10 mm kwi-VAS lichazwe njengeentlungu ezingezizo ngokuka-�berg et al. (26). Amanqaku e-ODI e-0�20% achazwa njengokukhubazeka okuncinci okanye akukho, kwaye amanqaku angaphezu kwe-40% achazwe njengokukhubazeka okukhulu (25). Ezi ziphumo eziphambili zisetyenziselwa ukuvavanya emva kokuhlinzwa ngenxa yeentlungu ezisezantsi kunye nokuvavanya izigulane ezine-lumbar disc herniation (27).
Amanyathelo omphumo wesibini aquka ubunzima bentlungu kwi-back rated usebenzisa i-VAS kunye neqondo le-kinesiophobia usebenzisa i-Tampa Scale ye-Kinesiophobia (TSK). Umlinganiselo we-TSK uhluka phakathi kwe-17 kunye ne-68 kunye ne-cut-cut-off ngaphezu kwe-37 ichazwe njengeqondo eliphezulu le-kinesiophobia (28). Umgangatho woBomi obuNxulumene neMpilo (HRQoL) kuMgangatho woBomi waseYurophu kwii-Questionnaires ze-5 Dimensions (EQ-5D) zisetyenzisiwe. I-EQ-5D iquka iinxalenye ze-2, i-EQ-5Dindex isuka kwi-0 ukuya kwi-1.0, apho i-1.0 inempilo efanelekileyo kunye ne-EQ-5DVAS yinqanaba elibonakalayo le-analogue ebonakalayo ukusuka kwi-0 (imeko yempilo embi kakhulu) ukuya kwi-100 (imeko yempilo engcono kakhulu) ( 29). I-Zung Self-Rating Depression Scale (ZDS) isuka kwi-20�80 kwaye isigulane sidangele ngakumbi, amanqaku aphezulu (30). I-Self-Efficacy Scale (SES) isuka kwi-8 ukuya kwi-64, kunye namanqaku aphezulu abonisa iinkolelo ezintle (31) nazo zisetyenziswe. Ubume bomsebenzi balinganiswa kusetyenziswa isikali se-Likert sebakala le-3: ukusebenza ngokusisigxina, ikhefu lokugula elisisigxina kunye nekhefu lokugula lethutyana. Ngokunjalo, ukwaneliseka kwesigulana kunyango kwalinganiswa kwisikali se-Likert se-3-grade; wanelisekile, waneliseka kancinci kwaye awanelisekanga (32). Ezi ziphumo zesibini zeziphumo zivavanya izinto ze-bio-psychosocial ezichazwe njengento ebalulekileyo malunga nokuhlinzwa kwe-lumbar disc (33).
Iziphumo zihanjiswe njengemilinganiselo ephakathi kunye ne-interquartile range (IQR), ngaphandle kobudala, oboniswe njengentetho kunye nokuphambuka okuqhelekileyo (SD). Utshintsho malunga nexesha ngaphakathi kweli qela lihlalutyiweyo kunye novavanyo lwe-Wilcoxon. Ukubaluleka kwesitatisti kwabekwa kwizinga le-alpha ye-0.05.
Impawu ezisisiseko ziboniswa kwiThebhile II. Akukho gulane esetyenziswe ngonyango kwi-3-inyanga yokulandela. Kwi-12-inyanga yokulandelelana, izigulane ze-3 zenze utyando kwaye, emva kokulandela inyanga ye-24, isiguli esongezelelweyo se-1 sasiqhutywe kuyo. Emva kokuhlinzwa, izi gulane ze-4 zazingabandakanywa ekulandeleni okuqhubekayo (umzobo 1).
Khu bazeka. Izigulane zibonise ukuphuculwa okuphawulekayo (p <0.001) kwi-ODI kwi-3-inyanga yokulandelelana xa kuthelekiswa nesiseko. Inqaku eliphakathi (IQR) lehlile ukusuka kwi-42 (27�53) ukuya kwi-14 (8�33). Olu phuculo lusenokubonwa kwiinyanga ze-12 kunye ne-24 (iThebhile III kunye ne-Fig. 2). Kwisiseko, izigulane ezingama-22 zichaze "ukukhubazeka okumandundu (54%) kunye nezigulane ezi-3 zichaze ukuba akukho kukhubazeka. Iqondo lokukhubazeka liye lancipha kwi-3 yenyanga yokulandelelana, njengoko izigulane ze-9 kuphela (22%) zichaze ukukhubazeka okukhulu kwaye i-26 (64%) ibike ukuba akukho kukhubazeka. Kwi-12- kunye ne-24-inyanga yokulandelela kuphela izigulane ze-2 (5%) zichaze ukukhubazeka okukhulu. Kwiinyanga ze-12 zokulandela izigulane ze-26 zisaxela ukuba akukho kukhubazeka, kwaye kwiinyanga ze-24 zokulandela izigulane ze-27 zibike ukuba akukho kukhubazeka.
Intlungu yomlenze. Ukunciphisa okuphawulekayo kwizigulane 'iintlungu zomlenze zifunyenwe kwi-3-inyanga yokulandelelana (p <0.001) kwi-VAS xa kuthelekiswa nesiseko. I-median (IQR) kwi-VAS yehla ukusuka kwi-60 (40�75) ukuya kwi-9 (2�27). Olu phuculo lusenokubonwa kwi-12- kunye ne-24-inyanga yokulandelelana (iThebhile III kunye ne-Fig. 2). Ngaphambi kokuba unyango, zonke izigulane zichaze intlungu yomlenze. Kwiinyanga ezintathu emva kokonyango, i-median kwi-VAS yayingu-9 mm, okt ihlelwe njengentlungu yomlenze (26). Izigulane ezingamashumi amabini anesithathu (56%) zibike ukuba akukho ntlungu yomlenze kwi-3-inyanga yokulandelelana. Kwiinyanga ze-12 zokulandela izigulane ze-22 zibike ukuba akukho ntlungu yomlenze, kwaye emva kweenyanga ze-24 izigulane ze-24 zibika ukuba akukho ntlungu yomlenze.
Umqolo obuhlungu. Ukuphuculwa okubalulekileyo kwintlungu ebuyela emva kwafunyanwa kwi-3-inyanga yokulandela (p <0.001) kwi-VAS xa kuthelekiswa nesiseko. Olu phuculo lusenokubonakala kwi-12 kunye ne-24 yeenyanga (Itheyibhile III). Kwisiseko, abaguli aba-6 (15%) abachazanga zintlungu zangasemva. Kwiinyanga ezintathu emva kokuqala konyango, izigulana ezingama-20 (49%) azichazanga zintlungu.
Kinesiophobia. Idigri ye-kinesiophobia ibonise ukuphucuka okubonakalayo ekulandeleleni kwenyanga ye-3 (p <0.001) kwaye ukuphuculwa kunokubonwa kulo lonke ixesha lokulandela (Itheyibhile III). Phambi konyango, izigulana ezingama-25 (61%) zahlelwa njengabantu abanesifo se-kinesiophobia kunye nezigulana ze-15 (i-37%) ezazingenaso isiyobisi, ngelixa idatha yesigulana esinye yayingekho. Emva kweenyanga ezi-1, izigulana ezili-3 (iipesenti ezingama-15) zazinesifo sokunganyaniseki kwaye ama-37 (ama-26%) ayengenaso nesi sifo. Ukulandelwa kweenyanga ezili-63, inani lezigulana ezine-kinesiophobia zinciphile zaya kwi-12 (4%) (Ikhiwane. 11).
Ubomi obunxulumene nempilo, ukuxinezeleka nokuzimelela. Lonke uvavanyo lwe-4 (i-EQ-5Dindex, i-EQ-5DVAS, i-ZDS kunye ne-SES) lubonise ukuphucuka okubonakalayo ekulandeleleni kwenyanga ye-3 (p <0.001). Olu phuculo lusenokubonakala kwi-12 kunye ne-24 yeenyanga (Itheyibhile III).
Umhlala phantsi wogula. Ekuqaleni, izigulane ezingama-22 (54%) bezikwikhefu lokugula elisisigxina (Itheyibhile IV), xa kuthelekiswa nezigulane eziyi-9 (22%) kulandelelo lweenyanga ezi-3. Ekuqaleni, izigulane ze-14 (34%) zazisebenza ngokusisigxina, xa kuthelekiswa ne-22 (54%) kwi-3-inyanga yokulandelela.
Kwi-3-inyanga yokulandelelana, i-32 (78%) yezigulane ze-41 zaneliswe unyango lwe-physiotherapy. Izigulane ezisixhenxe zazinelisekile kwaye izigulane ze-2 zazinganeliseki. Zombili izigulane ezinganelisekanga zagqitywa kamva. Kwi-2-year-follow-up, inani lezigulane ezinelisekile yi29 (80%) ye-36. Izigulane ezisixhenxe zazingenelisekanga, kodwa akukho namnye ongenelisekanga emva kwonyango olwenziweyo lwe-physiotherapy.
Insight of Dr. Alex Jimenez
I-disc herniation kwi-lumbar spine inokubangela intlungu, ukuphazamiseka kunye nobuthathaka kumqolo ongaphantsi. Ngenxa yobuzaza beempawu, izigulane ezininzi ezifuna ukuthomalalisa iintlungu ezikhawulezayo ziqwalasela utyando. Nangona kunjalo, iindlela ezininzi zonyango ezingasebenzisiyo zinokunceda ukuphucula kunye nokulawula iimpawu ze-disc ze-lumbar herniated.�Imodeli yonyango ye-physiotherapy eyakhiweyo inokubonelela ngokukhawuleza intlungu kwizigulane ezinokuthi zifanelekele ukuhlinzwa kwe-lumbar disc, ngokutsho kwenqaku elilandelayo. Izigulana ezijonge ukunqanda ukuthatha ixesha elide lekhefu lokugula emsebenzini ngenxa yeempawu zazo zinokuzuza kwimodeli yonyango lwephysiotherapy eyakhiweyo. Njengalo naluphi na uhlobo lokulimala kunye / okanye imeko, ukusetyenziswa kolunye ukhetho lonyango kufuneka kuqwalaselwe ngokufanelekileyo ngaphambi kokujika kungenelelo lotyando lokunciphisa intlungu ngokukhawuleza.
Ukufunyanwa kwinqununu kwesi sifundo kukuba izigulane ezifanelekileyo ukuhlinzwa ngecala lumbar ziphuculwe kwiqondo elibalulekileyo kunye neklinikhi eziqhelekileyo kwiinyanga ze-3 emva kokuqala kwonyango olwenziwe ngophethiyotherapy kuzo zonke iimvavanyo: ukukhubazeka, umlenze kunye nentlungu emva, i-kinesiophobia, umgangatho obunxulumene nobomi, ukudandatheka kunye nokuzimelela. Ukuphuculwa kusenokubonakala kwi-2-year-up-up.
Inkqubo yendalo yokuphilisa kufuneka icatshangwe ngokucophelele, ngakumbi xa kuhlolwa iimiphumo zonyango kwizigulane ezine-disc. Iimpawu zihlala zihluka ngexesha elide kwaye ezininzi iilaphu ziphilisa ngokukhawuleza kwaye iimpawu ziphela. Ngokumalunga ne-75% yezigulane ezine-sciatica, ezingenayo i-disc ye-MN-certified certification, ibuye ibuyele kwiinyanga ze-3, kwaye malunga nesithathu kwisigulane sezigulane zifumaneke kwiiveki ze-2 emva kokuqala kwe-sciatica (6). Inkqubo yemvelo ye-sciatica yavanywa kwilingo elilawulwa ngokungapheliyo (34), elifanisa ii-NSAID kunye ne-placebo. Kodwa ke izigulane zihlolwe ngaphakathi kweentsuku ze-14 emva kokuqala kobuhlungu bentlungu. Emva kweenyanga ze-3, i-60% yezigulane sele ifunyenwe kwaye, emva kweenyanga ze-12, i-70% yayifumane. Ukuze kuncitshiswe impembelelo yokuphulukiswa ngokukhawuleza kwisifundo samanje, izigulane zafakwa ke kuphela ukuba zinobuhlungu obuqhubekayo nokukhubazeka ngaphezu kweeveki ze-6. Enyanisweni, uninzi lwezigulane zineentlungu kunye nokukhubazeka kweenyanga ezili-3. Ngoko ke kunokwenzeka ukuba iziphumo zonyango ezibonwe kulolu cwaningo zikhona, kwisigininzi sezigulane, isiphumo somzekelo wonyango lwe-physiotherapy kwaye ayikho imbangela yokuphulukiswa ngokukhawuleza.
Kuphononongo olwenziwe nguWeber et al. (34), i-VAS yomlenze wentlungu ithetha ukuba amanqaku ancitshiswa ukusuka kwi-54 mm kwisiseko ukuya kwi-19 mm kwiiveki ze-4 kuzo zonke izigulane ze-183, kungakhathaliseki ukuba unyango. Emva konyaka we-1, intlungu yomlenze we-VAS ithetha ukuba i-17 mm. Izigulane ezikuphando olukhoyo olubi kakhulu kwisiseko (60 mm) zibike i-9 mm kwintlungu yomlenze we-VAS nje kwiinyanga ze-3 emva kwonyango. Ngenxa yoko, kwisifundo esikhoyo, inqanaba le-VAS eliphakathi sele lincitshiswe phantsi kwe-no-pain score, echazwe njenge-0�10 kwi-VAS (26), kwi-3-inyanga yokulandelelana kwaye oku kwagcinwa kwi-12 - kunye neenyanga ezingama-24 zokulandela.
Unyango lwe-Physiotherapy kwizigulane ezine-lumbar disc herniation zingakhokelela ekuphuculeni. UBr�tz et al. (17) yayiquka iqela elikhethiweyo lezigulane eziphendule nge-centralization yentlungu emva kweeseshoni zokuqala ze-5 zemihla ngemihla yonyango ngokwendlela ye-MDT. I-centralization yentlungu ichazwa njengotshintsho olubangelwa yiklinikhi kwindawo yeentlungu ezibhekiswe kumqolo, ohamba ukusuka kwindawo ekude kakhulu ukuya kwi-lumbar midline (35). Nangona kunjalo, izigulana ubude bexesha eliphakathi leempawu phambi kokuba unyango lube ziintsuku ezili-12 kuphela kwaye amathuba okuba izigulana zichache ngokwemvelo akanakukhutshelwa ngaphandle (17).
Kwisifundo esilandelayo, izigulane ze-95 zaphathwa ngeprogram yokubuyisela ukusebenza (36). Izigulane zafumana uphuculo olubalulekileyo emva kwexesha lokunyanga lonyango lweenyanga ze-8.7. Uvavanyo luye lwaqhutywa kuphela ekukhutsheni. Ngethuba lokunyanga lobude, kunjalo, kunzima ukuhlula phakathi kwemiphumo yonyango kunye nenkqubo yokuphilisa. Kwisifundo samanje, ixesha elincinci lokunyanga laphunyezwa, kwaye ukuphuculwa okukhulu kunye nokubaluleka okukhulu kwafunyanwa emva kweenyanga ze-3 kwaye bebekhona kwi-24-inyanga yokulandela. Ngoko ke akunakwenzeka ukuba inkqubo yokuphulukisa yendalo yayijongene nemiphumo emihle ekufundweni kwangoku.
Kwimeko yokufunda i-82 izigulane ezilandelanayo ezine-sciatica ezinzima, ezibandakanya ukuphathwa ngokuzimeleyo, kuphela iincinci zezigulane zenze i-Retro epheleleyo emva kweenyanga ze-12 (37). Iipesenti ezingamashumi amabini anesithandathu sezigulane zenze utyando ngaphakathi kweenyanga ze-4 kwaye enye yesithathu yahlinzwa ngo-1 ngonyaka. Nangona i-criteria yokungeniswa kweso sifundo ilandele iinqununu zokuhlinzwa (i-21, i-38), akukho nesigulane esadinga ukuhlinzwa kwiinyanga ze-3-emva kweenyanga ze-12, kuphela izigulane ze-3 (7%) bafumana unyango. Ukuchazwa kobugqwetha kunokuba kukuba imodeli yokwelapha ye-physiotherapy esetyenziswe kweso sifundo ibonakala ichaphazela izigulane nge-lumbar disniation in direction. Esinye isiluleko ke ukulandela imodeli yokwelapha ye-physiotherapy ngaphambi kokuqwalasela ukuhlinzwa.
Kulo pho nonongo, ukuqinisekiswa kwe-MRI ye-disniation is discordon inclusion. Kwiinkqubo zonyango, ukuqinisekiswa kwe-MRI akuvumelekanga, njengoko kunonyango kunyango, ngaphambi kokuzisa unyango lwe-physiotherapy olulungileyo kwizigulane ezineempawu ezisuka kwi-disc. Ngenxa yoko, unyango ngokwendlela yokwenza imodeli yokwelapha ye-physiotherapy iqala ngokukhawuleza emva kokuqala kweempawu, njengoko kungadingeki ukuba ulinde i-MRI. Kunokwenzeka ukuba ucacise ukuba, ukuba unyango olunomlinganiselo wesimo se-physiotherapy luqala kwangaphambili kunokuba lufundiswe ngoku, ukuphucula kuya kuba bhetele, kunciphise ngakumbi ingozi yentlungu eqhubekayo kunye neengxaki ezihambayo. Ngaphezu koko, imfuno ye-MRI iyakunciphisa; oku, ke, kufuneka ihlolwe ngakumbi kwiingxelo ezizayo.
Enye inkcazo yeziphumo ezilungileyo zolu pho nonokuthi izigulane zilandele imodeli yokwelapha ye-physiotherapy, equkethe i-MDT kunye ne-trunk yokuzinza ukuzinza, ukuvumela ukuba umntu aziyilo kunye nokuqhubela phambili kwonyango. Iziphumo ezifanayo zichazwe kwisifundo se-retrospective cohort (39) usebenzisa iindlela ezininzi zokhathaza ubuhlungu kunye nokuqeqeshwa koqeqesho kwizigulane nge-lumbar disc. Uvavanyo aluzange lwenzeke malunga neenyanga ze-31 emva kokunyanga. Iziphumo zeSaal et al. (I-39) kunye nokufundwa kweso sifundo ziyavumelana, kwindlela yokwelapha ye-physiotherapy enokuthi inciphise iimpawu, kodwa iimpawu zaxhaswa ngokukhawuleza kakhulu kwisifundo samanje.
Kuphononongo lwe-multicentre olubandakanya izigulane ze-501, i-randomized to surgery or non-operative care, i-18% yezigulane ezinikezelwe unyango olungasebenziyo zahlinzwa kwiiveki ze-6 kwaye i-30% yahlinzwa malunga neenyanga ze-3 (7). Iqela lonyango elingasebenziyo lifumene �ukhathalelo oluqhelekileyo� olungachazwanga, olunokubandakanya iindlela ezahlukeneyo zonyango. Ngokwahlukileyo koko, izigulane kwisifundo esikhoyo zanikwa imodeli yonyango ye-physiotherapy eyakhiweyo ebandakanya zombini i-bio-psychological and social components, njengoko kuchazwe kwi-International Classification of Functioning, Disability and Health (40).
Zininzi iinkcazo ezinokubakho malunga neziphumo ezilungileyo ezibonwe kolu phononongo lwangoku, kwaye ezi-5 kwezi ziya kuxoxwa ngoku. Okokuqala, izigulane zazizi kakuhle malunga nokuyila imodeli yonyango ye-physiotherapy eyakhiweyo, kubandakanywa nethayimthebhile yezigaba ezahlukeneyo zonyango kunye nokuba unyango lucetywe ukuba luphele. Olu lwazi lwaphucula ithuba lezigulane lokuzilawula kwaye lwabanika indima ebonakalayo ekwenzeni izigqibo ngonyango.
Okwesibini, izigulane zifumana izicwangciso zokujongana neentlungu zabo ngokusebenzisa imisebenzi eyahlukeneyo kunye nokunyakaza ukwenzela ukunciphisa intlungu ngokwendlela ye-MDT (14). Indlela ye-MDT ijolise ekwandiseni amandla ezigulane okumelana neempawu, ukukhuthaza isigulana ukuba sithobelane nonyango kwaye sibaxhobise ukuba bafikelele ukuzimela. Leijon et al. (41) baye babonisa ukuba amanqanaba aphantsi enkuthazo kunye neentlungu zizinto ezibalulekileyo eziphucula ukungahambelani nomsebenzi womzimba. Ngoko ke kubonakala kubalulekile ukunciphisa intlungu kunye nokwandisa ukukhuthaza ngokukhawuleza. Kunengqiqo ukukholelwa ukuba, xa izigulane zithatha inxaxheba ekuvavanyeni imisebenzi eyahlukeneyo kunye nokuzivocavoca, oku kwandisa ithuba labo lokufumanisa ukudibanisa phakathi kwemisebenzi kunye nokunciphisa okulandelayo okanye ukwanda kweempawu. Oku bekunokukhokelela ekwandeni kokuzisebenzela kunye nokuxhotyiswa kwezigulana. Ukusetyenziswa kokuxhotyiswa kwi-physiotherapy kuye kwacetyiswa kuhlaziyo lukaPerrault (42), othi ukuxhotyiswa kuphucula ukungenelela.
Okwesithathu, ukuqina kwemithambo kuye kwandiswa ngokuthe ngcembe kumntu ngamnye ngokubhekiselele kwizigulana ezixeliweyo zeentlungu. Injongo ibikukomeleza ukukwazi ukusebenza kwezigulane, okuye kwaphucuka kakhulu kolu phononongo lwangoku. Okwesine, i-trunk stabilization exercises yenziwa ngenjongo yokunyusa ukulawulwa kwemisipha ye-trunk enzulu (23). Kungacingelwa ukuba imiphumo ye-physiological yoqeqesho inokuthi iholele ekunciphiseni intlungu ngokunyuka kwegazi, ukuphumla kwemisipha kunye nokukhululwa kwezinto zokunciphisa intlungu, ezifana ne-endorphins.
Ekugqibeleni, esinye isizathu sokuba uphuculo lube yinto yokuba i-physiotherapists babe namava kwaye bafundiswa ngendlela ye-MDT. Emva koko, i-physiotherapists bakwazi ukukhokela izigulane ngexesha lokuvuselela. Nangona kunjalo, akunakwenzeka ukuchonga ukuba ingaba ziphi na izizathu ezichazwe ngasentla zinegalelo ekuphuculeni. Kubonakala kunengqiqo ukucinga ukuba zonke izinto ze-5 zisebenza.
Kule sifundo, uninzi lwezigulane zineenkwenkwezi zesifo ngaphambi kokuba unyango luqaliswe. Ngethuba leenyanga ze-3 emva kokuba unyango lwe-physiotherapy luqalile, inani lezigulane ezinobunzima bobuhlungu lawa ngokugqithisileyo kwaye uninzi lwezigulane aluzange lube nolwazi lwe-kinesiophobia. Ezi ziphumo ziyavumelana kunye nezifundo zezigulane ezineentlungu ezingapheliyo kunye ne-kinesiophobia ephakamileyo eye yandise izinga labo lomzimba emva kwenkqubo yolawulo lwentlungu eyenzelwe ukunika izigulane ukuphinda ziphinde zisebenze jikelele (43).
Kukho ukukhawulela kwesi sifundo. Akunakwenzeka ukuba ungabandakanyi ithuba lokuba ezinye izigulane zikwazi ukuphucula ngaphandle kwonyango. Amanyathelo athatyathwe ukunciphisa umngcipheko ngokusebenzisa iimpawu ubuncinane ubuncinane kwiiveki ze-6 njenge-criterion yokungena. Kwakhona, uninzi lwezigulane ezineempawu zeenyanga ezili-3. Enye imingcipheko ingabandakanya ukuba ngaba izigulane zikhethwe ngokuchanekileyo kwisifundo. Abagqirha bezilwanyana zonyango abavavanywe ngempilo bavavanya iziphumo zekliniki kunye ne-MRI kwaye bahlula izigulane njengabaviwa abagqityiweyo ngokusekelwe kwiingcebiso ezivela kwi-American Academy ye-Orthopedic Surgeons ukwenzela ukungenelela kwi-disc ye-disc ukushicilelwa kwi-1993 (21). Izigulana ezibandakanyiweyo kwisifundo samanje zizalisekise iziphakamiso njengoko zinikezwa yiBono kunye nabasebenzi be-2006 (38). Ngenxa yoko izigulane zingabonwa njengezilawulwa ngokwazo, kwaye ukuthelekiswa kungenziwa kunye neempawu zokuqala kunye nezigulane ezivela kwezinye izifundo. I-RCT yayiza kuba yindlela efanelekileyo yokuhlola iindlela ezahlukeneyo zonyango; Nangona kunjalo, asizange sifinyelele kwinani lezigulane ezifunekayo kwi-RCT. Njengoko imodeli yonyango esetyenzisiweyo kwiphononongo yangoku ayizange ihlolwe ngaphambili kwiqela lezigulane ezineentlungu ezide, kwaye uninzi lwezigulane zineentlungu ezingaphezu kweenyanga ze-3 ngenxa yokukhutshwa kwe-disc, kwaye njengoko iziphumo zonyango unomdla, kwagqitywa ukuba kuveze iziphumo njengoluhlolisiso lwamaqela.
Ekugqibeleni, olu cwaningo lubonisa ukuba izigulane ezifanelekileyo zokuhlinzwa ngecala lumbar ziphuculwe kakhulu emva kokunyangwa kwindlela yokwakhiwa kwe-physiotherapy, kwangoko kwiinyanga ze-3 emva kokunyanga, kwaye iziphumo zingabonakala kwi-24-inyanga yokulandela. Ngenxa yoko, ezi zigulane azizange zifaneleke ukuhlinzwa kwe-lumbar iinyanga ze-3 emva kokuba unyango lwe-physiotherapy luqale. Ngaphezu koko, uninzi lwezigulane ezineempawu zeenyanga ezili-3 ekuqaleni kwonyango kwaye, ngenxa yoko, ininzi yokuphulukiswa ngokukhawuleza kwakufanele kwenzeke ngaphambi kokuba kuqhutywe isifundo. Ngenxa yoko olu phofu lincoma ukwamkelwa komzekelo wonyango lwe-physiotherapy ngaphambi kokuba uhlolisise ukuhlinzwa xa izigulane zibika iimpawu ezinjengeentlungu kunye nokukhubazeka ngenxa ye-lumbar disc herniation.
Ababhali bangathanda ukubulela i-physiotherapists uPatrik Drevander, uChristina Grund�n, uSofia Frid�n no-Eva Fahlgren ngokunyanga izigulane kunye noValter Sundh ngenkxaso yezibalo. Olu phononongo luxhaswe ngenkxaso-mali evela kwiKomiti yezeMpilo kunye neNkathalelo yezoNyango yoMmandla we-V�stra G�taland, iSiseko seRené Eander's kunye neSiseko seSayensi sikaWilhelm & Martina Lundgren.
Iidiski ze-Herniated zingabangela intlungu, ukuphazamiseka kunye nobuthathaka, iintlobo zeempawu ezinokuthi zihlale zinzima kakhulu, ukuba utyando lunokubonakala ngathi lukhetho kuphela lokukhululeka ngokukhawuleza. Nangona kunjalo, imodeli yonyango ye-physiotherapy eyakhiweyo inokubonelela ngokukhawuleza kwizigulana ezifanelwe utyando lwe-lumbar disc, ngokweziphumo zophando lophando. Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lweBiotechnology (NCBI). Ububanzi bolwazi lwethu bukhawulelwe 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
Intlungu yesikhumba isishalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokwezibalo, ukulimala kwengozi yemoto kunye nokulimala kwe-whiplash zizinye zezona zinto zixhaphake iintlungu phakathi kwabantu bonke. Ngethuba lengozi yengozi, igalelo elizenzekelayo elivela kweso siganeko kunokubangela ukuba intloko nentamo iqhume ngokukhawuleza emva kwanoma iyiphi na indlela, eyonakalise izakhiwo eziyinkimbinkimbi ezungeze umgudu wesibeleko. Ixinzelelo kumathambo kunye nemigqa, kunye neyezinye izicubu entanyeni, kunokubangela iintlungu zentamo kunye nokubonakalisa imiqondiso emzimbeni womntu.
1. Konstantinou K, Dunn KM. Sciatica: ukuhlaziywa kwe-epidemiological
izifundo kunye nokulinganisela kokukhula. Isihlwele (Phila Pa 1976) 2008;
33:2464-2472.
2. U-Nygaard OP, uKloster R, uSolberg T. Ubude bentlungu yomlenze njengoko
ukuqikelela isiphumo emva kokuhlinzwa kwi-lumbar disc herniation:
ukufundelwa kwamanye amaqela kunye no-1-nyaka wokulandela. J Neurosurg
2000; 92: 131-134.
3. I-Orief T, i-Orz Y, i-Attia W, iAlmusrea K. I-resorption ngokukhawuleza
i-disvertebral disc herniation. Yehlabathi Neurosurg
2012; 77: 146-152.
4. UMaigne JY, u-Rime B, uDeligne B. Ulandelelwano lwentengiso yesicatshulwa
Ukufunda iziganeko ezingamashumi amane nesibhozo zokungasebenzi ngokungasebenzi ngokungqinelanayo
i-disc herniation. Umqolo (Phila Pa 1976) 1992; 17: 1071&1074.
5. Takada E, Takahashi M, Shimada K. Imbali yendalo ye disc lumbar
i-hernia enobuhlungu bomlenze obukhulu: iinguqu ze-MRI ezitshintshayo
ubukhulu kunye nokulungelelaniswa neziphumo zeklinikhi. J Orthopaed
Surg (Hong Kong) 2001; 9:1;7.
6. Vroomen PC, iKrom MC, uKnottnerus JA. Ukuqikelela isiphumo
lwe-sciatica kwixesha elifutshane elilandelelweyo. Br J Gen Pract 2002;
52:119-123.
7. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom
B, Skinner JS, et al. Ukuphanda nge-non-treatment treatment for lumbar
idiski yokuhlaselwa: Iziphumo zoMonde weziPhumo zoPhando lovavanyo
(SPORT): ulingo olungenamkhethe. JAMA 2006; 296: 2441�2450.
8. Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW.
Ukunyamekela okuqhubekayo kunye nokuhlinzwa kwangaphambili kwizigulane
i-sciatica ebangelwa i-lumbar disc herniation: iziphumo ezimbini zonyaka
ulingo olulawulwa ngokungakhethiyo. BMJ 2008; 336: 1355�1358.
9. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Ixesha elide
iziphumo zolawulo olugqityiweyo kunye nolawulo lwezonyango lwe-sciatica eyesibili
kwi-lumbar disc herniation: Iziphumo ze-10 ngonyaka ukusuka kumama
isifundo se-lumbar spine. Umqolo (Phila Pa 1976) 2005; 30: 927-935.
10. U-Weber H. Lumbar u-disc. Olawulayo, ozayo
ukufunda kunye neminyaka elishumi yokujonga. Isihlwele (Phila Pa 1976) 1983;
8:131-140.
11. Osterman H, Seitsalo S, Karppinen J, Malmivaara A. Ukusebenza kwe-microdiscectomy kwi-lumbar disc herniation: i-randomized
ilingo elilawulwayo kunye ne-2 iminyaka yokulandelelana. Isihlwele (Phila Pa 1976)
2006; 31: 2409-2414.
12. I-Jacobs WC, iVan Tulder M, UbuGcisa M, uRubinstein SM, iVan Middelkoop
M, Ostelo R, et al. Ukuhlinzwa ngokubhekiselele kulawulo olugcinayo
i-sciatica ngenxa ye-disc lumbar i-herniated disc: uhlaziyo oluchanekileyo. I-eur
Umqolo J 2011; 20: 513�522.
13. Svensson GL, Lundberg M, �stgaard HC, Wendt GK. Iqondo eliphezulu
ye-kinesiophobia emva kokutyunjwa kwe-lumbar disniation: i-crosssectional
uphononongo lwezigulane ezingama-84. Acta Orthop 2011; 82: 732-736.
14. UMcKenzie R, ngoMeyi S. I-lumbar spine: i-diagnosis diagnostic
kunye nonyango. Ngomhla wesi-2. Ushicilelo lweSpinal New Zealand Limited:
EWellington; 2003.
15. Clare HA, Adams R, Maher CG. Ukuphononongwa ngokuchanekileyo kokusebenza
lwe-McKenzie unyango lobuhlungu besisu. U-Aust J I-2004;
50:209-216.
16. Paatelma M, Kilpikoski S, Simonen R, Heinonen A, Alen M, Videman
I-T. Orthopedic yonyango, indlela kaMcKenzie okanye iingcebiso
kuphela ngenxa yentlungu ephantsi kumntu osebenzayo: ilawulwa ngokungenamsebenzi
ulingo olunokulandelela unyaka omnye. J Rehabil Med 2008; 40: 858-863.
17. Br�tz D, Kuker W, Maschke E, Wick W, Dichgans J, Weller M.
I-trial trial of physiotherapy ye-lumbar disk
ukwanda. J Neurol 2003; 250: 746�749.
18. Hodges PW, uMosesley GL. Ubuhlungu kunye nokulawulwa kwemoto ye-lumbopelvic
ummandla: umphumo kunye neendlela ezinokwenzeka. J Electromyogr
Kinesiol 2003; 13: 361-370.
19. Ufihla i-JA, uJull GA, uRichardson CA. Ixesha elide lomsebenzi othile
Ukuzilolonga kwe-episode episode. Isihlwele (Phila
Pa 1976) 2001; 26: E243�E248.
20. Yilmaz F, Yilmaz A, Merdol F, Parlar D, Sahin F, Kuran B. Ukusebenza
kwindlela yokusebenza yokuzinza okuzinzileyo kwi-lumbar microdiscectomy.
J Rehabil Med 2003; 35: 163-167.
21. Nachemson AL. Lumbar disc herniation � izigqibo. Acta Orthop
I-Scand Suppl 1993; 251: 49�50.
22. Kilpikoski S, Airaksinen O, Kankaanpaa M, Leminen P, Videman
T, Alen M. Interexaminer ukuthembeka kokuvavanywa kweentlungu eziphantsi
usebenzisa indlela kaMcKenzie. Isihlwele (Phila Pa 1976) 2002; 27:
E207�E214.
23. Richardson CA, Jull GA. Ukulawula ubuhlungu besisu. Ziziphi iimpawu
ungayalela? Indoda Ther 1995; 1: 2�10.
24. UScott J, u-Huskisson EC. Ukubonakaliswa kwegrafu yentlungu. Ubuhlungu 1976;
2:175-184.
25. Fairbank JC, Couper J, Davies JB, O�Brien JP. I-Oswestry
lemibuzo ekhubazekayo yomva. Physiotherapy 1980; 66:
271-273.
26. �berg B, Enthoven P, Kjellman G, Skargren E. Iintlungu zomqolo
Unonophelo olusisiseko: oza kuhlola ngokubanzi isiphumo sekliniki kwaye
nokusetyenziswa kwezempilo. Adv Physiother 2003; 5: 98.
27. I-Bombardier C. Iziphumo zokuvavanya ukuvavanya unyango
ukuphazamiseka komgulane: isishwankathelo kunye neziphakamiso eziqhelekileyo. Isihlwele
2000; 25: 3100-3103.
28. Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Ukwesaba
intshukumo / (kwakhona) ukulimala kwiintlungu ezingapheliyo zentlungu kunye nokuhambelana kwayo
ukusebenza kokuziphatha. Iintlungu 1995; 62: 363-372.
29. I-EuroQol � iziko elitsha lokulinganisa umgangatho onxulumene nempilo
yobomi. Iqela le-EuroQol. Umgaqo-nkqubo wezeMpilo ka-1990; 16: 199-208.
30. Zung WW. Isilinganiselo sokudakumba kwesistim. Arch Gen Psychiatry
1965; 12: 63-70.
31. Estlander AM, Vanharanta H, Moneta GB, Kaivanto K. Anthropometric
eziguqukayo, iinkolelo zokuzimela, nentlungu kunye nokukhubazeka
Ukulinganisa ukusebenza kwe-isokinetic yezigulana eziphantsi kweentlungu.
Umnqonqo 1994; 19: 941-947.
32. Str�mqvist B, J�nsson B, Fritzell P, H�gg O, Larsson BE, Lind B.
I-Register yeSizwe yaseSweden ye-lumbar ukuhlinzwa: IsiSweden
Umbutho woTyando loMnqonqo. I-Acta Orthop Scand 2001; 72: 99-106.
33. I-Boer JJ, i-Oostendorp RA, ibona uT, uMunkeke M, i-Oerlemans
M, Evers AW. Ukuphononongwa ngokuchanekileyo kwimiba yengozi ye-bio-psychosocial
ngenxa yesiphumo esingathandekiyo emva kokuhlinzwa kwe-lumbar disc. Eur Spine
J 2006; 15: 527-536.
34. Weber H, Holme I, Amlie E. Inkqubo yemvelo ye-acci sciatica
kunye neempawu zengcambu yomnyoba kwi-placebo elawulwa yi-placebo
ilingo livavanya umphumo we-piroxicam. Isihlwele (Phila Pa 1976)
1993; 18: 1433-1438.
35. Werneke M, Hart DL, Cook D. Uphononongo oluchazayo lwendawo
into. Uhlalutyo oluzayo. Isihlwele (Phila Pa
1976) 1999; 24: 676-683.
36. Hahne AJ, Ford JJ, Hinman RS, Taylor NF, Surkitt LD, Walters
AG, et al. Iziphumo kunye neziganeko ezimbi ezivela kwi-physiotherapy
ukubuyiswa komsebenzi we-lumbar disniation kunye nokuhambelana
iradiculopathy. Disabil Rehabil 2011; 33: 1537-1547.
37. UBalague F, uNordin M, uSheikhzadeh A, uEchegoyen AC, uBrisby H,
Hoogewoud HM, et al. Ukubuyiswa kwe-sciatica enzima. Isihlwele (Phila
Pa 1976) 1999; 24: 2516-2524.
38. Bono CM, Wisneski R, Garfin SR. I-Lumbar disc. Ku:
I-Herkowitz HN, i-Garfin SR, u-Eismont FJ, i-Bell GR, iBalderston RA,
abahleli. URothman-Simeone umlenze. 5th ed. Saunders Elsevier:
ePhiladelphia; 2006: iphe. 979'980.
39. Jalisa JA, Saal JS. Ukunganyangeki unyango lwe-lumbar
i-disvertebral disc ne-radiculopathy. Isiphumo sophando. Isihlwele
(Phila Pa 1976) 1989; 14: 431-437.
40. Umbutho WezeMpilo Wehlabathi. Ulwahlulo lwaMazwe ngamazwe lweeNtsebenzo,
Ukukhubazeka kunye neMpilo (ICF). I-2001 [icatshulwe nge2012 Oct 9].
Ifumaneka kwi: www.who.int/classifications/icf/en/.
41. Leijon ME, Faskunger J, uBendtsen P, uFestin K, uNilsen P. Ngubani
ukungabambeleli kwimisebenzi yokufakela, kwaye kutheni? Scand J Prim
Ukhathalelo lwezeMpilo ngo-2011; 29: 234-240.
42. Perreault K. Ukudibanisa ukukhuthaza impilo kunye ne-physiotherapy ephantsi
iintlungu zomqolo: uphononongo. J Rehabil Med 2008; 40: 401�409.
43. Koho P, Orenius T, Kautiainen H, Haanpaa M, Pohjolainen T, Hurri
H. Umbutho wokwesaba ukunyakaza kunye nexesha lokuzonwabisa
umsebenzi phakathi kwezigulane ezineentlungu ezingapheliyo. J Rehabil Med 2011;
43:794-799.
Umgangatho wobuchule wokuSebenza *
Ulwazi olulapha ku "Uncedo olukhawulezayo lweenhlungu ze-Herniated Discs e-El Paso, TX"Akujoliswanga ukuthatha indawo yobudlelwane obubodwa kunye nomntu oqeqeshiweyo wezempilo okanye ugqirha onelayisensi kwaye akusiyo isiluleko sonyango. Sikhuthaza ukuba wenze izigqibo zezempilo ngokusekelwe kuphando lwakho kunye nentsebenziswano kunye nochwepheshe bezempilo abaqeqeshiweyo.
Ulwazi lweBlog kunye neengxoxo zoMda
Umda wethu wolwazi ilinganiselwe kwiChiropractic, i-musculoskeletal, amayeza omzimba, impilo, igalelo le-etiological ukuphazamiseka kwe-viscerosomatic ngaphakathi kweentetho zeklinikhi, ezinxulumene ne-somatovisceral reflex clinical dynamics, i-subluxation complexes, imiba yezempilo ebuthathaka, kunye / okanye amanqaku amayeza asebenzayo, izihloko kunye neengxoxo.
Sibonelela kwaye sibonise intsebenziswano yeklinikhi neengcaphephe kumacandelo ahlukeneyo. Ingcali nganye ilawulwa ngumsebenzi wabo wobugcisa kunye negunya labo lokufumana iphepha-mvume. Sisebenzisa iiprothokholi ezisebenzayo zempilo kunye nempilo entle ukunyanga nokuxhasa ukhathalelo lokwenzakala okanye ukuphazamiseka kwenkqubo ye-musculoskeletal.
Iividiyo zethu, izithuba, izihloko, imixholo, kunye nokuqonda zibandakanya imiba yezonyango, imiba, kunye nezihloko eziyelelene kwaye zixhase ngokuthe ngqo okanye ngokungathanga ngqo umda wokuziqhelanisa wethu.
I-ofisi yethu izamile ngokufanelekileyo ukubonelela ngeengcaphulo ezixhasayo kwaye ichonge uphando olufanelekileyo lophando okanye izifundo ezixhasa izithuba zethu. Sinikezela ngeekopi zophando ezixhasayo ezifumanekayo kwiibhodi ezilawulayo nakuluntu ngesicelo.
Siyaqonda ukuba sigubungela imicimbi efuna inkcazo eyongezelelweyo yokuba inganceda njani kwisicwangciso esithile sokhathalelo okanye inkqubo yonyango; ke, ukuqhubeka nokuxoxa ngombandela ongentla, nceda ukhululeke ukubuza UDkt Alex Jimenez, DC, okanye qha ga mshelana nathi 915-850-0900.
Silapha ukunceda wena kunye nosapho lwakho.
Iintsikelelo
UDkt Alex Jimenez D.C., I-MSACP, RN*, I-CCST, IFMCP*, I-CIFM*, I-ATN*
email: qeqeshi@elpasofunctionalmedicine.com
Ilayisenisi njengoGqirha weChiropractic (DC) kwi Texas & New Mexico*
Texas DC Ilayisensi # TX5807, New Mexico DC Ilayisensi # I-NM-DC2182
Unikwe Ilayisensi njengoMongikazi oBhalisiweyo (RN*) in Florida
Florida License RN Ilayisensi # I-RN9617241 (Nombolo yolawulo. 3558029)
Ubume obubambeneyo: ILayisensi yeeNkcazo ezininzi: Ugunyaziswe Ukuziqhelanisa I-40 States*
UGqr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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