Chiropractic Management of Low Back Pain uye Low-Yakabatana-Yakaenderana Nezvokunyunyuta Kwemutemo: A Literature Synthesis

 

Chiropractic care inonyanyozivikanwa inobatanidza uye imwe nzira yekurapa sarudzo inowanzoshandiswa kuongorora, kubata nekudzivirira kukuvadzwa uye mamiriro ehutachiona uye hutsinye hurumende. Utano hwepamuviri ndehumwe humwe zvikonzero zvinowanzovhiringidza vanhu kutsvaga chiropractic, kunyanya kurwadziwa kwepashure uye sliatica zvikwangwani. Kunyange zvazvo kune marudzi akawanda akasiyana-siyana emishonga inowanika kubatsira kubatsira kuwedzera marwadzo ekurwadziwa uye zviratidzo zve sciatica, vanhu vakawanda vanowanzoda kusarudzwa kwemazuva ese pamusoro pekushandisa zvinodhaka / mishonga kana kupindira kwokuvhiya. Chidzidzo chinotevera chekutsvakurudza chinoratidza urongwa hwehuchapupu-based chiropractic nzira dzokurapa nemigumisiro yavo pakuvandudza zvakasiyana-siyana zvepfungwa dzehutano hwepelinha.

 

ngovepo

 

• Zvinangwa: Chinangwa chegadziriro iyi ndechekuongororazve mabhuku ekushandiswa kwepelinha yekugadzirisa marwadzo ekudzivirira kwepamusoro (LBP).
• Nzira: Asearch strategymodified kubva ku Cochrane Collaboration review forLBP yakaitwa kuburikidza nehuwandu hwemashoko: PubMed, Mantis, uye Cochrane Database. Mikoti yekupa zvinyorwa zvakakodzera yakawedzerwa kune basa kuburikidza nemaparidzi akaparidzirwa evhangeri uye nhepfenyuro. Scientific Commission yeChristian Chiropractic Guidelines uye Practice Parameters (CCGPP) yakapomerwa nekugadzira mabhuku eti syntheses, akarongedzwa neatomical region, kuongorora nekupa ruzivo pamusoro pechipupuriro chechikonzero chechiropractic care. Ichi chinyorwa ndicho chigumisiro chechikwereti ichi. Sezvimwe chikamu chekuita kweCCGPP, zvinyorwa zvekutanga zvezvinyorwa izvi zvakatumirwa paIndaneti yeCCGPP www.ccgpp.org (2006-8) kubvumira nzira yakasununguka uye yakawandisa inogona kuitwa nenzira yevanopindira.
• Results: Zvose zvinyorwa zvepa 887 zvakawanikwa. Mitsva yekutsvaga yakagadziriswa mumapoka ehurukuro akakurumbira sezvinotevera: miedzo yakarongedzwa yakawanda (RCTs) yeLBP uye kushandiswa; miedzo yakarongeka yeimwe nzira dzakabatanidzwa dzeLBP; mirayiridzo; kuongorora kwakarongeka uye meta-kuongorora; sasi inokosha; nyaya dzine chokuita nekuongororwa, nzira; kugadzirisa pfungwa uye nyaya dzepfungwa; mapoka ehurumende nemigumisiro; uye vamwe. Boka roga roga rakagoverwa nenyaya kuitira kuti nhengo dzeboka dzigamuchire zvinenge zvakaenzana nhamba dzezvinyorwa zveboka rimwe nerimwe, rakasarudzwa pamba kuti riparidzirwe. Dare racho rakasarudza kugadzirisa kuongororwa munharaunda iyi yekutanga kutungamira, kuongorora kwakarongeka, meta-kuongorora, RCTs, uye coh ort zvidzidzo. Izvi zvakabhadhara zvikamu zve 12, 64 RCTs, 13 kuongororwa kwakajeka / meta-kuongorora, uye zvidzidzo zveboka re 11.
• Mhedziso: Uchapupu huzhinji kana huripo huripo hwekushandiswa kwepfungwa dzepelinha kuderedza zviratidzo uye kuvandudza basa kune varwere vane chirwere chisingaperi cheLBP sekushandiswa mune zvakajeka uye zvinopesana neLBP. Kushandisa maitiro pamwe chete nekugadzirisa zvinogona kukurumidza uye kuvandudza zvigumisiro pamwe nekuderedza kudzokorora kwepisdic. Ikoko kwakanga kune uchapupu hushoma hwekushandisa kushandiswa kwevatano vane LBP uye kupisa marwadzo emakumbo, sciatica, kana radiculopathy. (J Manipulative Physiol Ther 2008; 31: 659-674)
• Key Indexing Terms: Low Back Pain; Kushushikana; Chiropractic; Spine; Sciatica; Radiculopathy; Kudzokorora, Kurongeka

 

Kanzuru yeChiropractic Guidelines uye Practice Parameter (CCGPP) yakaumbwa mu1995 neCongress yeChiropractic State Associations nerubatsiro kubva kuAmerican Chiropractic Association, Association yeChiropractic Makoreji, Kanzuru yeChiropractic Dzidzo, Federation of Chiropractic Licensing Boards, Foundation yeiyo Kufambira mberi kweChiropractic Sayenzi, Foundation yeChiropractic Dzidzo uye Tsvagiridzo, International Chiropractors Association, National Association yeChiropractic Attorneys, uye National Institute for Chiropractic Research. Iko kubhadharisa kuCCGPP kwaive kugadzira chiropractic kunyatsoita maitiro gwaro. Kanzuru yeChiropractic Guidelines uye Practice Parameter yakapihwa basa kuti iongorore nhungamiro dzese dziripo, parameter, maprotocol, uye maitiro akanakisa muUnited States nedzimwe nyika mukuvakwa kwegwaro iri.

 

Nekupedzisira, Scientific Commission yeCCGPP yakapomerwa kukudziridza mabhuku ekugadzira, yakarongedzwa nenharaunda (mutsipa, pasi pfupi, thoracic, kumusoro uye pasi, mapepa anonyorova) uye zvisiri izvo zvekare zvisingabatsiri, kushandiswa kwekudzivirirwa kwehutano / hutano, huwandu hwevanhu, kugutsikana, uye kuongorora kufungidzira.

 

Chinangwa chebasa iri ndechokupa tsanangudzo yakaenzana yemabhuku kuti awane nzira dzakachengeteka uye dzakagadziriswa dzokurapa mukuchengetwa kwevarwere vane kurwadziwa kwepashure (LBP) uye zvinetso zvakasiyana. Ichi chidimbu cheuchapupu chinotarisirwa kushanda senyanzvi yevashandi kuti vabatsire mukufunga kwezvakasiyana-siyana zvekutarisira kune vakadai. Icho hachisi chokutsiviwa chekutongwa kwechiremba kana nheyo yekutarisira kune mumwe munhu varwere.

 

 

nzira

 

Nzira yekuvandudza yakatungamirirwa nehutano hwemajeri emitemo nehurongwa hwekubvumirana kweRAND, kubatanidzwa kweCochrane, Sangano reHores Health and Policy Research, uye rakabudisa mazano akashandurwa kune zvinodikanwa nekambani.

 

Identification uye Retrieval

 

Nharaunda yemugumo uyu ndeye yeLBP uye zviratidzo zvepamakumbo zvakaderera. Achishandisa tsvakurudzo yebasa uye mabhuku pamusoro pekuongorora maitiro, sarudzo yakasarudza nyaya dzekuongororwa neyikuita.

 

Misoro yakasarudzwa zvichienderana nematambudziko anowanzoonekwa uye ezvinyorwa zvakajairika zvemishonga inoshandiswa nechiropractors kubva pamabhuku. Zvinyorwa zvekudzokorora zvakawanikwa kuburikidza nekutsvakurudza kwemaoko kwezvinyorwa zvakabudiswa uye zveyodhiyabhorosi zvinyorwa, ne rubatsiro kubva kune chiremba chiropractic korejiraibhurari. Nzira yekutsvaga yakagadzirwa, yakavakirwa paChrouraneWorking Group ye Low Back Pain. Ruramisiro yakarongedzwa miedzo (RCTs), kuongorora kwakagadziriswa / meta-kuongorora, nemitemo yakabudiswa kuburikidza ne2006 yakabatanidzwa; mamwe marudzi ose ezvidzidzo akabatanidzwa kuburikidza ne2004. Mikoti yekupa zvinyorwa zvakakodzera yakawedzerwa kune basa kuburikidza nemaparidzi akaparidzirwa evhangeri uye nhepfenyuro. Kutsvaga kwakatarira pane zvinotungamirirwa, meta-kuongorora, kuongororwa kwakagadziriswa, kuongororwa kwemakiriniki emakiromita, kuongororwa kweboka, uye nyaya dzenyaya.

 

Evaluation

 

Zvigadziriswa uye zvakagadziriswa zvinoshandiswa neScottish Intercollegiate Guidelines Network zvakashandiswa kuongorora maRCT uye kuongororwa kwakagadziriswa. Kuti uwane mazano, Kuongorora kweZvirevo zveKutsvakurudza nekugadzirisa chigadzirwa chaishandiswa. Nzira yakagadziridzwa yekuisa simba rehuchapupu yakashandiswa, sezvinotsanangurwa muChifananidzo 1. Dhipatimendi rega rega rega rezvematongerwo enyika rakaronga kuongorora nekuongorora kwehuchapupu.

 

 

Tsvaga tsvakurudzo yakaiswa muzvikwata zvakananga zvedzinotevera sezvizvi: RCTs yeLBP uye kushandiswa; miedzo yakarongeka yeimwe nzira dzakabatanidzwa dzeLBP; mirayiridzo; kuongorora kwakarongeka uye meta-kuongorora; sasi inokosha; zvidzidzo zvekuongorora; methodology; kugadzirisa pfungwa uye nyaya dzepfungwa; mapoka ehurumende nemigumisiro; uye vamwe. Boka roga roga rakagoverwa nenyaya kuitira kuti nhengo dzeboka dzigamuchire zvinenge zvakaenzana nhamba dzezvinyorwa zveboka rimwe nerimwe, rakasarudzwa pamba kuti riparidzirwe. Pachikonzero cheCCGPP yekugadzirisa kwehutano uye huwandu hwebasa huripo, sarudzo yakasarudza kugadzirisa kuongororwa munharaunda iyi yekutanga kune mirayiridzo, kuongororwa kwakarongeka, meta-analyzes, RCTs, nekuongororwa kweboka.

 

Dr. Alex Jimenez's Insight

Kuchengeta chiropractic kunobatsira sei vanhu vane kurwadziwa kwepashure uye sciatica?Sechiropractor ine ruzivo rwehutano hwemhando dzakasiyana-siyana dzehutano hwehutano, kusanganisira kurwadziwa kwepashure uye sciatica, kuchinja kwepelinha uye manzwiro ekunyora, uyewo dzimwe nzira dzisiri dzekusapedza, dzinogona kuve dzakachengetedzwa uye dzakagadziriswa kushandiswa pakuvandudza marwadzo ekudzokera shure zviratidzo. Chinangwa chekutsvakurudza kwekutsvakurudza ndekwekuratidza humwe uchapupu-kubva pamigumisiro yechiropractic mukurapa kwekukuvadzwa nemamiriro ezvinhu emishuloskeletal uye nervous system. Mashoko aya ari munyaya ino anogona kudzidzisa varwere kuti kusarudzwa kupi kwekurapa kunogona kubatsira kuvandudza kurwadziwa kwavo kwepamusoro uye sciatica. Sechiropractor, varwere vanogonawo kutumirwa kune vamwe vashandi vezvehutano, vakadai sekurapa kwepanyama, vashandi vezvemishonga vanoshanda uye vanachiremba, kuti vavabatsire kuti varambe vachirapa marwadzo avo mashoma uye zviratidzo zve sciatica. Chiropractic kuchengetedza inogona kushandiswa kudzivisa kupindira kwokuvhiya kwepfungwa dzehutano hwepfungwa.

 

Migumisiro nekukurukurirana

 

Chimwe chezvinyorwa zvepa 887 zvakatanga kuwanikwa. Izvi zvaisanganisira mitsara ye 12, 64 RCTs, 20 kuongororongedzwa kwakagadziriswa / meta-kuongorora, nekuongororwa kweboka re 12. Tafura 1 inopa chidimbu chechiverengero cheongororo yakaongororwa.

 

 

Kutsigirwa uye Mazano

 

Nzira yekutsvaga inoshandiswa neboka ndiyo yakagadzirwa naVan Tulder et al, uye boka rakaratidza miedzo ye11. Uchapupu hwakanaka hunoratidza kuti varwere vane LBP yakawanda pamubhedha wekurara vane marwadzo akawanda uye zvishoma kudarika kupora kupfuura avo vanogara vakashanda. Hapana musiyano mukurwadziwa uye kushanda kwehutano pakati pekuzorora pamubhedha uye kudzidzira. Kune varwere veSciatica, uchapupu hwakanaka hahuna mutsauko chaiyo mukurwadziwa uye kushanda kwehutano pakati pekuzorora kwevhesi uye kuramba uchishanda. Pane uchapupu hwakanaka hwekusava nehutano mukurwadziwa kwehutano pakati pekuzorora kwebhedha uye physiotherapy asi huri nani huri nani mukushanda. Pakupedzisira, pane musiyano mutsva mukurwadziwa kwekurwadziwa kana kushanda zvakanaka pakati pemazuva mashoma kana nguva refu.

 

Kubvunzurudzwa kweCochrane naHagen et al vakaratidza zvikomborero zviduku munguva pfupi uye kwenguva refu yekugara vachishanda pamubhedha wekuzorora, sezvakaitwa nekudzokorora kwakanaka kweDanish Society of Chiropractic uye Clinical Biomechanics, kusanganisira 4 kuongororongedzwa kwakagadziriswa, 4 yakawedzera RCTS , uye 6 mirayiridzo, paLBP yakawanda uye sciatica. Kubvunzurudzwa kwaChorkrane naHilde et al kunosanganisira miedzo ye4 uye vakapedzisa zvishoma zvingabatsirei zvekugara vachishanda zvakajeka, kusagadzikana kweLBP, asi hapana rubatsiro rwe sciatica. Zvidzidzo zvisere zvekugara zvakashanda uye 10 pamubhedha wezororo zvakabatanidzwa mukuongororwa neboka reWaddell. Mishonga yakawanda yakanga yakabatana nemazano ekuti igare yakashanda uye inosanganisira mishonga yekurapa, chirwere chepanyama, chikoro chekudzoka, uye maitiro ekupa mazano. Mubhedha wakasara weLBP yakaoma yakanga yakafanana nekusava nehutano uye placebo uye zvishoma kudarika pane kushandiswa kwekurapa. Migumisiro inofungidzirwa mukati mezviongorori yaive yehuwandu hwekudzoka, kurwadziwa, maitiro ekuita, nekushanda kwekushanda kwenguva. Kuramba wakashanda kwakawanikwa kuva nemigumisiro yakanaka.

 

Kuongororwa kwezvidzidzo zve4 zvisina kuvharwa kumwe kunzverwa kushandiswa kwemabhurocha / mabhukwana. Maitiro acho aive ekusiyana kwemhedzisiro yemapepa. Chimwe chakasarudzika chakacherechedzwa-kuti avo vakagashira kumanikidza vaive nezviratidzo zvishoma zvinoshungurudza mumavhiki mana uye nekuremara kushoma pamwedzi mitatu kune avo vakagashira kabhuku kaikurudzira kuramba vachishingaira.

 

Mukupfupisa, kuvimbisa varwere kuti vangangodaro vaite zvakanaka uye vachivakurudzira kuti varambe vakashanda uye vasaita zororo kurara ndiyo tsika yakanakisisa yekutungamirirwa kweLBP yakaoma. Bhedha rinosara kwenguva shomanana rinogona kubatsira kune varwere vane marwadzo anokonzerwa nemakumbo avo vari kusinganzwisisiki kuyerwa.

 

Kugadziriswa / Kushandiswa / Kukurudzira Vs Multiple Modalities

 

Ichi chiongororwa chakaongorora mabhuku e-high-velocity, lowamplitude (HVLA) maitiro, anowanzoreva kugadziriswa kana kushandiswa, nekugadzirisa. Nzira dzeHVLA dzinoshandisa nzira yekufambisa inoshandiswa nekukurumidza; kuunganidza kunoshandiswa nenzira yekutengesa. Nzira yeHVLA nekufambisa inogona kuve yakabatsirwa; magetsi anoshandiswa mafungiro anoonekwa seHVLA, uye nzira dzekudzora-kuvhiringidza nzira uye nzira dzinoramba dzichinyatsofambisa dziri munzira.

 

 

Dare rinokurudzira kubvuma kutsvaga kwekugadziriswa kwakarongwa naBronfort et al, nehuwandu hwehutano (QS) hwe88, huchinyora mabhuku kusvika ku2002. Muna 2006, kubatana kweCochrane kwakadzokorora zvakare (2004) kudzokorora kwepalinal manipulative therapy (SMT) yemarwadzo emarwadzo akaitwa naAssendelft et al. Izvi zvakashuma pamusoro pezvidzidzo zve 39 kusvika ku1999, zvakapetwa kazhinji kune izvo zvataurwa naBronfort uye al vachishandisa nzira dzakasiyana-siyana uye rutsva rutsva. Vanoti hapana misiyano pamigumisiro kubva mukurapa nekutengesa nemimwe nzira. Sezvo humwe humwe huwandu hweRCTs hwakanga hwaonekwa mune zvenguva, chikonzero chekudzorerazve kugadziriswa kwekare pasina kubvuma zvidzidzo zvitsva zvakanga zvisina kujeka.

 

Acute LBP. Ikoko kwakanga kune uchapupu hwakajeka hwekuti HVLA iri nani kwenguva pfupi kushanda kupfuura kukurudzira kana kutakura uye uchapupu hushoma hwehupfupi kwenguva shomanana huri nani kudarika maitiro, maitiro, uye ergonomic kugadziriswa.

 

Chronic LBP. Maitiro eHVLA akabatanidzwa nekusimbisa kurovedza muviri aibudirira pakurapa marwadzo seasina steroidal antiinfigueatory akachera nekurovedza muviri. Hufakazi hwakajeka hwakaratidza kuti kumanikidza kuri nani pane kurapa kwemuviri uye kurovedza muviri kumba kudzikisira hurema. Humbowo humbowo hunoratidza kuti kumanikidza kunovandudza mhedzisiro kupfuura kurapwa kwese kana placebo munguva pfupi uye nekurapa kwemuviri munguva refu. Maitiro eHVLA aive nemhedzisiro iri nani pane kurovedza muviri, transcutaneous electrical nerve kukurudzira, traction, kurovedza muviri, placebo uye sham manipulation, kana chemonucleolysis ye disk herniation.

 

Mixed (Acute uye Chronicle) LBP. Hurwitz yakawana kuti HVLA yakanga yakafanana nekurapa kwekutambudzika nekuremara; kuwedzera kurapa kwepanyama kudzvinyirira hakuna kuvandudza migumisiro. Hsieh akasawana kukosha kunokosha kweHVLA pamusoro pekudzoka kuchikoro kana myofascial therapy. Kukosha kwenguva pfupi yekushandura pamapletti uye hapana kusiyana pakati pekugadzirisa uye michina yeMcKenzie yakataurwa naChirkin et al. Meade akasiyana nekugadzirisa nekuchengetwa kwechipatara, kuwana ruzivo rwakanyanya rwekugadzirisa pamusoro penguva pfupi uye kwenguva refu. Doran naNewell vakaona kuti SMT yakaguma nekuvandudza kukuru pane kurapwa kwepanyama kana corsets.

 

Acute LBP

 

Rwere Rwokuenzanisa Kuenzanisa. Seferlis yakawanikwa kuti varwere vanorwara vakarongwa vakanyatsogadzirisa zviratidzo pashure pemwedzi we1 pasinei nekupindira, kusanganisira kushandiswa. Varwere vakanga vakagutsikana uye vakafunga kuti vakapiwa tsanangudzo yakanakisisa pamusoro pekutambudzika kwavo kubva kuvashandi vakashandisa manual therapy (QS, 62.5). Wand et al akaongorora zvirwere zvekurwara-kuzvinyora uye akacherechedza kuti boka rakagamuchira kuongororwa, mazano, uye kurapwa zvakagadziriswa zviri nani pane zvakaitwa neboka kuongororwa, mazano, uye avo vakaiswa pachirongwa chekumirira kweE6-vhiki. Kuvandudza kwakaonekwa mukuremara, hutano huzhinji, hupenyu hwehupenyu, uye mafungiro, kunyange marwadzo nekuremara zvakanga zvisina kusiyana nekureba kwenguva refu (QS, 68.75).

 

Physiologic Therapeutic Modality uye Kudzidzira. Hurley nevamwe vashandi vakaedza zvinokonzerwa nekugadzirisa pamwe chete nehutachiona hwekupindira huenzaniswa nehuwandu hwemagariro chete. Migumisiro yavo yakaratidza mapoka ose e3 akavandudza basa kune chidimbu chakafanana, zvose pamwedzi we6 uye pamwedzi we12 kutevera (QS, 81.25). Kushandisa rimwechete-rakapofumadzwa kuenzanisa kwekuenzanisa kuenzanisa kushandiswa kwekudzikisa uye kushandiswa kwema-electrostimulation, Mwarifrey et al akawana kuti hapana kusiyana pakati pemapoka e2 kusvika ku3-vhiki yekucherechedza nguva yenguva (QS, 19). Muchidzidzo cheRasmussen, zvigumisiro zvakaratidza kuti 94% yevarwere vaibata nekunyengedza kwakanga kusina zviratidzo mukati mezuva re14, zvichienzaniswa ne25% muboka rakagamuchira pfupi-wave diathermy. Simba remuenzaniso rakanga riri duku, zvisinei, uye semugumisiro, chidzidzo chacho chakatsiviwa (QS, 18). Danish chirongwa chekuongorora chakaongororwa 12 mitsva yezvemitemo yemitemo, 12 kuongororwa kwakagadziriswa, uye 10 mishonga yemakiriniki ekuongorora maitiro. Havana kuwana maitiro edzidziso chaiyo, pasinei nokuti rudzi rwakadini, rwakakosha mukurapa kweLBP yakaoma kunze kweMcKenzie kufamba.

 

Sham uye Alternate Manual Method Kufananidza. Kudzidza kwaHadler kwakagadziriswa nemigumisiro yekupa nekucherechedza uye kubatana kwepanyama nekuedza kwekutanga mukunyengedza sham nzira. Varwere vari muboka iro vakapinda mukutongwa pamwe nekurwara kwenguva yakareba pakutanga kwekutanga vakaudzwa kuti vakabatsirwa nekugadzirisa. Saizvozvowo, vakashandura nekukurumidza uye kusvika kune imwe huru (QS, 62.5). Haderi akaratidzira kuti pane chibatsiro chechikamu chimwe chete chekunyengedza zvichienzaniswa nechitendero chekuunganidza (QS, 69). Erhard akaudza kuti mukana wekupindura kwakanaka kumushonga unogadziriswa nechisimba chekudzinga-chengetedze chakange chiri chikuru kudarika nekuwedzera maitiro (QS, 25). Von Buerger akaongorora kushandiswa kwekushandiswa kweLBP yakaoma, achifananidza kushandiswa kwekushandura kune zvinyoro zvinyoro zvemafupa. Akaona kuti boka rekunyengedza rakapindura zviri nani kudarika boka rakapfava boka, kunyange zvazvo zviitiko zvakanyanya kuitika munguva pfupi. Zvigumisiro zvakare zvakakanganiswa nemhando yekumanikidzirwa kusarudzwa kwakawanda pane mafomu e data (QS, 31). Gemmell yakafananidza 2 maitiro ekugadziriswa kweLBP kwemavhiki mashoma anopfuura 6 akareba seizvi: Meric kugadzirisa (fomu yeHVLA) uye Activator mbatya (imwe maitiro anobatsira HVLA). Hapana misiyano yakaonekwa, uye zvose zvakabatsira kuderedza kunetseka kwakanyanya (QS, 37.5). MacDonald yakarondedzera kubhadhara kwenguva pfupi muhutano hwehurema mukati mekutanga 1 kusvika kumavhiki e2 ekutanga kwerapi yeboka rekunyengera rakanyangarika nemavhiki e4 muboka rinodzora (QS, 38). Basa raHoehler, kunyange zvazvo rine mashoko akavhenganiswa nevarwere vane chirwere chakasimba uye chisingaperi chine LBP, rinosanganiswa pano nokuti chikwata chikuru chevarwere vane LBP yakaoma vaibatanidzwa mukudzidza. Kushushikana kwevarwere kunoshuma kuponeswa nokukurumidza kakawanda, asi kwakanga kusina kusiyana pakati pemapoka ekubuda (QS, 25).

 

Mishonga. Kuchengetedza kwakaratidza kuti 50% yeboka rekubiridzira rakanga risina zviratidzo mukati me1 vhiki uye 87% yakabudiswa zviratidzo zvisina kusununguka mumasvondo e3, zvichienzaniswa ne27% ne60%, pamwe chete, yeboka rinodzora (zororo rekurara uye analgesics) (QS , 37.5). Doran naNewell vakafananidza kudzvinyirira, physiotherapy, corset, kana mishonga inoratidzika, kushandisa zvidzidzo zvakaongorora marwadzo nekufamba. Kwakange kusina kusiyana pakati pemapoka panguva. Waterworth kuenzanisa kushandiswa kwechirwere chepodotherapy uye 25 mg yezvipembenene kaviri pazuva pazuva re500. Kushandiswa kwakaratidza kusabatsiri kwehuwandu hwekuwanazve (QS, 10). Blomberg akafananidza kushandiswa kune injini ye-steroid uye neboka rinodzora rinowanzogadzirisa kurapa. Pashure pemwedzi ye62.5, boka rekumanikidzira rakanga risina kubhurwa zvishoma nezvishoma, zvishoma kuderedzwa pamativi ekumusoro-kupfugama kumativi ose maviri, marwadzo emunharaunda mishoma pakuwedzera uye kurudyi, kusanyanya kuderedza marwadzo, uye kusuruvara kwepamusoro pakusimudza mitsetse yakarurama (QS, 4 ). Bronfort haina kuwana misiyano yakasiyana pakati pechiropractic yekuenzaniswa nekuenzaniswa nekurapwa pamwedzi we56.25 wokurapa, asi paive nekuvandudzika kunooneka muboka rechiropractic paZvino 1 uye 3-mwedzi kutevera (QS, 6).

 

Subacute Back Pain

 

Kuramba Uchishanda. Grunnesjo akafananidza zvakabatanidzwa mhedzisiro yekurapa kwemazano nemazano ekuramba uchishingairira kuraira wega kune varwere vane acute uye subacute LBP Kuwedzerwa kwe-- manual therapy kwakaratidza kudzikamisa kurwadziwa nekuremara zvakanyanya kupfuura iyo stay active pfungwa yega (QS, 68.75).

 

Physiologic Therapeutic Modality uye Kudzidzira. Papa akaratidzira kuti kumonyanisa kwakapa kunatsiridzwa kwekurwadziwa kupfuura transcutaneous magetsi etsinga dzinosimudzira (QS 38). Sims-Williams akafananidza kudzvinyirira ne physiotherapy. Mhedzisiro yakaratidza bhenefiti-yenguva pfupi kubatsirwa kwekugadzirisa marwadzo uye kugona kuita basa rakareruka. Misiyano pakati pemapoka yakadzikira pa3 uye 12-mwedzi-yekutevera (QS, 43.75, 35). Skargren et al akafananidza chiropractic kune physiotherapy yevarwere vane LBP avo vasina kurapwa kwemwedzi wapfuura. Hapana misiyano mukuvandudzwa kwehutano, mutengo, kana kudzoka kwemitengo zvakacherechedzwa pakati pemapoka maviri. Nekudaro, zvichibva paOswestry zvikoro, chiropractic yakaita zvirinani kune varwere vairwadziwa isingasviki vhiki rimwe, nepo physiotherapy yaitaridzika kunge iri nani kune avo vairwadziwa kweanopfuura mavhiki e2 (QS, 1).

 

Danish chirongwa chekuongorora chakaongororwa 12 mitsva yezvemitemo yemitemo, 12 kuongororwa kwakagadziriswa, uye 10 mishonga yemakiriniki ekuongorora maitiro. Migumisiro inoratidza kuti kurovedza muviri, kazhinji, kunobatsira varwere vane chirwere chinorwadza chekurwadziwa. Kushandisa purogiramu yekutanga inogona kugadziriswa nyore nyore kusangana nemunhu umwe neumwe wezvirwere zvinokurudzirwa. Nyaya yesimba, kutsungirira, kusimbiswa, nekubatana pasina kunyanya kukwira zvinogona kutariswa pasina kushandiswa kwemichina yakakwirira. Kudzidzisa kwakasimba kune hukuru kupfuura 30 uye zvishoma kudarika maawa 100 ekudzidzira zvinonyanya kubudirira.

 

Sham uye Alternate Manual Method Kufananidza. Hoiriis yakafananidza kushanda kwechiropractic kushandiswa kune placebo / sham ye subacute LBP. Mapoka ese akavandudzwa pamatanho ekurwadziwa, kuremara, kuora mwoyo, uye Global Impression of Severity. Chiropractic manipulation yakawana zviri nani kupfuura placebo pakudzivirira kurwadziwa uye Global Impression of Severity scores (QS, 75). Andersson nevamwe vavo vakafananidza kushandiswa kweasteopathic pakuchengetedza kwakakwana kuvarwere vane subacute LBP, vachiona kuti mapoka acho maviri akavandudzirwa kwemaawa e12 nenguva inenge yakafanana (QS, 50).

 

Mishonga Inofananidzwa. Mune rumwe rutivi rwekurapa ruoko rwekudzidza kwaHoiriis, kushandiswa kwakanaka kwechiropractic kushandura kumusana kwekunonoka kwemuviri weLBP kwakadzidzwa. Mumapoka ose, kurwadziwa, kuremara, kuora mwoyo, uye Global Impression of Severity yakaderera. Chiropractic manipulation yaive yakashanda kupfuura yakasununguka musumbu mukuderedza Global Impression of Severity scores (QS, 75).

 

Chronic LBP

 

Kuramba Kuenzanisa Kwazvo. Aure yakafananidza nzira yekurapa kushandisa mune varwere vane chirwere chisingaperi chine LBP avo vairwara vakarongwa. Kunyange zvazvo mapoka maviri aya akaratidza kuvandudzwa mukurwadziwa kwakanyanya, kushanda kwakakwana, hutano hutano, uye kudzokera kubasa, bhuku remishonga rinoratidzira rakaratidza kuvandudza kukuru pane zvakaitwa neboka rechiito chezviitiko zvose. Zvigumisiro zvaive zvakafanana nezvose zvenguva pfupi uye kwenguva refu (QS, 81.25).

 

Physician Consult / Medical Care / Dzidzo. Niemisto akafananidza kushandiswa kwekutengesa, kugadzirisa maitiro, uye kubvunzurudza kwechiremba kunongororwa chete. Kupindira kwakabatanidzwa kwaive kwakanyatsobatsira mukuderedza kunetseka kwakanyanya nekuremara (QS, 81.25). Koes akafananidza kurapa kwehutano hwekuita kushandiswa, physiotherapy, uye placebo (yakavharwa ultrasound). Miedzo yakagadzirwa pa 3, 6, uye mavhiki e12. Bhuku rekushandura raive nekukurumidza uye kukura kukuru mukushanda kwepanyama zvichifananidzwa nedzimwe mishonga. Kuchinja kumusana wemagunha mumapoka maiva maduku uye kusagadzikana (QS, 68). Mutevedzeri wekutevera, Koes yakawanikwa panguva yeboka rekuongorora kuti kubudirira mune marwadzo kwaive kukuru kune kushandiswa kupfuura kune mamwe marapirwo emwedzi ye12 painofunga nezvevarwere vane zvirwere zvisingaperi, pamwe chete nevaya vaiva vaduku kupfuura makore 40 (QS, 43). Chimwe chidzidzo cheKoes chakaratidza kuti varwere vazhinji vari muchirongwa chekusaporesa mauto vakagamuchira kumwe kutarisirwa munguva yekutevera. Asi, kuvandudzwa kwekunyunyuta kukuru uye mukushanda kwemuviri kwakaramba kuri nani muboka rekutungamirira (QS, 50). Meade akacherechedza kuti chirwere chechiropractic chaive chakabudirira kupfuura chipatara chekuchengetedzwa kwepachipatara, sekuongororwa uchishandiswa Oswestry Scale (QS, 31). RCT yakaitwa muEgipita naRupert yakafananidza kushandiswa kwechiropractic, mushure mekurapa uye chiropractic kuongorora. Njodzi, mberi kufamba, kushingaira, uye gumbo rekusimudza rinosimudza zvose zvakasimudzirwa kusvika kune imwe huru muboka rechiropractic; zvisinei, tsanangudzo yemishonga pamwe nemigumisiro yakasiyana yakanga isinganzwisisiki (QS, 50).

 

Triano yakaenzanisa manotsi ekurapa zvirongwa zvekusingaperi LBP. Pakave nekuvandudza kwakanyanya mukurwadziwa, basa, uye kushivirira kwebasa muboka rekutonga, iro rakaenderera mberi kupfuura 2-vhiki rekurapa nguva (QS, 31).

 

Physiologic Therapeutic Modality. Muedzo wakashata wekubiridzira wakataurwa naGibson (QS, 38). Yakagadziriswa diathermy yakanzi iwane zvirinani mhedzisiro pamusoro pekunyengerera, kunyangwe paive nemisiyano yekutanga pakati pemapoka. Koes akadzidza kubudirira kwekubiridzira, physiotherapy, kurapwa nachiremba mukuru, uye nzvimbo inochengeterwa ultrasound. Ongororo dzakaitwa pa3, 6, uye gumi nemaviri mavhiki. Boka rekunyepedzera rakaratidza kukurumidza uye zvirinani kuvandudza musimba rekugona basa zvichienzaniswa nemamwe marapirwo. Kugadzikana kusiyanisa pakati pemapoka kwanga kusiri kukosha (QS, 12). Mumushumo wekutevera, Koes akawana kuti ongororo yesekisheni yakaratidza kuti kuvandudzwa kwekutambudzika kwaive kwakakura kune avo vaibatwa nekumanikidza, vese kune vadiki (b68) varwere uye avo vane mamiriro asingaperi pamwedzi gumi nemaviri yekutevera (QS, 40) . Kunyangwe varwere vazhinji vari mumapoka asiri ekumanikidza vakagamuchira kumwe kutarisirwa panguva yekutevera, kusimudzira kwakaramba kuri nani muboka rekunyengedza pane muboka rekurapa (QS, 12). Mune mumwe mushumo weboka rimwe chete, pakanga paine kuvandudzwa mune ese ari maviri physiotherapy uye emawoko ekurapa mapoka zvine chekuita nekuomarara kwezvichemo uye wepasirese anoonekwa mhedzisiro achienzaniswa nechengeti wevazhinji; zvisinei, misiyano pakati pemapoka e43 yakanga isina kukosha (QS , 50). Mathews et al vakawana kuti kumanikidza kwakakurumidza kupora kubva kuLBP kupfuura zvaiitwa nekutonga.

 

Ita maitiro. Hemilla akacherechedza kuti SMT yakatungamirira kukura kwemazuva mazhinji uye kwenguva pfupi kuderedzwa kwekuremara kwakaenzana nekurapa kwepanyama kana imba yekuvhima (QS, 63). Chinyorwa chechipiri cheboka rimwechete chakaona kuti hapana kuisa mapfupa kana kuita zvekurovedza muviri kwakasiyana zvikuru nekurapa kwechirwere chekudzivirira zvirwere, kunyange kugadzirisa mafupa kwakabatanidzwa nekuvandudzwa kwekushambadza uye mberi-kupfugama kwepamusoro kupfuura zvekuita (QS, 75). Coxhea akataura kuti HVLA yakapa migumisiro yakanakisisa kana ichienzaniswa nekurovedza muviri, corsets, traction, kana kuti hapana maitiro ekudzidza apo munguva pfupi (QS, 25). Kusiyana neizvi, Herzog yakawana kusanzwisisana pakati pokugadzirisa, kurairidzira, uye dzidzo kumashure mukuderedza kunetseka kana kuremara (QS, 6). Aure yakafananidza nzira yekurapa kushandisa mune varwere vane chirwere chisingaperi cheLBP avo vairwarawo vakarongwa. Kunyange zvazvo mapoka maviri aya akaratidza kuvandudzwa mukurwadziwa kwakanyanya, kuremara kwehutano, uye hutano huzhinji uye kudzokera kubasa, bhuku remishonga rinoratidzira rakaratidza kunatsiridza zvakanyanya kupfuura zvakaitwa neboka rechiito chezviitiko zvose. Ichi chigumisiro chakaramba chiripo kwenguva pfupi uye kwenguva refu (QS, 81.25). Muchikamu cheNiemisto uye vashandi pamwe navo, kubatana kwekubatanidza kushandiswa, kuitisa muviri (kugadzirisa mafomu), uye kubvunzurudza kwechiremba kuenzaniswa nekubvunzurudza chete kwakatsvakurudzwa. Kupindira kwakabatanidzwa kwaive kwakanyatsobatsira mukuderedza kunetseka kwakanyanya nekuremara (QS, 81.25). Sangano reUnited Kingdom Beam rakawana kuti kushandiswa kwakateverwa nemishonga kwakagadziriswa zvakanakira pamwedzi we3 uye mukana muduku pamwedzi we12. Saizvozvowo, kushandiswa kwakagadziriswa kuita zviduku kusvika kuenzanisiro pamwedzi we3 uye zvishoma kubatsiro pamwedzi we12. Kudzidzira woga kwaiva nekodzero duku pamwedzi we3 asi hapana kubatsirwa pamwedzi we12. Lewis et al akawana kuvandudzwa kwakaitika apo varwere vaibatwa nekubatanidzwa kwekubatanidza uye mushure mekugadzikana maitiro anoshandiswa vs kushandiswa kweC10-nzvimbo yekudzidzira chikoro.

 

Danish chirongwa chekuongorora chakaongororwa 12 mitsva yezvemitemo yemitemo, 12 kuongororwa kwakagadziriswa, uye 10 mishonga yemakiriniki ekuongorora maitiro. Migumisiro inoratidza kuti kurovedza muviri, kazhinji, kunobatsira varwere vane chirwere chisingaperi cheLBP. Hapana nzira yakajeka yakakwirira inozivikanwa. Kushandisa purogiramu yekutanga inogona kugadziriswa nyore nyore kusangana nemunhu umwe neumwe wezvirwere zvinokurudzirwa. Nyaya yesimba, kutsungirira, kusimbiswa, nekubatana pasina kunyanya kukwira zvinogona kutariswa pasina kushandiswa kwemichina yakakwirira. Kudzidzisa kwakasimba kune hukuru kupfuura 30 uye zvishoma kudarika maawa 100 ekudzidzira zvinonyanya kubudirira. Varwere vane chirwere chakaremara cheLBP, kusanganisira avo vari kunze kwebasa, vanorapwa zvakanakisisa nehurongwa hwekugadzirisa hutsika huzhinji. Pamusana pokuvhiya kugadziriswa, varwere vanotanga 4 kusvika kumavhiki e6 mushure mekuvhiyiwa kwedhikoni pasi pekudzidziswa kwakasimba vanowana ruzivo rwakakura kudarika zvirongwa zvekuedza.

 

Sham uye dzimwe nzira dzokushandisa. Triano yakawana kuti SMT yakabudisa migumisiro yakanakisisa yekurwadziwa nekuremara kwemazuva mashomanana, kupfuura kunyanya kushandiswa kwe sham (QS, 31). Cote haina kuwana mutsauko pane nguva kana kufananidza mukati kana pakati pekunyengera uye mapoka ekuunganidza (QS, 37.5). Vanyori vakatsanangura kuti kusakwanisa kuona kusiyana kwakadaro kunogona kunge kwakakonzerwa nekuderera kwekutendeuka kushandiswa mune zvishandiso zvinoshandiswa kuAlgometry, pamwe nechekukura kwemuenzaniso. Hsieh haana kuwana kukosha kweHVLA pamusoro pekudzoka kuchikoro kana myofascial therapy (QS, 63). Muchidzidzo cheLiscardone, kuenzaniswa kwakagadzirwa pakati pekudzivirira kweasteopathic (iyo inosanganisira kukurudzira uye nzira dzakapfavedza pamwe chete neHVLA), kushandiswa kwemasimba, uye kusava ne-kupindira kwekutarisira kune varwere vane LBP isingaperi. Mapoka ose akaratidza kuvandudzwa. Sham uye osteopathic kudzvinyirira zvaibatanidza nekuvandudzika kukuru kudarika kuonekwa muboka risina-kushandura, asi hapana misiyano yakaonekwa pakati pemashizha uye mashandisirwo mapoka (QS, 62.5). Zvose zvinotenderera uye zvinangwa zvakaratidzwa zvakaratidza kukurudzira kukuru muboka rekutengesa richienzaniswa nehutungamiri hwemashizha, mumushumo waWagen (QS, 44). Mune basa reKinalski, therapy inopedza nguva yekurapa kwevarwere vane LBP uye concomit intervertebral disk zvipembenene. Apo disk tsvina yakanga isati yasvika, kuderedza muscular hypertonia uye kuwedzera kufambira kwakaratidzwa. Ichi chinyorwa, zvisinei, chakanga chakagadziriswa netsanangudzo yakaipa yevarwere uye nzira (QS, 0).

 

Harrison et al akataura nezvekuedza kusinganzwisisiki kweboka rekuchengetedzwa kwechirwere chechirwere chenguva refu cheLBP chinosanganisira 3-point bending traction yakagadzirirwa kuwedzera kuputika kweganda remberi. Bhuku rekuedza rakagamuchira HVLA yekudzivirira kurwadziwa mukati mevhiki yekutanga ye3 (9 mishonga). Iboka rekutonga harina kugamuchira kurapwa. Kutevedzana pane zvinoreva mavhiki e11 hakuna kuratidza kushanduka mukurwadziwa kana kuvharwa kwehutano hwekutonga asi kuwedzera kukuru mukuputika uye kuderedza marwadzo muboka rekuedza. Avhareji yenhamba yemishonga yekuzadzisa chigumisiro ichi ndeye 36. Nguva yakareba yekutevera pamwedzi we17 yakaratidza kuchengetedza kwezvipo. Hapana nhoroondo yehukama pakati pekuchera makiriniki uye shanduko yehutano yakapiwa.

 

Haas uye vashandi pamwe chete vakaongorora maitiro-mapinduriro ekutengesa kwechirwere chenguva refu yeLBP. Varwere vaigara vachienda kumapoka anogamuchira 1, 2, 3, kana 4 kushanyira kwevhiki kwevhiki dze3, nemigumisiro yakanyorwa nokuda kwekurwadziwa uye kuremara kwebasa. Chiitiko chakakosha uye chechirwere chechirwere chechiropractic pahutano hwekurwadziwa nekuremara pamasvondo e4 zvakabatanidzwa nemapoka anowana mazinga akareba ekuchengetedza (QS, 62.5). Descarreaux et al awedzera basa iri, achibata 2 maduku maduku kwemavhiki e4 (3 dzimwe nguva pavhiki) mushure mekuongorora kwe2 kwekutanga kwevhiki dzakaparadzaniswa nemavhiki e4. Rimwe boka rakadaro rakarapwa masvondo ose e3; mumwe wacho haana. Kunyange zvazvo mapoka maviri aya aiva neAswestry madiki mashoma pamasvondo e12, pamwedzi we10, kuvandudzwa kwakaramba kuripo kune boka re SMT rakakura.

 

Mishonga. Burton nevamwe vaaishanda navo vakaratidza kuti HVLA yakatungamira mukuvandudza kwepfupi-kwenguva mukurwadziwa nekuremara kupfuura zvakaitwa chemonucleolysis yekutonga disk herniation (QS, 38). Bronfort akadzidza SMT inosanganisirwa neyekurovedza muviri vs musanganiswa weasina steroidal antiinfigueatory zvinodhaka uye kurovedza muviri. Mhedzisiro yakafanana yakawanikwa kumapoka ese ari maviri (QS, 81). Kumanikidza zvine simba pamwe ne sclerosant therapy (jekiseni remushonga wakawanda wakagadzirwa ne dextrose-glycerine-phenol) yakafananidzwa neanodzora masimba mashoma akabatanidzwa nemajekiseni esaline, mune ongororo yakaitwa naOngley. Iri boka rinogamuchira kumanikidza zvine simba ne sclerosant rakafamba zvirinani pane rimwe boka, asi mhedzisiro haigone kupatsanurwa pakati pemaitiro echinyorwa uye sclerosant (QS, 87.5). Giles naMuller vakafananidza maitiro eHVLA kumushonga uye kugadzirira. Kugadziriswa kwakaratidza kuwedzera kukuru mukuwandisa kwemarwadzo ekurwadziwa, marwadzo, Oswestry, uye SF-36 zvichienzaniswa nedzimwe nzira mbiri. Kunatsiridza kwakatora gore rimwe chete. Kushaya simba kwekudzidza kwaive kushandisa kweanogadzira-chete ongororo senge chinangwa chekurapa Oswestry, uye Visual Analogue Scale (VAS) yakanga isina kukosha.

 

Sciatica / Radicular / Radiating Leg Pain

 

Kuramba Active / Bed Rest. Postacchini yakadzidza boka rakavhengana revarwere vane LBP, uye uye pasina kupisa marwadzo emakumbo. Varwere vanogona kuenzanisirwa sevakagwinya kana vasingaperi uye vakaongororwa pamasvondo e3, mwedzi 2, uye mwedzi 6 mushure mekunge. Mishonga inosanganisira kushandiswa kwemishonga, drug therapy, physiotherapy, placebo, uye mubhedha wezororo. Kutambudzika kwakadzoka shure kusina mazai uye kusagadzikana kusingaperi kwakapindura zvakanaka nekubata; zvisinei, mune rimwe remamwe mapoka maitiro akashandisa mari pamwe chete nedzimwe nzira (QS, 6).

 

Physician Consult / Medical Care / Dzidzo. Arkuszewski akatarisa varwere vane marwadzo aLumbosacral kana sciatica. Rimwe boka rakagamuchira madhiragi, physiotherapy, uye kuongororwa mabhuku, asi rechipiri yakawedzera kushandiswa. Boka rinogamuchira kurapwa raive nekupfupika kwenguva yekurapa uye kuwedzerwa kwakanyanya. Pachine mwedzi we6 kutevera, boka rekunyengedzera rakaratidza zviri nani neuromotor system function uye unyanzvi huri nani hwokuenderera mberi nebasa. Kuremara kwaive kwakaderera muboka rekunyengera (QS, 18.75).

 

Physiologic Therapeutic Modality. Physiotherapy pamwe chete nekugadzirisa manzwiro uye mishonga yakaongororwa naArkuszewski, zvakasiyana nechinangwa chimwechete nekunyengedzwa kwakawedzerwa, sezvataurwa pamusoro apa. Migumisiro kubva mukugadzirisa kwaive nani pane yeurologic uye motokisi basa pamwe nekuremara (QS, 18.75). Postacchini yakatarisa varwere vane zvirwere zvakaoma kana zvisingagumi zvakaongororwa pamasvondo e3, mwedzi 2, uye mwedzi 6 mushure mekunge. Kushandiswa kwakange kusiri kwakakosha pakuchengeta varwere vane marwadzo erumbo chemakumbo semamwe maoko (QS, 6). Mathews uye vashandi pamwe chete vakaongorora zvirwere zvakawanda zvinosanganisira kushandiswa, kutengesa, kushandiswa kwechirwere, uye epidural injections yemarwadzo ekurwa ne sciatica. Kune varwere vane LBP uye vakadzora mhosho yakananga kuwedzera kuedza, kushandiswa kwakagadziriswa kwakanyanya kununurwa, zvakanyanya kupfuura kupindira kwedzimwe nzira (QS, 19). Coxhead et al vaisanganisira pakati pevatungamiri vavo vanorwara avo vairwara marwadzo kusvika pamasana. Kupindira kwakabatanidza kushungurudza, kushandura, kushandisa muviri, uye corset, uchishandiswa kugadzira zvinyorwa. Mushure memasvondo e4 ekutarisira, kushandiswa kwakaratidza huwandu hwekubatsira pane imwe yezviyero zvinoshandiswa kuongorora kufambira mberi. Pakanga pasina kupesana kwechokwadi pakati pemapoka emwedzi 4 uye mwedzi 16 posttherapy, zvisinei (QS, 25).

 

Ita maitiro. Mune mhaka yeLBP mushure mekuita kwemininectomy, Timm akataura kuti kuitisa kwakapa kubatsirwa zvose nekuda kwekununurwa kwepumusoro uye kushaya mari (QS, 25). Kushandiswa kwakangobatsira chete kuvandudzwa kwezviratidzo kana basa (QS, 25). Muchidzidzo chaCoxhead et al, kupisa marwadzo kusvika pamasana acho kwaive nani pashure pevhiki dze4 dzekutarisira kushandiswa, kusiyana nemamwe mishonga yakanyangarika mwedzi 4 uye 16 mwedzi posttherapy (QS, 25).

 

Sham uye Alternate Manual Method. Siehl akacherechedza kushandiswa kwekushungurudza pasi pehuwandu hweanesthesia kune varwere vane LBP uye unilateral kana kuti nyika inobvisa marwadzo erumbo. Kuvandudza kwechipatara kwekanguva kwekupedzisira kwakaratidzwa apo sarudzo yemagetsi ehupupuriro hwehutano hwemutsipa hwaive huripo. Ne electromyography isina kunaka, kushandiswa kwakaratidzwa kuti kuve nekugadzirisa kwenguva refu (QS, 31.25) Santilli nevamwe vaaishanda vakafananidza HVLA kune zvinyoro zvinyoro zvinyorwa zvisinganzwisisiki zvinokonzerwa nevarwere vane hutano hwakanaka hwemakumbo uye musana. Nzira dzeHVLA dzaive dzakanyanya kubudirira mukudzivirira marwadzo, kusvika pahupenyu husina marwadzo, uye nhamba yemazuva ose nemarwadzo. Zviratidzo zvakasiyana-siyana zvakaonekwa. Nhamba yose yekurapa yakatorwa pa 20 pamuyero we5 nguva pavhiki nekuchengetedza zvichienderana nemarwadzo ekurwadziwa. Kuitevera kwakaratidza kununurwa kupfuurira kuburikidza nemwedzi ye6.

 

Mishonga. Mixed acute uye mushure mekusuruvara kunorwadza nemirairo inobatwa mune imwe shanduro iko kushandisa mazana emishonga ekurapa yakaongororwa pamasvondo e3, mwedzi ye2, uye mwedzi ye6 inotungamirirwa neboka re Postacchini. Mishonga yekurapa yakashanda zviri nani kudarika kushandiswa apo kupisa marwadzo emakumbo kwaivapo (QS, 6). Mukusiyana, nokuda kwebasa reMatews uye vashanda pamwe navo, boka revarwere vane LBP uye rakagadzirirwa mhosho yakananga kuwedzera kuedza yakapindura zvakanyanya kudzvinyirira kupfuura epidural steroid kana sclerosants (QS, 19).

 

Disk Herniation

 

Nwuga akadzidza makumi mashanu neshanu nyaya dzaive dzichiongorora kuti yakadonha intervertebral disk uye ndiani akange aendeswa kunorapwa. Kugadziriswa kunonzi kwakakwirisa pane kurapwa kwakajairika (QS, 51). Zylbergold akawana kuti pakanga pasina misiyano pakati pe12.5 kurapwa lumbar flexion Exercises, kuchengetedza imba, uye kubata. Ipfupi-yenguva yekutevera uye diki saizi saizi yakapihwa nemunyori sehwaro hwekutadza kuramba iyo null hypothesis (QS, 3).

 

kusimbisa muviri

 

Kuita maekisesaizi ndeimwe yemhando dzakanyatsodzidzwa dzekurapa kweakaderera musana matambudziko. Kune nzira dzakawanda dzakasiyana dzekurovedza muviri. Nezve ichi chirevo, zvakakosha chete kusiyanisa multidisciplinary kugadzirisa. Aya mapurogiramu akagadzirirwa varwere vane kunyanya kusingaperi mamiriro ane akakosha matambudziko epfungwa. Ivo vanosanganisira trunk kurovedza muviri, inoshanda basa kudzidziswa kusanganisira basa simulation / kudzidziswa kwehunyanzvi, uye kuraira kwepfungwa.

 

 

Muchiitiko chechangobva kuongororwa cheCchrane pamusoro pekuvhiya kwekusagadzikana kweLBP (QS, 82), kubudirira kwehutano hwekurovedza muvarwere vanorondedzerwa sehupenzi, subacute, uye husingaperi zvakaenzaniswa pasina kurapa uye dzimwe nzira dzokurapa. Migumisiro yaisanganisira kuongorora kurwadziwa, basa, kudzokera kubasa, kusauya, uye / kana kuvandudza kwenyika. Mukuongorora, 61 miedzo yakawana mitemo yekubatanidza, iyo yakawanda inosangana nezvisingagumi (n = 43), asi nhamba shomanana dzakataurirwa zvakanyanya (n = 11) uye subacute (n = 6) marwadzo. Izvo zvipfungwa zvose zvakaitwa sezvizvi:

 

• kurovedza muviri hakusi kushanda sekurapa kweLBP yakaoma,
• uchapupu hwokuti kurovedza muviri kwaibatsira mune vanhu vasingaperi maererano nekufananidza kwakaitwa panguva yekutevera,
• zvinoreva kunatsiridza kweP13.3 pfungwa dzekutambudzika uye 6.9 pfungwa dzebasa dzaionekwa, uye
• kune humwe uchapupu hwekuti basa rekuita-basa-rinoshanda rinobudirira kuti rivecute LBP asi chete mumamiriro ekushanda

 

Kudzokorora kwakaongororwa kuwanda kwevanhu uye kupindira maitiro, pamwe nemigumisiro yekusvika pakugadzirisa kwayo. Kubudisa deta pakudzokera kubasa, kusauya, nekuvandudzika kwenyika yose kwakave kwakaoma zvikuru zvokuti marwadzo uye basa zvinogona kungorondedzerwa.

 

Zvidzidzo zvisere zvakawana zvakanaka pane zvakakosha zvinodiwa. Nezvekutarisirwa kwekliniki, dzakawanda zvemiedzo yakapa ruzivo rwakakwana, ne90% inotaurira vanhu vanoverengera asi 54% chete inotsanangura zvakakwana kushandiswa kwekuita basa. Zviitiko zvinobudirira zvakataurwa muna 70% yematambudziko.

 

Dzidzirai Pure LBP. Pakati pemishumo ye 11 (n n = 1192), 10 yakanga isina kuenzanisa mapoka mapoka. Miedzo yakapa uchapupu hunopesana. Eight mashomanana emhando miedzo yakaratidza kusawirirana pakati pekurovedza muviri uye kutarisirwa kwemazuva ose kana pasina kurapwa. Zvinyorwa zvakanyatsoratidzira zvakaratidza kuti pakanga pasina kupesana mukupererwa kwekunonoka kwepfupi pakati pekuita zvekuita uye kusina kurapwa, hapana misiyano mukutanga kutevera nekuda kwekutambudzika kana ichienzaniswa nezvimwe zvinopindira, uye hapana zvakakosha zvekuvhidzira pamigumisiro inoshanda.

 

Subacute LBP. Mune zvidzidzo zveC6 (n n = 881), 7 maitiro emagetsi aiva neboka risingaenzaniswi boka. Miedzo yakapa migumisiro yakavhengana maererano nehuchapupu hwehubudiriro, nehupupuriro hwakakwana hwekubudirira kwepurogiramu yekuita basa rekuita basa semuongorori chete wekuwana. Dhaleded data haina kuratidza uchapupu kune imwe yekutsigira kana kuramba kushandiswa kwekuita zvekuvhima kwechibharo cheLBP, zvichida nekuderedza marwadzo kana kuvandudza basa.

 

Chronic LBP. Paive nemiyedzo makumi mana nematatu yakasanganisirwa muboka iri (yakazara n = 43). Makumi matatu nematatu ezvidzidzo aive nemapoka ekuenzanisa asina kurovedza. Kuita maekisesaizi kwaive kushanda senge kumwe kupindira kwekuchengetedza kweLBP, uye 3907 zvidzidzo zvepamusoro uye 2 zvidzidzo zvepamusoro zvakaratidza kuti kurovedza muviri kunonyanya kushanda. Izvi zvidzidzo zvakashandisa zvakasarudzika zvirongwa zvekurovedza muviri, zvichitarisa zvakanyanya pakusimbisa kana trunk kudzikama. Paive nemiedzo gumi nemana iyo isina kuwana mutsauko pakati pekurovedza muviri nedzimwe nzira dzekuchengetedza; yeiyi, 9 akaverengwa zvakanyanya uye gumi nemaviri akadzika pasi. Kubatanidza iyo data kwakaratidza kuwedzera kunoreva kwe14 (2% nguva yekuvimba [CI], 12-10.2) anongedzera pane 95-mm marwadzo ekuyera ekurovedza muviri achienzaniswa pasina kurapwa uye 1.31 (19.09% CI, 100- 5.93) mapoinzi achienzaniswa kumwe kurapa kwakachengetedza. Mhedzisiro yekushanda yakaratidzawo kuvandudzwa kunotevera: 95 mapoinzi pakutevera kwekutanga zvichienzaniswa pasina kurapwa (2.21% CI,? 9.65 kusvika 3.0) uye 95 mapoinzi (0.53% CI, 6.48-2.37) zvichienzaniswa nemamwe marapirwo ekuchengetedza.

 

Nzira isina kukodzera yakagadziriswa yakawana kuti mitsva inoongorora kuongororwa kwehutano yevanhu yepamusoro yakanga yakasimudzira kunatsiridza marwadzo nekushanda kwepanyama zvichienzaniswa nemapoka avo ekuenzanisa kana kuti miedzo inowanikwa mumabasa kana vanhu vakawanda.

 

Vanyori vekudzokorora vakapa zvinotevera:

 

1. Muchirevo chakaoma cheLBP, maitiro anonyanya kushanda kupfuura mamwe mazano anobatsira. Meta-analysis haina kuratidza kubatsirika pamusoro pekurapa marwadzo nemigumisiro yebasa pamusoro pfupi kana kwenguva refu.
2. Pane uchapupu hwakanaka hwekubudirira kwesangano rekushandiswa kwemagadhi ekuita basa muSubacute LBP mumiganhu yebasa. Kubudirira kune mamwe maitiro ekurapa maitiro mune vamwe vanhu hakusi pachena.
3. Muzvisingagumi LBP, pane humwe huchapupu hwakanaka hwokuti kurovedza muviri kunogona kunge kwakagadzikana semamwe marapirwo anochengetedza. Zvirongwa zvakasikwa zvakasimbiswa kana kusimbiswa mapurogiramu anoita seanobudirira muzvigadziriro zvehutano. Meta-tsvakurudzo yakawana zviitiko zvinoshanda zvakavandudzwa; zvisinei, migumisiro yacho yaiva duku zvikuru, ine kusiyana kwepakati pe3-point (ye 100) musiyano pakati pekuenzanisa uye mapoka ekuenzanisa pakutevedzana kwokutanga. Migumisiro yemarwadzo yakakonzerwawo zvikuru mumapoka anogamuchira maitiro maererano nezvimwe zvakaenzaniswa, ane chinangwa chemazana e7. Migumisiro yakanga yakafanana nekufamba kwenguva refu, kunyange nguva dzekuvimba dzichiwedzera. Zvinoshandiswa kubudirira mukurwadziwa nekushanda zvinogona kunge zvakakosha mune zvidzidzo kubva kuhutano hwevanhu mune humwe huri nani huri nani huri nani pane hunoonekwa mune zvidzidzo kubva kune vanhu vakawanda kana vakavhengana.

 

Danish boka rekuongorora zvekurovedza muviri rakakwanisa kuona 5 kuongororwa kwakarongeka uye nhungamiro gumi nemaviri dzakakurukura kurovedza muviri kweLBP yakaoma, 12 kuongorora kwakarongeka uye nhungamiro gumi nembiri dzechisimba, uye 1 kuongororwa kwakarongeka uye gumi nematanhatu nhungamiro yezvisingaperi. Uyezve, vakaona 12 yakarongeka yekuongorora iyo yakasarudzika kuongororwa kwemashure ekuvhiya. Mhedziso yainge yakafanana neyaCochrane ongororo, kunze kwekunge paine rutsigiro rwakaringana rweMcKenzie manejimendi kune varwere vane chirwere chakakomba uye nehurongwa hwakanyanya hwekudzoreredza kwemavhiki mana kusvika matanhatu mushure mekuvhiyiwa kwediski pamusoro pezvirongwa zvekureruka.

 

Natural and Treatment History for LBP

 

Zviongorori zvakawanda zvakaratidza kuti inenge hafu yeLBP ichavandudza mukati me1 vhiki, asi inenge 90% yayo ichave yakapera nemavhiki e12. Kunyanya, Dixon akaratidza kuti zvichida sekunge 90% yeLBP ichazvigadzirisa pachayo, pasina kupindira chero chii zvacho. Von Korff akaratidza kuti nhamba yakawanda yevarwere vane LBP yakaoma inenge iine hurombo huripo kana ichitarirwa kusvika kumakore 2.

 

Phillips akawana kuti inenge 4 yevanhu vane 10 ichave neLBP mushure mekuitika kwegore ra 6 kubva pakatanga, kunyange kana kurwadziwa kwepakutanga kwakanyangarika nekuti kupfuura 6 mu 10 ichava neC1 inodzokorora zvakare mugore rekutanga mushure mechiitiko. Izvi zvinotanga kudzoka zvakare mumasvondo e8 kakawanda uye zvinogona kudzokera shure kwenguva, kunyange pakuderedza zvikamu.

 

Vashandi vanokwereta kubhadhara vashandi vakacherechedzwa kwegore re1 kuti vaongorore zviratidzo zvakasimba uye basa. Hafu yevaya vakadzidza yakashaya basa mushure memwedzi wokutanga mushure mekukuvara, asi 30% yakarasikirwa nenguva kubva kubasa nekuda kwekukuvara kwegore re 1. Pakati peavo vakashaya basa mumwedzi wokutanga nekuda kwekukuvara kwavo uye vakange vatokwanisa kudzokera kubasa, anenge anenge 20% akanga asina nguva mushure megore iroro. Izvi zvinoreva kuti kuongorora kudzokera kubasa kumwedzi we1 mushure mekukuvara kunokundikana kupa mhedziso yakatendeseka yezvisingagumi, zvakashata zveLBP. Kunyange zvazvo varwere vakawanda vadzokera kubasa, ivo vachazoona zvinetso zvinoramba zvichienderera mberi uye kusasangana-kushanda kwakabatana. Kuora mwoyo kuripo kune anopfuura mavhiki e12 kumashure kunogona kunge kwakakwirira kudarika izvo zvakambotaurwa mumabhuku, uko mazana e10% anowanzoonekwa. Zvechokwadi, mari yacho inogona kuenda ku3 kusvika ku4 nguva dzakakwirira.

 

Mune chidzidzo chaSchiotzz-Christensen uye vashandi pamwe navo, zvinotevera zvakaonekwa. Nekuda kwezororo rekurwara, LBP ine chirevo chakanaka, ne 50% kudzokera kubasa mukati mekutanga kwemazuva 8 uye chete 2% pazorwere rinorwara mushure me1 gore. Zvisinei, 15% yakanga iri pazororo rekurwara mukati megore rakatevera uye anenge hafu yakaramba ichigunun'una pamusoro pokutambudzika. Izvi zvakaratidza kuti chiitiko chakaoma cheLBP chakakosha zvakakonzera kuti murwere awane kushanyirwa kune mutungamiri mukuru anoteverwa nenguva yakareba yekuremara kwepamusoro-grade kupfuura yakambotaurwa. Uyewo, kunyange kune avo vakadzokera kubasa, kusvika ku16% vakaratidza kuti vakanga vasina kusimbiswa zvakanaka. Mune rumwe ruzivo kutarisa zvinoguma pashure pevhiki dze4 mushure mekutanga kuongororwa uye kurapwa, chete 28% yevarwere havana kumbova nemarwadzo. Zvimwe zvinotyisa, kutsungirira kwemarwadzo kwakasiyana pakati pemapoka ainge aita marwadzo uye avo vasina, ne65% yekare yekunzwa kuvandudzwa pavhiki dze4, vs 82% yekupedzisira. Zvose zvinowanikwa kubva padzidzo iyi zvakasiyana nevamwe kuti 72% yevarwere vakaramba vachinetseka mavhiki e4 mushure mekunge vaongororwa.

 

Hestbaek pamwe nevamwe vakagadzirisa nyaya dzakawanda mumutsoropodzwa wakarongeka. Zvigumisiro zvakaratidza kuti iyo inonzi yakarongwa nevarwere vakaramba vachirwadziwa mushure memwedzi ye12 mushure mokutanga kwaiva 62% pamwero, ne 16% varwere-vakanyorwa mumiriyoni 6 mushure mokunge vatanga, uye ne60% vari kurwarazve kwekusavapo kwebasa. Uyewo, vakawana kuti zvinoreva kuwandisa kweLBP kune varwere vaiva nezvikamu zvekare zveLBP zvaiva 56%, zvichienzaniswa ne22% chete kune avo vasina kumbova nehuwandu hwakadaro. Croft uye vashandi vakaita shanduko yekuongorora vachitarisa zvinogadziriswa neLBP mumutambo wakawanda, vachiona kuti 90% yevarwere vane LBP mukutarisira kwepamusoro vakange varega kubvunzurudza zviratidzo mukati memwedzi ye3; zvisinei, vazhinji vaive vachiri neLBP nekuremara kwegore re1 mushure mekutanga kushanyira. Chengetai 25% yakanga yadzoka zvakakwana mugore iroro iroro.

 

Kune mimwe migumisiro yakasiyana mukudzidza naWahlgren et al. Pano, varwere vakawanda vakaramba vachirwadziwa pamwedzi miviri ye6 uye 12 (78% uye 72%, maererano). Iko 20% chete yemuenzaniso yainge yawana zvizere nemwedzi ye6 uye chete 22% nemwedzi 12.

 

Von Korff akatipa rurefu rwemashoko anoona kuti rakakosha pakuongorora kliniki yemarwadzo ekudzokera shure sezvinotevera: makore, zvepabonde, dzinza, rudzi, dzidzo, basa, kushanduka mumabasa, nzvimbo yebasa, inshurensi yehurema, , kukanganisa / makore pakutanga kutanga kwekunzwa kurwadziwa, kuchema / makore apo kutarisirwa kwakatsvakwa, kuitika kwehutambudzo hwekare shure, nguva yezvino / yakanyanya kuitika mushure mokurwadziwa shure, mazuva ekurwadziwa kwemazuva, kurwadziwa kwemazuva ano, kurwadziwa kwakaipisisa simba, maitiro ekupindira nemabasa, basa rekuregererwa kwemazuva, kuchipatara kuongororwa kwechiitiko ichi, mazuva ekuzorora pamubhedha, kushanda kwemazuva, kukanganisa kwemarwadzo ekudzokera shure, uye nguva yenguva yakareba inopera.

 

Mune chiitiko-chekucherechedza chidzidzo cheHaas et al chavanenge vanenge 3000 vane chirwere chisina kunaka uye chisingagumi chakarapwa nechiropractors uye vanachiremba vanoona nezvekutanga, marwadzo akaonekwa muvarwere vane acute uye vasina kugadzirisa kusvika kusvika ku48 mwedzi mushure mekunyora. Pachine mwedzi ye36, 45% kusvika ku75% yevarwere vakarondedzera mashoma 30 mazuva ekurwadziwa mugore rakapera, uye 19% kusvika ku27% yevarwere vane chirwere chisingaperi vanorangarira kurwadziwa kwezuva nezuva pamusoro pegore rapfuura.

 

Kusiyana kunoitwa mune izvi uye zvimwe zvidzidzo zvakawanda zvinogona kutsanangurwa muchidimbu nekuoma kwekuita kuongororwa kwakakwana, nemasangano akasiyana-siyana akashandiswa mukugadzirisa LBP, nemagadzirirwo emagumisiro akasiyana-siyana anoshandiswa mune imwe neimwe yekudzidza uye nezvimwe zvinhu zvakawanda. Inoratidzawo kuoma kwakanyanya pakuwana kubata pane zuva nezuva kwechokwadi kune avo vane LBP.

 

Nharaunda Dzakasiyana uye Kuyera Kunzwisisa kweLBP

 

Ndezvipi Zviratidzo Zvinokosha Zvokuongorora Nzira Yekutarisira ?. Chimwe chiratidzo chakatsanangurwa pamusoro, icho chiri nhoroondo yechisikigo. Kuomarara uye stratification yengozi zvakakosha, sezvo paine nyaya dzemitengo; zvisinei, mutengo-unoshanda uri pamusoro pechiyero chemushumo uyu.

 

Zvinonzwisisika kuti varwere vane kusagadzikana kweLBP vanovandudza nekukurumidza kune avo vane matambudziko akasiyana-siyana, anokosha kupfuura mamwe ose ari kupisa marwadzo. Zvinhu zvakawanda zvinogona kukonzera marwadzo ekudzokera shure, kusanganisira comorbidity, ergonomic zvinhu, zera, mukana wehutano hwomurwere, zvakatipoteredza, uye pfungwa dzepfungwa. Iyo yekupedzisira iri kugamuchira kunyatsotarisirwa mumabhuku, kunyange zvazvo zvataurwa pane imwe nzvimbo mubhuku rino, kurangarira kwakadaro hakugoni kuve kwakarurama. Chero chezvinhu izvi, chete kana kuti zvakasanganiswa, zvinogona kukanganisa kana kutora nguva yekudzoka mushure mokukuvara.

 

Zvinoratidzika kuti biomechanical zvinhu zvinoita basa rinokosha munharaunda yekutanga-nguva zvikamu zveLBP uye zvinetso zvevarindi vakadai sekushanda kwebasa; Mafungiro epfungwa anonyanya kuitika mune zvikamu zvinotevera zveLBP. Izvo zvinhu zvinokonzerwa nehuomechanical zvinogona kutungamirira kumeso ekubvarura, izvo zvino zvinokonzera marwadzo uye kukwanisa kusagona kwemakore kuti vatevere. Izvi zvinokanganisa mumiviri hazvigone kuonekwa pamifananidzo yakafanana uye zvinogona kungooneka pane kuputika kana kuvhiyiwa.

 

Zvinokonzera njodzi yeLBP zvinosanganisira zvinotevera:

 

• zera, zvepabonde, kuoma kwezviratidzo;
• kuwedzera kwepeminha kugadziriswa, kuderedza musuru kutsungirira;
• kusati kwaitika kukuvadzwa kana kuvhiyiwa;
• kusanganisa kusina kufanana kana kutsika kwemajini;
• kugara kwenguva refu kana kutadza kufamba motokari;
• zvine chokuita nebasa zvakadai sokushanda kwemotokari, mitoro yakachengetedzwa, zvinhu zvokugadzirisa;
• basa renhoroondo uye kugutsikana; and
• mubayiro wemamiriro.

 

IJzelenberg naBurdorf vakacherechedza kana maitiro, maitiro ane chokuita nebasa, kana zvepfungwa zvinokonzerwa nezviitiko zvemasukloskeletal mamiriro ekugadzirisa kushandiswa kwekuchengetwa kwehutano nezororo rekurwara. Vakaona kuti mukati memwedzi ye6, inenge chikamu chetatu chevashandi vebhizimusi vane LBP (kana mitsipa nepamusoro-chinetso matambudziko) vakanga vachidzoka kwezorwere rinorwara kune chinetso ichocho uye 40% kudzokorora kushandiswa kweutano. Zvimwe zvine chokuita nebasa zvinosanganisira zviratidzo zvepishuloskeletal zvakafanana kune izvo zvinobatanidzwa nekushandiswa kweutano uye hosha yekurwara; asi, nokuda kweLBP, kukwegura uye kurarama moga zvakasarudza kana varwere vane matambudziko aya vakatora chero zororo rekurwara. Mwedzi we12 wekuwandisa kweLBP waiva 52%, uye yeavo vane zviratidzo pakutanga, 68% yakanga ichidzoka zvakare neLBP. Jarvik uye vashandi pamwe chete vanowedzera kuora mwoyo sechinhu chinonyanya kukosha cheLBP itsva. Vakawana kushandiswa kweMRI kuva chirevo chakakosha cheLBP kudarika kuora mwoyo.

 

Ndezvipi Zvinokonzera Maitiro Maitiro ?. Zvinyorwa zveKliniki Practice Practice zvakagadzirwa neCanada Chiropractic Association neCanada Federation of Chiropractic Regulatory Boards chinyorwa kuti kune mitezo yakawanda inogona kushandiswa kuratidza kuchinja sechikonzero chekurapa. Izvi zvinofanira kuva zvose zvakavimbika uye zvakavimbika. Maererano nemitemo yeCanada, mitemo yakakodzera inobatsira chiropractic tsika nokuti inokwanisa kuita zvinotevera:

 

• kuongororongedza zvinokonzerwa nekuchengeta kwenguva;
• rubatsiro runoratidza chinangwa chekugadzirisa kurapa;
• afukidze matambudziko ane chokuita nekuchengetedza zvakadai sekusateerera;
• nyanzvi yekuvandudza kune murwere, chiremba, uye vatatu;
• rinoratidza kugadziriswa kwezvinangwa zvekurapa kana zvichidiwa;
• vhura chiitiko chechipatara chechiremba;
• kururamisa rudzi, mazamu, uye nguva yekutarisirwa;
• rubatsiro kupa ruzivo rwekutsvakurudza; and
• anobatsira pakugadza mitemo yekurapwa kwemamiriro ezvinhu chaiwo.

 

Mapoka makuru akazara emigumisiro anosanganisira zvibudi zvinoshanda, zvinokonzererwa nemwoyo murefu, zvibereko zvehupenyu, zviongororwo zvehutano, uye zvinokonzerwa nehutano hwehutano. Chitsauko chino chinongoshanda chete nekushanda uye kushivirira maonero ekuongororwa kunoitwa nemibvunzo nemigumisiro inoshanda inongororwa nemaitiro matsva.

 

Zvitsva zvinoshanda. Aya ndiwo matambudziko anoyera kukanganisa kwemurwere pakuita mabasa ake ezuva nezuva. Chinenge chiri kutaridzirwa ndechekuita kwemamiriro ezvinhu kana chirwere kumurwere (kureva, LBP, iyo inoratidzirwa inogona kunge isipo kana inogoneka) pamwe nemigumisiro yekutarisira. Zvinhu zvakawanda zvakadaro zvinogadziriswa zviripo. Zvimwe zvezvinozivikanwa zviri nani zvinosanganisira zvinotevera:

 

• Roland Morris Dambudziko Rekunyora,
• Oswestry Disability Questionnaire,
• Pain Disability Index,
• Neck Disability Index,
• Waddell Disability Index, uye
• Mamiriyoni ekuremara Mibvunzo.

 

Izvi ndezvimwe zvezvimwe zvishandiswa zvekuongorora basa.

 

Muchikamu cheRCT chinyorwa cheLBP, zvakagadziriswa zvinoshanda zvakaratidzwa kuva mugumisiro unoratidza kuchinja kukuru nekuvandudzika ne SMT. Mabasa ehupenyu hwezuva nezuva, pamwechete nehutano hwekuzvidzivirira hurombo, ndiwo mitsara ye 2 yakaisvonaka yekuratidza kuwedzera kwakadaro. Zvimwe zviitiko zvakakonzerwa zvakanyanya, kusanganisira trunk range yekufamba (ROM) uye kururamisa mitsipa yakarurama.

 

Muchiziro chechiropractic, mitsva yekugadziriswa inoshandiswa kakawanda yeLBP ndeyeRandand Morris Inodhindwa Mibvunzo uye Oswestry Questionnaire. Mune chidzidzo muna 1992, Hsieh akawana kuti zvishandiso zviviri izvi zvakapa migumisiro yakazara pamusoro penzira yekuedzwa kwake, kunyange zvazvo mhinduro kubva kumibvunzo ye 2 yakasiyana.

 

Mwoyo Murefu Pfungwa. Chimwe chinhu chakakosha chezvibereko chinosanganisira kurwara kwekunzwisisa marwadzo uye kugutsikana kwavo nehanya. Ikutanga inosanganisira kuenzanisa kuchinja mukurwadziwa kunzwisisika pane nguva yekuwedzera kwayo, nguva, uye nguva. Pane huwandu hwemashandisirwo anobudirira anowanikwa anogona kuita izvi, kusanganisira zvinotevera:

 

Analog visual scale this ndeye 10-cm mutsetse uyo une marondedzero ekurwadziwa anoonekwa kumagumo ese emutsara uyo unomiririra hapana kurwadziwa kune kurwadziwa kusingatsungiririki; murwere anobvunzwa kutara poindi pamutsara uyo unoratidza kwavo kurwadziwa kwakanyanya. Kune misiyano yakati wandei yemhedzisiro iyi, kusanganisira iyo Numerical Rating Scale (apo murwere anopa nhamba iri pakati pe0 ne10 kumiririra huwandu hwehurombo hwavanazvo) uye mashandisirwo emazinga ekurwadziwa kubva pa0 kusvika gumi anoratidzwa mifananidzo mumabhokisi, izvo izvo murwere anogona kutarisa. Zvese izvi zvinoita kunge zvakavimbika zvakaenzana, asi kuitira nyore kushandisa, ingave yakajairwa VAS kana Numerical Rating Scale inowanzo shandiswa.

 

Dhayari dhayi Painaaya anogona kushandiswa kubatsira kutarisa akasiyana akasiyana marwadzo akasiyana (semuenzaniso, kuwanda, uko iyo VAS isingakwanise kuyera). Mafomu akasiyana anogona kushandiswa kuunganidza iyi ruzivo, asi inowanzo pedziswa zuva nezuva.

 

McGill Pain Questionnaire ichi chiyero chinobatsira kuyera akati wandei zvepfungwa zvikamu zvekurwadziwa zvinotevera: kuziva-kuongorora, kukurudzira-kukurudzira, uye kusarura kwekunzwa. Muchiridzwa ichi, pane zvikamu makumi maviri zvemazwi anotsanangura mhando yemarwadzo. Kubva pamhedzisiro, 20 akasiyana marwadzo akasiyana anogona kutemerwa.

 

Zvose zvezviridzwa zviri pamusoro zvakashandiswa panguva dzakasiyana-siyana kuti zviongorore kufambira mberi kwekurapa kwekunzwa kurwadziwa ne SMT.

 

Kugutsikana kwekushivirira kunotarisa zvose zvinobudirira zvekutarisirwa uyewo nzira yekugamuchira izvozvo. Kune nzira dzakawanda dzekuongorora kugutsikana kwechigarire, uye kwete dzose dzacho dzakagadzirirwa kushandiswa zvakananga kuLBP kana kushandiswa. Zvisinei, Deyo akaumba imwe yekushandisa neLBP. Chimbo chake chinotsvaga kubudirira kwekutarisira, ruzivo, uye kutarisira. Pano panewo Mibvunzo Yekugutsikana Kwevarwere, iyo inoongorora 8 dzakasiyana-siyana (zvakadai sekubudirira / zvibereko kana unyanzvi hwemhizha, somuenzaniso). Cherkin akacherechedza kuti Mubvunzo Wekushanyirwa Kunosangana Nekushanya unogona kushandiswa mukuongorora kwechiropractic.

 

Basa rapfupi rakaratidza kuti kuvimba kwegariro nekugutsikana nehanya kwakabatana nemigumisiro. Seferlis yakawana kuti varwere vakanga vakagutsikana uye vakafunga kuti vakapiwa tsanangudzo yakanakisisa pamusoro pekutambudzika kwavo kubva kuvashandi vakashandisa manotsi ekurapa. Pasinei nekurapwa, varwere vakagutsikana zvikuru pamasvondo e4 vainge vakanyanya kudarika varwere vasati vagutsikana kuti vaone kukura kwekurwisana kukuru mumwedzi we18 kutevera mukudzidza naHerwitz et al. Goldstein naMorgenstern vakawana kushamwaridzana kusina simba pakati pehutano hwekurapa muhutano hwavakawana nekuvandudzwa kweLBP. Kungoti nguva dzose zvinowanikwa zvinobva mukushandiswa kwekugadzirisa nzira ndezvikonzero zvechiremba kutarisa nekubata. Zvidzidzo zvakananga kuedza izvi zvinokonzerwa naHadler et al mune varwere vane chirwere chakanyanya uye naTrano et al mune varwere vane chirwere chisingaperi uye chisingaperi. Zvose zvidzidzo zvakaenzanisa kushandiswa kugadziriswa kwe placebo. Muchidzidzo cheHadler, kutarisa kwakatarisa kwekupa nguva nguva yekucherechedza uye kuwandisa, asi Triano et al zvakare vakawedzera purogiramu yezvidzidzo neimba yekuita mazano. Muzviitiko zvose izvi, migumisiro yakaratidza kuti kunyange kunyatsopiwa kune varwere kwaibatanidza nekuvandudzika kwemazuva, varwere vanowana kugadzirisa nzira dzinovandudzwa nekukurumidza.

 

Nheyo Dzezvirongwa Zvehutano Hwehutano. Izvi zvave zvichange zviri mamiriro akaoma kusvika pakugadzirisa zviyero asi humwe huwandu hwezvinhu zvenguva ichangopfuura huri kuratidza kuti hunogona kuitwa nekuvimbika. Iyo midziyo ye 2 huru yekuita saizvozvo ndiyo Kurwara Impact Profile uye SF-36. Ikokutanga kuongorora zviyero zvakadai sokufamba, kufungidzira, kupumha, basa, kushamwaridzana kwevanhu, nezvimwe zvakadaro; iyo yechipiri inotarisa zvikuru kunyanya, kuva nemamiriro ezvinhu, uye hutano hwakakwana, uyewo humwe hutano hwehutano hwe8, pakupedzisira hutsanangurira zvikwangwani zveC8 zvinogona kushandiswa kutsvaga hutano hwehupenyu hwose. Zvinhu zviri pano zvinosanganisira kushanda muviri, hutano hwevanhu, utano hwepfungwa, nevamwe. Iri shandisi rave rakashandiswa mumiganhu yakawanda uye rakagadziriswa kuva mafupi mafomu zvakare.

 

Physiologic Mhinduro Miedzo. Basa rechiropractic rine zviitiko zvakasiyana-siyana zve physiologic izvo zvinoshandiswa maererano nehutano hwekuita sarudzo. Izvi zvinosanganisira nzira dzakadai sokuenzanisa ROM, kusvibiswa kwemaviri, palpation, radiography, uye dzimwe nzira dzisina kufanana (mutsindo wekuyera, thermography, nevamwe). Ichi chitsauko chinongotaura chete zviitiko zve physiologic zvinongororwa nemunhu.

 

Range of Motion. Iyi nzira yekuongororwa inoshandiswa nechinenge chichiraira zvose uye inoshandiswa kuongorora kuora mwoyo nokuti yakabatana nemusana wemagunha. Zvinokwanisika kushandisa ROM senzira yekucherechedza kubudirira kwebasa pane nguva uye, naizvozvo, kubudirira sezvo ichienderana nekushandiswa kwe SMT. Mumwe anogona kuongorora nzvimbo uye pasi rose lumbar kufamba, somuenzaniso, uye shandisa icho sechimwe chiratidzo chekuvandudza.

 

Range yekufamba inogona kuyerwa kuburikidza nenzira dzakasiyana siyana. Mumwe anogona kushandisa goniometers yakawanda, inclinometers, uye zvigadzirwa zvakanyanyisa zvinoda kushandiswa kwemichina yakakwana nemakombiyuta. Kana uchidaro, zvakakosha kufunga nezvekuvimbika kwemunhu mumwe nomumwe nzira. Tsvakurudzo dzinoverengeka dzakaongorora maitiro akasiyana-siyana sezvinotevera:

 

• Zachman akawana kushandiswa kwemavaraometer zvinyatsovimbika,
• Nansel inowanikwa kuti kushandisa 5 zviyero zvinokonzerwa nekervical spine motion neine chidimbu chinogona kuvimbika,
• Liebenson akawana kuti shanduro yeSchrober yakashandurwa, pamwe chete nemaklinometers uye mafashoni evatongi vepelinha vaiva nerutsigiro rwakanakisisa kubva mumabhuku,
• Triano uye Schultz vakawana kuti ROM yeiyo, pamwe chete nesimba rakaita simba uye basa remyoelectrical, yakanga iri chiratidzo chekuremara kweLBP, uye
• tsvakurudzo dzinoverengeka dzakawana kuti chimiro chechimiro cheROM chekufamba kwepamuviri chiri chechokwadi.

 

Tsvina Inoshanda. Kuongorora misumbu inogona kuitwa kuburikidza nehutachiona hwemagetsi kana nenzira yekushandisa. Kunyange zvazvo maitiro ekuongorora maitiro eve maitiro akajairika ekuzivikanwa mukati mebasa rechiropractic, pane zvidzidzo zvishomanana zvinoratidzira kuvimbika kwechiremba kwekugadzirisa, uye izvi hazvirevi kuti ndezvokukwirira.

 

Maitiro akazvimirira anowedzera kuvimbika uye anokwanisa kuongorora masimeter parameters se simba, simba, kutsungirira, nebasa, uyewo kuongorora nzira dzakasiyana dzemusanganiswa mutsvuku (isotonic, isometric, isokinetic). Hsieh akawana kuti nzira yakagadziriswa nevarwere yakashanda zvakanaka mumasanganisi chaiwo, uye zvimwe zvidzidzo zvakaratidza dynamometer kuti igare yakavimbika.

 

Nhemberero yakakura kusaenzana. Zvishoma zvidzidzo zvemakumbo akareba zvakaratidza maitiro anogamuchirwa okuvimbika. Nzira dzakanakisisa dzekuongorora kutendeseka nekugadzirisa kwerutsoka rurefu dzinoshandisa nzira dzemaitiro uye saka dzinotarisana nehuwandu hwemisaisai eononi. Pakupedzisira, chirongwa chacho hachina kuongororwa sekutendeseka, zvichiita kushandiswa kweizvi sechiitiko chinopokana.

 

Soft Tissue Compliance. Kuteerera kunoongororwa nemabhuku maviri uye magetsi, kushandisa ruoko chete kana kushandisa chigadzirwa chakadai se algometer. Nokuongorora kuiteerera, chiropractor iri kutarisa kuongorora mutsara weutsi.

 

Maedzo ekutanga ekuteverwa naLawson akaratidza kuti akavimbika. Fisher yakawana kuwedzerwa kwezvinyorwa zvekutevedzera zvidzidzo zvinoshandiswa mukurapa. Waldorf akawana kuti kutenderera kwemavara kwakagadzikana kwakave kwakanaka kwekuedza / retest zvakasiyana-siyana zvishoma pane 10%.

 

Kushivirira kwekurwadziwa kunoongororwa uchishandisa nzira idzi kwawanikwa kwakavimbika, uye Vernon akawana iri nzira inobatsira pakuongorora remushonga wechibereko paraspinal musculature mushure mekugadzirisa. Boka renhungamiro kubva kuCanada Chiropractic Association uye neCanada Federation yeChiropractic Regulatory Boards yakagumisa kuti zviongorori zvakachengeteka uye zvisingadhuri uye zvinoita kunge zvinopindura mamiriro uye marapirwo anowanzoonekwa muchiropractic maitiro.

 

 

mhedziso

 

Kutsvakurudza kuripo kune uchapupu pamusoro pekubatsira kwepelinha kuchinja / kushandiswa / kuunganidza kunoratidza zvinotevera:

 

1. Uchapupu hwakawanda kana huzhinji huripo hwekushandiswa kwe SMT kuderedza zviratidzo uye kuvandudza basa kune varwere vane chirwere chisingaperi chine LBP sekushandiswa mune zvakajeka uye zvinopesana neLBP.
2. Kushandisa maitiro pamwe chete nekugadzirisa zvinogona kukurumidzira nekuvandudza zvigumisiro pamwe nekuderedza kudzoka kwepisdic.
3. Ikoko kwakanga kune uchapupu hushoma hwekushandisa kushandiswa kwevatano vane LBP uye kupisa marwadzo emakumbo, sciatica, kana radiculopathy.
4. Nyaya dzine kukwirira kwakanyanya kwezviratidzo zvinogona kubatsirwa nokuendeswa kunotora zviratidzo nemishonga.
5. Ikoko kwakanga kune uchapupu hushoma hwekushandiswa kwekushandiswa kwemamwe mamiriro ezvinhu anokonzera kumucheto kumashure uye zvishoma zvinyorwa zvinotsigira chikwata chepamusoro.

 

Kudzidzira muviri uye kuvimbisa zvakaratidzirwa kuve kwekukosha zvakanyanya mune isingagumi LBP uye yakaderera kumashure matambudziko ane hukama neakanyanya zviratidzo. Zviverengero zvakaenzana, zvakagadziriswa maturusi zviripo kubatsira kubatsira kutora zvine mutsigo kiriniki kuvandudza pamusoro penzira yekudzikira kumashure kurapwa. Kazhinji, kugadzirisa mashandiro (zvichipesana nezviri nyore kuderedzwa kudzikira kwemarwadzo ekurwadziwa) kunogona kuve kwakakosha kuchipatara yekutarisa mhinduro kumatarisiro. Iwo mabhuku akaongororwa anoramba ari mashoma mukufungidzira mhinduro kutarisiro, kugadzirisa mamwe masanganiswa eanopindira marimendi (kunyangwe iko kusanganisa kwekumanikidza uye kurovedza muviri kungave kuri nani pane kurovedza muviri wega), kana kuumba mamiriro-akasarudzika ekukurudzira kwehuwandu uye -kudzikisira kweanopindira. Tafura 2 inopfupisa kurudziro yechikwata, zvichibva pakuwongorora humbowo.

 

 

Applications Applications

 

• Uchapupu huripo hwekushandiswa kwekugadzirisa kwepelinha kuderedza zviratidzo uye kuvandudza basa kune varwere vane chirwere chisingaperi, chakanyanya, uye chebacute LBP.
• Kudzidzira pamwe chete nekugadzirisa zvinogona kukurumidzira nekuvandudza zvikamu uye kuderedza kudzokorora

 

Mukupedzisa, zvakawanda humbowo-hwakavakirwa pakutsvagisa zvidzidzo zvakawanikwa maererano nekubudirira kwechiropractic kuchengetedza kwekurwadziwa kwepashure uye sciatica. Chinyorwa ichi chakaratidzawo kuti kurovedza muviri kunofanirwa kushandiswa pamwechete nechiropractic kubatsira kukurumidza chirongwa chekuvandudza uyezve kugadzirisa kugadzirisa. Muzviitiko zvakawanda, chiropractic inogona kushandiswa kune manejimendi ekurwadziwa kwepashure uye sciatica, pasina chikonzero chekupindira kwekuvhiya. Nekudaro, kana kuvhiya kuchidikanwa kuti uwane kupora, chiropractor inogona kuendesa murwere kune anotevera akanakisa ezvehutano. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

 

Mimwe Misoro: Sciatica

 

Sciatica inotumidzwa sekusanganiswa kwezviratidzo kwete pane imwe rudzi rwekukuvara kana mamiriro. Zviratidzo izvi zvinoratidzika sehupenzi huri kurwadza, kupera uye kurira kwekunzwa kubva mumusana wakagadzika mumucheto wakadzika, pasi pamakumbo nemahudyu uye kuburikidza nemumwe kana makumbo maviri nemakumbo. Sciatica inowanzokonzera kutsamwa, kuvhiringidzika kana kuwedzerwa kwechiremera chikuru mumutumbi wemunhu, kazhinji zvichienderana nekodhi kana kuti bone spur.

 

 

NHAURWA INOKOSHA: KUDZIDZISA KWENYAYA: Kurapa Sciatica Pain