Kusuruvara kwepfungwa chimwe chezvikonzero zvakapararira zvekufurirwa kwehofisi. Vakawanda vevanhu vanovaona pane imwe nguva muhupenyu hwavo uye vanogona kukanganisa chero ani zvake, pasinei nezera, rudzi uye hutano. I International Headache Society, kana IHS, inoronga misoro sekutanga, iyo isingakonzerwi neimwe kukuvadzwa uye / kana mamiriro, kana yechipiri, kana pane chikonzero chinokonzera shure kwavo. Kubva migraines kuti kusungurwe misoro uye kushungurudzika misoro, vanhu vanotambura nekunetseka kwemusoro nguva dzose vangawana zvakaoma kupinda mumabasa avo ezuva nezuva. Vakawanda vezvehutano vanobata marwadzo edzimusoro, zvisinei, chiropractic kuchengetedza yava chinhu chakakurumbira chinoshandiswa kurapwa kwezvinhu zvakasiyana-siyana zvehutano. Chinangwa chenyaya inotevera ndechekuratidza uchapupu-hwakatungamirirwa nheyo dzechiropractic kurapwa kwevanhu vakuru vane musoro.

 

Zviratidzo-Kubva Mirayiridzo yeChiropractic Treatment of Adults vane Musoro

 

ngovepo

 

• Chinangwa: Chinangwa chechirongwa ichi ndechekupa uchapupu-ruzivo rwekuita mazano ekurapa kwechiropractic yemusoro kune vanhu vakuru.
• Nzira: Kutsvakurudza mabhuku kwakarongeka kwezviongorori zvekliniki zvakarongedzwa zvakabudiswa kuburikidza naAgasti 2009 zvakakodzera chiropractic tsika zvaiitwa uchishandiswa maDatabases MEDLINE; EMBASE; Vakabatanidzwa uye Vanobatana neMishonga; iyo Cumulative Index kune Nursing uye Allied Health Zvinyorwa; Manual, Alternative, uye Natural Therapy Index System; Alt HealthWatch; Index yeChiropractic Literature; uye Cochrane Library. Nhamba, hutano, uye kusagadzikana kwezvakawanikwa zvakaonekwa kuti zvinopa simba rose reuchapupu (rakasimba, rinononoka, risina kukwana, kana rinopesana) uye kuumba tsika yekuita mazano.
• Results: Zvinyorwa makumi maviri nemumwe zvakasangana nekugadziriswa zvirongwa uye zvakashandiswa kukudziridza mazano. Uchapupu hwakanga huri kupfuura huwandu hwakanaka. Kune migraine, kushandiswa kwepelinha uye miviri yakasiyana-siyana inosanganisira masheji inokurudzirwa kutarisira varwere vane episodic kana vasingaperi migraine. Nokuda kwehutano-hutano hwemusoro, kusanganisa kwemagunha hakugoni kukurudzirwa kutungamirirwa kwepisodic-type-head headache. A kukurudzira hakugoni kuitwa kana kupikisa kushandiswa kwepelinha kune varwere vane chirwere chisingaperi chisingabatsiri. Kutsika-miviri kunokwidziridzwa kunogona kubatsira kwenguva yakareba kurairirwa kwevarwere vane episodic kana chronic tension-type headaches. Pamusoro pemusoro wepervicogenic, kugona kwepasina kunorudzirwa. Kubatanidza pamwe chete kana mukati memutsipa wakadzikama maitiro zvinogona kuvandudza zviratidzo. Ikoko hakusi kuwedzera kuwedzerwa kubatsirana kwekubatanidza kushamwaridzana pamwe nekudzika shati flexor exercises kune varwere vane cervicogenic headache. Zviitiko zvakashata zvakanga zvisingatauri mumatambudziko akawanda emakiriniki; uye kana vaive, pakanga pasina kana kana vari vaduku.
• Mhedziso: Uchapupu hunoratidza kuti chiropractic kuchengetedza, kusanganisira kugadzirwa kwemusana, kunowedzera migraine
  uye cervicogenic musoro. Mhando, nguva yakawanda, muyero, uye nguva yemishonga (s) inofanira kunge yakabva pane zvinotungamirirwa mazano, kliniki ruzivo, nekuwana. Uchapupu hwekushandiswa kwemasimba emagunha sekupindira kwega kwega kune varwere vane mhirizhonga-musoro wemusoro unoramba uripo. (J Manipulative Physiol Ther 2011; 34: 274-289)
• Key Indexing Terms: Kugunun'una kwepamuviri; Migraine Matambudziko; Mhirizhonga-Nyora Musoro; Post-traumatic Headache; Practice Guideline; Chiropractic

 

Dr. Alex Jimenez's Insight

Musoro, kana kurwadza musoro, kusanganisira migraine nedzimwe mhando dzemusoro, ndeimwe yemhando dzakawanda dzinorwadza dzinoratidzwa pakati pevanhu vakawanda. Izvozvo zvinogona kuitika kune imwe kana mativi maviri emusoro, zvinogona kusarudzwa kune imwe nzvimbo kana kuti dzinogona kutenderera musoro kubva pane imwe pfungwa. Kunyange zvazvo zviratidzo zvemusoro zvinogona kusiyana zvichienderana nemhando yemarwadzo edzimhosva uye nekuda kwechikonzero chehutano hwehutano, misoro inonzi inofungidzirwa kuti inonyunyuta zvachose pasinei nekutsungirira kwavo uye mafomu. Musoro, kana kurwadza musoro, kunogona kuitika semugumisiro wekusapisa kwepelinha, kana kugunun'una, pamwe nehurefu hwepamusoro. Kuburikidza nekushandiswa kwepelinha uye maitiro ekushandisa, chiropractic kuchengetedza inogona kuchengeteka uye inogadzirisa zvirwere zvepfungwa, kuderedza kushungurudzika uye kumanikidzwa kune zvivako zvakapoteredza musana, kuti pakupedzisira kubatsire kugadzirisa zvirwere zvekurwadziwa kwepfungwa uyewo hutano hwakakwana uye hukama.

 

Musoro unowanzoitika kune vanhu vakuru. Kudzokorora misoro kunoshatisa hupenyu hwemhuri, mararamiro emagariro evanhu, uye kubasa kwebasa. [1,2] Munyika yose, maererano neWorld Health Organization, migraine oga ndeye 19th pakati pezvose zvinokonzera makore akagara nehurema. Musoro ndewechitatu pazvikonzero zvekutsvaga chiropractic kuchengetedza muNorth America. [3]

 

Kurongeka kwakagadziriswa chinhu chikuru chekutarisira uye kurapwa, uye huwandu hwakasiyana-siyana hwemusoro huripo hunorondedzerwa muInternational Classification ye Headache Disorders 2 (International Headache Society [IHS]). [4] Zvikamu izvi zvinotarisirwa kuchipatara pamwe nekushandiswa kwekutsvakurudza. Musoro wepamusoro-soro, kushungurudzika-rudzi uye migraine, kunofungidzirwa semusoro wepamusoro unove episodic kana kusingaperi mune zvakasikwa. Episodic migraine kana kushungurudzika kwemusoro-musoro kunowanikwa zvishoma kudarika mazuva 15 pamwedzi, asi misoro isingagumi inowedzera kupfuura mazuva 15 pamwedzi kunyanya 3 (migraine) kana kuti 6 mwedzi (mutsauko wemusoro-soro). [4] Musoro wemusoro unonzi zvinokonzera matambudziko emakiriniki mumusoro kana mumitsipa inogonawo kuva episodic kana kusingaperi. Cervicogenic misoro ndeyemusoro wemusoro inowanzobatwa nechiropractors uye inosanganisira kurwadziwa kunobva kune imwe nzvimbo mumutsipa uye kunonzwisiswa mu1 kana dzimwe nzvimbo dzepamusoro. IHS inobvuma cervicogenic musoro sechirwere chakasiyana, [4] uye uchapupu hwokuti misoro inogona kuonekwa nehutano hwemutsipa kana chironda chinobva pane zvakaitika uye zvipatara zvinowanikwa (nhoroondo yekutambudzika kwemutsipa, kushandiswa kwemakumbo kwemitsipa, kurwadziwa kwechiedza chechivharo chekufamba, uye [4,5] Apo myofascial inorwadza ndoga ndicho chikonzero, murwere anofanirwa kutarisirwa seanenge ane musoro wepfungwa. [4] Izvozvi zvinotarisirwa kuti zviongororwe asi hazvina kupokana mumabhuku. [XNUMX]

 

Mishonga inogadziriswa inoshandiswa nechiropractors kutarisira varwere vane misoro inosanganisira kugadzirwa kwepelinha, kuunganidza, kushandiswa kwemagetsi-kushandiswa kugadzirwa kwemumumvuri, dzidzo pamusoro pekuchinja mararamiro ezvimwe zvinhu, maitiro ekurapa mararamiro, kupisa / mazaya, kuisa massage, zvakanyanya kufema tissue therapies dzakadai sedgger point therapy, uye kusimbisa uye kutambanudza maitiro. Pane tariro inowedzera yezvehutano, kusanganisira chiropractic, kugamuchira nekushandisa ruzivo rwekutsvakurudza, kutora kukwana kwakakwana kwehutano hwehuchapupu hunotsvaga hunozivisa kugadzirisa chirongwa. Somugumisiro, chinangwa cheCanada Chiropractic Association (CCA) neCanada Federation of Chiropractic Regulatory uye Educational Accrediting Boards (Project) Clinic Practice Guidelines Project ndeyekudziridza mazano ekuita zvinoenderana nouchapupu hunowanikwa. Chinangwa chechirongwa ichi ndechekupa uchapupu-ruzivo rwekuita mazano ekurapa kwechiropractic yemusoro kune vanhu vakuru.

 

nzira

 

The Guidelines Development Committee (GDC) yakaronga uye yakagadziridza maitiro akarongeka ekutsvaga mabhuku, kuongorora, kuongorora, kuongorora, uye kududzira. Nzira dzinoenderana nemaitiro akakurudzirwa ne �Kuongororwa kweMitemo Yekutsvagisa neKuongorora� kubatana (www.agreecollaboration.org). Iyi nhungamiro chishandiso chinotsigira varapi. Izvo hazvina kuitirwa seyakajairwa kurapwa. Iyo yedhairekitori inobatanidza iripo yakadhindwa humbowo kuchipatara tsika uye inongova 1 chikamu cheuchapupu-hwakadzikiswa nzira yekurapa kwevarwere.

 

Dhina Zvinyorwa uye Tsvakurudzo

 

Kutsvaga kwakagadziriswa uye kuongororwa kwemabhuku ekurapa kwakaitwa kuburikidza nenzira dzakarondedzerwa neChorane Cooperation Rezve Review Group [6] naOxman naGuyatt. [7] Tsananguro yekutsvaga yakagadzirwa muM MEDLINE nekuongorora mitemo yeMSH inobatanidza chiropractic uye mamwe mazano uye gare gare modified for other database. Shanduro yekutsvakurudza mabhuku yaive yakawanda. Chiropractic mishonga yakatsanangurwa seyo kusanganisira nzira dzakajairika dzokurapa dzinoshandiswa nevashandi uye dzakanga dzisingangoregi kurapwa kwezvirwere zvakapiwa chete nechiropractors. Mushonga wakakura wakakandwa kunosanganisira kurapa kunogona kugoverwa muchiropractic kutarisira pamwe chete neaigonawo kuendeswa mumamiriro ekutarisira nevamwe vadzidzisi vezvehutano mune imwe tsvakurudzo yekuongorora (Appendikisi A). Kugadzirisa kwepamuviri kwakarondedzerwa se-high-velocity low-amplitude yakakonzerwa kumusana. Kunze kwekurapa kunosanganisira kushaya maitiro anorema kana maitiro ekudzivirira maitiro, pharmacotherapy, majekesheni e-botulinum toxin, kugadziriswa kana maitiro ekurapa, uye kugadziriswa.

 

Kutsvaga kwemabhuku kwakapedzwa kubva munaKubvumbi kusvika Chivabvu 2006, kwakagadziriswa muna 2007 (chikamu 1), uye kwakagadziridzwa zvakare muna Nyamavhuvhu 2009 (chikamu 2). Databases yakatsvaga yaisanganisira MEDLINE; EMBASE; Allied uye Inowirirana Mushonga; iyo Yekuwedzera Index kune Nursing uye Allied Hutano Mabhuku; Chinyorwa, Imwe nzira, uye Natural Therapy Index System; Alt HealthWatch; Index kuChiropractic Literature; uye raCochrane Library (Appendikisi A). Kutsvaga kwaisanganisira zvinyorwa zvakaburitswa muChirungu kana neChirungu zvinyorwa. Iyo yekutsvaga nzira yakatemerwa kune vakuru (? 18 makore); kunyangwe hazvo zvidzidzo zvekutsvagisa nemusoro wenyaya wekubatanidza zvinosanganisira huwandu hwakareba hwemazera, senge vakuru nevechiri kuyaruka, vakadzoserwa vachishandisa nzira yekutsvaga. Referensi zvinyorwa zvakapihwa mune zvakarongeka ongororo (SRs) zvakaongororwa zvakare neGDC kudzikisira akakodzera zvinyorwa kubva mukushaikwa.

 

Uchapupu Hutsanangudzo Criteria

 

Mitsva yekutsvaga yakaongororwa zvemagetsi, uye kuongororwa kwakawanda-nhanho kwakashandiswa (Appendikisi B): nhanho 1A (zita), 1B (isingabvumirwe); danho 2A (zvinyorwa zvizere), 2B (yakazara zvinyorwa-maitiro, kukosha); uye nhanho 3 (yakazara zvinyorwa-zvekupedzisira GDC kuongorora kunge kiriniki zvemukati nyanzvi). Duplicate zvinyorwa zvakabviswa, uye zvinyorwa zvinoenderana zvakatorwa semagetsi asuye / kana makopi akaomarara kuti anyatsoongorora. Vaongorori vakasiyana, vachishandisa nzira imwecheteyo, vakapedza zvinyorwa zvemabhuku mu2007 na2009 nekuda kwenguva iyo pakati pekutsvaga.

 

Chengeteredzwa keriniki miedzo (CCTs); miedzo yakarongeka, yakarongedzwa (RCTs); uye maitiro ekugadzirisa (SRs) akasarudzwa sehumwe huchapupu hwehutungamiri huno hunoenderana nemamiriro ezvinhu ezvino ekududzira kliniki yekuwana. Iko GDC haina kukoshesa zvidzidzo zvekucherechedza, nyaya dzenyaya, kana nyaya dzinopomerwa nekuda kwemamiriro avo asina kudzora uye zvishoma nezvishoma pasi methodological quality vs CCTs. Iyi nzira isinganzwisisi nzira dzakagadziriswa dzeRS dzakabudiswa neCochrane Back Review Group. [8] Kana dzakawanda SRs dzakabudiswa nevanyori vakadaro pane imwe nhaurwa, bhuku rekupedzisira chete ndiro rakaverengwa uye rinoshandiswa kuti rive pachena. Kuongororwa kwakagadziriswa kweSR kwave kusatorwawo kuitira kuti usaverengeka kuverenga kaviri kwemigumisiro yekutsvakurudza.

 

Kuongorora Zvinyorwa uye Kushandurwa

 

Hunhu ratidziro dzeCCTs kana maRCTs aisanganisira gumi nematanhatu mhinduro dzakapindurwa nemae (zvibodzwa 11) kana no (zvibodzwa 1) / handizive (mamakisi 0) (Tafura 0). Iyo GDC yakanyora 1 yekuwedzera nzira yekufarira: (2) mashandisirwo evashandisi eiyo IHS yekuongorora nzira yekunyora zvinyorwa uye (1) kuongororwa kwemhedzisiro (Tafura 2, makoramu L uye M). Kushandiswa kweiyo IHS nzira [1] yaive inoenderana neiyi Clinical Practice Guideline (CPG) maitiro ekusimbisa kuongororwa kwehunyanzvi mukati nepakati pezvidzidzo zvekutsvaga. Zvidzidzo zvakasarudzika kana IHS yekuongorora nzira isina kuiswa nevatsvagiri vechinhu kuiswa muchidzidzo (Appendikisi C); uye kana pamberi pa4, pamberi pekervicogenic musoro uchisanganisirwa muhurongwa hweHS, nzira dzekuongorora dzeCervicogenic Headache International Study Boka [2004] hadzina kushandiswa. Zvimwe zvinokanganisa zvakaongororwa sevamiririri vengozi (s) pamwe nekurapwa. Hapana chekuyera (s) chakashandiswa kune mumwe munhu maitiro, uye zvingangodaro zviyero zvemhando zvakatangira kubva pa9 kusvika pa0. Zvese zviri zviviri kupofumadza zvidzidzo nevatapi venhepfenyuro zvakaverengerwa muzvinyorwa zvekutsvagisa neGDC, sezvo zvinhu izvi zvakanyorwa mune yehunhu hwekupima mhando. [11] Maitiro eGDC haana kugadzirisa kana kushandura chishandiso chekupimisa. Pfungwa yemaitiro aya yaive yekuti dzimwe nzira dzekurapa (semuenzaniso, transcutaneous magetsi etsinga dzinosimudzira [TENS], ultrasound) uye dhizaini dhizaini inogona kuwana murwere uye / kana murapi anopofomadza. [6] Iyo GDC haina kudzikamisa kuongororwa kweaya mabhenji emhando yemhando kana zvirokwazvo iwo akataurwa muzvidzidzo zvekiriniki zvekurapa kusagadzikana kwemusoro. GDC yakazvitorawo kunze kwehunyanzvi hwavo kugadzirisa, pasina kusimbiswa, chishandiso chakashandiswa zvakanyanya kuyera zvinyorwa zvemakiriniki. [10] Zvishandiso zvitsva zvekutsvagisa uye kuyera kwemanyorerwo ehunyanzvi mabhuku, zvisinei, anodiwa nekukurumidza uye anoonekwa senzvimbo yekutsvaga mune ramangwana muchikamu chehurukuro pazasi.

 

 

Vanoongorora mabhuku vaive vabatsiri vepurojekiti vakaparadzaniswa neGDC uye vaive vasina kufefeterwa sekudzidza vanyori, masangano, uye magazini enhau. Nhengo nhatu dzeGDC (MD, RR, uye LS) dzakatsigira nzira dzekupimisa mhando nekuzadzisa ongororo yemhando yepamusoro paseti yezvinyorwa gumi. [10-11] Chikamu chepamusoro chechibvumirano chakasimbiswa pamatanho emhando. Chibvumirano chakazara pazvinhu zvese chakawanikwa muzvidzidzo zvishanu: mune gumi zvezvinhu gumi nezviviri zvezvidzidzo zvina uye zvisere zvezvinhu gumi neimwe zvechi20 chekudzidza chasara. Kusanzwisisika kwese kwakagadziriswa zviri nyore kuburikidza nekukurukurirana uye nekubvumirana neGDC (Tafura 5). Nekuda kweiyo heterogeneity yenzira dzekutsvagisa pamiedzo, hapana meta-ongororo kana kuwanda kwenhamba yemhedzisiro yekuedzwa kwakaitwa. Miedzo yakarova inopfuura hafu yehuwandu hwehuwandu hunokwanisika (kureva ,,? 10) yaionekwa semhando yepamusoro. Miedzo yekumisikidza 11 kusvika ku4 yaionekwa senge yakaderera mhando. Zvidzidzo zvine zvikanganiso zvakakura zvemaitiro kana kuongorora maitiro ekurapa akasarudzika (semuenzaniso, kurapwa kusingatariswe kwakakodzera neGDC yekurapa chiropractic kwevarwere vane musoro; Appendikisi Tafura 8).

 

Hunhu hwehuwandu hweSRs hwaisanganisira 9 zviyero zvakapindurwa hongu (mamaki 1) kana kwete (mamakisi 0) / handizive (mamakisi 0) uye mhinduro yehunhu yechinhu J no zvikanganiso, zvishoma zvikanganiso, kana major zvikanganiso (Tafura 2). Kuyera kunogona kuitika kwakatangira pa0 kusvika pa9. Kumisikidzwa kwehuwandu hwesainzi hweSR ine zvikanganiso zvakakura, zvidiki zvikanganiso, kana pasina zvikanganiso, sezvakanyorwa mukoramu J (Tafura 2), yaive yakavakirwa pamhinduro dzevanyori vemabhuku kuzvinhu zvipfumbamwe zvakapfuura. . Iyi inotevera parameter yakashandiswa kuwana iyo yakazara sainzi mhando yeiyo SR: kana iyo / isingazive mhinduro yakashandiswa, iyo SR ingangove iine zvidiki zvikanganiso pakanyanya. Zvisinei, kana No yakashandiswa pazvinhu B, D, F, kana H, ongororo yacho inogona kunge iine zvikanganiso zvakakura. [9] Ongororo dzakarongeka dzichitora inopfuura hafu yehuwandu hwehuwandu hunokwanisika (kureva ,, 21) isina kana zvidiki zvikanganiso zvakaverengerwa semhando yepamusoro. Ongororo dzakarongeka dzichitora 5 kana zvishoma uye / kana nezvikanganiso zvakakura zvakabviswa.

 

 

Ongororo dzakatsanangurwa senge dzakarongeka kana dzaisanganisira nzira yakajeka uye inodzokororwa yekutsvaga uye kuongorora zvinyorwa uye kana kuiswa uye nzira dzekuregedza dzezvidzidzo zvakatsanangurwa. Maitiro, maitiro ekubatanidza, nzira dzekuyera mhando yemhando, hunhu hwezvisanganisira zvidzidzo, nzira dzekugadzirisa data, uye mhedzisiro yakaongororwa. MaRaters akawana chibvumirano chakazara chezviyero zvese zve7 SRs [22-28] uye ye7 yezvinhu 9 zveiyo 2 zvimwe maSR. [29,30] Kusanzwanana kwakanzi kudiki uye kwakagadziriswa zviri nyore kuburikidza nekuongororwa kweGDC uye kubvumirana (Tafura 2 ).

 

Kukurudzira Mazano Okuita

 

GDC yakashandura humwe uchapupu hunobatsira kuchiropractic kurapwa kwevarwere vemusoro. Tsanangudzo yakazara yezvinyorwa zvakakosha ichaendeswa kune webasaiti reCCA / Federation Clinical Practice Guidelines Project.

 

Randomized, kutongedzwa miedzo uye zvavakawana zvakaongororwa kuudza mazano ekurapa. Kupa simba rose reuchapupu (rakasimba, rinononoka, risina kukwana, rinopesana, kana risina uchapupu), [6] GDC yakarangarira nhamba, hutano, uye kusagadzikana kwemigumisiro yekutsvakurudza (Tafura 3). Uchapupu hwakasimba hwaiongororwa bedzi apo vazhinji vezvikwata zvepamusoro zveRCTs zvakatsigira zvitsva zvevamwe vaongorori mune dzimwe nzvimbo. Yese SRs yakakwirira yakarongedzwa maererano nemuviri wehuchapupu uye kuzivisa mazano ekurapa. Iko GDC yakaronga kurapwa kwemaitiro ekuti ibatsirwe rubatsiro (s) kana ikatsigirwa nehuwandu hwehuwandu hwehupupuri hwehupupuriro.

 

 

Zvirongwa zvekuita zvakagadzirwa mumisangano yakabatana yekushanda.

 

Results

 

 

 

 

 

Literature

 

Kubva pakutsvaga mabhuku, pakutanga 6206 zvinyorwa zvakaonekwa. Zvinyorwa makumi maviri nemumwe zvakasangana nemagumo ekupedzisira ekubatanidzwa uye zvaionekwa mukudzidzira maitiro mazano (16 CCTs / RCTs [11-20,31-36] uye 5 SRs [24-27,29]). Kuyera kwehutano hwezvinyorwa zvinowanikwa zvinowanikwa muTables 1 uye 2. Mashoko Okuwedzera Table 3 inonyora nyaya dzisingabatanidzwi pakuongorora kwekupedzisira neGDC uye kufunga (s) kwekuregererwa kwavo. Kutadza kwechidzidzo uye chiremba kupofumadza uye kusagutsikana kutsanangurwa kwekusungirirwa kwemari kwaiwanzoonekwa nzira dzekugadzirisa dzematambudziko akadzorwa. Musoro wemhando dzinoongororwa mumatambudziko aya zvaisanganisira migraine (Tafura 4), hutano hwemusoro (Table Table 5), uye cervicogenic musoro (Table 6). Nekudaro, izvi chete misoro yepamusoro inomiririrwa nehuchapupu uye kuita zvinorayirwa mune iyi CPG. Uchapupu hwemashoko eRS anopiwa muTebhenekeri 7.

 

Dzidzira Mazano: Kurapa kweMigraine

 

• Kugadzirisa kwepamuviri kunokurudzirwa kuti vatungamiri vevarwere vane episodic kana vasingagumi migraine vane kana vasina kanara. Izvi zvinokurudzirwa kubva pane zvidzidzo zvakashandisa maitiro ekurapa 1 nguva 2 pavhiki kwemavhiki e8 (unhu hwehuchapupu, huwandu). Imwe yepamusoro yeRCT, [20] 1 yepamusoro-soro RCT, [17] uye 1 high-quality SR [24] inotsigira kushandiswa kwepelinha kune varwere vane episodic kana kusingaperi migraine (Tables 4 ne7).
• Kupera kwemasvondo kwevhiki nevhiki kunorudzirwa kuti kuderedze episodic migraine nguva uye nekuvandudza zviratidzo zvehutano zvingangobatanidza kurwadziwa kwepfungwa (uhu hunhu, huwandu). Imwe yepamusoro yepamusoro RCT [16] inotsigira chirevo ichi chekuita (Table Table 4). Vatsvakurudzi vakashandisa muto we45-kutarisa nekutarisa neuromuscular and trigger point framework ye kumashure, fudzi, mutsipa, uye musoro.
• Multimodal multidisciplinary kutarisira (kuedza, kuporesa, kushungurudzika uye kurapa kunovaka muviri, kurapa kurapa) kunokurudzirwa kutarisira varwere vane episodic kana vasingaperi migraine. Ratidza sezvakakodzera (uchapupu hwehutano, huwandu). Imwe yepamusoro yepamusoro RCT [32] inobatsira kubudirira kwemamiriyoni akawanda emitemo inopindira kune migraine (Tafura 4). Kupindira kunotungamirira kushandiswa kwehutungamiri huzhinji hunosanganisira kurovedza muviri, dzidzo, kuchinja mararamiro, uye kuzvitonga.
• Pane huwandu hwekliniki dzedzinhare dzinoratidzira kana kuti dzipikise kushandiswa kwekurovedza muviri chete kana kuti kurovedza muviri pamwe chete nemishonga miviri yepamusoro yekurapa kwevarwere vane episodic kana chisingagumi migraine (aerobic exercise, kervical range of motion [cROM], kana muviri wose kutambanudza). Zvishoma zvitatu zveCCTs [13,33,34] zvinobatsira pakupedzisira (Table 4).

 

Dzidzira Mazano: Mhirizhonga-Nyora Musoro

 

• Low-load craniocervical mobilization (semuenzaniso, Thera-Band, Resistive Exercise Systems; Hygenic Corporation, Akron, OH) inokurudzirwa kwenguva yakareba (semuenzaniso, mwedzi mitanhatu) manejimendi evarwere vane episodic kana -chronic tension-mhando misoro (humbowo hwehuviri, zvine mwero). Imwe yepamusoro-soro RCT [6] yakaratidza kuti yakaderera-mutoro kuunganidza kwakadzora zvakanyanya zviratidzo zvekupokana-mhando misoro yevarwere munguva yakareba (Tafura 36).
• Kugadzirisa kwepamuviri hakugoni kukurudzirwa kutarisira varwere vane episodic-type-head headache (uchapupu wepamusoro, kuenzanisa). Ikoko kune huwandu hwehutano hwehutachiona hunokonzerwa nemaspinal mushure mekutanga kushandura mhando dzakanyanyisa hutachiona hunopa humwe humwe rubatsiro kune varwere vane mitsipa yakashata. Imwe yepamusoro yeRCT [12] (Tafura 5) uye zvinyorwa zvichitsanangurwa mu4 SRs [24-27] (Table Table 7) zvinoratidza kuti hapana kubatsirwa kwepfungwa dzepelinha kune varwere vane maziso episodic-type-tension.
• A kukurudzira hakugoni kuitwa kana kupikisa kushandiswa kwemagunha (2 dzimwe nguva kwevhiki kwevhiki dze6) kune varwere vane mvere dzisingagumi-nyoro dzemusoro. Vanyori ve1 RCT [11] vakaratidzirwa sehupamhi hwepamusoro nehutano hwehutano hwepamhando [6] (Tafura 1), uye zvinyorwa zvechidzidzo ichi mu 2 SRs [24,26] zvinoratidza kuti kudzvinyirira kwepamuviri kunogona kuve kwakagadzikana nekusingaperi kwemusoro-tema musoro. Zvisinei, GDC inofunga kuti RCT [11] yakaoma kududzira uye kusingazivi (Table 5). Mhosva yacho haina kukodzera kutariswa nekusawirirana muhuwandu hwehutano-chiremba chinosangana pakati pezvikwata zvekudzidza (semuenzaniso, 12 kushanyira kune zvinyorwa mumapfupa akanyorovedza marwadzo pamwe nemasana ekugadzirisa boka vs 2 kushanyira nyaya dziri mumamitriptyline boka). Hapana nzira yekuziva kana nhamba yakaenzana yekutarisa kwevanhu munyaya ye amitriptyline boka ingave yakakanganisa zvidzidzo zvidzidzo. Izvi zvinyorwa uye kududzirwa kubva kune 2 imwe SRS [25,27] inobatsira pakupedzisira (Table Table 7).
• Pane humwe hunopupu husina kukwana hunoratidzira kana kuti hunopesana nekushandiswa kwebhuku rinoshandiswa, kushandiswa kwechigunwe chekunyengera, kuunganidza kwaCyriax, kana kurovedza muviri / kudzidzira muviri kune varwere vane episodic kana chronic tension-type headache. Zvitatu zvisingabatsiri zvidzidzo zvisinganzwisisiki [19,31,35] (Tafura 5), 1 yakashata-negative hasi RCT, [14] uye 1 SR [25] inobatsira pakupedzisira (Table Table 7).

 

Dzidzira Mazano: Cervicogenic Headache

 

• Kugadzirwa kwemasana kunokurudzirwa kuti vatungamiri vevarwere vane cervicogenic musoro. Izvi zvinokurudzirwa pachirongwa che 1 chakashandisa maitiro ekurapa kwe2 nguva pavhiki kwemavhiki e3 (uchapupu hwehutano, huwandu). Mune unhu hwakanaka hweRCT, Nilsson et al [18] (Tafura 6) yakaratidza unhu hwakanaka hwekukurumidza-kutsika, pasi-amplitude kugadzirwa kwepelinha kwevarwere vane cervicogenic musoro. Uchapupu hwehuwandu kubva ku2 SRs [24,29] (Tafura 7) inotsigira iri tsika yekukurudzira.
• Kushamwaridzana kwakabatanidzwa kunorudzirwa kune vatungamiri vevarwere vane cervicogenic musoro (uchapupu hwepamusoro, kuenzanisa). Jull et al [15] akaongorora migumisiro yeMaitland akabatanidza kuunganidza 8 kune 12 mishonga kwemavhiki e6 mune yepamusoro RCT (Tafura 6). Kukurudzira kwakatevedzerwa nenzira yekuchirapa, iyo kusarudzwa kwepasi-velocity uye-high-velocity techniques zvaive zvakatangira kuongororwa kwekutanga uye kunofambira mberi kwechirwere chevashandi vemakwenzi echirwere chisingaiti. Zvibereko zvinobatsira zvakataurwa pamusoro pemusoro wepamusoro, kuwedzera, pamwe nekurwadziwa kwemutsipa nekuremara. Uchapupu hwehuwandu kubva ku2 SRs [24,29] (Tafura 7) inotsigira iyi tsika yekukurudzira.
• Deep neck flexor maitiro inokurudzirwa kutungamirirwa nevarwere vane cervicogenic headache (uchapupu wezinga, kuenzanisa). Izvi zvinokurudzirwa kubva pakudzidza nguva dze2 zuva nezuva kwevhiki dze 6. Hakuchina kuwedzera kuwedzerwa kubatsirana kwekubatanidza yakadzika shingo flexor maitiro uye kubatana kwekubatana kwe cervicogenic headache. Imwe yepamusoro yeRCT [15] (Tafura 6) uye zvinyorwa zvinowanikwa mu2 SRs [24,29] (Tafura 7) kutsigira mutsika iyi inokurudzira.

 

chengetedzo

 

Varapi vanosarudza maitiro ekurapa pamwe chete nechero ruzivo rwekiriniki kune murwere akapiwa. Pakati pe16 CCTs / RCTS [11-20,31-36] inosanganisirwa mumuviri weuchapupu hweiyi CPG, zvidzidzo zvitanhatu chete [6] zvakaongororwa zvakaringana kana kukurukura mhedzisiro yemurwere kana chengetedzo parameter (Tafura 11,12,15,20,32,36, ikholamu M). Pakazara, njodzi dzakataurwa dzaive shoma. Zvitatu zvezviedzo zvakazivisa ruzivo rwekuchengetedzeka kwemagunha. [1] Boline et al [11,12,20] vakataura kuti 11% yezvidzidzo yakawana kuomarara kwemutsipa mushure mekutanga kwekumanikidza kwepelinha kwakanyangarika kune ese zviitiko mushure memavhiki ekutanga e4.3 ekurapwa. Kusuwa kana kuwedzera mumusoro mushure mekunyengedza musana (n = 2) zvaive zvikonzero zvekuregera kurapwa kwakataurwa naTuchin et al. [2] Hapana mhedzisiro yakaverengerwa nechero zvidzidzo zvakadzidzwa naBove et al [20] vachishandisa musana kugadziriswa kwekurapa episodic tension-mhando misoro. Miedzo yekurapa kuti uongorore mhedzisiro yekubudirira inogona kusakwanisa kunyoresa nhamba dzakaringana dzezvidzidzo kuti zviongorore zviitiko zvezviitiko zvisingawanzo kuitika. Dzimwe nzira dzekutsvagisa dzinodikanwa kuti dzigadzirise kunzwisiswa kuzere kwechiyero pakati pezvakanaka nenjodzi.

 

hurukuro

 

Kurapa kwemasana uye mamwe mazano ekurapa anowanzoshandiswa mu chiropractic ave akadzidza mune dzimwe nhengo dzeCCTs dzisinganzwisisiki mukunyorwa kwezvinyorwa, kugadzirwa, uye huwandu hwehutano. Mwoyo murefu uye misoro yakanyatsogadziriswa inomiririra muhumwe hunopupu hunonzi migraine, mhirizhonga-musoro wemusoro, uye cervicogenic musoro. Mhedzisiro yehutano yemamiriro ehutano inoshuvarurwa ndeyekuti inowanzobata musoro, kuwedzera, nguva, uye mararamiro ehupenyu. Icho uchapupu hahupfu kune huwandu hwakanaka panguva ino.

 

Uchapupu hunosimbisa kushandiswa kwemagunha kwechiropractic kutarisira varwere vane migraine kana cervicogenic misoro asi kwete misoro-inonzi headaches. Kune migraine, kutarisirwa kwezvinhu zvakasiyana-siyana uchishandisa vhiki nevhiki 45-miniti yekurapa kurapwa uye kutarisirwa kwemamiriyoni (kuedza, kusununguka, uye kushungurudzika nekupa mazano ekudya) zvinogonawo kushanda. Zvimwe, kubatanidza pamwe chete kana kudzika mukati memutsipa mafomu zvinoshandiswa kurudzirwa kuvandudza zviratidzo zve cervicogenic musoro. Ikoko kunoratidzika kusina kuwedzera kuwedzerwa kubatsirana kwekubatanidza kuunganidza pamwe nekudzika shingo flexor maitiro kune varwere vane cervicogenic musoro. Uchapupu hwakajeka hunotsigira kushandiswa kwemaodzora-masimba ekugadzirisa maitiro ekugadzirisa kwenguva refu kwehutano-hutsika hwemusoro.

 

Nokuremara

 

Kukanganisa kwechirevo ichi kunosanganisira huwandu uye hutano hunotsigira uchapupu hunowanika panguva yekutsvaga. Pasina kunyatsogadziriswa zvakakodzwa zvidzidzo zvekutsvakurudza zvakakosha nekuwanikwa kwechirwere chechipatara zvakabudiswa nekuda kwechiropractic kuchengetwa kwevatano vemawere. Dzidzo dzinodiwa kuti tifambise kunzwisisa kwatinoita mazano ekurapa mukutarisa kana kuti mumakambani akachengetedzwa zvakanaka pakuchengetedzwa kwemigraine, hutano hwemusoro-soro, cervicogenic headache, kana mamwe mhando dzepamusoro dzinounza kuvakiriniki (semuenzaniso, musumbu, mushure mutsva) . Imwe kukanganisa kwemabhuku aya ndeye kuvimba kwezvinyorwa zvitsvakurudzo zvitsvakurudzo nemazana mashoma ekuenzanisa (Tables 4-6), nguva pfupi yekurapa paradigms, uye nguva yekutevera. Zvakanyatsogadziriswa kliniki miedzo ine nhamba yakakwana yezvidzidzo, kurapwa kwemazuva mazhinji, uye nguva yekutevera inoda kubhadharwa kufambisa chiropractic kuchengetedza, uye kushandiswa kwepelinha kunyanya, kwekutarisira kwevarwere vane matambudziko epfungwa. Sezvakaitwa nekuongorora kwebhuku uye chirongwa chekurapa kwekliniki, nheyo yehutano uye mabhuku akabudiswa ari kuchinja. Zvidzidzo zvinogona kunge zvakanyatsozivisa basa iri zvingave zvakabudiswa mushure mekupedzisira kwekudzidza. [37-39]

 

Kufunga nezveKutsvakurudza Kwemangwana

 

Iko GDC kubvumirana ndeyekuti kune chido chekuwedzera chiropractic zvidzidzo nevarwere vane matambudziko epfungwa.

 

• Zvimwe zvepamusoro-soro zvekuchirapa zvinotsvakwa. Ongororo yeramangwana inoda kudzidza zvishandiso uchishandise zvakaenzanisa uye nontreatment uye / kana placebo boka (s) kukurudzira uchapupu hwehutano hwekutarisira kurapa. Mwoyo mupofu unofuridzira kupindira kwemuviri kuti utarisire kutarisira mitezo inodiwa uye wakatsvakurudzwa nevatsvakurudzi mu chiropractic kune mamwe marwadzo. [10] Kushayikwa kwekugadziriswa kwezvidzidzo zvakarondedzerwa kunopa dambudziko rakakosha pakuita uchapupu hunotungamirirwa nekurapa mazano. Zvose zvidzidzo zvemangwana zvinofanira kugadziriswa kuburikidza nekushandisa nzira dzakagadziriswa dzakagadziriswa (semuenzaniso, Consolidated Standards of Reporting Trials [KUSIMBISA] uye Kuparara Kwekuona kweZvitsauko neZviitiko Zvisina Kunyoreswa [TREND]).
• Kuburitswa kwehutano hwekuchengetedza dambudziko kunodiwa mukutsvakurudza chiropractic. Zvose zviyero zvemakiriniki zvinofanira kuunganidza uye kugadzirisa pamusoro pemigumisiro inogona kuitika kana kukuvadza kunyange kana pasina kuonekwa.
• Shandisa inovheti zviyero zvekutarisa manotsi ekuongorora. Kupofumadza kunotungamirira kutarisira matambudziko nemigumisiro isingabatsiri yekugadzirisa-kugoverana kunobatanidzwa mumapoka ekudzidza. Zvinowanzosakwanisi kupofumadza zvidzidzo nevatapi muzvidzidzo zvinobudirira zvekurapa mazano. Pasinei nokukanganisa kwezvakaitwa, zvose zvakapofumadza zvidzidzo nevanotarisira vanoverengerwa zvakarongwa munyaya dzekutsvakurudza neGDC, sezvo zvinhu izvi zvakabatanidzwa mune zvepamusoro-shanduro zvishandiso. [6] Zvishandiso zvekutsvakurudza zvakapfurikidza zvekuongorora nekuenzanisa kwakatevera kwebhuku re manual therapy nokukurumidza inoda.
• Kupfuurira mberi tsvakurudzo pamagumisiro ekushanda mune chiropractic kutarisira misoro. Iyi nhungamiro yakaratidza kuti misoro yepamusoro inoshandisa nzira dzakasiyana-siyana dzehutano mukuongorora maitiro ekurapa pamigumisiro yehutano. Musoro wehutachiona, simba, uye nguva ndeye mhinduro dzinoshandiswa nguva dzose (Tables 4-6). Kuedza kwakakomba kunofanirwa kusanganisira kugadziriswa kwehutano-hukuru hwehutano matanho mu chiropractic tsvakurudzo inobatanidza nekuvandudzika kwehupenyu hwezuva nezuva nekudzoka kwezvinhu zvinogadzirisa zvirongwa.
• Mutengo-kubudirira. Hapana tsvakurudzo dzekutsvakurudza dzakanga dzadzorerwa pamutengo-kubudirira kwepfungwa dzepeminwa yekurapa kushungurudzwa kwepfungwa. Mumazuva ano zviongorori zvinokonzerwa nekudzvinyirira kwepamuviri zvinofanira kuongorora mari-inoshanda.

 

Dzimwe nzira dzokutsvakurudza dzinodiwa kuti dzikudziridze kunyatsonzwisisa kweruzhinji pakati pezvikomborero uye njodzi. Iyi CPG haina kupa rekuongorora kwezvose chiropractic mishonga. Chero kusvibiswa kunoratidzira zvikwereti mumakiriniki mabhuku. Mhando, maitiro, kuwedzerwa, uye nguva yehutano (s) inofanira kunge yakabva pane zvinotungamirirwa mazano, kliniki ruzivo, uye ruzivo rwemuurwere kusvikira hupamhi hwehupupuri huripo.

 

mhedziso

 

Pano pane nheyo yehupupuriro yekutsigira chiropractic kuchengetedza, kusanganisira kushandiswa kwepelinha, kwekutarisira migraine uye cervicogenic musoro. Mhando, nguva yakawanda, muyero, uye nguva yehutano (s) inofanira kunge yakavakirwa pane zvinotungamirirwa mazano, kliniki ruzivo, uye ruzivo rwomurwere. Uchapupu hwekushandiswa kwemasimba emagunha sekupindira kwega kwega kune varwere vane mhirizhonga-musoro wemusoro unoramba uripo. Kutsvakurudza kwakawanda kunodiwa.
Mirayiridzo yekudzidzira inobatanidza hwakanakisisa humbowo huripo kune hwakanaka kiriniki yekudzidzira uye inongova chikamu chimwe chete cheuchapupu-hwakajeka nzira yekupa chengeto yakanaka Iyi nhungamiro inoitirwa kunge iri sosi yekuendesa kwechiropractic kuchengetedza kune varwere vane musoro. Iri igwaro "rinorarama" uye rinotarisirwa kuti riongororwe pamwe nekubuda kwe data idzva. Uyezve, haisi chinotsiva chiitiko chekiriniki uye hunyanzvi. Iyi gwaro haina kuitirwa kuti ishandire seyakajairwa kurapwa. Asi, gwara rinoratidza kuzvipira kwehunyanzvi kusimudzira hunhu-hwakavakirwa maitiro kuburikidza nekuchinjana ruzivo uye kutamisa maitiro kutsigira kufamba kweruzivo rwekutsvagisa kuita.

 

Applications Applications

 

• Iyi nhungamiro inobatsira pakupa chiropractic kutarisira kune varwere vane misoro.
• Kugadzikana kwepamuviri kunokurudzirwa kuti vatungamiri vevarwere vane migraine kana cervicogenic musoro.
• Multimodal interdisciplinary intervention inosanganisira massage inogona kubatsira varwere vane migraine.
• Kubatanidza pamwe chete kana kumutsipa mutsipa mafomu zvinogona kuwedzera zviratidzo zve cervicogenic musoro.
• Kutsika-mutoro kunokwidziridzwa kwepamusoro kunogona kuwedzera hutano hwemusoro.

 

KUTENDA

 

Vanyori vanotenda zvinotevera nekuisa pane ino nhungamiro: Ron Brady, DC; Greyden Bridge, DC; H James Duncan; Wanda Lee MacPhee, DC; Keith Thomson, DC, ND; Dean Wright, DC; naPeter Waite (Nhengo dzeKiriniki Yekudzidzira Maitiro Ekutungamira Task Force). Vanyori vanotenda zvinotevera nerubatsiro neChikamu I ongororo yekutsvaga mabhuku: Simon Dagenais, DC, PhD; uye Thor Eglinton, MSc, RN. Vanyori vanotenda zvinotevera nerubatsiro neChikamu II chekuwedzera kutsvaga kwemabhuku uye chiyero cheuchapupu: Seema Bhatt, PhD; Mary-Doug Wright, MLS. Vanyori vacho vanotenda Karin Sorra, PhD nerubatsiro rwekutsvagisa mabhuku, chiyero cheuchapupu, uye rutsigiro rwekunyora.

 

Marizi Mitsara uye Zvimwe Zvimwe Nharo dzekufarira

 

Mari yekubhadhara yakapiwa neCCA, Canada Chiropractic Protective Association, uye mapurogiramu epachipiri emapurojekiti kubva kumativi ose enyika kunze kweBritain Columbia. Iri basa raibhadharwa neCCA uye Federation. Hapana nharo dzekufarira dzakataurwa pamusoro pekudzidza uku.

 

Mukupedzisa, Musoro ndeimwe yezvikonzero zvakakosha vanhu vanotsvaka kurapwa. Kunyange zvazvo vakawanda vashandi vezvehutano vanogona kubata mishonga yepamusoro, chiropractic kuchengetedza inonyanya kuzivikanwa sarudzo inoshandiswa kakawanda inoshandiswa kubata mhando dzakasiyana-siyana dzeutano, kusanganisira mhando dzakasiyana dzemusoro. Maererano nenyaya iri pamusoro apa, humwe uchapupu hunoratidza kuti chiropractic kuchengetedza, kusanganisira mitezo yemusana uye maitiro ekushandisa, inogona kuvandudza misoro uye migraine. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

NYAYA INOKOSHA INOKOSHA: eckNeck Pain Treatment El Paso, TX Chiropractor

 

 

DZIMWE MASHOKO: KUNYANYA KWENYAYA: El Paso, Tx | Vatambi