Kurwadziwa kwepashure kunomiririra chimwe chezvichemo zvinowanzoitika munzvimbo dzehutano. Kunyange zvazvo kukuvara kwakasiyana-siyana uye mamiriro ezvinhu ane chokuita ne musculoskeletal uye nervous system zvinogona kukonzera kurwadziwa kwepashure, vazhinji vezvehutano vanotenda kuti kukuvara kwebasa kunogona kuva nekubatana kwakawanda kune kurwadziwa kwepashure. Semuenzaniso, kumira kusina kunaka uye kudzokorora kufamba kunogona kukonzera kukuvara kwebasa. Mune zvimwe zviitiko, tsaona dzezvakatipoteredza kubasa dzinogona kukonzera kukuvara kwebasa. Chero zvazvingava, kuongorora kwakabva kurwadza kwemusana kwemurwere kunyatsoona kuti ndeipi ingava nzira yekurapa yakanakisa yekudzorera hutano hwepakutanga hwemunhu kazhinji zvinonetsa.

Chokutanga uye chakakosha, kuwana vanachiremba vakarurama kune yako chaiyo sosi yekurwadziwa kwakadzika kumashure kunokosha kuti uwane zororo kubva kune zviratidzo zvako. Vazhinji vashandi vehutano vanokwanisa uye vane ruzivo mukurapa-ane chekuita nebasa kurwadziwa kwemusana, kusanganisira vanachiremba vechiropractic kana chiropractors. Somugumisiro, mazano akawanda ekurapa kwekukuvara kwebasa akaiswa kuti agadzirise marwadzo ekudzokera shure muhutano hwehutano. Chiropractic kuchengetedza inotarisa pakuongorora, kurapa, nekudzivirira kukuvara kwakasiyana-siyana uye mamiriro ezvinhu, akadai seLBP, akabatanidzwa ne musculoskeletal uye nervous system. Nekunyatsogadzirisa kusarongeka kwemusana, chiropractic kuchengetedza inogona kubatsira kuvandudza zviratidzo zvekurwadziwa kwepashure, pakati pezvimwe zviratidzo. Chinangwa chechinyorwa chinotevera ndechekukurukura mazano ehutano hwebasa rekutungamira kwemarwadzo ekudzokera shure.

Occupational Health Guidelines for the Management of Low Back Pain: An International Comparing

ngovepo

• Background: Mutoro wakakura wehupfumi hwemagariro ekurwadziwa kwemusana unosimbisa kukosha kwekugadzirisa dambudziko iri, kunyanya mumamiriro ekushanda zvakanaka. Kugadzirisa izvi, nhungamiro dzebasa dzakapihwa munyika dzakasiyana siyana.
• Chinangwa: Kuenzanisa inowanika pasi rose mazano ekugadzirisa marwadzo ekudzokera shure muhutano hwehutano hwehutano.
• Nzira: Nhungamiro dzakaenzaniswa maererano nemaitiro anowanzo gamuchirwa emhando uchishandisa chiridzwa cheAGREE uye zvakare akapfupikiswa maererano nedare rekutungamira, mharidzo, boka rinotarisirwa, uye ongororo uye manejimendi kurudziro (kureva, zano, kudzokera kubasa zano, uye kurapwa).
• Mhinduro uye Kugumisa: Mhedzisiro yacho inoratidza kuti nhungamiro dzakasiyana dzakasangana nemhando yemhando. Kukanganisa kwakajairika kune chekuita nekusavepo kwekuongorora kwekunze kwakakodzera muhurongwa hwekuvandudza, kusatarisisa kwezvipingamupinyi zvesangano uye zvinokonzeresa mutengo, uye kushaikwa kweruzivo pamusoro pekuti vapepeti nevagadziri vakazvimiririra. Paive nekubvumirana kwakawanda pane dzakawanda nyaya dzinokosha kuhutano hwebasa rekutungamira kwemarwadzo ekudzokera shure. Kurudziro yekuongorora yaisanganisira kuongororwa kwekuongorora, kuongorora mireza matsvuku uye matambudziko etsinga, uye kuona zvingangoita zvepfungwa uye zvebasa zvipingamupinyi zvekupora. Nhungamiro dzakabvumiranawo pamusoro pemazano ekuti kurwadziwa kwepashure ndiko kuzvidzora uye kuti kuramba uri kubasa kana kutanga (zvishoma nezvishoma) kudzokera kubasa, kana zvichidiwa nemabasa akagadziridzwa, inofanira kukurudzirwa uye kutsigirwa.

Dr. Alex Jimenez's Insight

Kutambudzika kunodzoka shure ndechimwe chezvinhu zvakapararira zvehutano zvakabatwa mu chiropractic mahofisi. Kunyange zvazvo nyaya inotevera ichitsanangura kurwadziwa kwakanyanya kwepashure semamiriro ekudzivirira, chinokonzerwa neLBP chomunhu chinogonawo kukonzera kurwadziwa nekurwadza uye kusagadzikana kwebato rakasatorwa. Zvakakosha kune munhu ane zviratidzo zvekurwadziwa kunorwadza kutsvaga kurapa kwakakodzera nechiropractor kunyatsoongorora uye kubata zvirwere zvehutano hwavo uye kuvadzivisa kudzoka munguva yemberi. Varwere vanonzwa kurwadziwa kunorwadza shure kwemwedzi inopfuura 3 vasingapfuuri ne3 muzana vanogona kudzokera kubasa. Chiropractic kuchengetedza ndeyekuchengeteka uye inobudirira kumwe kushandiswa kurapwa kusarudzwa kunogona kubatsira kudzorera basa rekutanga remusana. Uyezve, chiremba wechiropractic, kana chiropractor, anogona kupa mararamiro ehupenyu, zvakadai sekurapa kwehutano uye yehutano, kukurumidza kugadzirisa chirwere chacho. Kuporesa kuburikidza nekufambisa kunokosha kuti LBP iwanezve.

Low back pain (LBP) nderimwe rematambudziko ehutano munyika dzeindasitiri. Pasinei nehunhu hwayo hwakanaka uye kosi inonzwika, LBP inowanzobatanidzwa nekusakwanisa, kurasikirwa kwechigadzirwa nekuda kwezororo rekurwara, uye kudhura kwakanyanya kwevanhu. [1]

Nekuda kwesimba iroro, pane kudiwa kuri pachena kwemaitiro ekutonga anobudirira anoenderana nehumbowo hwesainzi hunobva muzvidzidzo zvemhando yehudhirowa. Kazhinji, izvi zvinongorongedzwa zviedzo (RCTs) pamusoro pekubudirira kwemaitiro ekurapa, zvidzidzo zvekuongorora, kana zvidzidzo zvinotarisirwa zvekucherechedza pamusoro pezvipingamupinyi kana migumisiro. Uchapupu hwezvesayenzi, hwakapfupikiswa mukuongorora kwakarongeka uye meta-kuongorora, hunopa hwaro hwakasimba hwemazano ekugadzirisa LBP. Mune bepa rakapfuura, Koes et al. akaenzanisa akasiyana-siyana aripo nhungamiro yekiriniki yekutarisira LBP yakanangwa kune vekutanga hutano nyanzvi, ichiratidza kuwirirana kwakakura.[2]

Matambudziko ekuchengetwa kwehutano hwemabasa akasiyana. Utungamiri hunonyanya kukoshesa kupa mazano kune mushandi neLBP uye kugadzirisa nyaya dzekuvabatsira kuti varambe vachishanda kana kudzokera kubasa (RTW) mushure mekurwara mazita. Nekudaro, LBP inyaya yakakoshawo mukutarisirwa kwehutano hwebasa nekuda kwekusakwanisa kushanda, kurasikirwa kwechigadzirwa, uye zororo rekurwara. Nhungamiro dzinoverengeka, kana zvikamu zvemirayiridzo, zvave kuburitswa zvichibata nezvenyaya dzehutungamiriri munzvimbo yehutano hwebasa. Sezvo humbowo huri munyika yose, zvingatarisirwa kuti mazano emitemo yakasiyana-siyana yebasa reLBP angave akada kufanana. Zvisinei, hazvina kujeka kana nhungamiro inosangana nezvinogamuchirwa zvemhando yepamusoro.

Iri pepa rinonyatsoongorora nhungamiro yebasa iripo pakugadzirisa LBP uye inoenzanisa maitiro avo ekuongorora uye mazano ekutungamirira.

Main Messages

• Munyika dzakasiyana-siyana, mazano ehutano hwebasa anopiwa kuti avandudze hutungamiri hwemarwadzo ekudzokera shure mumamiriro ekushanda.
• Kukanganisa kwakajairika kweiyi nhungamiro kune chekuita nekusavepo kwekuongorora kwekunze kwakakodzera muhurongwa hwekuvandudza, kusatarisisa kwezvipingamupinyi zvesangano nemitengo yemitengo, uye kushaikwa kweruzivo pamusoro pekuzvimiririra kwevapepeti nevagadziri.
• Kazhinji, kurudziro yekuongorora mumirayiridzo yaisanganisira kuongororwa, kuongorora mireza yakatsvuka uye matambudziko etsinga, uye kuona zvingangoitika zvepfungwa uye zvebasa zvipingamupinyi zvekupora.
• Pane kubvumirana kwakawanda pamusoro pemazano ekuti kurwadziwa kwepashure ndiko kuzvidzora uye kuti kuramba uri kubasa kana kutanga (zvishoma nezvishoma) kudzokera kubasa, kana zvichidiwa nemabasa akagadziridzwa, inofanira kukurudzirwa uye kutsigirwa.

nzira

Nhungamiro pamusoro pehutano hwehutano hwehutano hweLBP hwakatorwa kubva kune vanyori 'mafaira ega. Kudzorerwa kwakatariswa nekutsvaga kweMedline uchishandisa mazwi makuru anorwadza shure, nhungamiro, uye basa kusvika muna Gumiguru 2001, uye kutaurirana kwevanhu pachavo nenyanzvi mumunda. Mitemo yaifanirwa kuzadzisa zvinotevera zvinosanganisira maitiro:

• Nhungamiro ine chinangwa chekutonga vashandi neLBP (muzvirongwa zvehutano hwemabasa kana kugadzirisa nyaya dzebasa) kana zvikamu zvakasiyana zvemitemo inobata nenyaya idzi.
• Mazano anowanikwa muChirungu kana Dutch (kana kuturikirwa mumitauro iyi).

Nzira dzekuregera dzaiva:

• Nhungamiro pamusoro pekudzivirira kwekutanga (kureva, kudzivirira kusati kwatanga zviratidzo) zveLBP ine chokuita nebasa (somuenzaniso, kusimudza mirayiridzo yevashandi).
• Mazano ekurapa kwekutungamirirwa kweLBP mukutarisira kwekutanga. [2]

Hunhu hwemirayiridzo yaisanganisirwa yakaongororwa pachishandiswa chiridzwa cheAGREE, chishandiso chegeneric chakagadzirirwa zvakanyanya kubatsira vanogadzira nhungamiro nevashandisi kuongorora maitiro ehutano hwemakiriniki maitiro ekutungamira.[3]

Chimbo che AGREE chinopa hurongwa hwekuongorora kunaka kwezvinhu zve24 (tafura 1), imwe neimwe yakarongwa pachiyero chezvikamu zvina. Kushanda kuzere kunowanikwa pa www.agreecollaboration.org.

Vaongorori vaviri (BS neHH) vakayera vakazvimiririra kunaka kwegwaro uye vakazosangana kuti vakurukure kusawirirana uye kusvika pakubvumirana pazviyero. Pavakatadza kubvumirana, muongorori wechitatu (MvT) akayananisa misiyano yakasara uye akasarudza pazviyero. Kufambisa ongororo muongororo iyi, zviyero zvakashandurwa kuita dichotomous variables yekuti chinhu chega chega chemhando chaive kana kuti chisina kusangana.

Mazano ekuongorora akapfupikiswa uye akaenzaniswa nemazano pamusoro pemazano, kurapwa, uye kudzokera kumabasa ekushanda. Nhungamiro dzakasarudzwa dzakawedzera kucherechedzwa uye dzakasvika maererano nekomiti yekutungamira, kuratidzwa kwemaitiro, boka rinotarisirwa, uye nhanho iyo kurudziro yakavakirwa pauchapupu hwesainzi huripo. Idzi ruzivo rwese rwakatorwa zvakananga kubva kune yakadhindwa nhungamiro.

Purogiramu Inobatsira

• Kutungamirirwa kwemarwadzo ekudzokera shure muhutano hwehutano hwehutano hunofanira kutevera uchapupu-based guidelines.
• Nhepfenyuro yeramangwana yebasa rekugadzirisa marwadzo ekudzokera shure uye kuvandudzwa kweiyo nhungamiro kunofanirwa kufunga nezvemaitiro ekusimudzira kwakakodzera, kuita, uye kuongororwa kwemaitiro sekutaurwa kwekubatana kweAGREE.

Results

Kusarudzwa kweZvino

Tsvakurudzo yedu yakawana mazano gumi, asi mana akanga asina kubatanidzwa nokuti aibata nehutungamiri hweLBP mukutarisira kwekutanga, [15] yakanga yakananga kutungamirirwa kwevashandi vanorwara-vakanyorwa muhuwandu (kwete kunyanya LBP), [16] yakanga yakagadzirirwa kudzivirira kwekutanga kweLBP kubasa, [17] kana kusawanikwa muChirungu kana chiDutch.[18] Sarudzo yekupedzisira, saka, yaive nemirairo mitanhatu inotevera, yakanyorwa nezuva rekuburitswa:

(1) Kanadha (Quebec). Nzira yesainzi yekuongorora uye kutungamira kwemaitiro ane chekuita nemusana kusagadzikana. A monograph yevarapi. Chirevo cheQuebec Task Force pane Spinal Disorders. Quebec Canada (1987) [4]

(2) Australia (Victoria). Nhungamiro dzehutungamiri hwevashandi vane marwadzo ekudzokera shure. Victorian WorkCover Authority, Australia (1996) [5] (Iyi ivhezheni yakadzokororwa yegwara rakagadzirwa neSouth Australian WorkCover Corporation muna Gumiguru 1993.)

(3) USA. Occupational Medicine Practice Guidelines. American College yeOccupational uye Environmental Medicine. USA (1997) [6]

(4) New Zealand

(a)Inoshanda uye inoshanda! Kugadzirisa acute low back pain munzvimbo yebasa. Accident Compensation Corporation uye National Health Committee. New Zealand (2000) [7]

(b) Mutungamiri wevarwere kune acute low back pain management. Accident Compensation Corporation uye National Health Committee. New Zealand (1998) [8]

(c) Ongorora psychosocial yero mireza mune acute low back pain. Accident Compensation Corporation uye National Health Committee. New Zealand (1997) [9]

(5) Netherlands. Dutch guideline yekutarisira vanachiremba vebasa revashandi vane kurwadziwa kwepashure. Dutch Association yeOccupational Medicine (NVAB). Netherlands (1999) [10]

(6) UK

(a) Mirayiridzo yehutano yebasa rekugadzirisa marwadzo ekudzokera shure pabasa guru mazano. Faculty of Occupational Medicine. UK (2000) [11]

(b) Mirayiridzo yehutano yebasa rekugadzirisa marwadzo ekudzokera shure papepa rekushanda kune varapi. Faculty of Occupational Medicine. UK (2000) [12]

(c) Mirayiridzo yehutano yebasa rekugadzirisa marwadzo ekudzokera shure pabasa rekuongorora uchapupu. Faculty of Occupational Medicine. UK (2000) [13]

(d)The Back Book, The Stationery Office. UK (1996) [14]

Nhungamiro mbiri (4 uye 6) haigone kuongororwa yakazvimirira kubva kune mamwe magwaro avanoreva (4bc, 6bd), saka magwaro aya akaiswawo muongororo.

Kuongorora kwehutano hweMitungamiri

Pakutanga, pakanga paine chibvumirano pakati pevaongorori vaviri maererano ne106 (77%) ye138 chinhu ratings. Mushure memisangano miviri, kubvumirana kwakasvika kune zvese kunze kwezvinhu zvina, izvo zvaida kutongwa nemuongorori wechitatu. Tafura 1 inopa zviyero zvekupedzisira.

Zvose zvaisanganisira mirayiridzo yakaratidza nzira dzakasiyana-siyana dzekutarisira LBP muhutano hwebasa. Mune zvishanu pamatanho matanhatu, zvinangwa zvese zvemaitiro zvakatsanangurwa zvakajeka, [46, 1014] vavariro yevashandisi vehurongwa vakatsanangurwa zvakajeka, [514] zvinozivikanwa zviri nyore zvinongedzo zvakabatanidzwa, [4, 614] kana kuongororwa kwakadzama. maitiro akaunzwa kuti atarise uye aongorore zvinangwa.[49, 1114]

Mhedzisiro yekuongorora kweAGREE yakaratidza kuti hapana kana imwe yemitemo yakabhadhara zvakakwana kune zvingave zvipingamupinyi zvesangano uye zvinodhura mukuita mazano. Hazvina kujeka zvakare kune vese vanosanganisira gwara rekuti vaive vakazvimirira here kubva kuboka rinopa mari uye kuti paive nemakakatanwa ezvido zvenhengo dzemakomiti ebudiriro. Pamusoro pezvo, zvanga zvisina kujeka kune zvese zvinongedzo kana nyanzvi dzakaongorora kunze mitemo isati yaburitswa. Chete nhungamiro yeUK yakatsanangura zvakajeka nzira yakashandiswa kugadzira kurudziro uye yakapihwa yekuvandudza nzira.[11]

Kuvandudzwa kweMitungamiri

Tafura 2 inopa ruzivo rwemashoko pamusoro pekufambiswa kwemitemo.

Vashandisi vezvinangwa zvemirayiridzo vaive vanachiremba nevamwe vatapi vehutano mumunda wehutano hwemabasa. Mitemo yakati wandei yaitungamirwawo kuzivisa vashandirwi, vashandi [68, 11, 14], kana nhengo dzemasangano anofarira hutano hwebasa.[4] Nhungamiro yechiDutch yaingonangwa kuna chiremba wezvehutano hwepabasa.[10]

Makomiti ekutungamira aitarisira kugadzira nhungamiro aiwanzo siyana-siyana, kusanganisira chirango senge epidemiology, ergonomics, physiotherapy, general practice, occupational medicine, occupational therapy, orthopedics, uye vamiriri vemasangano evashandirwi nemasangano evashandi. Chiropractic uye osteopathic vamiririri vaiva mugwaro komiti yeNew Zealand nhungamiro.[79] The Quebec task force (Canada) yaisanganisirawo vamiriri vemishonga yekudzoreredza, rheumatology, hutano hwehupfumi, mutemo, neurosurgery, biomechanical engineering, uye raibhurari sainzi. Kusiyana neizvi, komiti yekutungamira yeDutch guideline yaisanganisira vanachiremba vebasa chete.[10]

Nhungamiro dzakapihwa segwaro rakasiyana, [4, 5, 10] sechitsauko mubhuku, [6] kana semagwaro akati wandei ane hukama.[79, 1114]

Iyo UK, [13] iyo USA, [6] neCanada [4] nhungamiro dzakapa ruzivo nezve zano rekutsvaga rinoshandiswa mukuzivikanwa kwemabhuku akakodzera uye kuyerwa kwehumbowo. Kune rimwe divi, maDutch[10] neAustralia[5] nhungamiro yakatsigira kurudziro yavo chete nemareferensi. Nhungamiro yeNew Zealand haina kuratidza hukama hwakananga pakati pemazano uye zvinonetsa [79]. Muverengi aiendeswa kune mamwe mabhuku kuti awane ruzivo.

Varwere Vagari Navanoona Mazano

Kunyange zvazvo mazano ose akatarisa kune vashandi vane LBP, zvakanga zvisinganyatsozivikanwi kana vakabata neLBP yakaoma kana isingagumi kana zvose. Acute uye isingaperi LBP yaiwanzosatsanangurwa, uye mapoinzi ekucheka akapihwa (semuenzaniso, <mwedzi mitatu). Zvaiwanzosajeka kana izvi zvaireva kutanga kwezviratidzo kana kusavapo kubasa. Zvisineyi, nhungamiro yeCanada yakaunza hurongwa hwekuronga (acute/subacute/ chronic) zvichibva pakuparadzirwa kwezvichemo zvehosha dzemusana nenguva kubva pakusaenda kubasa.[3]

Nhungamiro dzese dzinosiyanisa LBP yakananga uye isiri yakananga. Specific LBP inobata mamiriro angangove akakomba emureza mutsvuku sekutyoka, mapundu, kana kutapukirwa, uye nhungamiro dzeDutch neUK dzinosiyanisa radicular syndrome kana tsinga midzi marwadzo.[1013] Maitiro ese aienderana mukurudziro yavo yekutora nhoroondo yekiriniki uye kuita ongororo yemuviri, kusanganisira neurological screening. Muzviitiko zvekufungidzirwa chaiko pathology (mireza matsvuku), x-ray bvunzo dzakakurudzirwa nemirairo yakawanda. Pamusoro pezvo, New Zealand uye nhungamiro yeUS yakakurudzirawo kuongororwa kwex-ray apo zviratidzo zvisina kunaka mushure memavhiki mana. [6, 9] Nhungamiro yeUK yakataura kuti bvunzo dze x-ray hadziratidzirwe uye hadzibatsire hutano hwehutano hwebasa. murwere ane LBP (yakasiyana nechero zviratidzo zvekiriniki).[1113]

Mazhinji nhungamiro akafunga nezve psychosocial zvinhu seyero mireza sezvipingamupinyi mukupora izvo vanopa hutano vanofanirwa kugadzirisa. Iyo New Zealand [9] uye UK nhungamiro [11, 12] yakanyatso nyora zvinhu uye mibvunzo yakakurudzira yekuziva iwo psychosocial yellow mireza.

Nhungamiro dzese dzakataura kukosha kwenhoroondo yekiriniki inozivisa zvinhu zvemuviri uye zvepfungwa zvepanzvimbo yebasa zvinoenderana neLBP, kusanganisira zvinodiwa zvemuviri zvebasa (kubata nemaoko, kusimudza, kukotama, kumonyoroka, uye kuratidzwa kune muviri wese kudedera), tsaona kana kukuvara, uye zvinoonekwa zvinonetsa. mukudzoka kubasa kana hukama kubasa. Mirayiridzo yeDutch neCanada yaive nemazano ekuita ongororo yenzvimbo yebasa[10] kana ongororo yehunyanzvi hwebasa pazvinenge zvakakodzera.[4]

Nhaurirano yeZvirongwa zveKuongorora kweLBP

• Kuongorora kuongorora (kwete-LBP chaiyo, radicular syndrome, yakananga LBP).
• Usasanganise mireza matsvuku uye kuongorora kwetsinga.
• Ziva maonero ehupfungwa uye zvipingamupinyi zvinogona kuitika kuti uwanezve.
• Ziva nzvimbo dzebasa (zvepanyama uye zvepfungwa) izvo zvingave zvakabatana nechinetso cheLBP uye kudzokera kubasa.
• X-Ray bvunzo dzinongowanikwa kune dzinofungidzirwa nyaya dzeiyo chaiyo pathology.

Mazano Pamusoro Pemazano uye Mazano, Kurapa, uye Kudzokera Kumagadzirirwo Emabasa

Mitemo yakawanda inokurudzirwa kuvimbisa mushandi uye kupa ruzivo pamusoro pekuzvigadzirisa kweLBP uye kufungidzira kwakanaka. Kurudziro yekudzokera kumabasa enguva dzose sezvinobvira yaiwanzopiwa zano.

Maererano nekurudziro yekudzokera kumabasa enguva dzose, mazano ose akasimbisawo kukosha kwekudzoka kubasa nekukurumidza sezvinobvira, kunyange kana kuchine imwe LBP uye, kana zvichidiwa, kutanga nemabasa akagadziridzwa mumatambudziko akaoma. Mabasa ebasa aigona ipapo kuwedzerwa zvishoma nezvishoma (maawa nemabasa) kutozosvikira kudzokera kubasa kwasvikwa. Nhungamiro dzeUS neDutch dzakapa dzakadzama nguva dzekudzokera kubasa. Maonero echiDutch akakurudzira kudzokera kubasa mukati memavhiki maviri nekuchinja kwemabasa pazvinenge zvakakodzera.[10] Hurongwa hwechiDutch hwakasimbisawo kukosha kwekutonga-nguva-nguva nezvekudzoka kubasa.[10] Nhungamiro yeUS yakaronga kuedza kwese kuchengetedza murwere padanho repamusoro rekuita, kusanganisira mabasa ebasa; zvinangwa zvenguva yehurema maererano nekudzoka kubasa zvakapiwa semazuva 02 ane mabasa akagadziridzwa uye mazuva 714 kana mabasa akagadziridzwa asina kushandiswa / aripo.[6] Mukusiyana nemamwe, gwara rekuCanada rakakurudzira kudzokera kubasa chete kana zviratidzo uye zvirambidzo zvekushanda zvave nani.[4]

Nzira dzekurapa dzinowanzokurudzirwa mumitemo yose yakabatanidzwa yaiva: mishonga yekunyaradza marwadzo, [5, 7, 8] zvishoma nezvishoma zvirongwa zvekurovedza muviri zvinofambira mberi, [6, 10] uye kuvandudzwa kwemarudzi akawanda.[1013] Nhungamiro yeU.S. yakakurudzira kuendeswa mukati memavhiki maviri kuchirongwa chekurovedza muviri chinosanganisira maekisesaizi e-aerobic, maekisesaizi ekugadzirisa tsandanyama dzehunde, uye chiyero chekurovedza muviri.[6] Nhungamiro yeDutch yakakurudzira kuti kana pasina kufambira mberi mukati memavhiki maviri ekusavapo kwebasa, vashandi vanofanira kuendeswa kune purogiramu yebasa regiredhi (zvishoma nezvishoma kuwedzera maekisesaizi) uye, kana pasina kuvandudzika nemavhiki mana, kuchirongwa chekugadzirisa zvinhu zvakawanda.[10] ] Nhungamiro yeUK yakakurudzira kuti vashandi vanoomerwa nekudzoka kumabasa enguva dzose nemavhiki mazana mana negumi nemaviri vanofanirwa kuendeswa kuchirongwa chekuvandudza chinoshanda. Iyi purogiramu yekudzorera inofanira kusanganisira dzidzo, kuvimbiswa uye mazano, chirongwa chinofambira mberi chakasimba chekurovedza muviri uye chirongwa chehutano, uye kugadzirisa marwadzo maererano nemitemo yekuzvibata; inofanira kuiswa munharaunda yebasa uye yakanangidzirwa zvakasimba kune kudzokera kubasa.[412-11] Mazita akawanda ezvingasarudzwa zvekurapa zvakaratidzwa mumirayiridzo yeCanada neAustralia [13, 4], kunyange zvazvo zvizhinji zveizvi zvakanga zvisina kuvakirwa. pauchapupu hwesainzi.

Nhepfenyuro yezvikurudziro pamusoro peRuzivo, Mazano, Kudzokera Kumabasa Matsanho, uye Kurapa kune Vashandi vane LBP

• Simbisa mushandi uye upe ruzivo rwakakwana pamusoro pekuzvimisa kweLBP uye kufungidzira kwakanaka.
• Rairira mushandi kuti aenderere mberi nemabasa akajairika kana kuti adzokere kuekisesaizi yenguva dzose uye kushanda nokukurumidza sezvinobvira, kunyange kana pachine mamwe marwadzo.
• Vazhinji vashandi vane LBP vanodzokera kune mamwe kana mashoma mabasa enguva dzose nekukurumidza. Funga nezvekuchinja kwechinguvana kwemabasa ebasa (maawa / mabasa) chete kana zvichidikanwa.
• Kana mushandi akakundikana kudzokera kubasa mukati memavhiki e212 (kune kusiyana kukuru muchiyero chenguva mumitemo yakasiyana-siyana), vataurire kune chirongwa chekuwedzera zvishoma nezvishoma chekurovedza muviri, kana kugadziriswa kwemarudzi akawanda (maitiro, dzidzo, kuvimbiswa, uye marwadzo ekutungamirira kutevera mitemo yehutsika). ) Aya mapurogiramu ekudzorera
  inofanira kuiswa mumamiriro ekushanda.

hurukuro

Utungamiri hweLBP muhutano hwehutano hwebasa hunofanira kugadzirisa hukama pakati pezvichemo zvakaderera shure uye basa nekugadzira mazano ane chinangwa chekudzoka kwakachengeteka kubasa. Ongororo iyi yakaenzanisa nhungamiro yehutano hwebasa iripo kubva kunyika dzakasiyana siyana. Mitemo haiwanzo kunyoreswa muMedline, saka kana tichitsvaga nhungamiro, taifanira kuvimba zvakanyanya nemafaira emunhu uye kutaurirana pachedu.

Maitiro Ehutano uye Kuvandudzwa kweMitemo

Kuongororwa kwechirongwa cheAITREE [3] kwakaratidza kusiyana kwehutano hwehutungamiri huri kuongororwa, izvo zvingangodaro zvingaratidza kushandiswa kwemazuva ekufambiswa nekubudiswa kwemitungamiri. ICanada nhungamiro, somuenzaniso, yakabudiswa mu1987 uye Australian guideline muna 1996. [4, 5] Mimwe mirayiridzo yakanga ichangobva kuitika uye yakawedzera huwandu hwomupupuriro hwehuwandu uye huripo kusvikira nhasi maitiro ehutungamiri.

Zvikanganiso zvakasiyana-siyana zvinowanzoenderana nehutano hwekufambiswa kwemirayiridzo yakaratidzwa nekuongororwa nechombo chechirongwa. Chokutanga, zvakakosha kujekesa kana mutungamiri wekuzvimiririra wehurumende kubva kumubatanidzwa wemari, uye kana pane kukakavara kwevanhu vanoita komiti inotungamirira. Hapana yemitemo yakabatanidzwa yakanyatsorondedzera nyaya idzi. Zvakare, yakarondedzera kubvunzurudzwa kwekunze kwechirongwa nemakiriniki uye mazano vekugadzirwa kwepamusoro kusati kwadhindwa kwaive kusinawo mazano ose akabatanidzwa munyaya iyi.

Mitsara yakawanda yakapa ruzivo rwakakwana pamusoro penzira yakakodzera mabhuku yakatsvakurudzwa uye yakashandurwa muzvirongwa. [4, 6, 11, 13] Mamwe mirayiridzo yakatsigira mazano avo nezviratidzo, [5, 7, 9, 10] asi izvi hazvibvumi kuongorora kubwinya kwemashoko kana mazano avo.

Mirayiridzo inobva kune uchapupu hwezvesayenzi, hunochinja munguva, uye zvinoshamisa kuti imwe chete inotungamirirwa inopa hurumende itsva. [11, 12] Zvichida pane zvigadziriswa zvakarongwa kune mamwe mazano asi hazvirevi zvakananga (uye zvakatarisa kutaura ipapo richave rakanaka remangwana hazvirevi kuti richaitika zvechokwadi). Kushaikwa kwekupa ruzivo kunogonawo kubata kwechokwadi kune zvimwe zvinotenderwa zvinotenderwa izvo zvatakaverenga zvisina kunaka. Kushandiswa kwechirongwa chechirongwa semutungamiri wekukudziridza uye kubudiswa kwemitemo kunofanira kubatsira kuvandudza hutungamiri hwehupenyu huri mberi.

Kuongorora uye Kutungamirirwa kweLBP

Nzira dzekuongorora dzinokurudzirwa mumitemo yehutano hwebasa dzakanga dzakanyanya kufanana nemazano emitemo yekiriniki, [2] uye, zvine musoro, musiyano mukuru waiva kusimbiswa kwekugadzirisa nyaya dzebasa. Nzira dzakataurwa dzekugadzirisa zvinhu zvepabasa mukuongororwa kweLBP yemushandi wega wega ane chokuita nekuzivikanwa kwemabasa akaoma, zvinhu zvinokanganisa, uye zvipingamupinyi zvekudzoka kubasa nenhoroondo dzebasa. Zviripachena, zvipingamupinyi izvi zvekudzokera kubasa hazvinei nekuremerwa kwemuviri chete, asiwo matambudziko epfungwa ane chekuita nebasa, kushanda pamwe nevaunoshanda navo, uye magariro kumabasa.[10] Kuongororwa kwemabasa ane chekuita nemagariro eyero mireza kunogona kubatsira kuona vashandi vari panjodzi yekurwadziwa kusingaperi nekuremara.[1113]

Chimwe chinhu chinonyanya kukosha chemitungamiri ndechekuti vaisagadzikana pamusoro pezvavanorayira kuti vatsigire mushandi neLBP, uye kukurudzira nekusigira kudzokera kubasa kunyange nezvimwe zviratidzo zvinoramba zvichiitika. Pane kubvumirana kwakawanda iyo vazhinji vashandi havafaniri kumirira kusvikira vasisina zvachose marwadzo vasati vadzokera kubasa. Mazita ezvokurapa anopiwa neCanada neAustralia mazano angaratidza kusasha kwehuchapupu panguva iyoyo, [4, 5] achisiya vashandi vemirayiridzo yavanosarudza ivo pachavo. Izvozvi, zvisinei, hazvina chokwadi kana mitsamba yakadaro inobatsira chaizvo pakuvandudza kutarisira, uye mumaonero edu mazano ekufambisa anofanirwa kunge akavakirwa pauchapupu hwezvesayenzi.

IUS, Dutch, uye UK occupational guidelines [6, 1013] inokurudzira kuti kushingaira kwehutano hwemarudzi akawanda ndiko kupindira kunovimbisa kwekudzoka kubasa, uye izvi zvinotsigirwa nehuchapupu hwakasimba kubva kuRCTs [19, 20] Zvisinei, tsvakurudzo yakawanda ichiri zvinodikanwa kuona zvakanangana zvemukati uye kusimba kweaya mapakeji ekurapa.[13, 21]

Pasinei nehumwe humbowo hwemupiro wezvinhu zvepabasa mune aetiology yeLBP, [22] nzira dzakarongeka dzekugadzirisa nzvimbo dzebasa dzinoshaikwa, uye hazvipiwi sekurudziro mumirayiridzo. Zvichida izvi zvinomiririra kushaikwa kwechivimbo muhumbowo hwezvese zvinokonzeresa zvinhu zvepabasa, kuomerwa kweshanduro kuita nhungamiro inoshanda, kana nekuti nyaya idzi dzinovhiringika nemutemo wenzvimbo (iyo yakapihwa mugwaro reUK [11]). Zvingave kuti kupindira kweergonomics inobatanidzwa, iyo inokurudzira kubvunzana nemushandi, mushandirwi, uye ergonomist, ichava kudzoka kunobatsira kupindira kwebasa. 23] yakasimbiswa muDutch uye UK mirayiridzo, [24] asi imwezve kuongororwa kweiyi nzira uye kushandiswa kwayo kunodiwa.

Kuvandudza Kwemangwana Mitsva muZvipational Health Care

Chinangwa chekuongororwa uku ndechokupa zvose zvakanyatsorongeka uye kuongororwa kwakakosha kwemashoko emabasa ekutungamirirwa kweLBP. Kuongorora kwakakosha kwemitungamiri inofanirwa kubatsira rubatsiro rwakananga mune ramangwana uye kugadziriswa kwakarongwa kwemitemo. Muchiri chichiri kubuda munharaunda yenzira yekufambisa tinotarisa matanho ose akapfuura seanoyemura; tinoziva chido chekuraira kwechipatara, uye tinoziva kuti vatungamiri vanosimudzira havagoni kumirira kutsvakurudza kuti vape nzira dzose uye uchapupu hunodiwa. Zvisinei, pane nzvimbo yekuvandudza uye mirayiridzo yeramangwana uye kuvandudzwa kunofanirwa kutarisa zvinotarisirwa pakuchengetedza kwakanaka, kushandiswa, uye kuongororwa kwevatungamiri sezvinoratidzirwa nekushandira pamwe.

Kushandiswa kwemitungamiri yacho hakupfuuri kuongororwa uku, asi zvakataurwa kuti hapana mimwe mitungamiri inonyorwa inotsanangurwa zvakananga maitiro ekushandisa, saka hazvizivikanwe kuti zvikamu zvitsva zvingave zvave zvasvika sei, uye zvii zvingave zvakakonzerwa . Izvi zvinogona kuva nzvimbo inobereka kutsvaga kutsvakurudza.

Kuvepo chaiko kweaya mazano ehutano hwebasa anoratidza kuti nhungamiro iripo yekiriniki yekutarisira yeLBP2 inoonekwa seisina kufanira kana kusakwana pakutarisirwa kwehutano hwebasa. Pane maonero akajeka pasi rose kuti zvinodikanwa zvemushandi ari kurwadziwa shure zvakabatanidzwa kune zvakasiyana-siyana zvebasa rebasa risingafukidzwi neyakajairwa kutungamira kwekutanga kutungamira uye, nekudaro, kudzidzira. Chinobuda ndechekuti, kunyangwe paine kukanganisa kwemaitiro, chibvumirano chakakura chinoonekwa pane dzakasiyana siyana dzehutano hwemabasa ekugadzirisa mushandi ane marwadzo ekumusana, mamwe acho ari matsva uye dambudziko raimboitwa maonero. Pane chibvumirano pamusoro peshoko rinokosha rokuti kurasikirwa kwebasa kwenguva refu kunokuvadza, uye kuti kukurumidza kudzoka kwebasa kunofanira kukurudzirwa uye kurerutswa; hapana chikonzero chekumirira kugadziriswa kwechiratidzo chakakwana. Kunyange zvazvo nzira dzinokurudzirwa dzichisiyana, pane kubvumirana kukuru pamusoro pekukosha kwekusimbiswa kwakanaka uye mazano, kuvapo (kwenguva pfupi) basa rakagadziridzwa, kugadzirisa zvinhu zvepabasa (kuita kuti vatambi vose vamire), uye kugadziriswa kwevashandi vane dambudziko rekudzokera kubasa.

KUTENDA

Ichi chidzidzo chakatsigirwa neDutch Health Care Insurance Council (CVZ), kupa DPZ kwete. 169 / 0, Amstelveen, Netherlands. JB Staal iye zvino ari kushanda paDhipatimendi reEpidemiology, Maastricht University, PO Box 616 6200 MD Maastricht, Netherlands. W van Mechelen zvakare chikamu cheChishopiti Chekuongorora pamusoro Pechiitiko Chekuita, Basa Nehutano, Muviri @ Kushanda TNO-VUmc.

Mukupedzisa, zviratidzo zvekurwadziwa kwepashure ndezvimwe zvezvinhu zvakasiyana-siyana zvehutano zvine chokuita nekukuvara kwebasa. Nemhaka yei, mitemo yakawanda yehutano yehutano yakagadzirirwa kutungamirirwa kwekutambudzika kwepamusoro. Chiropractic kuchengetedza, pakati pemamwe nzira dzokurapa, inogona kushandiswa kuitira kubatsira murwere kuwana rusununguko kubva kune LBP yavo. Uyezve, nyaya iri pamusoro apa yakaratidza kuchengetedzwa nekubudirira kwezvimwe zvakasiyana-siyana zvetsika pamwe nekusarudzwa kwekurapa mune zvekuongororwa, kurapwa uye kudzivirirwa kwezviitiko zvakasiyana-siyana zvinorwadza shure. Zvisinei, zvimwe zvidzidzo zvekutsvakurudza zvinotarisirwa kuitira kuti zvigadzirise zvakanakira nzira imwe neimwe yekurapa. 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

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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.

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