主动运动与推拿治疗非特异性下腰痛：临床随机对照

目的：主动运动和中医推拿被广泛用于腰痛的治疗，比较主动运动和中医推拿对随机就诊非特异性下腰痛患者的疼痛程度和日常生活活动功能的影响。方法：实验于1996一叭／1998—12在阿曼马斯喀特亚洲医学中心完成：189例非特异性下腰痛患者按就诊顺序随机分成A组(137例)主动运动加推拿治疗；B组(52例)按摩治疗；治疗前后用疼痛模拟量尺(visual analog scale，VAS)和Oswestry腰痛残疾问卷量表(Oswestry low back pain disability index，OSW)，评定两组患者的疼痛程度和日常生活活动受限程度。结果：A，B两组VAS和OSW指数都有下降，A组VAS指数下降明显大于B组(t=2．657，P&;lt;0．01)；A组OSW指数下降亦明显大于B组(江15．733，P&;lt;0．01)。6个月～2年随访表明A组复发率15．08％(19／126)低于B组35．42％(17／48)，经检验χ^2=8．761，P&;lt;0．01)结论：主动运动和按摩治疗均可减轻疼痛、改善日常生活活动功能。主动运动有利于预防复发，运动疗法是经济有效的治疗腰痛方法。     

定量有氧运动早期干预对非特异性下腰痛的康复作用

背景非特异性下腰痛的临床治疗方法较多,但多为被动对症治疗,有关主动运动早期干预治疗的报道较少.目的研究定量有氧运动早期干预加功能重建对非特异性下腰痛的治疗效果.设计临床随机对照试验设计.地点和对象资料收集于阿曼首都马斯喀特亚洲医学中心1996-01/1998-12门诊收治非特异性下腰痛(nonspecific low back pain,NLBP)患者189例,其中男112例,女77例(均为阿拉伯人和欧洲人).干预189例非特异性下腰痛患者按就诊顺序随机分成两组A组(137例)主动运动早期干预加推拿治疗,B组(52例)推拿治疗;用视觉模拟量表(VAS)和腰痛问卷调查量表(OSW),对两组患者进行治疗前后分析评估.主要观察指标治疗前后VAS和OSW评分指数变化.结果两组VAS和OSW指数都有下降,A组指数下降明显大于B组[A组VAS治疗前后的值分别为(59.64±1.19),(28.98±0.95),B组为(63.33±1.91),(36.86±1.47),t=36.644,19.785,P＜0.01;A组OSW治疗前后的值分别为(26.781±0.492),(11.649±0.357),B组为(27.098±0.756),(15.625±0.570)(t=42.216,18.202,P＜0.01).6个月～2年随访表明A组复发率(15.08%,19/126)低于B组(35.42%,17/48).结论运动疗法早期介入治疗非特异性下腰痛,可缓解疼痛,改善和重建腰部功能,预防机体功能下降,提高日常生活活动能力.     

定量有氧运动早期干预对非特异性下腰痛的康复作用

背景：非特异性下腰痛的临床治疗方法较多，但多为被动对症治疗，有关主动运动早期干预治疗的报道较少。目的：研究定量有氧运动早期干预加功能重建对非特异性下腰痛的治疗效果。设计：临床随机对照试验设计。地点和对象：资料收集于阿曼首都马斯喀特亚洲医学中心1996-01／1998-12门诊收治非特异性下腰痛(nonspecific low back pain，NLBP)患者189例，其中男112例，女77例(均为阿拉伯人和欧洲人)。干预：189例非特异性下腰痛患者按就诊顺序随机分成两组：A组(137例)主动运动早期干预加推拿治疗，B组(52例)推拿治疗；用视觉模拟量表(VAS)和腰痛问卷调查量表(OSW)，对两组患者进行治疗前后分析评估。主要观察指标：治疗前后VAS和OSW评分指数变化。结果：两组VAS和OSW指数都有下降，A组指数下降明显大于B组[A组VAS治疗前后的值分别为(59．64&;#177;1．19)，(28．98&;#177;0．95)，B组为(63．33&;#177;1．91)，(36．86&;#177;1．47)，t=36．644，19．785，P&;lt;0．01；A组OSW治疗前后的值分别为(26．781&;#177;0．492)，(11．649&;#177;0．357)，B组为(27．098&;#177;0．756)，(15．625&;#177;0．570)(t=42．216，18．202，P&;lt;0．01)。6个月-2年随访表明A组复发率(15．08％，19／126)低于B组(35．42％，17／48)。结论：运动疗法早期介入治疗非特异性下腰痛，可缓解疼痛，改善和重建腰部功能，预防机体功能下降，提高日常生活活动能力。     

非特异性腰痛康复治疗的临床循证

非特异性腰痛为腰骶部疼痛，就其康复治疗进行循证，在cochrane图书馆收集了11篇文章，系统评价了针灸、推拿、物理疗法、运动疗法在康复治疗中的作用。     

非特异性下腰痛的临床与康复

下腰痛(low back pain，LBP)是指下腰、腰骶、骶髂、臀部或腿部一组疼痛的主观感觉，伴有腿部疼痛、麻木和无力就称为坐骨神经痛。大约有60％—80％，的成年人在生活中有过LBP的经历，是仅次于上呼吸道疾患而就诊的第二位常见的临床症状，是45岁以下人群最常见的致残原因。对于疼痛没有客观的测量，只能通过主观的自我描述(如疼痛的刻     

慢性下腰痛的治疗方法评价

目的：慢性下腰痛治疗方法较多，对其有效性和安全性的评价很重要。资料来源：应用计算机检索Medline和Ovid数据库1990-01／2004—11期间的相关章，检索词“chronic low back pain，rehabilitation／therapy”，并限定章语言为English。资料选择：选取随机对照试验，不限制盲法条件。选取平行对照试验，对照组为安慰对照、假性处理对照或以不同疗法进行对照，治疗组以药物、物理因子、按摩、针刺、运动等方法进行治疗。资料提炼：共收集到26篇关于慢性下腰痛治疗的研究原，20个试验符合纳入标准，另有1个手术疗效观察性试验被特别纳入，排除的5篇试验中，2篇因系重复的同一研究，3篇为Meta分析研究。资料综合：21个试验包括3358例患，其中4个试验为药物疗法，1个试验为物理疗法，2个试验为按摩疗法，3个试验为针刺疗法，3个试验为运动疗法．4个试验为综合疗法，4个试验为外科疗法。结论：按摩疗法、激光疗法和运动疗法对慢性下腰痛具有明显的疗效，基本上是安全的，对于非特异慢性下腰痛来说，多学科综合疗法最为有效。关节神经切断术和椎间盘内电热疗法分别对慢性关节源和椎间盘源的腰痛具有确切的疗效，无明显损害作用。     

非特异性腰痛的临床特征

目的：对非特异性腰痛。国内还缺乏规范的诊断分类。回顾非特异性腰痛相关的临床和基础研究，阐述非特异性腰痛的临床特征和研究进展，对本病科学规范的康复干预很有必要。资料来源：检索美国国家图书馆医学在线(Medline)数据库、中国万方、中国生物医学献、中国学术期刊CAJ和VIP数据库。资料选择：以“nonspecific／非特异性”和“low back pain／腰痛”为检索词，获取非特异性腰痛的全部资料和信息，英163篇；中22篇。对获取的资料以“in title”、“2000—2004”加以限制，筛选出近5年的主题献，英28篇；中9篇。对重点献的主要参考献进行手工检索追踪相关全。献包括基础研究、临床研究。资料提炼：对主题献全中的与非特异性腰痛相关的信息进行分类综合研究。资料综合：现有的临床指南一般将腰痛分为三类：非特异性腰痛，特异性腰痛和坐骨神经／根性疼痛综合征。非特异性腰痛占腰痛的85％以上，其病因不明，与许多危险因素相关。非特异性腰痛的治疗方法很多，但都是选择性治疗。结论：研究表明逐需建立规范的腰痛诊断分类标准，以利于指导临床实践；腰痛的预防与腰痛的治疗相比确实更为可取；多学科参与的三级预防策略是有希望的减轻疼痛、预防复发和致残的有效途径。     

推拿加腰背肌训练对非特异性下腰痛的疗效及其机制

目的探讨推拿加腰背肌训练治疗非特异性下腰痛的作用机理。方法200例非特异性下腰痛（NLBP）患者分为4组：空白组、训练组、推拿组、推拿加训练组，各50例。在治疗开始和治疗4周后，对4组患者进行肌酸激酶（CK）、乳酸脱氢酶（LDH）、超氧化物歧化酶（SOD）活性、丙二醛（MDA）含量的测定及目测类比定级法（VAS）评定。结果4组患者的CK、LDH、SOD和MDA含量以及VAS指数均有不同程度的改善。组间比较，推拿加训练组的CK、LDH、SOD和MDA含量以及VAS指数均明显优于其他3组（均P〈0．01）。结论中医推拿技术结合主动功能训练治疗NLBP具有明显的康复疗效。     

非特异性腰痛康复治疗的临床循证

非特异性腰痛为腰骶部疼痛,就其康复治疗进行循证,在cochrane图书馆收集了11篇文章,系统评价了针灸、推拿、物理疗法、运动疗法在康复治疗中的作用。     

慢性下腰痛的康复治疗与护理

人类已进入信息化社会,体力劳动强度较工业时代大大减轻,但下腰痛仍然是影响人类社会生活的重要疾病之一。下腰痛是指腰骶部脊柱及其两侧区域的疼痛。按照疼痛的持续时间分为急性（〈4周）、亚急性（4～12周）和慢性（〉12周）。在美国,每年用于治疗下腰痛的医疗费用为140亿;每年约有1亿美国人因慢性下腰痛（chronic low back pain,CLBP）而导致残疾;同时损失25亿个工作日。而在我国,下腰痛也是导致病休缺勤,严重影响劳动力的常见疾患。     

Effect of pulsed electromagnetic field on nonspecific low back pain patients: a randomized controlled trial

BackgroundFurther research on pulsed electromagnetic field (PEMF) effects on the different conditions of low back pain was warranted due to lack of studies in this area.ObjectivesTo investigate the effects of pulsed electromagnetic field therapy with 50 Hz frequency, with low intensity of 20 Gauss compared to conventional non-invasive treatment modalities in patients with chronic non-specific low back pain.MethodsDesign – A prospective, randomized, patient-blinded, controlled trial. Setting – The study was conducted at Outpatient Physiotherapy Clinic in Cairo, Egypt. The study was conducted between May 2015 and September 2016. Participants – Fifty participants with non-specific low back pain enrolled into experimental and control groups. Interventions – The experimental group received the Conventional physical therapy Protocol as well as magnetic field, while the control group received the same Conventional physical therapy and sham electromagnetic field. Both groups received 12 sessions over 4 weeks’ period. Outcome measures – Primary outcome measures was pain intensity while the secondary outcome measures were disability and lumbar range of motion – ROM. There were no adverse events occurred during the study.ResultsFifty participants with non-specific low back pain (control group n = 25; experimental group n = 25) were randomized. There were significant between-group differences in pain scores (mean difference – MD 1.52; 95%CI −0.34 to 3.35), function disability (MD 8.14; 95%CI 6.5 to 9.96), Range of Motion (ROM) of lumbar flexion (MD −1.27; 95%CI −1.09 to −1.45), ROM of lumbar extension (MD −1.1; 95%CI −0.97 to −1.23), ROM of lumbar right side bending (MD 8.2; 95%CI 6.56 to 9.84) and ROM of lumbar left side bending (MD 10.4; 95%CI 8.81 to 11.99) in favour of the experimental group.ConclusionAdding pulsed electromagnetic field to Conventional physical therapy Protocol yields superior clinical improvement in pain, functional disability, and lumbar ROM in patients with non-specific low back pain than Conventional physical therapy alone.     

Effect of soft and prolonged Graeco-Arabic massage in low back pain - A randomized controlled clinical trial

BackgroundLow back pain (waja-uz-zahr) due to lumbar spondylosis affects approximately 60–80% of the population at any point of life. The present study was aimed to evaluate the efficacy of soft and prolonged massage with roghan-i-suranjan on low back pain.Material and methodsClinically and radiologically diagnosed patients of low back pain were randomized into test and control groups consisting 20 patients in each group. The patients in test group received soft and prolonged massage with roghan-i-suranjan; while, in control group, short wave diathermy was given on every alternate day up to 20 min for 3 weeks. The patients were assessed before and after the treatment using the VAS and ODI (OLBP) scales.ResultsVAS score was reduced to 42.14%, (p < 0.001) in massage and 13.94%, (p < 0.008) in control group after the treatment [Percentual Change (PC) between the groups = 54.35%, p < 0.001]. OLBP score was improved to 37.16% (p < 0.001) in massage and 5.93% (p < 0.0012) in control group after the treatment [PC between the groups = 29.57%, p < 0.02].ConclusionApart from the muhallil-i-awram (anti-inflammatory), mulattif (attenuative), daf-i-alam (analgesic), and musakkin (sedative) activities of the tested-drugs, the specific strokes soft and prolonged massage further enhances the evacuative and rejuvenative process through its own action of tahleel (dissolution), talteef (attenuation), taskeen (sedation), and taskheen (diaphoresis) induced by the various manipulations used in this massage. Soft and prolonged massage with tested oil was found effective in reducing the pain and improving the quality of life in the patients of low back pain.     

Increasing days at work using function-centered rehabilitation in nonacute nonspecific low back pain: a randomized controlled trial

OBJECTIVE: To evaluate the effect of function-centered compared with pain-centered inpatient rehabilitation in patients whose absence from work is due to chronic nonspecific low back pain (LBP). DESIGN: Single-blinded randomized controlled trial with follow-up assessments immediately after treatment and at 3 months. SETTING: Center for work rehabilitation in Switzerland. PARTICIPANTS: Patients with more than 6 weeks of work absence due to chronic nonspecific LBP (N=174; 137 men, 37 women; mean age +/- standard deviation, 42+/-8 y; mean sick leave before study, 6.5 mo). INTERVENTIONS: Function-centered treatment (FCT) (4h/d, 6d/wk, for 3 wk) consisted of work simulation, strength, endurance, and cardiovascular training. Pain-centered treatment (PCT) (2.5h/d, 6d/wk, for 3 wk) used a mini back school, individually selected passive and active mobilization, stretching, and low-intensity strength training. MAIN OUTCOME MEASURES: The number of days at work in 3 months after treatment, self-efficacy, lifting capacity, pain, mobility, strength, and global perceived effect. Effect sizes (ESs) (Cohen d ) were defined as small (ES range, 0.2-0.5), moderate (ES range, 0.5-0.8), and large (ES, >0.8). RESULTS: Groups were comparable at baseline. Moderate ESs for the FCT group versus PCT group were found for days at work (25.9 d vs 15.8d, ES=.36, P =.029), self-efficacy (5.9 points vs -7.4 points, ES=.55, P =.003), and lifting capacity (2.3 kg vs 0.2 kg, ES=.54, P =.004). CONCLUSIONS: Function-centered rehabilitation increases the number of work days, self-efficacy, and lifting capacity in patients with nonacute nonspecific LBP.     

Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial

Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial.

Objective

To examine the effect of adding aerobic exercise to conventional physiotherapy treatment for patients with chronic low back pain (LBP) in reducing pain and disability.

Design

Randomized controlled trial.

Setting

A physiotherapy outpatient setting in Hong Kong.

Participants

Patients with chronic LBP (N=46) were recruited and randomly assigned to either a control (n=22) or an intervention (n=24) group.

Interventions

An 8-week intervention; both groups received conventional physiotherapy with additional individually tailored aerobic exercise prescribed only to the intervention group.

Main Outcome Measures

Visual analog pain scale, Aberdeen Low Back Pain Disability Scale, and physical fitness measurements were taken at baseline, 8 weeks, and 12 months from the commencement of the intervention. Multivariate analysis of variance was performed to examine between-group differences.

Results

Both groups demonstrated a significant reduction in pain (P<.001) and an improvement in disability (P<.001) at 8 weeks and 12 months; however, no differences were observed between groups. There was no significant difference in LBP relapse at 12 months between the 2 groups (χ²=2.30, P=.13).

Conclusions

The addition of aerobic training to conventional physiotherapy treatment did not enhance either short- or long-term improvement of pain and disability in patients with chronic LBP.     

Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial

Abstract

Objectives:

Low back pain (LBP) is a common condition in adolescents. Although much has been written about the efficacy of lumbar manipulation for adults with LBP, little is known about its effectiveness in adolescents. This study had two primary aims: (1) to assess the efficacy of adding lumbar manipulation to an exercise program in adolescents with acute (<90 days) LBP and (2) to report and assess any adverse reactions associated with lumbar manipulation noted in this study.

Methods:

Patients were randomly assigned to receive lumbar manipulation or sham manipulation. All patients performed 4 weeks of physical therapy exercise. Pain, patient-specific functional scale (PSFS), and global rating of change (GROC) scores were measured at evaluation, 1 week, 4 weeks, and 6 months. Relative risk was calculated for adverse reactions noted.

Results:

We recruited 35 consecutive patients with acute LBP. One patient was excluded after being diagnosed with a spondylolysis, 34 patients remained for analysis. Both groups experienced significant improvement over time in all measures. There were no differences between groups for pain, PSFS, or GROC scores. No increased risk of adverse reaction from lumbar manipulation was noted.

Discussion:

The addition of lumbar manipulation to exercise did not benefit adolescents with acute LBP. There was not an increased risk of an adverse reaction noted in this study from lumbar manipulation performed on adolescents. Further research needs to be done to identify factors that predict positive outcomes following lumbar manipulation in adolescents.     

Lumbar manipulation and exercise for the treatment of acute low back pain in adolescents: a randomized controlled trial

ObjectivesLow back pain (LBP) is a common condition in adolescents. Although much has been written about the efficacy of lumbar manipulation for adults with LBP, little is known about its effectiveness in adolescents. This study had two primary aims: (1) to assess the efficacy of adding lumbar manipulation to an exercise program in adolescents with acute (<90 days) LBP and (2) to report and assess any adverse reactions associated with lumbar manipulation noted in this study.MethodsPatients were randomly assigned to receive lumbar manipulation or sham manipulation. All patients performed 4 weeks of physical therapy exercise. Pain, patient-specific functional scale (PSFS), and global rating of change (GROC) scores were measured at evaluation, 1 week, 4 weeks, and 6 months. Relative risk was calculated for adverse reactions noted.ResultsWe recruited 35 consecutive patients with acute LBP. One patient was excluded after being diagnosed with a spondylolysis, 34 patients remained for analysis. Both groups experienced significant improvement over time in all measures. There were no differences between groups for pain, PSFS, or GROC scores. No increased risk of adverse reaction from lumbar manipulation was noted.DiscussionThe addition of lumbar manipulation to exercise did not benefit adolescents with acute LBP. There was not an increased risk of an adverse reaction noted in this study from lumbar manipulation performed on adolescents. Further research needs to be done to identify factors that predict positive outcomes following lumbar manipulation in adolescents.     

A randomized, controlled trial of manual therapy and specific adjuvant exercise for chronic low back pain

OBJECTIVE: This article examines the effectiveness of manual therapy with specific adjuvant exercise for treating chronic low back pain and disability. METHODS: A single blind, randomized, controlled trial was employed. Patients were prescribed an exercise program that was tailored to treat their musculoskeletal dysfunctions or given a nonspecific program of general stretching and aerobic conditioning. In addition, patients received manual therapy or sham manual therapy. Participants were seen for 6 weekly sessions and were asked to perform their exercise program twice daily. RESULTS: Seventy-two out of 100 patients completed the study. Multivariate tests conducted for measures of pain and disability revealed a significant group by time interaction (P = 0.04 and P = 0.05, respectively), indicating differential change in these measures pretreatment to posttreatment as a function of the treatment received. When controlling for pretreatment scores, patients receiving manual therapy with specific adjuvant exercise reported significant reductions in pain. No change in perceived disability was observed, with the exception that patients receiving sham manual therapy with specific adjuvant exercise reported significantly greater disability at posttreatment. DISCUSSION: Manual therapy with specific adjuvant exercise appears to be beneficial in treating chronic low back pain. Despite changes in pain, perceived function did not improve. It is possible that impacting chronic low back pain alone does not address psychosocial or other factors that may contribute to disability. Further studies are needed to examine the long-term effects of these interventions and to address what adjuncts are beneficial in improving function in this population.     

Low-energy laser treatment and exercise for chronic low back pain: double-blind controlled trial

Twenty patients with chronic low back pain were enrolled in a randomized double-blind trial to test the efficacy of low-energy laser biostimulation combined with exercise. Ten patients received low-energy gallium-arsenide laser treatment, and ten received placebo laser treatment. Both groups were also placed on an active exercise program. Visual analogue and disability pain scores were assessed pretreatment and one month posttreatment and showed significant (p less than .02) improvements in both groups, but no relative advantage was found for either group. Objective parameters using computerized triaxial measurements of range of motion, isometric torque, and isodynamic velocity were also performed before and after treatment. There were significant improvements in objective parameters in both the laser and placebo groups, but no relative advantage accrued to either group. Under the conditions of this study, low-energy laser stimulation plus exercise did not provide a significant advantage over exercise alone.