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SELECTED OSTEOPATHIC TECHNIQUES IN LOW BACK PAIN TREATMENT
Abstract and Figures
Introduction. Low back pain is a serious problem of Western societies in the 21st cen- tury. It sometimes starts with a so-called acute state, which is characterized by a rapid, strong, peracute course, which makes the patient unable to function normally; sometimes this pain is the sum of overlapping pathologies and dysfunctions.
Method. The aim of the authors is to present a treatment process of low back pain which is based on the osteopathy concept. Osteopathy treats the dysfunction, which means the loss of mobility in the myofascial, joint and visceral system, and not the pathology or structural lesions. Due to the fact, that back pain can be caused by many factors, some- times even life threatening, the osteopath is obliged to make a preliminary differential diagnosis. This relates both to the medical plane in terms of excluding pathologies and the functional plane based on a palpatory evaluation as well as osteopathic tests for dysfunctions in joint, tissue and visceral mobility. A detailed diagnostic approach based on medical knowledge and palpatory skills enables one to choose the right treatment technique.
Conclusion. The osteopathic approach to low back pain in both acute and chronic states delivers positive results. Applied techniques are safe, non-invasive and non-traumatic. These techniques consist of direct, indirect, functional, and reflex techniques (these use the nervous and muscular reactions), and techniques which drain parts of the body af- fected by an inflammatory state.
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... It is known that almost 80% of the population is aff ected by this dysfunction, and that half of them underwent at least one kind of painful incident a year. This problem aff ects people between 45 and 60 years of age, professionally active [1,2]. If LBP persists for 3 months it is considered as chronic and may cause physical and psychological limits, and a major economic burden causes absence from work [3][4][5]. ...
... The OMT protocol will be limited to the following OMT techniques: [1,21] ...
Introduction: Numerous modalities of conservative therapeutic interventions are available to achieve the best health benefits in people with Low Back Pain (LBP), e.g., kinesiotherapy, physical therapy, behavior therapy. People with LBP continue to experience pain and disability despite receiving the best evidence based therapy. Osteopathic Manual Therapy (OMT) and Kaltenborn-Evjenth Ortopedic Manual Therapy (KEOMT) are the other options, although their effectiveness remains controversial. The aim of this study is a proposal for a protocol for randomized trials to compare the effectiveness of OMT vs. KEOMT on pain and disability in people suffering from LBP. Methods and analysis: It's a randomized study with two-arms parallel, designed with concealed allocation, the assessor's blinding with intention to-treat analysis. It will include 34 people a group with severe disability ranged from 41 to 60% in Oswestry Disability Index (ODI). There will be two groups: a treatment group (OMT) and a comparison group (KEOMT). All the patients in both groups will receive 2 treatments a week for 5 weeks. Each session in both groups will not exceed 30 minutes. During each session OMT and KEOMT techniques will be repeated 3 times. A baseline assessment will be performed pre and post intervention, two days later. The following parameters will be assessed during the evaluations: Numeric Pain Rating Scale – NPRS, ODI. Ethics and dissemination: The trial was approved by the Scientific Research Ethics Committee of University of Warmia and Mazury, Olsztyn, Poland. Registration approval number: 9/2018. Trial registration: The study protocol was prospectively registered in the Chinese Clinical Trial Registry on December 28, 2019 (registration ID: ChiCTR1900028580). Strengths and Limitations of this Study The participants' random allocation to the experimental and the control groups. The same experienced physiotherapist, blind to the outcome measures, provides the interventions. The same assistant, blind to the group allocation, administrates the outcomes. The same number of the interventions, the compared contact time with the physiotherapist providing the interventions. A short follow-up period and/or a rather small sample size.
Doğru beslenme, bireylerin gereksinimleri kadar besin ögelerinin vücuda
alınıp, uygun şekilde vücutta kullanılması ile sağlanmaktadır. Ancak bireyin
psikolojik durumu ya da sekonder tıbbi komplikasyonlar beslenme ve yeme
davranışını / tutumunu değiştirebilmekte, dolayısıyla beslenme veya yeme
bozuklukları meydana gelebilmektedir. Yeme bozukluklarının gelişiminde
etkili risk faktörleri birçok farklı çalışmada çalışılmış ve incelenmiştir. Bu
çalışmalara göre yeme bozukluğu gelişiminde toplum baskısı, beden
algısındaki değişiklikler, genetik faktörler ve psikolojik faktörler etkili
olabilmektedir. Daha önceki çalışmalar bu etkenlerden genetik üzerinde
fazla durmasa da son yıllarda genetik birtakım farklılıkların da yeme
bozukluğu patofizyolojisinde etkili olabileceği gösterilmiştir. Yeme
bozuklukları üzerine 20. yüzyıla kadar pek fazla çalışılmamış, belirli bir
sınıflandırma yapılmamıştır. Tanımlanan ilk yeme bozuklukları anoreksiya
nervoza ve bulimia nervozadır. Amerikan Psikiyatri Derneği’nin yayınladığı
Zihin Hastalıklarının Tanısal ve İstatistiksel El Kitabı`nda (DSM) yeme ve
beslenme bozukluklarının tanımları yapılmakta ve tanı kriterleri
yayınlanmaktadır. DSM kriterlerinin 2013 yılında son güncellenmesi
yapılmış ve DSM-V yayınlanmıştır. Hastalıkların etiyolojisinin dışında DSM,
hastalıkların tanımlanmasında kullanılan kriterleri de belirlemektedir. Aynı
zamanda tanı saptanırken dikkat edilmesi gereken davranışlar ve bu
davranışların süreleri ile ilgili de tanımlamalar yapmaktadır. 2013 yılında
en son yayınlanan DSM-V kılavuzuna göre yeme bozuklukları sekiz alt
kategoride toplanmıştır. Bu kategorizasyona göre tanımlanan yeme
bozuklukları; pika, ruminasyon bozuklukları, kaçıngan/kısıtlayıcı beslenme,
anoreksiya nervoza, bulimia nervoza, tıkanırcasına yeme bozukluğu,
tanımlanmış diğer beslenme ve yeme bozuklukları, tanımlanmamış diğer
beslenme ve yeme bozuklukları şeklindedir. Ancak tanımlanmayan diğer
beslenme ve yeme bozuklukları hakkında çalışmaların devam etmesi
gerektiği, literatürde bulunan bazı patolojik durumların da yeme ve
beslenme bozukluğu olarak sınıflandırılabileceği bildirilmiştir. Bu derleme
çalışmada güncel DSM kılavuzuna göre yeme bozukluklarının
sınıflandırılmasının ve patofizyolojisinin incelenmesi amaçlanmıştır.
Bel ve boyun ağrıları oldukça yaygın görülen, kalıcı fonksiyonel kayıplara ve iş gücü kaybına neden olan en önemli bir sağlık sorunudur. Ağrı hastaların psikolojik durumlarını önemli oranda etkilemekte, beraberinde hastaların günlük yaşam aktivitelerinde kısıtlama ve depresyona yatkınlık oluşturmaktadır. Osteopatik manuel terapi (OMT); kas iskelet sistemi hastalıklarında konvansiyonel tedaviyi tamamlamak amacıyla sıkça kullanılan, önemli bir tedavi şeklidir. OMT bedeni bir bütün olarak değerlendiren, homeostatik mekanizmaları geliştiren, yapı ve fonksiyon ilişkilerini en üst düzeye çıkarmak için tanı ve tedavi stratejileri içeren bir yaklaşımdır. OMT, kas-iskelet ağrısını azaltır, disfonksiyonun vücut sistemleri üzerindeki etkisini azaltır, solunum mekaniğini geliştirir, venöz ve lenfatik drenajı iyileştirir. OMT parietal, visseral ve kranial osteopati olmak üzere 3 sistem üzerinden etki gösterir. Parietal Osteopati; Kas iskelet sisteminden kaynaklanan ağrı ve disfonksiyonların tedavisinde kullanılır. Visseral osteopati, visseral yapılardaki problemleri tedavi ederek, bunların neden olduğu ağrı ve şikâyetleri ortadan kaldıran bir tedavi yaklaşımıdır. Kranial osteopati hassas ve hafif dokunuşlarla yapılan osteopatik bir tedavi tipidir. Hastada var olan ağrı ve şikâyetlerin ortadan kaldırılmasına yardımcı olur.
A systematic review of randomized controlled trials.
To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain.
Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy.
A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results.
The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100-point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti-inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short-term effects.
The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.
Rozložená tit. s. Obálkový podnázev: anatomie, poruchy a ošetření
Biochemical and biophysical studies have demonstrated that proteoglycan monomers from immature and adult articular cartilage differ in composition and size. To investigate the structural basis of age-related differences in articular cartilage proteoglycan monomers and aggregates, we isolated and purified high buoyant density proteoglycans from the articular cartilages of 2- to 3-month-old calves and 18-month-old steers. The molecular architecture and dimensions of the proteoglycans were examined using the electron microscope monolayer method. Aggregated and nonaggregated monomers from calf cartilage were longer and less variable in length than the corresponding monomers from steer articular cartilage. Calf monomer lengths had unimodal frequency distributions whereas nonaggregated steer monomer lengths had a bimodal distribution. These observations were confirmed by acrylamide-agarose electrophoresis, which demonstrated that the samples contained only one species of proteoglycan monomer in calf but two species in steer. In addition, calf aggregated monomers had longer thin segments indicating that calf and steer monomers differed in structure as well as in size. Steer proteoglycan aggregates were shorter and had fewer monomers than those from calf. These observations demonstrate the existence of significant age-related structural differences in articular cartilage proteoglycans and form the basis for future study of the mechanisms responsible for these differences.
The prevention of needless pain must begin with the obvious: research aimed at eliminating the injuries and illnesses that cause pain. Others have been assigned such topics at this meeting, and I will not further address primary prevention of pain by the elimination of its inciting tissue damage. There are pain prevention issues that are in great need of innovative research, but a necessary first step must be epidemiologic studies of the incidence, natural history, and distribution of significant painful conditions within our population.
Despite an initial lack of acceptance by mainstream medicine, and amidst projections of a serious oversupply of physicians, the osteopathic profession continues to grow, successfully competing for shrinking health care resources and attracting the attention of insurers and those in managed care. However, a recent telephone survey of 800 health maintenance organization beneficiaries suggested that the public is not yet familiar with osteopathic medicine. The history, philosophy, and current status of the osteopathic profession are presented, along with theories of the physiologic basis of and supporting evidence for palpatory diagnosis and manipulative therapy.
In Britain, as in many other countries, back pain is a major cause of disability, especially in adults of working age. During the decade to 1993, outpatient attendances for back pain rose fivefold, and the number of days of incapacity from back disorders for which social security benefits were paid more than doubled.1 It is unclear whether this represents an increase in the occurrence of diseases affecting the back or a change in people's behaviour when they have symptoms. To address this question we compared the prevalence of low back pain and associated disability in two postal surveys 10 years apart.
Low back pain is a common reason for patient visits to a health care provider. For most patients, low back symptoms are nonspecific, meaning that the pain is localized to the back or buttocks and is due to a presumed musculoligamentous process. For patients with radicular leg symptoms, a precise etiology is more commonly identified. The history and physical examination usually provide clues to the uncommon but potentially serious causes of low back pain, as well as to those patients at risk for prolonged recovery. Diagnostic testing should not be a routine part of the initial evaluation, but used selectively based upon the history, examination, and initial treatment response. For patients without significant neurological impairment, initial treatments should include activity modification, nonnarcotic analgesics, and education. For patients whose symptoms are not improving over 2 to 4 weeks, referral for physical treatments is appropriate. A variety of therapeutic options of limited or unproven benefit are available for patients with radicular leg symptoms or chronic low back pain. Patients with radicular pain and little or no neurological findings should receive conservative treatment, but elective surgery is appropriate for those with nerve root compression who are unresponsive to conservative therapy.