| Titel: | Effective physical treatment for chronic low back pain. | | Kategori: | Manipulation/mob, Massage, Laser | | Författare: | Maher CG. | | Källa: | Orthop Clin North Am. | | År: | 2004 | | Sidor: | 57-64 | | Sammanfattning: | | It is now feasible to adopt an evidence-based approach when providing physicaltreatment for patients with chronic LBP. A summary of the efficacy of a range ofphysical treatments is provided in Table 1. The evidence-based primary careoptions are exercise, laser, massage, and spinal manipulation; however, thelatter three have small or transient effects that limit their value as therapiesfor chronic LBP. In contrast, exercise produces large reductions in pain anddisability, a feature that suggests that exercise should play a major role inthe management of chronic LBP. Physical treatments, such as acupuncture,backschool, hydrotherapy, lumbar supports, magnets, TENS, traction, ultrasound,Pilates therapy, Feldenkrais therapy, Alexander technique, and craniosacraltherapy are either of unknown value or ineffective and so should not beconsidered. Outside of primary care, multidisciplinary treatment or functionalrestoration is effective; however, the high cost probably means that theseprograms should be reserved for patients who do not respond to cheaper treatmentoptions for chronic LBP. Although there are now effective treatment options forchronic LBP, it needs to be acknowledged that the problem of chronic LBP is farfrom solved. Though treatments can provide marked improvements in the patient'scondition, the available evidence suggests that the typical chronic LBP patientis left with some residual pain and disability. Developing new, more powerfultreatments and refining the current group of known effective treatments is thechallenge for the future. |
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