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Chronischer lumbaler Rückenschmerz

Vergleich zwischen Mobilisationstraining und Training der rumpfstabilisierenden Muskulatur

Chronic low back pain

Comparison of mobilization and core stability exercises

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Zusammenfassung

Hintergrund

In der Behandlung chronischer lumbaler Rückenschmerzen werden Übungen zur Kräftigung der rumpfstabilisierenden Muskulatur und zur Mobilisation des Rumpfes eingesetzt. Das Ziel dieser prospektiven randomisierten klinischen Pilotstudie war, die Wirksamkeit einer Trainingsmethode der segmentalen Beweglichkeit der Wirbelsäule mit einem Training der rumpfstabilisierenden Muskulatur hinsichtlich objektiver und subjektiver Outcomes bei Patienten mit chronischen lumbalen Rückenschmerzen zu vergleichen.

Methodik

Nach einer Per-Protocol-Analyse wurden die Daten von 27 Patienten mit chronischen lumbalen Rückenschmerzen, die einer von 2 Gruppen randomisiert zugeordnet wurden, ausgewertet. Die Interventionsgruppe (GM) führte ein Mobilisationstraining nach der BALLance-Methode®, die Vergleichsgruppe (GS) ein Training der rumpfstabilisierenden Muskulatur über einen Zeitraum von 4 Wochen mit anschließendem Heimübungsprogramm über weitere 4 Wochen durch. Zu 3 Zeitpunkten (Vorher, nach 4 Wochen, Follow-up nach 8 Wochen) wurden die Beweglichkeit, die Kraftausdauer der Rumpfmuskulatur, die schmerzbedingte Behinderung bei Aktivitäten im Alltag, sowie das Schmerzvermeidungsverhalten erhoben.

Ergebnisse

Im Mittel verbesserte nur die GS signifikant die Haltezeit im Unterarmstütz und Seitstütz über die Zeit (p < 0,001) mit signifikanten Unterschieden zur GM (p < 0,05). In der Mehrzahl der subjektiven Outcomes konnte innerhalb beider Gruppen eine signifikante Verbesserung festgestellt werden (p < 0,05). Zwischen den Gruppen bestanden dabei keine signifikanten Unterschiede.

Diskussion

Patienten mit chronischen lumbalen Rückenschmerzen scheinen in Bezug auf ihre Beschwerden im Alltag sowohl mit gezielten Mobilisationsübungen als auch mit Übungen zur Kräftigung der rumpfstabilisierenden Muskulatur behandelt werden zu können.

Abstract

Background

For the treatment of chronic low back pain (cLBP), both core stability and mobilization exercises were introduced. The aim of this prospective randomized clinical pilot study was to compare the efficacy of mobilization and core stability exercises with regard to objective and subjective outcome measures in patients with cLBP.

Method

After a per-protocol analysis, the data of 27 patients with cLBP, who were randomly allocated to one of the two groups, were analyzed. The intervention group (GM) performed mobilization exercises using the BALLance-Methode®, the control group (GS) carried out core stability exercises for 4 weeks, and continued the exercises for an additional 4 weeks at home. Flexibility, strength endurance of the core stabilizing muscles, pain-induced disability, and pain avoidance behavior were the objective and subjective outcomes that were measured before, 4 weeks after, and 8 weeks after the onset of the intervention. The significance of differences within and between groups was analyzed.

Results

During the observation period, only in the GS patients could maintain the prone-plank position and the side-plank position improvements over time (p < 0.001), with significant differences compared with the GM (p < 0.05). Within both groups significant improvements in the subjective outcome measures were found (p < 0.05). Therefore, no significant differences existed between the groups.

Conclusion

With regard to their daily complaints, patients with cLBP can be treated using standardized mobilization exercises in addition to core stability exercises.

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Authors and Affiliations

  1. Fachbereich Gesundheitswesen, Therapiewissenschaften, Hochschule Niederrhein, Reinarzstr. 49, 47805, Krefeld, Deutschland

    M. Alfuth

  2. Universitäre Weiterbildung M.Sc. Sportphysiotherapie, Deutsche Sporthochschule Köln, Am Sportpark Müngersdorf 6, 50933, Köln, Deutschland

    M. Alfuth & D. Cornely

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Correspondence to M. Alfuth.

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Interessenkonflikt

M. Alfuth und D. Cornely geben an, dass kein Interessenkonflikt besteht.

Alle beteiligten Patienten nahmen freiwillig an der Studie teil und gaben nach Aufklärung schriftlich ihr Einverständnis. Alle hier beschriebenen Untersuchungen am Menschen wurden im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Ferner erhielten die Patienten beider Gruppen eine in der Praxis und Wissenschaft bereits erprobte Behandlungsmaßnahme, sodass hier keine ethischen Bedenken bestanden. Daher wurde auf die Vorlage eines Antrags zur ethischen Prüfung des Vorhabens bei einer Ethikkommission verzichtet.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Alfuth, M., Cornely, D. Chronischer lumbaler Rückenschmerz. Orthopäde 45, 579–590 (2016). https://doi.org/10.1007/s00132-016-3233-1

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