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Oefenen als behandeling voor chronische lage-rugpijn

Exercise as a treament for chronic low back pain [The Spine Journal;4(2004):106-115]

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Stimulus

Samenvatting

Achtergrond. Oefenen is een veel voorgeschreven behandeling voor chronische lage-rugpijn, met een aangetoonde effectiviteit voor verbetering van functie en werk.

Doel. Het doel van dit artikel is een overzicht te geven van verschillende sleutelelementen met betrekking tot veiligheid en effectiviteit van het oefenen. Dit kan behandelaars helpen het nut ervan bij de behandeling van chronische rugpijn te begrijpen.

Onderzoeksopzet/kader. Op MEDLINE is een geautomatiseerde zoektocht door de literatuur uitgevoerd met behulp van de zoektermen: ‘exercise’, ‘fitness’, ‘back pain’, ‘backache’ en ‘rehabilitation’. Van de gevonden artikelen werden de samenvattingen gescand en nuttige artikelen werden voor nadere beoordeling opgevraagd. Extra referenties werden verkregen uit onderzoeksartikelen in het bezit van de auteurs en door het opnieuw bekijken van eerdere besprekingen van dit onderwerp. Deze laatste artikelen werden nageplozen op gegevens die relevant waren voor de sleutelelementen van het oefenen die in dit artikel worden behandeld.

Resultaten. Er bestaat geen bewijs dat oefenen het risico van extra rugproblemen of arbeidsongeschiktheid vergroot voor mensen met acute, subacute of chronische lage-rugpijn. De huidige medische literatuur lijkt er juist op te wijzen dat oefenen ofwel een neutraal effect heeft of het risico van toekomstig rugletsel iets kan verminderen. Er zijn drie duidelijke doelstellingen om oefenen aan patiënten met lage-rugpijn voor te schrijven. Het eerste en meest voor de hand liggende doel is het verbeteren of doen verdwijnen van beperkingen in rugmobiliteit en -kracht en het verbeteren van de prestaties bij duuractiviteiten. Er is zeer veel bewijs dat een meerderheid van patiënten met chronische lage-rugpijn dit doel kan bereiken. Het tweede doel van oefenen is het verminderen van de intensiteit van rugpijn. In de meeste onderzoeken naar oefenen is na oefentherapie een globale afname van rugpijnintensiteit waargenomen. Deze afname varieert van 10 tot 50 procent. Het derde doel van oefenen is de met de rugpijn gepaard gaande beperkingen te verminderen door de patiënt minder gevoelig te maken voor angsten en zorgen, de houding tegenover pijn te veranderen en de gemoedstoestand te verbeteren. De mechanismen waardoor oefenen dit doel kan bereiken, is het onderwerp geweest van veel onderzoek.

Conclusies. Oefenen is veilig voor mensen met rugpijn, omdat het het risico van toekomstig rugletsel of arbeidsverzuim niet vergroot. Er bestaat substantieel bewijs dat oefenen gebruikt kan worden als een therapeutisch middel om stoornissen in flexibiliteit en kracht van de rug te verbeteren. Uit de meeste onderzoeken blijken globale pijnscores na oefenprogramma’s te verbeteren en vaak blijkt dat oefenen aspecten op gebied van gedrag, cognitie, gemoedstoestand en beperkingen bij rugpijnsyndromen kan verminderen.

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    James Rainville

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The Spine Center van het New England Baptist Hospital, Boston, Verenigde Staten.

Harvard Medical School, Boston, Verenigde Staten.

Vertaald door: D. Plancken-Kroon

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Rainville, J., Hartigan, C., Martinez, E. et al. Oefenen als behandeling voor chronische lage-rugpijn. STIM 24, 7–19 (2005). https://doi.org/10.1007/BF03076115

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