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Manuelle Medizin in der Behandlung von Rückenschmerzen

Eine kritische Bestandsaufnahme

Manual medicine in the treatment of low back pain

A critical review

  • Leitthema
  • Published:
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Zusammenfassung

Hintergrund

Rückenschmerzen sind häufig und manualmedizinische Verfahren spielen oft in der Behandlung eine wichtige Rolle. Vor dem Hintergrund der evidenzbasierten Medizin stellt sich die Frage nach der Effektivität angewandter Behandlungsverfahren.

Methode

Der aktuelle Wissenstand wurde auf Grundlage einer systematischen Literaturrecherche in PubMed beleuchtet.

Ergebnisse

Zum Thema wurden 94 relevante klinische Studien gefunden. Physiologische Grundlagen für die Anwendung manualmedizinischer Verfahren sind in der Literatur beschrieben. Die kurzfristige Effektivität manualmedizinischer Anwendungen lässt sich bei akuten und chronischen Rückenschmerzen nachweisen. Insbesondere bei chronischen Rückenschmerzen sind komplexere manualmedizinische Behandlungsansätze den monomodalen überlegen. Wichtige Faktoren mit Einfluss auf das Behandlungsergebnis sind die Reaktion auf die initiale manualmedizinische Behandlung, die Schmerzausbreitung, psychosoziale Faktoren sowie die initiale Schmerzstärke und Behinderung.

Diskussion

Die Anwendung manualmedizinischer Verfahren beruht auf einer physiologischen Grundlage und zeigt positive klinisch relevante Effekte. Bei komplexeren Schmerzbildern sind vielschichtigere Befundlagen zu erwarten, die entsprechend diagnostiziert und therapiert werden sollten. Weitere wissenschaftliche Untersuchungen zur therapeutischen Subgruppenbildung und einzelnen manualmedizinischen Verfahren wären sinnvoll.

Abstract

Background

Low back pain is very frequent and manual therapy often plays an important role in the management. Against the background of evidence-based medicine a systematic literature search was undertaken to show its effectiveness.

Method

A systematic literature search was carried out in PubMed to assess the current state of knowledge.

Results

A total of 94 relevant clinical studies were found. A sound physiological basis for the use of manual medicine is described in the literature. For acute and chronic low back pain a short lasting effect could be shown. For chronic low back pain complex multimodal treatment programs were more effective. Important further factors influencing treatment outcome are the reaction to the initial manual treatment, the extent of pain, psychosocial factors, the initial pain intensity and degree of disability.

Discussion

The treatment of low back pain by manual medicine techniques has a physiological basis and shows clinically relevant positive effects. More complex pain syndromes require a complex diagnostic and therapeutic approach. Further scientific evaluation of the formation of therapeutic subgroups and individual manual medicine procedures is required.

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  1. Klinik für Manuelle Therapie, Klinik für Wirbelsäulen-, Gelenkleiden und Schmerztherapie, Kompetenzzentrum für Schmerzmedizin, Ostenallee 83, 59071, Hamm, Deutschland

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Niemier, K. Manuelle Medizin in der Behandlung von Rückenschmerzen. Manuelle Medizin 53, 424–446 (2015). https://doi.org/10.1007/s00337-015-0054-y

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