Interdependência Regional na Lombalgia: Intervenções Ir para: navegação, pesquisa

Regional Interdependence

• [1].
  
• There is a growing body of evidence to support the treatment of Examination 

  Interventions

  Interventions directed at the Thoracic Spine[2] 

  Thoracic Manipulation

  • One case study reported improved outcomes in patients with chronic low back pain after utilizing the following intervention aimed at the thoracic spine. 
  • Supine Thoracic Posterior to Anterior Thrust Manipulation^[2]

  Hip^{[3][4][5][6][7]}

  Hip Manipulation

  • One case series found that the use of hip manipulaiton was beneficial for their patients with low back pain. ^[7]
  • Supine Long Axis Distraction Thrust Manipulation

  [3]^[4][6][7]

• Supine Hip Caudal Glide Mobilization

  

• Prone Hip Posterior to Anterior Mobilization

  

• Hip Posterior to Anterior Mobilization with Flexion, Abduction, and External Rotation

• Hip Anterior to Posterior Mobilization with Flexion, Adduction, and Internal Rotation      

  

HIp Therapeutic Exercise

          + One case study found that the following strengthening exercise helped to decrease low back pain. ^[5]

          – Hip Abduction with slight extension and internal rotation

  

          + Two studies found the following stretches to be useful in the treatment of low back pain.^[4][3]

          – Supine Iliopsoas Stretch

  

          – Prone Rectus Femoris Stretch

  

Outcomes

Articles	Body Region Treated	Level of Evidence	Improved Oswestry Disability Index Score	Improved Fear Avoidance Behavioral Questionairre Score	Improved Global Rating of Change Score	Improved Modified Spinal Stenosis Scale Score	Improved Pain Pressure Threshold	Decreased Pain	Improved Function
Burns et al.	Hip	4	X	X	X				X
Cibulka	Hip	4	X					X	X
Oliviera et al.	Thoracic Spine	2					X	X
Whitman et al. 2003	Hip	4	X		X	X			X
Whitman et al. 2006	Hip	2	X		X	X		X	X
Lejkowski & Poulsen	Hip	4						X	X

          – An “X” denotes improvement in each specific category regardless of statistical significance. 

Clinical Implications

Utilizing manual therapy interventions targeted at the hip and thoracic spine along with therapeutic exercise has been shown to provide improved outcomes for patients with low back pain. Clinicians should consider these interventions along with treatments focused on the low back to treat the entire patient and achieve improved results. Additional information can be found in the references listed below.

References

1. ↑ Wainner RS, Whitman JM, Cleland JA, Flynn TW. Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come. J Orthop Sports Phys Ther 2007;37(11):658-660. Pub Med Link: ↑ 2.0^2.1 Oliveira RF, Liebano RE, Costa LCM, Rissato LL, Costa LOP. Immediate Effects of Region-Specific and Non-Region-Specific Spinal Manipulative Therapy in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. Phys Ther 2013;93(6):748-756. Pub Med Link: ↑ 3.0^3.13.2 Whitman JM, Flynn TW, Fritz, JM. Nonsurgical management of patients with lumbar spinal stenosis: a literature review and a case series of three patients managed with physical therapy. Phys Med Rehabil Clin N Am 2003;14:77-101. Pub Med Link: ↑ 4.0^4.14.2 Whitman JM, Flynn TW, Childs JD, et al. A comparison between two physical therapy treatment programs for patients with lumbar spinal stenosis: a randomized clinical trial. Spine 2006;31(22):2541-2549. Pub Med Link: ↑ 5.0^5.1 Cibulka MT. Low Back Pain and its Relation to the Hip and Foot. J Orthop Sports Phys Ther 1999;29(10):595-601. Pub Med Link: ↑ 6.0^6.1 Lejkowski PM, Poulsen E. Elimination of intermittent chronic low back pain in a recreational golfer following improvement of hip range of motion impairments. Journal of Bodywork & Movement Therapies 2013;17:448-452. Pub Med Link: ↑ 7.0^7.17.2 Burns SA, Mintken PE, Austin GP, Cleland J. Short-term response of hip mobilizations and exercise in individuals with chronic low back pain: a case series. Journal of Manual and Manipulative Therapy 2011;19(2):100-107. Pub Med Link: function gtElInit() { var lib = new google.translate.TranslateService(); lib.setCheckVisibility(false); lib.translatePage('en', 'pt', function (progress, done, error) { if (progress == 100 || done || error) { document.getElementById("gt-dt-spinner").style.display = "none"; } }); }