运动疗法在慢性非特异性腰痛中的治疗进展

邹洋; 盛莉; 吴宗辉

doi:10.16766/j.cnki.issn.1674-4152.002468

运动疗法在慢性非特异性腰痛中的治疗进展

doi: 10.16766/j.cnki.issn.1674-4152.002468

邹洋^{1, 2},
盛莉²,
吴宗辉^{1, 2, ,}

1.
西南大学运动康复研究所，重庆 400715
2.
西南大学体育学院，重庆 400715

详细信息

通讯作者:
吴宗辉，E-mail：wuzh@swu.edu.cn

中图分类号: R681.57 R455
计量
- 文章访问数: 152
- HTML全文浏览量: 105
- PDF下载量: 11
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-23
- 网络出版日期: 2022-09-05

Progress in the treatment of chronic nonspecific low back pain with exercise therapy

ZOU Yang^{1, 2},
SHENG Li²,
WU Zong-hui^{1, 2
, ,}

1.
Sport Rehabilitation Research Institute, Southwest University, Chongqing 400715, China

摘要

摘要: 腰痛是常见的一种健康和社会问题，是所有年龄段都会出现的症状，在中老年阶段发病率最高。根据持续时间可分为急性腰痛、亚急性腰痛和慢性腰痛，临床上绝大部分腰痛是慢性非特异性的。慢性非特异性腰痛持续时间在12周以上，没有明确的病理解剖学原因，也没有具体的方法推荐给临床医生治愈慢性非特异性腰痛。因其致病因素不明确、持续时间长、预后易反复等特点严重影响患者的生活质量，造成巨大的经济负担。慢性非特异性腰痛的治疗方法纷繁多样，目前尚无高质量证据的研究表明哪种治疗方法疗效最好。其中，运动疗法具有危害小、成本低、便于实施等特点，成为临床上改善慢性非特异性腰痛主流的治疗方法。虽然运动疗法在中国急/慢性非特异性腰背痛专家共识、美国医师学会临床实践指南中被推荐用于慢性腰痛的治疗，但哪种特定的运动方式治疗慢性非特异性腰痛的疗效更好，目前证据还不够充分。运动疗法主要有核心稳定性训练、抗阻训练、有氧运动、伸展运动、普拉提、瑜伽、太极、麦肯基疗法等，随着研究的深入，运动治疗慢性非特异性腰痛的研究有所增多，本文通过查阅相关文献，将近年来国内外学者研究运动疗法治疗慢性非特异性腰痛的进展进行系统综述。
- 慢性非特异性腰痛 /
- 运动疗法 /
- 治疗进展
Abstract: Low back pain is a common health and social problem that occurs at all ages, with the highest incidence in the middle and old ages. According to the duration, low back pain can be divided into acute, subacute, and chronic low back pain. Most of them are chronic nonspecific clinically. Chronic nonspecific low back pain lasts for more than 12 weeks without a clear pathoanatomical cause. No specific evidence-based methods are recommended for clinicians to cure chronic nonspecific low back pain. Given of its unclear pathogenic factors, long duration, and prognostic recurrence, the quality of life of patients is seriously affected, resulting in a huge economic burden. The treatment of chronic nonspecific low back pain is numerous and varied, and no high-quality evidence study has shown which treatment is the best. Amongst them, exercise therapy has the characteristics of low harm, low cost, and easy implementation and has thus become the mainstream clinical treatment for improving chronic nonspecific low back pain. Exercise therapy is recommended for the treatment of chronic low back pain in the Chinese expert consensus on acute/chronic nonspecific low back pain and the American College of Physicians' clinical practice guidelines. However, the evidence is insufficient to determine which specific exercise method is more effective in treating chronic nonspecific low back pain at present. Exercise therapy primarily includes core-stability training, resistance training, aerobic exercise, stretching, Pilates, yoga, Tai Chi, and McKenzie therapy. With further research, the study on the exercise treatment of chronic nonspecific low back pain has increased. Using related literature, this paper systematically reviews the progress of domestic and foreign scholars on the treatment of chronic nonspecific low back pain with exercise therapy in recent years.
- Chronic nonspecific low back pain /
- Exercise therapy /
- Treatment progress

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参考文献(45)

[1]	沈峥嵘, 王勇, 吴哲. 非特异性下腰痛评估量表、发病机制及诊疗的研究进展[J]. 中国临床医生杂志, 2017, 45(8): 16-19. doi: 10.3969/j.issn.2095-8552.2017.08.005 SHEN Z R, WANG Y, WU Z. Research progress of non-specific low back pain assessment scale, pathogenesis, diagnosis and treatment[J]. Chinese Journal for Clinicians, 2017, 45(8): 16-19. doi: 10.3969/j.issn.2095-8552.2017.08.005
[2]	MAHER C, UNDERWOOD M, BUCHBINDER R. Non-specific low back pain[J]. Lancet, 2017, 389(10070): 736-747. doi: 10.1016/S0140-6736(16)30970-9
[3]	DESCONSI M B, BARTZ P T, FIEGENBAUM T R, et al. Treatment of patients of nonspecific chronic low back pain by physical therapists: A cross-sectional study[J]. Fisioter Pesqui, 2019, 26(1): 15-21. doi: 10.1590/1809-2950/17003626012019
[4]	VERBRUGGHE J, AGTEN A, STEVENS S, et al. High intensity training to treat chronic nonspecific low back pain: Effectiveness of various exercise modes[J]. J Clin Med, 2020, 9(8): 2401. doi: 10.3390/jcm9082401
[5]	中国康复医学会脊柱脊髓专业委员会专家组. 中国急/慢性非特异性腰背痛诊疗专家共识[J]. 中国脊柱脊髓杂志, 2016, 26(12): 1134-1138. doi: 10.3969/j.issn.1004-406X.2016.12.16 Expert group of Spinal Cord Committee of Chinese Rehabilitation Medical Association. Expert consensus on acute/chronic nonspecific low back pain in China[J]. Chinese Journal of Spine and Spinal Cord, 2016, 26(12): 1134-1138. doi: 10.3969/j.issn.1004-406X.2016.12.16
[6]	刘建航, 余绍涌, 李锦威. 非特异性下腰痛的治疗进展[J]. 中华全科医学, 2019, 17(3): 459-463. doi: 10.16766/j.cnki.issn.1674-4152.000708 LIU J H, YU S Y, LI J W. Progress in the treatment of nonspecific low back pain[J]. Chinese general practice, 2019, 17(3): 459-463. doi: 10.16766/j.cnki.issn.1674-4152.000708
[7]	WASEEM M, KARIMI H, GILANI S A, et al. Treatment of disability associated with chronic non-specific low back pain using core stabilization exercises in Pakistani population[J]. J Back Musculoskelet, 2019, 32(1): 149-154. doi: 10.3233/BMR-171114
[8]	AKHTAR M W, KARIMI H, GILANI S A. Effectiveness of core stabilization exercises and routine exercise therapy in management of pain in chronic non-specific low back pain: A randomized controlled clinical trial[J]. Pak J Med Sci, 2017, 33(4): 1002-1006.
[9]	SHAMSI M B, REZAEI M, ZAMANLOU M, et al. Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial[J]. Physiother Theory Pr, 2016, 32(3): 171-178. doi: 10.3109/09593985.2015.1117550
[10]	SHAMSI M B, SARRAFZADEH J, JAMSHIDI A, et al. Comparison of spinal stability following motor control and general exercises in nonspecific chronic low back pain patients[J]. Clinical Biomechanics, 2017, 48(7): 42-48.
[11]	NABAVI N, MOHSENI BANDPEI M A, MOSALLANEZHAD Z, et al. The effect of 2 different exercise programs on pain intensity and muscle dimensions in patients with chronic low back pain: A randomized controlled trial[J]. J Manipulative Physiol Ther, 2018, 41(2): 102-110. doi: 10.1016/j.jmpt.2017.03.011
[12]	郭湄. 核心稳定性训练对非特异性腰痛疗效的影响[J]. 中国康复医学杂志, 2016, 31(1): 88-90. doi: 10.3969/j.issn.1001-1242.2016.01.021 GUO M. The effect of core stability training on the efficacy of non-specific low back pain[J]. Chinese Journal of Rehabilitation Medicine, 2016, 31(1): 88-90. doi: 10.3969/j.issn.1001-1242.2016.01.021
[13]	HAHM S C, SHIN H J, LEE M G, et al. Mud therapy combined with core exercise for chronic nonspecific low back pain: A pilot, single-blind, randomized controlled trial[J]. Evid Based Complement Alternat Med, 2020, 2020(3): 1-8.
[14]	DOS SANTOS I, LUNARDI A C, DE OLIVEIRA N T B, et al. Effects of aerobic exercise on pain and disability in patients with non-specific chronic low back pain: A systematic review protocol[J]. Systematic Reviews, 2019, 8(1): 101. doi: 10.1186/s13643-019-1019-3
[15]	BARNI L, CALABRETTA L, LEPORI L, et al. Does an aerobic exercise improve outcomes in older sedentary nonspecific low back pain subjects? A randomized controlled study[J]. Top Geriatr Rehabil, 2018, 34(2): 88-94. doi: 10.1097/TGR.0000000000000177
[16]	李霞, 罗丽, 陈东. 有氧运动对非特异性腰背痛患者的康复效果研究[J]. 中国煤炭工业医学杂志, 2018, 21(2): 187-191. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGY201802020.htm LI X, LUO L, CHEN D. Rehabilitation effect of aerobic exercise on patients with no specific low back pain[J]. Chinese Journal of Coal Industry Medicine, 2018, 21(2): 187-191. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGY201802020.htm
[17]	TJ∅SVOLL S O, MORK P J, IVERSEN V M, et al. Periodized resistance training for persistent non-specific low back pain: A mixed methods feasibility study[J]. BMC Sports Sci Med R, 2020, 12(1): 30. doi: 10.1186/s13102-020-00181-0
[18]	BAE C, JIN Y, YOON B, et al. Effects of assisted sit-up exercise compared to core stabilization exercise on patients with non-specific low back pain: A randomized controlled trial[J]. J Back Musculoskelet, 2018, 31(5): 871-880. doi: 10.3233/BMR-170997
[19]	VERBRUGGHE J, AGTEN A, O EIJNDE B, et al. Feasibility of high intensity training in nonspecific chronic low back pain: A clinical trial[J]. J Back Musculoskelet, 2018, 31(4): 657-666. doi: 10.3233/BMR-170810
[20]	VERBRUGGHE J, AGTEN A, STEVENS S, et al. Exercise Intensity matters in chronic nonspecific low back pain rehabilitation[J]. Med Sci Sports Exerc, 2019, 51(12): 2434-2442. doi: 10.1249/MSS.0000000000002078
[21]	MASATAKA Y, KEⅡCHI T, NOBUHIRO H, et al. The effectiveness of the mckenzie method or stretching or both, for patients with chronic non-specific low back paina single-blind controlled clinical trial[J]. Physical Therapy Japan, 2016, 43(4): 305-314.
[22]	GUASTALA F A M, GUERINI M H, KLEIN P F, et al. Effect of global postural re-education and isostretching in patients with nonspecific chronic low back pain: A randomized clinical trial[J]. Fisioter Mov, 2016, 29(3): 515-525. doi: 10.1590/1980-5918.029.003.AO09
[23]	闵吉, 孙萍萍, 陈伟. 悬吊技术对于慢性非特异性下腰痛的治疗现状及研究进展[J]. 颈腰痛杂志, 2020, 41(4): 493-495. doi: 10.3969/j.issn.1005-7234.2020.04.037 MIN J, SUN P P, CHEN W. Current status and research progress of suspension technique in the treatment of chronic non-specific low back pain[J]. The Journal of Cervicodynia and Lumbodynia, 2020, 41(4): 493-495. doi: 10.3969/j.issn.1005-7234.2020.04.037
[24]	王欣, 田秀娟, 王金玲, 等. 悬吊运动训练治疗慢性非特异性腰痛的效果[J]. 中国康复理论与实践, 2019, 25(4): 385-389. doi: 10.3969/j.issn.1006-9771.2019.04.004 WANG X, TIAN X J, WANG J L, et al. Effect of sling exercise therapy on chronic nonspecific low back pain[J]. Chin J Rehabil Theory Pract, 2019, 25(4): 385-389. doi: 10.3969/j.issn.1006-9771.2019.04.004
[25]	KO K J, HA G C, YOOK Y S, et al. Effects of 12-week lumbar stabilization exercise and sling exercise on lumbosacral region angle, lumbar muscle strength, and pain scale of patients with chronic low back pain[J]. J Phys Ther Sci, 2018, 30(1): 18-22. doi: 10.1589/jpts.30.18
[26]	谢卫东. 慢性非特异性腰痛悬吊训练的临床应用[J]. 中国疼痛医学杂志, 2018, 24(4): 319-320. doi: 10.3969/j.issn.1006-9852.2018.04.018 XIE W D. Clinical application of suspension training for chronic non-specific low back pain[J]. Chinese Journal of Pain Medicine, 2018, 24(4): 319-320. doi: 10.3969/j.issn.1006-9852.2018.04.018
[27]	FRANCO K F M, FRANCO Y R D S, OLIVEIRA N T B D, et al. Predictive factors for progression through the difficulty levels of pilates exercises in patients with low back pain: A secondary analysis of a randomized controlled trial[J]. Braz J Phys Ther, 2018, 22(6): 512-518. doi: 10.1016/j.bjpt.2018.04.004
[28]	SILVEIRA A P D B, NAGEL L Z, PEREIRA D D, et al. Immediate effect of a Pilates method exercise session on the co-contraction pattern of the trunk stabilizing muscles in individuals with and without nonspecific chronic low back pain[J]. Fisioter Pesqui, 2018, 25(2): 173-181. doi: 10.1590/1809-2950/17594425022018
[29]	PATTI A, BIANCO A, PAOLI A, et al. Pain perception and stabilometric parameters in people with chronic low back pain after a pilates exercise program[J]. Medicine, 2016, 95(2): e2414. DOI: 10.1097/MD.0000000000002414.
[30]	VALENZA M C, RODRÍGUEZ-TORRES J, CABRERA-MARTOS I, et al. Results of a Pilates exercise program in patients with chronic non-specific low back pain: A randomized controlled trial[J]. Clin Rehabil, 2016, 31(6): 753-760.
[31]	MIYAMOTO G C, FRANCO K F M, VAN DONGEN J M, et al. Different doses of Pilates-based exercise therapy for chronic low back pain: A randomised controlled trial with economic evaluation[J]. Br J Sports Med, 2018, 52(13): 859-868. doi: 10.1136/bjsports-2017-098825
[32]	FRANCO K M, FRANCO Y D, OLIVEIRA N B, et al. Is interferential current before pilates exercises more effective than placebo in patients with chronic nonspecific low back pain? A randomized controlled trial[J]. Arch Phys Med Rehabil, 2017, 98(2): 320-328. doi: 10.1016/j.apmr.2016.08.485
[33]	FRANCO Y R, FRANCO K F, SILVA L A, et al. Does the use of interferential current prior to pilates exercises accelerate improvement of chronic nonspecific low back pain?[J]. Pain Manag, 2018, 8(6): 465-474. doi: 10.2217/pmt-2018-0034
[34]	SAPER R B, LEMASTER C, DELITTO A, et al. Yoga, physical therapy, or education for chronic low back pain[J]. Ann Intern Med, 2017, 167(2): 85. doi: 10.7326/M16-2579
[35]	NEYAZ O, SUMILA L, NANDA S, et al. Effectiveness of hatha yoga versus conventional therapeutic exercises for chronic nonspecific low-back pain[J]. J Altern Complem Med, 2019, 25(9): 938-945. doi: 10.1089/acm.2019.0140
[36]	王廉秀. 健身瑜伽对非特异性慢性下腰痛患者康复效果的研究[D]. 曲阜: 曲阜师范大学, 2020. WANG L X. Research on the rehabilitation effect of fitness yoga on patients with non-specific chronic low back pain[D]. Qufu: Qufu Normal University, 2020.
[37]	ALHAKAMI A M, DAVIS S, QASHEESH M, et al. Effects of McKenzie and stabilization exercises in reducing pain intensity and functional disability in individuals with nonspecific chronic low back pain: A systematic review[J]. J Phys Ther Sci, 2019, 31(7): 590-597. doi: 10.1589/jpts.31.590
[38]	王芳, 叶金波. 肌内效贴联合麦肯基技术治疗慢性非特异性下腰痛的疗效[J]. 实用疼痛学杂志, 2016, 12(6): 424-427. WANG F, YE J B. Effect of Kinesio taping combined with Mckenzie therapy in the treatment of chronic low back pain[J]. Pain Clinic Journal, 2016, 12(6): 424-427.
[39]	张国永, 闫冬, 王凯, 等. Mckenzie疗法配合重复周围磁刺激对慢性非特异性下腰痛患者腰椎功能及表面肌电特征的影响[J]. 颈腰痛杂志, 2018, 39(5): 614-616. https://www.cnki.com.cn/Article/CJFDTOTAL-JYTZ201805023.htm ZHANG G Y, YAN D, WANG K, et al. Effects of Mckenzie therapy combined with repeated magnetic stimulation on lumbar function and surface electromyography in patients with chronic nonspecific low back pain[J]. The Journal of Cervicodynia and Lumbodynia, 2018, 39(5): 614-616. https://www.cnki.com.cn/Article/CJFDTOTAL-JYTZ201805023.htm
[40]	童晓. 改良太极拳"闪通背"法对慢性非特异性下腰痛患者腰骶部多裂肌功能的影响[D]. 成都: 成都中医药大学, 2017. TONG X. Improvement of tai chi chuan " flash back " method to lumbosacral multifidus muscle function in patients with chronic nonspecific low back pain[D]. Chengdu: Chengdu University of Traditional Chinese Medicine, 2017.
[41]	LIU J, YEUNG A, XIAO T, et al. Chen-Style Tai Chi for individuals (aged 50 years old or above) with chronic non-specific low back pain: A randomized controlled trial[J]. Int J Env Res Pub He, 2019, 16(3): 517. doi: 10.3390/ijerph16030517
[42]	ZOU L Y, ZHANG Y J, LIU Y, et al. The effects of Tai Chi Chuan versus core stability training on lower-limb neuromuscular function in aging individuals with non-specific chronic lower back pain[J]. Medicina, 2019, 55(3): 60. doi: 10.3390/medicina55030060
[43]	LETAFATKAR A, NAZARZADEH M, HADADNEZHAD M, et al. The efficacy of a HUBER exercise system mediated sensorimotor training protocol on proprioceptive system, lumbar movement control and quality of life in patients with chronic non-specific low back pain[J]. J Back Musculoskelet, 2017, 30(4): 767-778. doi: 10.3233/BMR-150404
[44]	曹婷婷, 金侠. 分级诊疗模式下重力肌群锻炼对非特异性腰痛患者生活质量影响的研究[J]. 北京医学, 2020, 42(6): 527-530. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202006013.htm CAO T T, JIN X. Effect of gravity muscle group exercise on quality of life in patients with non-specific low back pain under graded diagnosis and treatment mode[J]. Beijing Medical Journal, 2020, 42(6): 527-530. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202006013.htm
[45]	何彦, 刘敏. 立式八段锦治疗慢性非特异性下腰痛的疗效观察[J]. 湖南中医药大学学报, 2020, 40(1): 105-108. doi: 10.3969/j.issn.1674-070X.2020.01.023 HE Y, LIU M. Observation on curative effects of vertical baduanjin on chronic non-specific low back pain[J]. Journal of Hunan University of Chinese Medicine, 2020, 40(1): 105-108. doi: 10.3969/j.issn.1674-070X.2020.01.023