Rainville James, Hartigan Carol, Martinez Eugenio, Limke Janet, Jouve Cristin, Finno Mark
The Spine Center at New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120, USA.
Spine J. 2004 Jan-Feb;4(1):106-15. doi: 10.1016/s1529-9430(03)00174-8.
Exercise is a widely prescribed treatment for chronic low back pain, with demonstrated effectiveness for improving function and work.
The goal of this article is to review several key aspects about the safety and efficacy of exercise that may help clinicians understand its utility in treating chronic back pain.
STUDY DESIGN/SETTING: A computerized literature search of MEDLINE was conducted using "exercise," "fitness," "back pain," "backache" and "rehabilitation" as search words. Identified abstracts were scanned, and useful articles were acquired for further review. Additional references were acquired through the personal collections of research papers possessed by the authors and by reviewing prior review articles on this subject. These final papers were scrutinized for data relevant to the key aspects about exercise covered in this article.
For people with acute, subacute or chronic low back pain, there is no evidence that exercise increases the risk of additional back problems or work disability. To the contrary, current medical literature suggests that exercise has either a neutral effect or may slightly reduce risk of future back injuries. Exercise can be prescribed for patients with chronic low back pain with three distinct goals. The first and most obvious goal is to improve or eliminate impairments in back flexibility and strength, and improve performance of endurance activities. There is a large body of evidence confirming that this goal can be accomplished for a majority of patients with chronic low back pain. The second goal of exercise is to reduce the intensity of back pain. Most studies of exercise have noted overall reduction in back pain intensity that ranges from 10% to 50% after exercise treatment. The third goal of exercise is to reduce back pain-related disability through a process of desensitization of fears and concerns, altering pain attitudes and beliefs and improving affect. The mechanisms through which exercise can accomplish this goal have been the subject of substantial research.
Exercise is safe for individuals with back pain, because it does not increase the risk of future back injuries or work absence. Substantial evidence exists supporting the use of exercise as a therapeutic tool to improve impairments in back flexibility and strength. Most studies have observed improvements in global pain ratings after exercise programs, and many have observed that exercise can lessen the behavioral, cognitive, affect and disability aspects of back pain syndromes.
运动是治疗慢性下腰痛广泛采用的方法，已证实其在改善功能和工作能力方面有效。
本文旨在综述运动安全性和有效性的几个关键方面，以帮助临床医生了解其在治疗慢性腰痛中的作用。
研究设计/研究地点：使用“运动”“健身”“背痛”“腰痛”和“康复”作为检索词，对MEDLINE进行计算机文献检索。对检索到的摘要进行筛选，并获取有用的文章进行进一步综述。通过作者个人收藏的研究论文以及查阅此前关于该主题的综述文章获取更多参考文献。对这些最终论文进行审查，以获取与本文所涵盖的运动关键方面相关的数据。
对于急性、亚急性或慢性下腰痛患者，没有证据表明运动会增加额外背部问题或工作能力丧失的风险。相反，当前医学文献表明运动要么具有中性作用，要么可能略微降低未来背部受伤的风险。运动可针对慢性下腰痛患者设定三个不同目标。第一个也是最明显的目标是改善或消除背部灵活性和力量的损伤，提高耐力活动的表现。有大量证据证实，大多数慢性下腰痛患者可以实现这一目标。运动的第二个目标是减轻背痛的强度。大多数运动研究指出，运动治疗后背痛强度总体降低幅度为10%至50%。运动的第三个目标是通过减轻恐惧和担忧、改变疼痛态度和信念以及改善情绪等脱敏过程，减少与背痛相关的残疾。运动实现这一目标的机制一直是大量研究的主题。
运动对背痛患者是安全的，因为它不会增加未来背部受伤或缺勤的风险。有大量证据支持将运动作为一种治疗工具来改善背部灵活性和力量的损伤。大多数研究观察到运动计划后整体疼痛评分有所改善，许多研究还观察到运动可以减轻背痛综合征在行为、认知、情绪和残疾方面的影响。
