School of Physiotherapy, University of Sydney, Sydney, Australia.
Med Hypotheses. 2012 Aug;79(2):232-40. doi: 10.1016/j.mehy.2012.04.047. Epub 2012 May 31.
Back pain resolution has not statistically improved over many years with some literature suggesting chronic back pain to be increasing. From a search of literature on causes, events, mechanisms, factors and treatment for back pain, a model is developed that relates causes of back injury to factors that result in pain through two primary mechanisms; muscle fatigue and muscle/tendon/connective tissue strain or sprain with other main mechanisms being diminished reactivity and strength, changes in tendon/tissue mechanical properties and fear of back pain recurrence/fear of movement following a back pain episode. The model highlights the fact that back pain/injury is multi-factorial with numerous circular relationships. Therefore treatment should also be multi-factorial; a combination of physical and psychological therapy with attention to mechanisms at work or in daily living that exacerbate the injury and delay recovery thereof. Exercise is one method that can reduce muscle imbalance, improve resilience to muscle fatigue, and address reactivity and strength. More importantly, eccentric exercise can rectify musculotendinous or connective tissue injury which plays a role in prolonging the back injury cycle. Posture is identified as a causative factor for back pain with the time exposure for posture representing the largest portion of daily activities. From literature and from clinical observation, treatment methods can be improved and incorporated into integrated multi-modal programs. An integrated exercise program that commences with motor control exercise and progresses into functional movement is suggested. Furthermore a modification of the McKenzie extension movement may benefit back injury rehabilitation for a majority of lower back pain patients. Otherwise the sit-to-stand movement is a regular and frequent exacerbating mechanism of back pain and likely continuously tears connective tissue during the movement thus prolonging the cycle of back pain and can be addressed instantly with a modification in sit-to-stand technique.
多年来，背痛的缓解并没有在统计学上得到改善，一些文献表明慢性背痛正在增加。从对背痛的原因、事件、机制、因素和治疗的文献搜索中，开发了一个模型，该模型将背部损伤的原因与通过两种主要机制导致疼痛的因素联系起来；肌肉疲劳和肌肉/肌腱/结缔组织劳损或扭伤，其他主要机制是反应性和强度降低、肌腱/组织机械性能变化以及对背痛复发的恐惧/对背痛发作后运动的恐惧。该模型突出了一个事实，即背痛/损伤是多因素的，存在许多循环关系。因此，治疗也应该是多因素的；物理和心理治疗相结合，注意在日常生活中加重损伤并延迟恢复的机制。运动是一种可以减少肌肉不平衡、提高肌肉疲劳抵抗力、解决反应性和强度的方法。更重要的是，离心运动可以纠正肌肉肌腱或结缔组织损伤，从而延长背部损伤周期。姿势被确定为背痛的一个致病因素，姿势的时间暴露代表了日常活动的最大部分。从文献和临床观察来看，可以改进治疗方法并将其纳入综合多模式方案。建议采用起始于运动控制运动并逐渐发展为功能性运动的综合运动方案。此外，麦肯齐伸展运动的修改可能有利于大多数下背痛患者的背部损伤康复。否则，从坐到站的运动是背痛的常见且频繁的加重机制，在运动过程中可能会不断撕裂结缔组织，从而延长背痛周期，可以通过修改从坐到站的技术立即解决。
