Lejkowski Peter M, Poulsen Erik
Faculty of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
J Bodyw Mov Ther. 2013 Oct;17(4):448-52. doi: 10.1016/j.jbmt.2013.01.004. Epub 2013 Feb 9.
The biomechanical relationship between the hip and low back is well described and impairment of hip range of motion is thought to affect lumbar spine function, possibly leading to increased loading and subsequent symptoms. However therapy for low back pain (LBP) patients is commonly directed solely to the low back area overlooking possible hip impairment.
A 56-year-old male recreational golfer presented with a chronic golf-related low back complaint. Previous conservative therapy targeting the spine did not result in complete symptom relief. A working diagnosis of L4-S1 facet joint irritation and lower lumbar segmental instability secondary to bilateral hip ROM impairment was established. A trial of therapy strictly addressing the hip ROM impairments was initiated and following 2 treatment sessions, a complete resolution of symptoms was achieved and maintained at a 2-month follow-up.
This case demonstrated a complete and rapid relief of un-resolving low back pain with a management strategy focused on hip ROM impairments. Clinicians should remember to look beyond the local area of complaint and appreciate the interdependent nature of the musculoskeletal system.
髋部与下背部之间的生物力学关系已有充分描述，且髋关节活动范围受损被认为会影响腰椎功能，可能导致负荷增加及后续症状。然而，腰痛（LBP）患者的治疗通常仅针对下背部区域，而忽略了可能存在的髋关节损伤。
一名56岁的男性业余高尔夫球手因与高尔夫相关的慢性下背部疼痛前来就诊。先前针对脊柱的保守治疗未能完全缓解症状。经诊断，确定为L4-S1小关节刺激以及继发于双侧髋关节活动度受损的下腰椎节段不稳定。开始了一项严格针对髋关节活动度受损的治疗试验，经过2次治疗后，症状完全缓解，并在2个月的随访中得以维持。
该病例表明，通过专注于髋关节活动度受损的管理策略，可使未缓解的腰痛得到完全且迅速的缓解。临床医生应牢记，不要局限于主诉局部区域，而应认识到肌肉骨骼系统的相互依存性。
