Roy Jean-Sébastien, Bouyer Laurent J, Langevin Pierre, Mercier Catherine
J Orthop Sports Phys Ther. 2017 Nov;47(11):817-821. doi: 10.2519/jospt.2017.0608.
To a large extent, management of musculoskeletal disorders has traditionally focused on structural dysfunctions found within the musculoskeletal system, mainly around the affected joint. While a structural-dysfunction approach may be effective for musculoskeletal conditions in some populations, especially in acute presentations, its effectiveness remains limited in patients with recurrent or chronic musculoskeletal pain. Numerous studies have shown that the human central nervous system can undergo plastic reorganizations following musculoskeletal disorders; however, they can be maladaptive and contribute to altered joint control and chronic pain. In this Viewpoint, the authors argue that to improve rehabilitation outcomes in patients with chronic musculoskeletal pain, a global view of the disorder that incorporates both central (neural) and peripheral (joint-level) changes is needed. The authors also discuss the challenge of evaluating and rehabilitating central changes and the need for large, high-level studies to evaluate approaches incorporating central and peripheral changes and emerging therapies. J Orthop Sports Phys Ther 2017;47(11):817-821. doi:10.2519/jospt.2017.0608.
在很大程度上，肌肉骨骼疾病的管理传统上主要集中于肌肉骨骼系统内发现的结构功能障碍，主要围绕受影响的关节。虽然结构功能障碍方法可能对某些人群的肌肉骨骼疾病有效，尤其是在急性发病时，但其在复发性或慢性肌肉骨骼疼痛患者中的有效性仍然有限。大量研究表明，人类中枢神经系统在肌肉骨骼疾病后会发生可塑性重组；然而，这些重组可能是适应不良的，并导致关节控制改变和慢性疼痛。在本观点文章中，作者认为，为了改善慢性肌肉骨骼疼痛患者的康复效果，需要对该疾病有一个全面的认识，包括中枢（神经）和外周（关节水平）的变化。作者还讨论了评估和康复中枢变化的挑战，以及开展大型、高水平研究以评估结合中枢和外周变化的方法及新兴疗法的必要性。《矫形与运动物理治疗杂志》2017年；47(11):817 - 821。doi:10.2519/jospt.2017.0608 。
