Nachemson A
Int Orthop. 1985;9(1):1-10. doi: 10.1007/BF00267031.
There is at the present time an epidemic of low back pain in the industrialized countries. Although the exact origin of such pain is still unknown, there is increasing awareness that the outcome is usually favourable. Only some 10% of those suffering an acute episode of back pain are incapacitated for more than 6 weeks. The causes of long standing back pain are being identified in an increasing number of patients. They include anatomical and pathological disturbances in the motion segment as well as psychological, social and political causes. There are numerous factors which influence the pathophysiology of the motion segment. The degree of loading has been successfully measured and delineated for various postures and exercises, including those at work. The nutritional pathways to the disc have been established and the effect of various external factors measured. Movement is good for the disc and the importance of continuous passive motion for the healing of diseased or injured connective tissues is not established. Activation of large muscle groups increases the production of the body's pain reducing encephalins. Early diagnosis and early mobilisation of the patient should be of benefit, and long term bed rest and inactivity must be prevented. Fewer cases will need operation in the future. Improved imaging techniques and better methods of operation and fixation will help those few who have a definite pathological lesion amenable to surgery.
目前，工业化国家中腰痛成患。虽然这种疼痛的确切根源仍不明晰，但人们越来越意识到其预后通常良好。在急性腰痛发作的患者中，只有约10%的人会丧失能力超过6周。越来越多的长期腰痛患者的病因正在被查明。这些病因包括活动节段的解剖学和病理学紊乱，以及心理、社会和政治方面的原因。有许多因素会影响活动节段的病理生理学。已经成功测量并描绘了各种姿势和运动（包括工作中的姿势和运动）的负荷程度。椎间盘的营养途径已经明确，并且测量了各种外部因素的影响。运动对椎间盘有益，而持续被动运动对患病或受伤的结缔组织愈合的重要性尚未确定。激活大肌肉群会增加人体减轻疼痛的脑啡肽的产生。对患者进行早期诊断和早期活动应该有益，而且必须避免长期卧床休息和不活动。未来需要手术的病例会减少。改进的成像技术以及更好的手术和固定方法将有助于那些有明确病理病变且适合手术的少数患者。
