Troyanovich S J, Harrison D E, Harrison D D
University of Alabama, Huntsville, USA.
J Manipulative Physiol Ther. 1998 Jan;21(1):37-50.
To provide a rationale for active chiropractic rehabilitative treatment that extends beyond the single goal of resolution of symptomatic complaints.
A manual search of available reference texts and a search of MEDLINE were collected with an emphasis on tissue healing sequelae and the role of mechanical loading on this process.
The reviewed material indicates that all tissue growth and repair is influenced by mechanical loading and body posture and is positively affected by body postures that normalize/minimize adverse mechanical stresses and strains. Altered alignment of the human frame may lead to poor healing of the body tissues and eventual pathological architectural changes may occur in muscle, ligament, bone and central nervous system. Minimization of altered postural/structural loading of the human frame may take longer than resolution, or maximal reduction, of offensive symptoms. By itself, a patient's perception of pain is not a valid indicator of health.
Because mechanical loading of the neuromusculoskeletal tissues plays a vital role in influencing proper growth and repair, chiropractic rehabilitative care should focus on the normalization/minimization of aberrant stresses and strains acting on spinal tissues. Manipulation alone cannot restore body postures or improve an altered sagittal spinal curve. Therefore, postural chiropractic adjustments, active exercises and stretches, resting spinal blocking procedures, extension traction and ergonomic education are deemed necessary for maximal spinal rehabilitation. Chiropractic studies that demonstrate structural improvements are sorely lacking and needed. The use of passive treatment modalities as the sole means of chiropractic intervention for the management of patients suffering with neuromusculoskeletal dysfunction no longer has a place in modern chiropractic practice after the acute phase of healing has passed.
为积极的整脊康复治疗提供理论依据，该治疗的目标不仅限于解决症状性主诉。
通过人工检索现有参考文献及检索MEDLINE收集数据，重点关注组织愈合后遗症以及机械负荷在此过程中的作用。
综述材料表明，所有组织的生长和修复均受机械负荷和身体姿势的影响，而能使不良机械应力和应变正常化/最小化的身体姿势对其有积极影响。人体骨骼排列改变可能导致身体组织愈合不良，肌肉、韧带、骨骼和中枢神经系统最终可能会发生病理性结构变化。使人体骨骼姿势/结构负荷改变最小化所需的时间可能比缓解或最大程度减轻不适症状的时间更长。患者自身对疼痛的感知本身并非健康的有效指标。
由于神经肌肉骨骼组织的机械负荷在影响正常生长和修复方面起着至关重要的作用，整脊康复护理应着重于使作用于脊柱组织的异常应力和应变正常化/最小化。仅靠手法治疗无法恢复身体姿势或改善脊柱矢状曲线的改变。因此，姿势性整脊调整、主动运动和拉伸、脊柱制动休息程序、伸展牵引以及人体工程学教育对于最大程度的脊柱康复而言是必要的。目前严重缺乏且急需能证明结构改善的整脊研究。在愈合急性期过后，将被动治疗方式作为整脊干预的唯一手段来治疗神经肌肉骨骼功能障碍患者，在现代整脊实践中已不再适用。
