Медицинский совет (Mar 2021)
Effects of kinesitherapy on chronic non-specific low back pain: discussion based on clinical observations
Abstract
In chronic nonspecific low back pain (CNLBP), an integrated approach is effective, which must include kinesitherapy. Unfortunately, in our country, kinesitherapy is not always used in CNLBP, ineffective methods of therapy are often used. The article presents an observation of a 55-year-old female patient who suffered from CNLBP. Magnetic resonance imaging of the lumbar spine revealed protrusions up to 4 mm at the level of L4-L5, L5-S1 segments, which were regarded as the cause of back pain. The patient was prescribed non-steroidal anti-inflammatory drugs (NSAIDs), ointments at the place of residence, limitation of physical activity was recommended, which did not have a significant positive effect. In a specialized neurological center, during manual examination, the patient showed signs of lesion of the right sacroiliac joint (SIJ), and with diagnostic and treatment blockade (with anesthetics and corticosteroids) of the right SIJ, an almost complete temporary regression of pain was noted. The patient was explained the causes of pain, the role of SIJ lesions, prolonged physical inactivity and static loads as the causes of CNLBP, the safety and effectiveness of kinesitherapy. Movalis® (meloxicam) was used as an NSAID at 15 mg per day. The patient underwent exercises to activate the gluteal muscles, rectus abdominis muscles, strengthen the back of the thigh, relieve tension from the square muscles of the lower back, and relax the hip flexor muscles. Techniques for controlling the neutral position of the spine and the walking pattern were worked out. Within 10 days, the pain completely disappeared, functional disorders on the Oswestry scale decreased from 34% to 10%. Over the next 3 months, the patient regularly performed therapeutic exercises, avoided static loads, her physical activity increased from 10 to 26 points, back pain did not bother her. The issues of the effectiveness of kinesitherapy in CNLBP are discussed. It is noted that in CNLBP, regularity of physical exercises, exclusion of abrupt and excessive movements, and static loads are of leading importance. Walking represent a highly effective method of treatment and prevention of CNLBP and should be combined with other methods of kinesitherapy. The efficacy and low risk of complications from the use of meloxicam in patients with CNLBP not only from the gastrointestinal tract, but also from the cardiovascular system are noted. The use of kinesitherapy in complex therapy can help many patients with CNLBP, in whom it has not been previously used.
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