Abstract | Križobolja je klinički entitet koji karakterizira bol i funkcijski deficit u lumbalnom dijelu kralježnice. Predstavlja veliki zdravstveni i socioekonomski problem jer većina ljudi tijekom života doživi barem jednu epizodu križobolje. Obično su joj skloniji oni čija zanimanja zahtijevaju značajno opterećenje sustava za kretanje, fizičko preopterećenje, podizanje teških predmeta pretklonom, potezanje, guranje, izvedbu rotatornih pokreta i slično. Kod starije populacije gotovo je uvijek riječ o degenerativnim promjenama kralježničkih struktura. Pacijenti su suočeni s izrazitom boli, umorom i funkcijskim deficitom, te su zbog toga najčešće podvrgnuti nefarmakološkom liječenju. Zbog toga su pacijenti, prije i poslije terapije, izloženi fizikalnom pregledu, koji obuhvaća procjenu sagitalne gibljivosti, procjenu boli i umora, te procjenu funkcionalne sposobnosti i kvalitete života. Također se promatra držanje i hod, provode se neurološka testiranja i manualni mišićni test. . Potrebno je evaluirati proces rehabilitacije i prema tome postaviti ciljeve samog liječenja . Najčešće se provodi simptomatsko liječenje, a cilj mu je suzbiti bol i povećati funkcijske sposobnosti kroz aktivnosti svakodnevnog života. Terapijski pristup se razlikuje u akutnoj i kroničnoj fazi bolesti. Srž rehabilitacijskog postupka su kinezioterapijske vježbe praćene nekom fizikalnom ili toplinskom procedurom. Pristup može biti individualan (mobilizacija i manipulacija, funkcionalna i frikcijska masaža, PIR, masaža vezivnog tkiva, pristup po McKenzie konceptu i po Kaltenborn Evjenth konceptu), te grupni pristup (Reganova i Bruckova metoda). Naglasak treba staviti na edukaciji, odnosno upoznavanju pacijenata sa svim čimbenicima rizika koji uvjetuju nastanak križobolje kako bi spriječili i prevenirali razvoj bolesti. Trebaju biti upoznati sa prirodom bolesti, njezinom prognozom i rehabilitacijom. Kako bi održali,odnosno poboljšali postojeće stanje, pacijenti moraju svakodnevno provoditi preporučene vježbe kod kuće. Nakon početne procjene i provedenog rehabilitacijskog postupka pod nadzorom stručne osobe, te potom završne procjene, možemo zaključiti da je kombinirana fizikalna terapija učinkovita u suzbijanju boli i povećanju funkcionalnih sposobnosti kod pacijenata s križoboljom. |
Abstract (english) | Lumbago is a clinical entity characterized by pain and functional deficit in the lumbar spine. It is a major health and socioeconomic problem, as most people experience at least one episode of lumbago during their lifetime. It is usually more prone to those whose occupations require a significant load on the muscular system, physical overload, lifting heavy objects by bending forward, pulling, pushing, the rotator cuff muscles movement, and the like. In the elderly population, it is almost always about degenerative changes in the vertebral column structures. Patients are faced with extreme pain, fatigue and functional deficit, and are therefore most often subjected to non-pharmacological treatment. Because of that, before and after the therapy, patients are exposed to physical examination, which includes assessment of sagittal flexibility, pain and fatigue assessment, and assessment of functional abilities and quality of life. Posture and gait are also monitored, neurological testing and manual muscle testing are performed. It is necessary to evaluate the process of rehabilitation and according to that set goals for the treatment itself. Symptomatic treatment is most often given, and its aim is to suppress pain and increase functional abilities through activities of everyday life. There are differences between therapeutic approaches in the acute and chronic stages of the disease. The most important aspects of the rehabilitation process are kinesiotherapy exercises followed by some physical or thermal procedure. There is individual (mobilization and manipulation, functional and friction massage, PIR, connective tissue massage, McKenzie method and Kaltenborn-Evjenth concept), and group approach (Regan's and Bruck's method). Emphasis should be put on education, or to be more specific, on the acquaintance of patients with all the risk factors that cause the onset of lumbago in order to prevent the development of the disease. They need to be acquainted with the nature of the disease, its prognosis and rehabilitation. In order to maintain, or improve their condition, patients need to carry out recommended home exercises on a daily basis. After an initial assessment, and after the rehabilitation procedure under the supervision of an expert is completed, as well as a final assessment, only then we conclude that combined physical therapy is effective in reducing pain and increasing functional abilities in lumbago patients. |