Effects of fascial mobilization and manipulation in patients with low back pain - literature review

Uvod: Večina ljudi se v svojem življenju vsaj enkrat spopade z določeno vrsto bolečine v križu. Sklepa se, da je lahko za bolečino vzrok tudi fascija. Fascija je vezivno tkivo, ki ovija in povezuje vse mišice, kosti, organe in živčna vlakna ter teče neprekinjeno skozi celo telo. Je bogato oživčena in vsebuje veliko prostih živčnih končičev. Obstajajo različni fizioterapevtski pristopi za obravnavo fascij. Osredotočajo se na odpravljanje sprememb v fasciji, zaradi katerih naj bi prišlo do bolečine in zmanjšanja mobilnosti. Obstaja nekaj smernic za terapijo pri bolečini v križu, vendar so le redke podprte z dokazi. Prav tako ni smernic s priporočili za terapevtski pristop, ki bi se osredotočal na fascialno tkivo. Namen: Namen diplomskega dela je, na podlagi pregleda literature, predstaviti učinke mobilizacije in manipulacije fascij pri pacientih z bolečino v križu. Metode dela: Literaturo smo iskali po podatkovnih zbirkah PubMed, CINAHL in PEDro. Za analizo so bile uporabljene raziskave v angleškem jeziku, objavljene po letu 2010, s ključnimi besedami fascial manipulation AND low back pain, fascial mobilization AND low back pain, myofascial release AND low back pain, fascia AND low back pain. V analizo smo vključili devet raziskav. Rezultati: V vseh raziskavah so ob uporabi tehnike mobilizacije in manipulacije fascij ugotovili zmanjšanje bolečine in stopnje nezmožnosti kot tudi zmanjšanje izogibanja aktivnostim zaradi bolečine, izboljšanje kakovosti življenja in povečanje obsega gibljivosti v ledvenem delu hrbtenice pri preiskovancih z bolečino v križu. Če sta tehniki dodani k standardni terapiji, pomembno izboljšata njene izide. Pozitivni učinki so vidni še nekaj časa po koncu terapij. Razprava in zaključek: Izsledki pregledanih raziskav so pokazali, da so opisane fascialne tehnike učinkovite za zmanjševanje bolečin v križu in funkcijske nezmožnosti. Učinkovitejše so v kombinaciji z drugimi fizioterapevtskimi postopki. Potrebne bi bile nadaljnje raziskave z večjim številom preiskovancev, da bi potrdile dobljene rezultate.Introduction: Most people will experience some type of low back pain during their lifetime. It has been suggested, that fascia might be the cause of pain. Fascia is connective tissue that surrounds and connects all muscles, bones, organs and nerve fibers, and runs continuously throughout the body. It is highly innervated and contains abundant free nerve endings. There are various physiotherapeutic approaches for fascial treatments. They are focused on removing changes in fascia that are causing pain and reducing mobility. Several guidelines on low back pain treatment exist, but a lot of them are not supported by evidence. Moreover, no guidelines can be found with the recommendations of a therapeutic approach focused on fascial tissue. Purpose: The purpose of this thesis is to determine the effect of fascial mobilization and manipulation with subjects that have low back pain, based on the research of given literature. Methods: Literature was researched using databases PubMed, CINAHL and PEDro. In the analysis, researches in English language, conducted after year 2010 were studied. Keywords used were fascial manipulation AND low back pain, fascial mobilization AND low back pain, myofascial release AND low back pain, fascia AND low back pain. Nine researches were included in the analysis. Results: In all studies, the use of fascial mobilization and manipulation techniques found a reduction in pain and functional disability, as well as a reduction in the avoidance of pain activity, an improvement in quality of life, and an increase in the range of lumbar spine mobility in subjects with low back pain. When techniques are added to standard therapy, they significantly improve its outcome. Positive effects can also be seen for some time after the end of therapies. Discussion and conclusion: The results of the examined researches have shown that described fascial techniques effectively decrease pain and functional disability. The highest efficiency is achieved by combining them, with other physiotherapeutic approaches. Further researches with larger number of subjects are required to confirm the obtained results