Konservative Therapie des chronischen Rückenschmerzes: spezifisches Krafttraining der Rückenmuskulatur oder Steigerung der allgemeinen körperlichen Fitness

Zusammenfassung.

Studienziel: Eine systematische Literaturauswertung wurde durchgeführt, um die Wirksamkeit eines isolierten Rückenmuskel- und Fitnesstrainings zur Behandlung des chronischen Rückenschmerzes zu untersuchen. Methode: Mit Hilfe einer Medline-Analyse (19861999) wurden randomisierte klinische Studien bestimmt, die mindestens eines der Rehabilitationskonzepte untersuchten. Die Methode jeder Studie wurde anhand eines Bewertungssystems beurteilt und die Evidenz von drei Kriterien (Rückenschmerz, körperliche Leistungsfähigkeit und Allgemeinzustand) ermittelt. Ergebnisse: Zwölf randomisierte klinische Studien wurde gefunden, von denen neun eine ausreichende Studienqualität aufwiesen. Rückenmuskel- und Fitnesstraining führten zu einer zuverlässigen Besserung der Beschwerden. Im Vergleich zu passiver oder keiner Behandlung war eine hohe Evidenz für den Rückenschmerz und körperlicher Leistungsfähigkeit bei beiden Konzepten, ein positiver Einfluss für den Allgemeinzustand nur durch Fitnesstraining nachweislich. Zwei Studien mit einem direkten Vergleich beider Konzepte haben hingegen keinen bemerkenswerten Unterschied in allen drei Parametern feststellen können. Schlussfolgerung: Zur Behandlung des chronischen Rückenschmerzes ist ein spezifisches Krafttraining der Rückenmuskeln als auch ein unspezifisches körperliches Fitnesstraining gleichermaßen wirkungsvoll.

Aim: A systematic review was performed to evaluate the clinical effects of specific back muscle and non-specific physical fitness training in chronic low back pain. Method: A computer-aided Medline research (19861999) of randomised clinical trials concerning both rehabilitation concepts was conducted. A rating system was used to assess the methodological score of each study. The results were analysed and a final statement for evidence according to three main parameters (back pain, physical capacity, and patients comfort) was postulated. Results: Twelve randomised clinical trials were identified. Nine studies were determined as high-quality trials. For chronic low back pain specific back muscle exercises as well as non-specific fitness training were able to improve the patients' conditions sufficiently. In comparison with passive treatment or no treatment there is strong evidence for pain and physical capacity in both groups, but only a positive influence for patient' comfort in fitness groups. Nevertheless, a confrontation of both concepts in two studies did not reveal any notable differences in all three parameters. Conclusion: Principally, a specific strength training for back rnuscles as well as a non-specific fitness training are comparably effective to rehabilitate chronic low back pain.

Schlüsselwörter:

tiefer Rückenschmerz - konservative Behandlung - Ausdauertraining - Krafttraining - Analyse

Key words:

Low back pain - conservative treatment - fitness training - back muscle strength - review

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