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Stimulus

, Volume 24, Issue 1, pp 7–19 | Cite as

Oefenen als behandeling voor chronische lage-rugpijn

Exercise as a treament for chronic low back pain [The Spine Journal;4(2004):106-115]
  • James Rainville
  • Carol Hartigan
  • Eugenio Martinez
  • Janet Limke
  • Christin Jouve
  • Mark Finno
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  • 126 Downloads

Samenvatting

Achtergrond. Oefenen is een veel voorgeschreven behandeling voor chronische lage-rugpijn, met een aangetoonde effectiviteit voor verbetering van functie en werk.

Doel. Het doel van dit artikel is een overzicht te geven van verschillende sleutelelementen met betrekking tot veiligheid en effectiviteit van het oefenen. Dit kan behandelaars helpen het nut ervan bij de behandeling van chronische rugpijn te begrijpen.

Onderzoeksopzet/kader. Op MEDLINE is een geautomatiseerde zoektocht door de literatuur uitgevoerd met behulp van de zoektermen: ‘exercise’, ‘fitness’, ‘back pain’, ‘backache’ en ‘rehabilitation’. Van de gevonden artikelen werden de samenvattingen gescand en nuttige artikelen werden voor nadere beoordeling opgevraagd. Extra referenties werden verkregen uit onderzoeksartikelen in het bezit van de auteurs en door het opnieuw bekijken van eerdere besprekingen van dit onderwerp. Deze laatste artikelen werden nageplozen op gegevens die relevant waren voor de sleutelelementen van het oefenen die in dit artikel worden behandeld.

Resultaten. Er bestaat geen bewijs dat oefenen het risico van extra rugproblemen of arbeidsongeschiktheid vergroot voor mensen met acute, subacute of chronische lage-rugpijn. De huidige medische literatuur lijkt er juist op te wijzen dat oefenen ofwel een neutraal effect heeft of het risico van toekomstig rugletsel iets kan verminderen. Er zijn drie duidelijke doelstellingen om oefenen aan patiënten met lage-rugpijn voor te schrijven. Het eerste en meest voor de hand liggende doel is het verbeteren of doen verdwijnen van beperkingen in rugmobiliteit en -kracht en het verbeteren van de prestaties bij duuractiviteiten. Er is zeer veel bewijs dat een meerderheid van patiënten met chronische lage-rugpijn dit doel kan bereiken. Het tweede doel van oefenen is het verminderen van de intensiteit van rugpijn. In de meeste onderzoeken naar oefenen is na oefentherapie een globale afname van rugpijnintensiteit waargenomen. Deze afname varieert van 10 tot 50 procent. Het derde doel van oefenen is de met de rugpijn gepaard gaande beperkingen te verminderen door de patiënt minder gevoelig te maken voor angsten en zorgen, de houding tegenover pijn te veranderen en de gemoedstoestand te verbeteren. De mechanismen waardoor oefenen dit doel kan bereiken, is het onderwerp geweest van veel onderzoek.

Conclusies. Oefenen is veilig voor mensen met rugpijn, omdat het het risico van toekomstig rugletsel of arbeidsverzuim niet vergroot. Er bestaat substantieel bewijs dat oefenen gebruikt kan worden als een therapeutisch middel om stoornissen in flexibiliteit en kracht van de rug te verbeteren. Uit de meeste onderzoeken blijken globale pijnscores na oefenprogramma’s te verbeteren en vaak blijkt dat oefenen aspecten op gebied van gedrag, cognitie, gemoedstoestand en beperkingen bij rugpijnsyndromen kan verminderen.

Literatuur

  1. Ahern DK, Hannon DJ, Goreczny AJ, Follick MJ, Parziale JR. Correlation of chronic low-back pain behavior and muscle function examination of the flexion-relaxation response. Spine 1990;15:92-5.Google Scholar
  2. Ai-Obaidi S, Nelson RM, AI-Awadhi S, AI-Shuwaie N. The role of anticipation and fear of pain in the persistence of avoidance behavior in patients with chronic low back pain. Spine 2000;25:1126-31.Google Scholar
  3. Alaranta H, Rytokoski U, Rissanen A, et al. Intensive physical and psychosocial training program for patients with chronic low back pain. Spine 1994;19:1339-49.Google Scholar
  4. Babyak M, Blumenthal JA, Herrman S, et al. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000;62:633-8.Google Scholar
  5. Banks SM, Kerns RD. Explaining high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull 1996;119:95-110.Google Scholar
  6. Bendix T, Bendix A, Labriola M, Haestrup C, Ebbehoj N. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 2000;25:2494-500.Google Scholar
  7. Bentsen H, Lindgarde F, Manthorpe R. The effect of dynamic strength back exercise and/or a home training program in 57-year-old women with chronic low back pain. Results of a prospective randomized study with a 3-year follow-up period. Spine 1997;22:1494-500.Google Scholar
  8. Blazer D, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the national comorbidity survey. Am J Psychiat 1994;151:979-86.Google Scholar
  9. Carpenter DM, Nelson BW. Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc 1999;31:18-24.Google Scholar
  10. Council J, Ahem DK, Fol1ick MJ, Kline CL. Expectancies and functional impairment in chronic low back pain. Pain 1988;33:323-31.Google Scholar
  11. Croft PR, Papageorgiou AC, Thomas E, Macfarlane GJ, Si1man AJ. Short-term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study. Spine 1999;24:1556-61.Google Scholar
  12. Denis C, Fouquet R, Poty P, Geyssant A, Lacour JR. Effect of 40 weeks of endurance training on anaerobic threshold. Int J Sports Med 1982;3:208-14.Google Scholar
  13. Dettori JR. Bullock SH, Sutlive TG, Franklin RJ, Patience T. The effects of spinal flexion and extension exercises and their associated postures in patients with acute low back pain. Spine 1995;20:2303-12.Google Scholar
  14. Donchin M, Woolf O, Kaplan L, Floman Y. Secondary prevention of low-back pain. A clinical trial. Spine 1990;15:1317-20.Google Scholar
  15. Edwards BC, Zusman M, Hardcastle P, Twomey L, O’Sul1ivan P, McLean N. A physical approach to the rehabilitation of patients disabled by chronic low back pain. Med J Australia 1992;156:167-71.Google Scholar
  16. Elnaggar IM, Nordin M, Sheikhzadeh A, Pamianpour M, Kahanovitz N. Effect of spina1 flexion and extension exercises on low-back pain and spinal mobility in chronic mechanica1 low-back pain patients. Spine 1991;16:967-72.Google Scholar
  17. Estlander AM, Mellin G, Vanharanta H, Hupli M. Effects and follow-up of a multimodal treatment program including intensive physical training for low back pain patients. Scand J Rehab Med 1991;23:97-102.Google Scholar
  18. Evans WJ. Muscle damage: nutritional considerations. Int J Sports Nutrition 1991;1:214-24.Google Scholar
  19. Faas A, Chavannes AW, Eijk JT van, Gubbels JW. A randomized, placebo-controlled trial of exercise therapy in patients with acute low back pain. Spine 1993;18:1388-95.Google Scholar
  20. Faas A, van Eijk JT, Chavannes AW, Gubbels JW. A randomized trial of exercise therapy in patients with acute low back pain. Efficacy on sickness absence. Spine 1995;20:941-7.Google Scholar
  21. Feigenbaum MS, Pollock ML. Prescription of resistance training for health and disease. Med Sci Sports Exerc 1999;31:38-45.Google Scholar
  22. Fordyce W, Fowler RS, Lehmann JF, Delateur BJ, Sand PL, Trieschmann RB. Operant conditioning in the treatment of chronic pain. Arch Phys Med Rehabil 1973;54:399-408.Google Scholar
  23. Frost H, Klaber Moffett JA, Moser JS, Fairbank JC. Randomised controlled trial for evaluation of fitness program for patients with chronic low back pain. Br Med J 1995;310:151-4.Google Scholar
  24. Gatchel R, Polatin TB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine 1995;20:702-9.Google Scholar
  25. Graves JE, Pollock ML, Foster D, et a1. Effect of training frequency and specificity on isometric lumbar extension strength. Spine 1990;15:504-9.Google Scholar
  26. Greenough CG, Fraser RD. The effects of compensation on recovery from low back injury. Spine 1989;14:947-55.Google Scholar
  27. Hadier NH, Carey TS, Garrett J. The influence of indemnification by workers’ compensation insurance on recovery from acute backache. Spine 1995;20:271-5.Google Scholar
  28. Hansen FR, Bendix T, Skoy P, et al. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-controlled treatment of low-back pain: a randomized, observer-blinded trial. Spine 1993;18:98-108.Google Scholar
  29. Harreby M, Hesselsoe G, Kjer J, Neergaard K. Low back pain and physical exercise in leisure time in 38-year-old men and women: a 25-year prospective cohort study of 640 school children. Eur Spine J 1997;6:181-6.Google Scholar
  30. Hartigan C, Rainville J, Sobel JB, Hipona M. Long-term exercise adherence after intensive rehabilitation for chronic low back pain. Med Sci Sports Exerc 2000;32:551-7.Google Scholar
  31. Hartung GH, Smolensky MH, Harrist RB, Rangel R, Skroyan C. Effects of varied duration of training on improvement in cardiorespiratory endurance. J Hum Ergol 1977;6:61-8.Google Scholar
  32. Hazard RG, Fenwick JW, Kalisch SM, et al. Functional restoration with behavioral support: a one-year prospective study of patients with chronic low-back pain. Spine 1989;14:157-61.Google Scholar
  33. Hides JA, Jull GA, Richardson CA. Long-term effects of specific stabilizing for first-episode low back pain. Spine 2001;26:E243-8.Google Scholar
  34. Holmes B, Leggett S, Mooney V, Nichols J, Negri S, Hoeyberghs A. Comparison of female geriatric lumbar-extension strength: asymptomatic versus chronic low back pain patients and their response to active rehabilitation. J Spina1 Disord 1996;9:17-22.Google Scholar
  35. Hoogendoorn W, Pollel MNM van, Bongers PM, Koes BW, Bouter LM. Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine 2000;25:2114-25.Google Scholar
  36. Hurri H, Mel1in G, Korhonen O, Harjula R, Harkapaa K, Luoma J. Aerobic capacity among chronic low-back-pain patients. J Spina1 Disord 1991;4:34-8.Google Scholar
  37. Ito T, Shirado O, Suzuki H, Takahashi M, Kaneda K, Strax TE. Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil 1996;77:75-9.Google Scholar
  38. Johannsen F, Remvig L, Kryger P, et al. Exercise for chronic low back pain: a clinical trial. J Orthop Sports Phys Ther 1995;22:52-9.Google Scholar
  39. Kankaanpää M, Taimela S, Airaksinen O, Hanninen 0. The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self-experienced disability, and lumbar fatigability. Spine 1999;24:1034-42.Google Scholar
  40. Kinney RK, Gatchel RJ, Polatin PB, Fogarty WT, Mayer TG. Prevalence of psychology in acute and chronic low back pain patients. J Occ Rehab 1993;3:95-103.Google Scholar
  41. Kori S, MilIer RP, Todd DD. Kinesophobia: a new view of chronic pain behavior. Pain Manag 1990;3:35-43.Google Scholar
  42. Kraemer WJ, Adams K, Cafarelli E, et a1. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364-80.Google Scholar
  43. Krusen E. Compensation factor in low back injuries. JAMA 1958;166:1128-33.Google Scholar
  44. Leggett S, Mooney V, Matheson LN, et al. Restorative exercise for clinical low back pain. A prospective two-center study with 1-year follow-up. Spine 1999;24:889-98.Google Scholar
  45. Lethem J, Slade PD, Troup JD, Bentley G. Outline of a fear-avoidance model of exaggerated pain perception. Behav Res Ther 1983;4:401-8.Google Scholar
  46. Lindstrom I, Ohlund C, Eek C, et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant conditioning behavioral approach. Phys Ther 1992;72:279-90.Google Scholar
  47. Ljunggren AE, Weber H, Kogstad 0, Thom E, Kirkesola G. Effect of exercise on sick leaye due to low back pain: a randormized, comparative, long-term study. Spine 1997;22:1610-7.Google Scholar
  48. Manniche C, Lundberg E, Christensen I, Bentzen L, Hesselsoe G. Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain 1991;47:53-63.Google Scholar
  49. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine 1999;24:2435-48.Google Scholar
  50. Mayer TG, Gatchel RJ, Mayer H, Kishino ND, Keeley J, Mooney V. A prospective two-year study of functional restoration in industrial low back injury. An objective assessment procedure. JAMA 1987;258:1763-7.Google Scholar
  51. Mayer TG, Smith S, Keeley J, Mooney V. Quantification of lumbar function part 2: sagittal plane trunk strength in chronic low back pain patients. Spine 1985;10:765-72.Google Scholar
  52. McCracken LM, Zayfert C, Gross RT. The pain and anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain 1992;50:67-73.Google Scholar
  53. Mellin G, Härkäpää K, Vanharanta H, Mupli M, Heinonen R, Järvikoski A. Outcome of a multimodal treatment including intensive physical training of patients with chronic low back pain. Spine 1993;18:825-9.Google Scholar
  54. Miranda H, Vikari-Juntura E, Martikainen R. Takala EP, Rihimaki H. Individual factors, occupational loading, and physical exercise as predictors of sciatic pain. Spine 2002;27:1102-9.Google Scholar
  55. Moffett JK, Torgerson D, Bell-Syer S, et al. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. Br Med J 1999;319:279-83.Google Scholar
  56. Nelson BW, Carpenter DM, Dreisinger TE, Mitchell M, Kelly CE, Wegner JA. Can spinal surgery be prevented by aggressive strengthening exercises? A prospective study of cervical and lumbar patients. Arch Phys Med Rehabil 1999;80:20-5.Google Scholar
  57. Phillips H. Avoidance behavior and its role in sustaining chronic pain. Behav Res Ther 1987;25:273-9.Google Scholar
  58. Pincus T, Burton AK, Vagel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 2002;27:E109-20.Google Scholar
  59. Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low back pain. Spine 1993;18:66-71.Google Scholar
  60. Rainville J, Ahem DK, Pha1en L, Childs LA, Sutherland R. The association of pain with physical activities in chronic low back pain. Spine 1992;17:1060-4.Google Scholar
  61. Rainville J, Ahem DK, Phalen L. Altering beliefs about pain and impairment in a functionally oriented treatment program for chronic back pain. Clin J Pain 1993;9:196-201.Google Scholar
  62. Rainville J, Jouve CA, Hartigan C, Martinez E, Hipona M. Comparison of short- and long-term outcomes for aggressive spine rehabilitation delivered two versus three times per week. Spine J 2002;2:402-7.Google Scholar
  63. Rainville J, Sobel JB, Hartigan C, Wright A. The effect of compensation involvement on the reporting of pain and disability by patients referred for rehabilitation of chronic low back pain. Spine 1997;22: 2016-24.Google Scholar
  64. Riley J, Ahem DK, Follick MJ. Chronic pain and functional impairment: assessing beliefs about their relationship. Arch Phys Med Rehabil 1988;69:579-82.Google Scholar
  65. Risch SV, Norweil NK, Pollock ML, et a1. Lumbar strengthening in chronic low back pain patients: physiologic and psychological benefits. Spine 1993;18:232-8.Google Scholar
  66. Rissanen A, Kalimo H, Alaranta H. Effect of intensive training on the isokinetic strength and structure of lumbar muscles in patients with chronic low back pain. Spine 1995;20:333-40.Google Scholar
  67. Robert JJ, B1ide RW, McWhorter K, Coursey C. The effects of a work hardening program on cardiovascular fitness and muscular strength. Spine 1995;20:1187-93.Google Scholar
  68. Sachs BL, David JAF, Olimpio D, Sca1a AAD, Lacroix M. Spina1 rehabilitation by work tolerance based on objective physical capacity assessment of dysfunction. Spine 1990;15:1325-32.Google Scholar
  69. Singh NA, Clements KM, Singh MA. The efficacy of exercise as a long-term antidepressant in elderly subjects: a randomized, controlled trial. J Gerontol A Bio Sci Med Sci 2001;56:M497-504.Google Scholar
  70. Sobel JB, Hartigan C, Rainville J, Wright A. Rehabilitation of the post spinal arthrodesis patient. In: Margulies JY, Floman Y, Farcy JPC, Neuwirth MG, editors. Lumbosacral and spinopelvic fixation arthrodesis. Philadelphia: Lippincott-Raven Publishers, 1996:837-49.Google Scholar
  71. Soukup MG, Glomsrol B, Uinn JH, Bo K, Larsen S. The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain. A randomized, controlled trial with 12-month follow-up. Spine 1999;24:1585-91.Google Scholar
  72. Suni JH, Oja P, Miilunpalo SI, Pasanen ME, Vuori IM, Bos K. Health-related fitness test battery for adults: associations with perceived health, mobility, and back function and symptoms. Arch Phys Med Rehabil 1998;79:559-69.Google Scholar
  73. Taimela S, Diederich C, Hubsch M, Heinricy M. The role of physical exercise and inactivity in pain recurrence and absenteeism from work after active outpatient rehabilitation for recurrent or chronic low back pain. Spine 2000;25:1809-16.Google Scholar
  74. Talo S, Hendier N, Brodie J. Effects of active and completed litigation on treatment results: workers’ compensation patients compared with other litigation patients. J Occ Med 1989;31:265-9.Google Scholar
  75. Torstensen TA, Ljunggren AE, Meed HD, et al. Efficacy and cost of medical exercise therapy, conventional physiotherapy and self-exercise in patients with chronic low back pain: a pragmatic, randomized, single-blinded, controlled trial with 1 year follow-up. Spine 1998;23:2616-24.Google Scholar
  76. Tucci JT, Carpenter DM, Pollock ML, Graves JE, Leggett SH. Effect of reduced frequency of training and detraining on lumbar extension strength. Spine 1992;17:1497-501.Google Scholar
  77. Tulder M van, Malmivaara A, Esmail R, Koes B. Exercise therapy for low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;25:2784-96.Google Scholar
  78. Veale D, Lefevre K, Pantelis C, deSouza V, Mann A, Sargeabt A. Aerobic exercise in the adjunctive treatment of depression: a randomized controlled trial. J R Soc Med 1992;85:541-4.Google Scholar
  79. Velde G van der, Mierau D. The effect of exercise on percentile rank aerobic capacity, pain, and self-rated disability in patients with chronic low-back pain: a retrospective chart review. Arch Phys Med Rehabil 2000;81:1457-63.Google Scholar
  80. Videman T, Sarna S, Battie MC, et al. The long term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine 1995;20:699-709.Google Scholar
  81. Vlaeyen JM, Kole-Snijders AM, Boeren RG, Eek H van. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62:363-72.Google Scholar
  82. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993;52:157-68.Google Scholar
  83. Wittink H, Michel TH, Sukiennik A, Gascon C, Rogers W. The association of pain with aerobic fitness in patients with chronic low back pain. Arch Phys Med Rehabil 2002;83:1467-71.Google Scholar
  84. Wittink H, Rogers W, Gascon C, Sukiennik A, Cynn D, Carr DB. Relative contribution of mental health and exercise-related pain increments to treadmill test intolerance in patients with chronic low back pain. Spine 2001;26:2368-74.Google Scholar

Copyright information

© Bohn Stafleu van Loghum 2005

Authors and Affiliations

  • James Rainville
    • 1
  • Carol Hartigan
  • Eugenio Martinez
  • Janet Limke
  • Christin Jouve
  • Mark Finno
  1. 1.

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