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下背痛

Updated: May 30



1.

全球約 90% 的普羅大眾,一生中都會經歷最少一次下背痛.

Low back pain is a common condition affecting many individuals at some point in their lives.


Meucci, R. D., Fassa, A. G., & Faria, N. M. X. (2015). Prevalence of chronic low back pain: systematic review. Revista de saude publica, 49, 73.


下背痛的問題同樣也在香港肆虐:衛生署於2014年至2015年的人口健康調查報告指出,21.5%的受訪者於調查前30天曾經患有腰背痛的問題。

Similar incidence rate could be found in Hong Kong. According to the Report of Population Health Survey 2014/15,21.5% of interviewers had encountered low back pain during the 30 days preceding the survey.


2.

「撥雲見日,事半功倍」

Clarify and Proceed

要解決下背痛的問題,應先了其出現的原因,它可以與不良的坐姿有關。而下背部的組織有很多,要找到源頭並不容易。臨床醫學角度來看,專業人士也有機會以不同方式,如X光、磁力共震掃描,配以不同的測試手法與觸診,藉此找到相關成因,對症下藥。

There are different factors contributing to low back pain, such as improper sitting posture. However, the lower back is a compound of tissues and nerves which may be a hindrance to determine one's situation without checking. Therefore, even professionals would also assure diagnosis with the help of X-ray, MRI, clinical tests or palpation.




2.5

在找到成因後,物理治療師會以不同的手段幫你處理下腰背痛的問題:

Our physiotherapist will handle low back pain with following means according to your situation:


主動治療

Active treatment


運動治療

Exercise Therapy 


伸展及柔韌性訓練 與 核心肌群訓練 

脊椎穩定訓練

Stretching ,strengthening and stabilizing


動作控制練習

Motor control exercise 


肌電圖生物回饋

Electromyography biofeedback


認知行為治療

Cognitive behavioral therapy



被動治療

Passive Treament: 


熱敷

Superficial heat 


按摩

Massage


針灸

Acupuncture


電療

Interferential Therapy


手法治療

Spinal manipulation





3.

物理治療真的能夠幫助減輕下背痛的問題嗎?

Does physiotherapy help in managing low back pain?


國際權威期刊《內科醫學年鑑》建議有慢性下腰痛的患者先選擇非藥物的治療手法,例如運動治療、由多個專業人士協助的復康、針灸以及靜觀減壓。

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction


Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(7), 514-530


《肌肉骨骼科學與實踐》於2018年亦指出動作控制的練習對於非特定性下背痛和失去動作控作的人而言,無論在長短期也比其他居家或沒有任何練習更能改善下背的活動幅度;更能在短期內減少相關痛錯。

Movement control exercise intervention for people with non-specific low back pain and movement control impairment appears to be more effective in improving disability compared to other interventions, both over the short and long term. Pain was reduced in the short term.


Luomajoki, H. A., Bonet Beltran, M. B., Careddu, S., & Bauer, C. M. (2018). Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis. Musculoskeletal science & practice, 36, 1–11. https://doi.org/10.1016/j.msksp.2018.03.008




最新的文獻(2022年)也建議:在處理年輕族群的非特定性下背痛時,可選擇以物理治療與心理治療(認知為行治療)醫治;如果是慣性或有嚴重痛楚的情況,則應尋求運動醫學團隊的協助,訂制復康計劃。

Physical therapy (particularly physical activity) and psychotherapy (particularly cognitive behavioral therapy) are recommended for treating non-specific back pain in the younger population. Intensive interdisciplinary treatment programs should be provided for chronic and severe pain. 


Frosch, M., Leinwather, S., Bielack, S., Blödt, S., Dirksen, U., Dobe, M., Geiger, F., Häfner, R., Höfel, L., Hübner-Möhler, B., von Kalle, T., Lawrenz, B., Leutner, A., Mecher, F., Mladenov, K., Norda, H., Stahlschmidt, L., Steinborn, M., Stücker, R., Trauzeddel, R., … Zernikow, B. (2022). Treatment of Unspecific Back Pain in Children and Adolescents: Results of an Evidence-Based Interdisciplinary Guideline. Children (Basel, Switzerland), 9(3), 417. https://doi.org/10.3390/children9030417


3.5

非特定下背痛:

沒有特定原因或明顯結構受損所引致的下背痛。

There is no specific underlying condition or no pathoanatomic cause leading to low back pain.


特定下背痛

有特定原因或結構性受損所導致的下背痛。

Low back pain can be diagnosed  with a structural/pathoanatomical focus among clinicians.


Petersen, T., Laslett, M., & Juhl, C. (2017). Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC musculoskeletal disorders, 18(1), 188. https://doi.org/10.1186/s12891-017-1549-6


高達85-95%的患者均屬非特定下背痛。

From 85% to 95% of affected LBP patients no pathoanatomic cause can be identified.


Luomajoki, H. A., Bonet Beltran, M. B., Careddu, S., & Bauer, C. M. (2018). Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis. Musculoskeletal science & practice, 36, 1–11. https://doi.org/10.1016/j.msksp.2018.03.008

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