Боли в ноге

[Dr.Vad]

Ссылка на стволовые клетки [Ссылки доступны только зарегистрированным пользователям ]

На предлагаемой Вами ссылке показана и описана очень похожая техника, о которой уже упоминал и никакого отношения к "стимуляции роста хрящевых клеток и восстановлению тканей межпозвонкового диска" не имеет. (реклама, однако).

Кратко о краткосрочной и долгосрочной эффективности на примере этой методики. Вот что пишет сам автор:

J Clin Laser Med Surg. 2001 Feb;19(1):15-20.

Response of extruded intervertebral herniated discs to percutaneous laser disc decompression.

Choy DS.

Laser Spine Center and Columbia University College of Physicians & Surgeons, New York, New York 10021, USA.

OBJECTIVE: To describe the clinical features of 21 patients with extruded (but nonsequestered) herniated intervertebral discs before and after treatment with percutaneous laser disc decompression (PLDD). BACKGROUND DATA: PLDD was introduced in February, 1986, by Choy and Ascher. This relatively noninvasive technique for the treatment of herniated intervertebral discs has been extensively described elsewhere. Previously, only uncomplicated disc herniations were treated with PLDD, with a success rate according to the MacNab criteria of 89% and a complication rate of 0.4 to 1.0%.

METHODS: Twenty-one patients with magnetic resonance imaging (MRI)-documented extruded, but nonsequestered, herniated discs with appropriate pain syndromes were treated with PLDD. RESULTS: 18 of the 21 patients treated achieved the top category of the MacNab criteria, with good pain relief, and in some instances, reversal of neurologic deficits.

Согласно ему, от 85 до 89% краткосрочная эффективность (более выборочный подход, б0льшая опытность и тп.)

Далее:
J Clin Laser Med Surg. 2001 Feb;19(1):3-8.
Cervical percutaneous laser disc decompression: preliminary results of an ongoing prospective outcome study.
Knight MT, Goswami A, Patko JT.
The Spinal Foundation, Rochdale, UK.

The sustained nature of the benefit (mean 3.5 years at final follow up) after long-term preoperative symptoms (mean 3.9 years) in 76% patients rules out placebo effect.


J Clin Laser Med Surg. 2003 Jun;21(3):131-8.
Image-guided percutaneous laser disk decompression for herniated lumbar disks: a 4-year follow-up in 200 patients.
Gronemeyer DH, Buschkamp H, Braun M, Schirp S, Weinsheimer PA, Gevargez A.
Gronemeyer Institute of MicroTherapy, Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum, Germany.

200 patients, who were treated with image-guided PLDD for herniated lumbar disks, were observed over a period of 4 +/- 1.3 years. Treatments were carried out under CT/fluoroscopy guidance with local anesthesia on an outpatient basis with an Nd:YAG laser of 1064 nm. RESULTS: At follow-up, back pain was eliminated or reduced in 73% of the patients. Regarding sensorimotor impairment, PLDD did have a positive effect on 74% of the patients. In the majority of patients, the number of sick days and consumption of pain medication was reduced. In one patient, diskitis occurred as a complication of PLDD; 74% of the patients said they were satisfied with the outcome of the therapy; and 81.5% of the patients would have required another PLDD in cases of disk herniation.

В обоих публикациях в течение 3-4 лет наблюдения эффективность лечения оценивалась в среднем 75%.

Думаю, дело не только в процедуре, но кто и как ее делает, по каким показаниям и тп. В нормальных клиниках, как видим оценивают свою и долгосрочную эффективность.

[Dr.Vad]

The Journal of Family Practice • August 2004 • Vol. 53, No. 8

Does yoga speed healing for patients with low back pain?

Evidence-Based Answer

The use of yoga is consistent with recommendations for activity, as tolerated, for patients with low back pain. Literature evaluating the effectiveness of yoga for low back pain is scant, so it is unclear if yoga is equivalent to, or superior to, standard therapies (strength of recommendation: C, based on 1 randomized pilot study and limited case series).

Evidence Summary

Yoga, through static physical postures (or asanas), uses stretching to improve muscular strength and flexibility, which could be beneficial for low-back-related pain management. Hatha yoga, which incorporates breathing and movement, has provided limited benefit in musculoskeletal-related pain. Hatha yoga is distinguished from other yoga practices in that it is based on the knowledge, development, and balance of psychophysical energies. A large systematic review of yoga used for various medical conditions found over 120 studies. Anecdotal reports were excluded. The authors reported no studies directly evaluating effect of yoga on back pain.

A randomized controlled trial studied a 6-week modified hatha yoga protocol with 22 patients. The yoga group spent an hour with a certified instructor twice weekly, while the control group received the same intervention delayed until the study phase was completed. This underpowered pilot study found trends in functional measurement scores for improved balance and flexibility, as well as decreased disability and depression in the yoga group, but the sample size was too small to detect significant changes.

Patients who practice hatha yoga say it is valuable for preventing and managing stress-related chronic health problems, including low back pain. In a survey of 3000 people receiving yoga for health ailments (1142 [38%] with back pain), 98% claimed that yoga benefited them.

In a case series of 16 patients using various asanas for rehabilitation, 11 (69%) reported significant improvement, with near normal mobility and absence of pain. Those who reported recurring back pain also reported irregular practice of yoga. In another case series, 21 women aged more 60 years (mean age, 75) with hyperkyphosis, participated in twice-weekly 1-hour sessions of hatha yoga for 12 weeks. Measured height increased by a mean of 0.52 cm, forward curvature diminished, patients were able to get out of chairs faster, and they had longer functional reach. Eleven patients (48%) reported increased postural awareness/improvement and improved well-being; 58% perceived improvement in their physical functioning.

Clearly, more studies are required to determine the effects of yoga on lower back pain. Larger randomized sample sizes, group and individualized formats, and longer follow-up are needed. Control groups should involve both group and nongroup settings, to detect any benefit that may be derived from group support. No reports of harm from yoga in low-back pain therapy were reported in the few studies found.

Recommendations from others

The Philadelphia Panel formulated evidence-based guidelines for selected rehabilitation interventions in the management of low back pain for outpatient adults. Continuation of normal activity improves rate of return to work compared with enforced bed rest. Randomized controlled trials demonstrate no clinically important effect (15% improvement compared with control) with stretching or strengthening exercises, mechanical traction, or TENS. The panel found insufficient evidence to support the use of mechanical traction for patient global improvement and return to work. Therapeutic exercise—including stretching, strengthening, and mobility exercises—significantly reduces pain and improves function for chronic low back pain (longer than 12 weeks); but there was no clinical benefit in facilitating return to work. No specific comments on yoga appeared in their recommendations.

The US Preventive Services Task Force reports that evidence is insufficient to recommend for or against counseling patients to exercise to prevent low back pain; it makes no mention about yoga.

Nathan Graves, MD, Martin Krepcho, PhD, Helen G. Mayo, MLS,
University of Texas Southwestern Medical Center at Dallas

Clinical commentary:

Information suggests yoga—and all exercise—effective for low back pain

Good evidence supports the concept that activity is more effective than bed rest for acute low back pain. Recent studies in the rehabilitation and physical therapy literature have emphasized core stability exercises for acute and chronic back pain. As balance, strength, and flexibility improve, the episodes and intensity of acute low back pain diminish.

It stands to reason that activities such as hatha yoga that improve muscular strength, flexibility, and balance would similarly improve function and decrease low back pain. The available information would lead me to recommend yoga for my patients with low back pain. Yoga may well be effective, and no reports in the literature show harm.

John Hill, MD,
Rose Family Medicine Residency, Denver, Colorado

[Spinet]

…А если человек больше не вспоминает о болях и остеохондрозе вообще, так что еще нужно ?!!!...
Человеку больше ни чего, но Медицине же нужны объективные статистические данные.

На счет йоги, тоже слышал большое количество положительных отзывов. Но если я не ошибаюсь, занятия йогой являются, грубо говоря, обезболивающим, как и ЛФК (на своем опыте).

Получается, что нет смысла в попытках избавиться от грыжи диска, так как это невозможно, а стоит методами консервативного лечения снижать боль?

P.S.
Ну не могу я перевести этот текст, рад бы :-)

[Dr.Vad]

Согласно международным рекомендациям, пациентам с хр. болями в спине рекомендуется комплекс физ. упражнений при отсутствии данных, что какой-то из них более эффективен, нежели другой:

...patients who have subacute intermittent or recurrent subacute low back pain be encouraged to follow an active exercise program...
...there is sufficient scientific evidence to recommend that patients who have chronic low back pain perform physical, therapeutic, or recreational exercises, keeping in mind that no specific active technique or method is superior to another.

Spine. 2000 Feb 15;25(4 Suppl):1S-33S.

The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain.

Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser RL, Legrand E, Rozenberg S, Vautravers P.

Montreal Department of Public Health, Quebec, Canada.

Practice Guideline

[EVP]

Dr. Vad большое спасибо за ссылки. То есть там написано, что несмотря на положительные результаты в плане снижения болей в спине у занимающихся хатха-йогой,проведенных исследований недостаточно, чтобы делать прямые выводы о положительном влиянии хатха-йоги на боль в спине и что нет литературных данных, указывающих на какой-либо вред от хатха-йоги ?

[Dr.Vad]

Все верно. с позиций EBM мало свидетельств о пользе, но при отсутствии вреда и с учетом рекомендаций что любые физ. упражнения примерно одинаково хороши в этой ситуации, то при желании пациента заниматься именно йогой, пусть будет данный вид мыш. тренировки как способствующий борьбе с недугом.