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Z Orthop Ihre Grenzgeb 2001; 139(4): 287-293
DOI: 10.1055/s-2001-16912
WIRBELSÄULE

Georg Thieme Verlag Stuttgart · New York

Die Kräftigung der Lumbalextensoren (MedX) - die Therapie beim chronischen Rückenschmerz - eine Übersicht und Metaanalyse

Lumbar Extension Exercise (MedX) - Treatment for Chronic Low Back Pain - Review and Meta-Analysis O.  Miltner, D.  C.  Wirtz, C.  H.  Siebert
  • Orthopädische Universitätsklinik der RWTH Aachen (Direktor: Prof. Dr. med. F. U. Niethard)
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Publication History

Publication Date:
04 September 2001 (online)

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Zusammenfassung.

Studienziel: Die Behandlung des chronischen Rückenschmerzes ist eines der schwierigsten und kostenintensivsten Probleme in der industrialisierten Welt. Zahlreiche Studien zeigen, dass der chronische Rückenschmerzpatient eine deutliche Kraftminderung der Lumbalextensoren aufweist. Die isolierte Lumbalextensorenkräftigung fand Anfang der 90er Jahre Einzug in das Behandlungskonzept des chronischen Rückenschmerzes. Methode: Im Sinne einer Metaanalyse wurden zu dem Themenkomplex der isolierten Lumbalextensorenkräftigung vorliegende Publikationen ausgewertet und nach einem international gebräuchlichen Schlüssel validiert. Ergebnisse: Aus 21 Publikationen und Abstrakts konnten 1100 Fälle gesammelt werden, wovon 895 Fälle aus einer einzigen Studie stammen. Es fand sich keine Studie (Typ A), die prospektiv mit Kontrollgruppe und adäquater Nachuntersuchung geplant war. Die untersuchten Studien zeigen eine Reduktion von Schmerz, Verbesserung der Beweglichkeit, eine Verbesserung des Beschwerdebildes und eine Zunahme der Lumbalextensorenkraft. Schlussfolgerung: Prospektiv, randomisierte und kontrollierte Studien mit adäquaten Nachuntersuchungszeiträumen und Vergleichsstudien mit anderen Therapieansätzen sind dringend notwendig um das Therapiekonzept der isolierten Kräftigung der Lumbalextensoren zu validieren.

Aim: Low back pain ranks high among the reasons for physican office visits and is costly in terms of medical treatment. A number of studies have shown that low back pain patients have significantly lower trunk strength when compared with healthy controls. The working hypothesis at the beginning of the 1990's was that low back pain patients could be treated effectively using lumbar extension exercise. Method: 21 papers and abstracts reporting on lumbar extension training are rated. Validation was performed for each paper according to the internationally accepted system of the American Association of Spine Surgery in types A-E. Results: 1100 cases from 21 publications and abstracts dealing with lumbar extension training were evaluated. We did not find a single type A study in our search. The clinical outcome of the studies was a reduction of pain, improvement of range of motion, improvement of spinal condition and of the lumbar extension strength. Conclusion: Prospective, randomized, controlled studies with long-term results should help to delineate further the role of isolated lumbar extension exercise for the treatment of low back pain and to test the efficancy compared to other methods of care.

Schlüsselwörter:

chronischer Rückenschmerz - MedX - Lumbalextensoren - Review - Wirbelsäulenrehabilitation

Key words:

chronic low back pain - MedX - lumbar extension - review - vertebral rehabilitation

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Dr. med. Oliver Miltner

Orthopädische Universitätsklinik der RWTH Aachen

Pauwelsstr. 30

52074 Aachen

Fax: Fax 0241/8888507

Email: E-mail: Miltner.Heuter@t-online.de