Von der Schmerzanalyse zur Diagnose bei Schmerzen am Bewegungsorgan

[Spinal manipulation therapy in low back pain : Why? When? Where? How?]

BACKGROUND

Manipulation and mobilisation for low back pain are presented in an evidence-based manner with regard to mechanisms of action, indications, efficacy, cost-effectiveness ratio, user criteria and adverse effects. Terms such as non-specific or specific are replaced by the introduction of "entities" related to possible different low back pain forms.

EFFICACY

MM is effective for acute and chronic low back pain in terms of pain relief, recovery of function and relapse prevention. It is equally effective but less risky compared to other recommended therapies. MM can be used alone in acute cases and not only in the case of chronic low back pain where it is always and necessarily part of a multimodal therapy programme, especially in combination with activating measures. The users of MM should exclusively be physician specialists trained according to the criteria of the German Medical Association (Bundesärztekammer) with an additional competence in manual medicine or appropriately trained certified therapists. The application of MM follows all rules of Good Clinical Practice.

ADVERSE EFFECTS

Significant adverse effects of MM for low back pain are reported in the international literature with a frequency of 1 per 50,000 to 1 per 3.7 million applications, i.e. MM for low back pain is practically risk-free and safe if performed according to the rules of the European Training Requirements of the UEMS.

Manual medicine, manual therapy

Manual medicine is the medical discipline that deals with diagnosis, treatment, and prevention of reversible functional disturbances in the locomotor system and other related organ systems. The current article illustrates neuroanatomical and neurophysiological fundamentals of the mechanisms of manual diagnostics and treatment. Based on the recent literature and consideration of different scientifically based clinical guidelines, the evidence-based effectiveness of manual therapeutic procedures is presented. Acute and chronic low back pain, cervicogenic headache, neck and shoulder pain, radicular arm pain, dysfunctional thoracic pain syndromes, diseases of the rotator cuff, carpal tunnel syndrome, and plantar fasciitis are included. Clinical case studies illustrate the clinical procedures. The term, the origin, and the clinical presence of “osteopathy” are addressed in detail, and the national and international societies of manual medicine (Deutsche Gesellschaft für Manuelle Medizin [DGMM], European Scientific Society of Manual Medicine [ESSOMM], Fédération Internationale de Medicine Manuelle [FIMM]) are portrayed lexically. Finally, contraindications to manual intervention are presented and an outlook on the requirements and possibilities of scientific pain analysis is given in accordance with the preamble of the Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (GSOOC) guidelines on specific low back pain.

[Manual medicine, manual treatment : Principles, mode of action, indications and evidence]

Manual medicine is the medical discipline that comprehensively deals with the diagnosis, treatment and prevention of reversible functional disorders of the musculoskeletal system and other related organ systems. The article illustrates the neuroanatomical and neurophysiological basic elements and mechanisms of manual medical diagnostics and treatment. Based on the most recent literature and in consideration of various scientific guidelines, the evidence-based effectiveness of manual medical procedures is presented. In detail: acute and chronic low back pain, cervicogenic headache, neck and shoulder pain, radicular arm pain, dysfunctional thoracic pain syndromes, diseases of the rotator cuff, carpal tunnel syndrome and plantar fasciitis. Clinical case examples illustrate the clinical approach. The terminology, origin and clinical presence of "osteopathy" are described in detail and the national and international associations and societies of manual medicine, the German Society for Manual Medicine (DGMM), the European Scientific Society of Manual Medicine (ESSOMM) and the Fédération Internationale de Medicine Manuelle (FIMM) are lexically presented. Finally, contraindications for manual interventions and an outlook on requirements and possibilities of the scientific analysis of pain are presented, as they are postulated in the preamble of the guidelines on specific low back pain of the German Society for Orthopedics and Orthopedic Surgery (DGOOC).