荷兰腰背痛物理治疗指南
背部酸疼疗法
HON YUNZHE LEIAeroplan会员号: 367 836 8146181891这种情况考虑可能背肌损伤引起，建议注意休息，局部热敷按摩理疗，应用消痛贴膏，服用芬必得后背痛你应该去检查一下有没有胸膜炎和冠心病，只有找到病因后进行治疗可能才能取得更好的疗效长期的不合理姿势是会造成腰背部酸痛,矫正姿势是康复的关键.可以在家中试试这种锻炼方法,看看有没有效果：在家中赤足或穿平底鞋,前脚掌踩在厚度约为20毫米的书上,坚持直立,时间越长越好,可以感觉一下疼痛有无减轻.进行负跟站立锻炼的同时可以做一下正之本拉伸：这是对模特训练和康复训练的综合及改进.仰卧,双脚分开与肩同宽,膝关节屈起并拢,双手上举过头平放,掌心向上或者向内掌心相对.最初双臂伸不直也没关系,保持时间越长效果越好.正之本拉伸可有效矫正颈部和肩背部的姿态,缓解颈肩背部的僵硬,对颈椎病和驼背的效果显著,明显优化颈肩部线条,拉长颈部.能够缓解僵硬,有利于姿势矫正.负跟站立锻炼和拉伸锻炼对背痛有好处的话就是长期不合理姿势造成的,日常生活中要注意姿势,不要久站久坐长时间保持一个固定的姿势,维持一个姿势一旦超过了20分钟肌肉就开始紧绷,无论是什么姿势维持太久都不好,而错误的姿势是会加重腰酸背痛的.具体的病情要到大医院进行确诊,及时治疗.这种情况是要考虑强直性脊柱炎的,因为此病可以出现脊柱前屈侧弯后伸活动受限,X线胸椎可以有骨质增生,甚至表现为“竹节样”变.一般背部强直是夜间及休息时明显,活动后稍缓解.意见建议:最重要的是去医院做一个骶髂关节片,看有无骶髂关节炎的表现,这是诊断的最客观依据.另外HLA-B27阳性有一定的参考价值.诊断明确,早日采取系统治疗,加用抗风湿药物,柳氮磺吡啶和沙利度胺等.这些药可以延缓病情进展,单纯靠止痛药物或者激素治疗是不可取的.生活护理:平时注意多做伸展运动,多吃新鲜蔬菜和水果,不要受凉,最好睡平板床,别枕枕头.希望对你有帮助,祝健康生姜食疗谱。
下腰痛指南
缓减患者疼痛和功能障碍都是有用的。 （基于强证据建议）
干 预 -身 体 协 调 性 、 力 量 及 耐 力 训 练 ： 对于患有亚急性或慢性的下腰痛伴随有 运动协调性受损的患者以及腰椎微创手 术后的患者，临床医生应该考虑应用身体 的协调性、力量及耐力练习以减轻患者的 下背部疼痛和功能障碍。（基于强证据建 议）
引言
指南目的
针对世界卫生组织（WHO） 的国 际功能，残疾和健康分类（ICF）325 中所描述的肌肉骨骼损伤患者，美国 物理治疗协会（APTA）骨科分会长期
以来不懈努力，致力于创建以循证为 基础的骨科物理治疗管理的实践指 南。
临床指南的目的是： · 描述以循证为基础的物理治疗实
鉴 别 诊 当有以下情况时 应向专科转诊：1.临床检查提示患者有严 重的内科疾病或存在心理问题，2.提示的 活动受限或身体功能和结构的损伤与诊 断/分类指南是不一致的，3.使用恢复患者 身体功能受损的干预方法并不能缓解患 者症状。（基于强证据建议）
干 预 -牵 引 ： 对下腰痛患者使用间歇性腰 椎牵引是否有疗效的证据是矛盾的。初步
的证据显示：对一组有神经根受压症状伴 外周症状直抬腿测试阳性的患者进行俯 卧位腰椎间歇性牵引是有利的。中等证据 显示对于急性、亚急性、非神经根性下腰 痛的患者或慢性下腰痛的患者临床师不 应该使用间歇性或静力性腰椎牵引。（基 于相互矛盾的证据建议）
检 查 -疗 效 测 量 ： 临床师应该采用有效的 自我报告调查问卷,比如：Oswestry 残疾指 数和 Roland-Morris 残疾问卷。这些问卷 对于确定患者的疼痛、功能和残疾的基本 状态以及在治疗过程中监控患者状态是 有否改变是非常有用的。（基于强证据建 议）
Thera-Band训练系统对运动员慢性腰背痛的康复效果
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ｂ ｃ ｐａｎ ｏ ｈｅａｔ ｌ ｔ ｓ Ｍ ｅｈｏ ４５ａ ｈ ｅ ｅ ｉｈ ｔ ｏ ｔｔｓ ｕ ｅ ｉ ｅ ｅｔ ｓ ｅ ｏｒｐａｎ ａｎ ｈｅｆ ａ ｋ ｉ ｆｔ ｈ ｅ ｅ ． ｔ ｄｓ ｔ ｌ ｔ ｓｗ ｔ ｈｅｓ ｆ ｉｓ ｅ ｌ ｓｏｎ ｗ ｒ ｅ ｔ ｄ ｆ ｉ ｄ ｔ ｕｎｃ ｉ ｆｌ ｍ ｂａ ｃ ｕｓ １ ｔｏｎ ｏ ｕ ｒｂａ ｋ ｍ ｅｅ ｗａ ｖ ｌ ｔ ｄ Ｔｈｅ ｌ ａ ｅ ｒ ｒ ｉ ｄ ｗ ｉｈ Ｔｈｅ ａ Ｂａ ｓ ｅ ｓ ｓ ｅ ａ ｕａ ｅ ． ｎ ａ ｌｃ ｓ ｓ ｗｅ ｅｔ ａｎｅ ｔ ｒ － ｎｄ Ｓｙ ｔ ｍ ．Ｒｅ ｕ ｔ Ａｆ ｅ ｒ ｉ ｉ ｇ，ｔ ｃ ｅ ｆｐａ ｎ ａ ｕｎ ｔｏｎ ｅ ｌ — ｓ ｌｓ ｔ ｒ ｔａ ｎ ｎ ｈｅ ｓ ｏｒ ｓ ｏ ｉ ｎｄ ｆ ｃ ｉ ｖａｕａ ｔｏｎ ｏｆｌ ｂ ｒ ｂａ ｋ ｕｓ ｌ ｃ ｅ ｓ ｄ ｓｇｎ ｆｃ ｔｙ ｉ ｕｍ ａ ｃ ｍ ｃｅ ｄｅ ｒ ａ ｅ ｉ ｉｉａｎ ｌ ．Ｃｏｎ ｌ ｉ Ｔｈｅ ａ Ｂａ ｃｕｓｏｎ ｒ — ｎｄ Ｓｙｓ ｅ ｓｏｆｐ ｏｇｒ ｓ ｉ ｘｅ ｃｓ ｓｔ ｅ ｏ ｔｍ ｒ ｅ ｓｖｅｅ ｒ ｉｅ ｈａ ｈ ｂｖｉｕｓａｎ ｏ — ｏ ｄ ｐ ｓｉ
《中国急慢性非特异性腰背痛管理指南》解读
我国缺乏非特异性腰背痛诊疗规范
• 部分欧美国家对于非特异性腰背痛[6-8]都已制定了相关的临床诊疗 指南。然而，我国作为全球人口第一大国，腰痛的人群年患病率 高达26.1%[9]，却至今缺乏针对非特异性腰背痛的诊疗规范
临床需要规范诊治的指导意见
中国康复医学会脊柱脊髓专业委员会
参考欧美等国家近年来的 指南，结合中国流行病学 、治疗特点
• 因脊柱触诊检查不精确可靠，不能仅依靠脊柱触诊结果来诊断慢性非特异 性腰背痛。
影像学评估
• 常用的脊柱影像学检查包括：X线平片、CT、MRI、骨扫描、骨密度检查。
✓ 推荐应用X线平片评估骨结构情况； ✓ 推荐采用骨密度检查排除骨质疏松腰背痛； ✓ 推荐在有严重红色警示(red flag)和有神经根症状的患者应用MRI诊断； ✓ 不推荐MRI、CT、小关节封闭用于小关节源性疼痛的诊断和椎间盘源性疼
卧床会加重疼痛延长恢复时间及恢复正常工作的时间建议患者保持活动状态两丧系统性回顾性研究収现建议患者保持活动无论是否联合其他治疗可减少功能障碍疼痛以及恢复正常工作的时间运动疗法丌推荐特异性运动疗法如伸展运动屈曲运动等用二治疗急性腰背痛治疗脊柱推拿术对二丌能恢复正常工作的患者考虑采用脊柱推拿术药物治疗药物推荐意见对乙酰氨基酚缓解疼痛首选其疗效虽丌如nsaids但丌良反应为轻微安全性较好nsaids缓解疼痛次选其临床疗效较好但胃肠道丌良反应常见nsaids无法有效控制疼痛戒者控制疼痛丌佳时建议加用肌松剂丨药治疗根据丨医腰痛的证治分类选择相应的内治方法肌松剂用于lbp患者显著缓解疼痛vantuldermwtourayfurlanadetal
慢性化 肥胖 受教育程度低 疼痛和功能障碍较严重
悲痛 抑郁 负面情感躯体化
工作需要频繁上举重物 初回工作岗位时无法提供强度较轻的工作 工作满意度较低
WCPT物理治疗课程指南
课程内容 The Curriculum
1、生物、物理科学相关内容及学习经验 解剖或细胞生物学 组织学 生理学 运动生理学 运动科学 生物力学 人体运动学 神经病学 病理学 影像以及药理学
8/24/2012
WCPT物理治疗课程指南
王于领 副主任物理治疗师 副教授
CONTENT
物理治疗师教育的本质 物理治疗师专业教育准入标准细则 课程内容 教学与临床实习的最低要求
物理治疗师教育的本质
The Nature of Physical Therapist Education
物理治疗师教育的本质
The Nature of Physical Therapist Education
由于不同国家间社会、经济、文化和政治环境迥异， WCPT意识到物理治疗教育必须在各种不同的环境下 展开。
WCPT建议，最短4年制的入门级教育应当在大学或相 当于大学水平的教育机构开展，当然也包括学士、硕 士和博士水平的准入资格，但无论是何种水平的课程， 其本质都是让物理治疗师掌握必要的知识和技能。
物理治疗师专业教育准入标准细则
准入标准所规定的课程里应设立研究方法学。 应当鼓励物理治疗师参加理疗或有关专业的研究生课程学
习以便取得更高的专业发展。 专业物理治疗的教师应该由物理治疗的专业教育人员担
任，他们应具备传授有关物理治疗的评估、治疗以及预后 等知识和技能的能力，其中还包括物理治疗的理论和方法 的评论分析。 教师应该具有相应的教学经验与资质。他们应该理解和领 会教学的内涵。
腰背痛的诊疗指南
腰背痛的诊疗指南【概述】腰背痛（low back pain，LBP）是一类严重影响患者生活质量的常见病症，可导致患者运动功能障碍，甚至丧失生活自理能力。
【临床表现】急性非特异性腰背痛临床表现多样，发病较急，多伴有机械性外力损害，如搬提重物、扭转腰部等；疼痛程度多较为剧烈，可伴局限性或弥漫性压痛；腰椎活动多可引发腰背痛，伴或不伴有下肢放射性疼痛；多数患者有腰部僵硬感、活动受限或协调能力下降。
慢性非特异性腰背痛的临床表现多样，以腰背部、腰骶部疼痛为主要表现。
多数患者可同时存在腰部无力、僵硬感、活动受限或协调性下降，严重者可发生睡眠障碍[。
疼痛症状多于卧床休息后减轻或消失，弯腰、久坐、久站后加重。
经热敷、按摩等保守治疗后疼痛症状多可暂时缓解。
体格检查常可发现疼痛部位存在肌张力增高或明显局限性压痛点（扳机点）。
【诊断要点】1、典型的临床表现及体征。
2、MRI 在显示软组织方面具有独特优势，可区分椎间盘的髓核和纤维环、显示韧带。
MRI 可直接从矢状位和冠状位显示椎管狭窄等情况。
MRI 不产生电离辐射，安全性较高，可用于腰背痛的诊断、严重程度和恢复情况的评估、治疗目标的制定等。
3、SPECT 可用于全身性骨骼显像，明确不易被发现的骨折、感染、骨肿瘤以及肿瘤分期4、骨密度检查可用于确定患者有无骨质疏松的情况，以排除骨质疏松性腰背痛。
目前常用的骨密度测量技术包括双能 X 线骨密度测量（DXA），四肢 DXA（pDXA）和定量CT（QCT）等。
【康复评定】1、疼痛评定。
2、腰椎关节活动范围评定。
3、腰背肌肌力的评定。
4、行走能力的评定。
5、日常生活活动能力（ADL）评定。
【治疗原则】原则急性期以缓解疼痛，改善活动度，改善功能，预防复发，避免向慢性转归。
慢性期：改善患者的躯体功能、恢复正常活动、预防残疾及维持工作能力。
1、急性期：不强调卧床休息，研究显示，与维持正常活动的患者相比，卧床休息不仅对患者没有益处，还可能产生不良影响。
欧美下腰痛诊疗指南解读(二)
欧美下腰痛诊疗指南解读（二）引言概述：腰痛是一种常见的症状，对患者的生活质量和工作能力都会产生负面影响。
欧美下腰痛诊疗指南是针对腰痛患者制定的临床指南，旨在提供科学、规范和全面的腰痛诊断和治疗建议。
本文将对欧美下腰痛诊疗指南的内容进行解读，帮助读者更好地了解腰痛的诊断和治疗方法。
正文：一、腰痛的分类和定位1. 根据疼痛性质和病程，腰痛可分为急性腰痛、亚急性腰痛和慢性腰痛。
2. 了解腰痛的定位，可以帮助确定疼痛的来源和可能的病因。
二、腰痛的评估和诊断1. 详细询问病史，了解腰痛发生的时间、性质、诱因等信息。
2. 进行体格检查，包括活动范围、神经系统和腰部结构的检查。
3. 辅助检查如X线、CT、MRI等可以提供进一步的诊断信息。
4. 根据病史、体格检查和辅助检查结果，进行腰痛的综合评估和诊断。
三、腰痛的非手术治疗1. 医学物理治疗包括热敷、冷敷、按摩、理疗等方法，可缓解腰痛症状。
2. 药物治疗可以使用非处方药和处方药，如非甾体抗炎药、镇痛药等。
3. 改善生活习惯，保持适当的体重，合理的锻炼和休息，可以减轻腰痛症状。
四、腰痛的手术治疗1. 腰椎间盘突出症和脊柱管狭窄症等慢性腰痛可以考虑手术治疗。
2. 手术治疗的选择包括椎间盘切除术、脊柱融合术等。
五、腰痛的预防和康复1. 加强运动和体育锻炼，特别是腰部肌肉的锻炼，可以预防腰痛的发生。
2. 合理的劳动保护和姿势调整，减少腰部受力，可以预防腰痛的发生。
3. 康复治疗包括物理治疗、康复运动等，帮助患者恢复功能和减轻腰痛症状。
总结：欧美下腰痛诊疗指南提供了腰痛的科学诊断和治疗建议，包括腰痛的分类和定位、评估和诊断、非手术治疗、手术治疗、预防和康复等方面的内容。
读者可以根据指南的建议，选择适合自己的诊疗方法，更好地管理和治疗腰痛问题。
欧美下腰痛诊疗指南解读
椎间盘源性腰痛的疼痛机理
退变髓核 致敏神经
炎性介质
应力集中
疼痛
炎性肉芽组织
纤维环内破裂 血管神经长入
腰背肌痉挛导致腰痛
n腰痛导致腰背肌的反射性痉挛，进而出现肌源性疼 痛 n这种现象被称之为“疼痛-肌肉痉挛-疼痛恶性循环 ”
n反射
n肌源性疼 痛
nvan Dieen JH, Selen LP, Chole wiCki J. Trunk muscle activation in low-back pain patients , n ananalysis of the literature. J Electromyogr Kinesiol. 2003;13:333-351
流行病学
发病率：23% (欧洲） 在美国居第2位（仅次于上呼吸道感染） 80%以上的成人有患病史 3%：住院治疗；0.5%：手术干预
多种分类方法并存
非特异性下腰痛 脊柱退行性病变导致下腰痛 特殊脊柱病变相关的下腰痛
分类
椎管内疾患
椎管外疾患
椎间盘源性疼痛最常见
腰脊神经后支源性 下腰痛最常见
Grade III High pressure
V Low Pressure IV Medium Pressure
IDD诊断标准
n 腰痛6个月以上； n 系统保守治疗无效； n 神经系统检查正常； n 直腿抬高试验阴性； n 椎间盘造影有1-2个椎间盘异常，并有
6/10原疼痛强度的诱发疼痛。
（Derby R，et al：Neuromodulation，2000，3（2）：82
Chou R, et al. Ann Int Med 2007 Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.
腰背痛康复新理念
01
闭链运动则为肢体远端固定并承受身体重量所进行的运动(近端肢体在固定的远端肢体基础上移动)“
前者使得原动肌和协同肌兴奋,但拮抗肌不同时收缩;而后者则使原动肌!协同肌和拮抗肌同时兴奋,
所以非常适于进行康复及体育训练
02
03
什么叫闭链运动？
SET技术
借助于S-E-T® (Sling Exercise Therapy) 系统的训练，进行高水平的神经肌肉刺激，恢复中枢神经系统对下位的控制，使失活的深层肌肉恢复功能（唤醒）
04
腰椎滑脱（假性）
05
腰椎骨折（恢复期）
06
頸腰痛
SET技术可治疗的腰背痛
低负荷与渐进抗阻训练（支撑带、弹力绳）
无痛原则
非对称、不稳定原则
振动原则
离心收缩与姿势控制
闭链训练与开链训练相结合原则 （可获得神经肌肉控制的最大恢复）
SET训练要点
01
03
05
02
04
06
分阶段进行
肌肉训练原则
内层运动控制 学习节段
01
二是从医学角度特指脊柱过度活动可以导致疼痛、潜在的脊柱变形和神经组织受压损伤。
02
前者时后者的基础，后者是前者的反映
03
医学领域对脊柱稳定性的理解
目前包含两个层面的意义
脊柱稳定性的逐渐丧失
是一个渐变的过程
我们应提前给予干预，不让其发展到椎管狭窄、脊柱滑脱
从生物力学的视角看腰背痛的病理过程
脊柱运动控制功能障碍
稳定肌与运动肌比较
位于背部深层 腱膜状（aponeurotic） 慢肌、白肌为主 耐力活动时激活 选择性弱化 募集较差，可以被抑制 在30－40％MVC条件下激活
理疗治疗腰背痛的综合非药物方法
理疗治疗腰背痛的综合非药物方法近年来，随着生活节奏的加快以及长时间坐姿和缺乏运动等不良习惯的形成，腰背痛已经成为一种常见的健康问题。
虽然药物治疗是腰背痛的一种方法，但为了避免对身体造成不良影响，综合非药物方法也是治疗腰背痛的首选。
本文将介绍几种有效的理疗方法，帮助缓解腰背痛，提高生活质量。
一、按摩疗法按摩是一种古老而有效的理疗方法，通过刺激背部的肌肉和神经，有助于放松紧张的肌肉，改善血液循环，减轻疼痛。
在进行按摩疗法时，可以选择一种合适的按摩油，如芦荟或迷迭香油，用适度的力度按摩腰部和背部。
轻揉、推拿、拍打等按摩手法都可以采用，每次按摩约15-20分钟，每周进行2-3次。
二、温热敷疗法温热敷疗法是一种简单而有效的理疗方法，可以有效缓解腰背痛。
通过向腰部和背部施加温热物质，如热水袋、热敷贴或温水浴，可以促进血液循环，减轻疼痛和炎症。
在进行温热敷疗法时，要确保温度适中，不要过热，避免烫伤皮肤。
每次敷热约15-20分钟，每天进行2-3次。
三、牵引疗法牵引疗法是一种通过用力拉伸脊椎来减轻腰背痛的方法。
可以选择医用牵引设备或者特制的牵引架，将身体部分悬空，并逐渐施加力量来拉伸脊椎。
这种方法可以减轻脊椎的压力，扩大椎间隙，减轻腰背疼痛。
牵引疗法需要在专业人员的指导下进行，每次牵引时间应控制在15-20分钟，每周进行2-3次。
四、腰腹肌肉锻炼腰腹肌肉的强化和拉伸可以有效缓解腰背痛。
一些简单的腰腹肌肉锻炼包括：仰卧起坐、平板支撑和腹肌收缩等。
这些锻炼有助于增强核心肌肉的力量，维持脊椎的稳定性，减轻腰背负荷，改善腰背疼痛。
每天进行适量的腰腹肌肉锻炼，可以帮助缓解疼痛。
五、腰带的使用腰带是一种简单而便捷的理疗辅助工具，可以有效减轻腰背痛。
腰带的使用可以提供额外的支撑和压力，减轻腰背负荷，在一定程度上缓解疼痛。
在选择腰带时，要选择合适的尺寸，确保不会过紧或过松，同时遵循医生或理疗师的指导，避免长时间佩戴。
总结：理疗治疗腰背痛的综合非药物方法包括按摩疗法、温热敷疗法、牵引疗法、腰腹肌肉锻炼和腰带的使用。
脊柱疼痛的自我物理治疗
完整ppt课件杯立即施行温热疗法
❖ 外出时如果出现身体疼痛，可以用热水杯或饮料罐温特疼 痛处。把热水杯慢慢按在可以缓解腰痛的志室穴、肾俞穴、 大肠俞穴上，利用热度缓解疼痛，
完整ppt课件
11
芳香疗法
❖ Aromatherapy又称为芳香疗法，是使用从植物中提 取的精油来治疗身心疾病的方法。芳香疗法由可以 细分为直接吸入香气、沐浴、用植物性精油按摩身 体等方法，在菏泽里建议大家首先尝试在自己喜欢 的香气里做腹式呼吸。第一次尝试这种疗法的人， 通常比较喜欢柏树、迷迭香、薄荷等香气，以香气 的放松作用来缓解肌肉疼痛。现在，可以进行芳香 疗法的地方渐渐多了起来，在百货商场、便利店、 药店等都可以买到芳香疗法需要的东西。
❖ 用热毛巾或吹风机温暖患处
❖ 把湿毛巾轻轻拧一下装进塑料袋，放进微波炉里加热，注 意塑料袋口要敞开。加热后用另一条干毛巾裹住塑料袋，然 后趴在床上，把毛巾放在腰上热敷。或用吹风机的暖风吹疼 痛处，注意保持吹风机与患处的适当距离。
完整ppt课件
3
用吹风机的暖风刺激穴位
用吹风机吹头发时，可以同时用暖风来刺激肩 膀周围的穴位，这对消除肩膀酸痛很有效。
完整ppt课件
4
有效利用市售的膏药
市售的膏药可以分为两大类，一类是含有辣椒提取物的温 热型膏药；另一类是含有薄荷脑的清凉型膏药。
❖ 肩膀总是在活动，所以膏药很难贴住。建议把膏药剪成 3厘米左右见方的小片，再贴在个穴位上。这样既能防止膏 药脱落，还能达到治疗效果。
❖
想缓解由肌肉僵硬引起的头痛，改善血液循环，缓解肌
WCPT物理治疗教育指南
WCPT guideline for standard evaluation process for accreditation/recognition of physical therapistprofessional entry leveleducation programmesWCPT guideline for standard evaluation process for accreditation/recognition of physical therapist professional entry level education programmesContentsSection 1: Background (3)1.1 Introduction (3)Section 2: Concept of accreditation/recognition (4)2.1 What do we mean by accreditation/recognition? (4)2.2 Why is accreditation/recognition important? (4)2.3 Who drives accreditation/recognition? (5)2.4 When does accreditation/recognition occur? (5)2.5 What processes need to be in place for accreditation/recognition? (5)Section 3: Models of accreditation/recognition (6)Section 4: Implementation and review of the accreditation/recognition ofprofessional entry level physical therapy education programmes (7)Section 5: Criteria for accreditation/recognition of physical therapist professionalentry level education programmes (8)5.1 Introduction (8)5.2 The profession and the practice environment (8)5.3 The nature of physical therapist education (8)environment (9)5.4 Theacademic5.5 The standards required of a quality physical therapist professional entry levelprogramme (9)5.6 Curriculum plan, evaluation, content and outcomes (10)plan and content (10)5.6.1 Curriculum5.6.2 Curricularevaluation (10)5.7 Institution and programme resources (11)5.7.1 Institution (11)5.7.2 Physical therapist professional entry level programme (11)............................................................................................11resources5.7.3 Humanresources (13)5.7.4 OtherGlossary (15)Resources (15)Acknowledgement (16)References ................................................................................... Error! Bookmark not defined. Appendix A: Models of accreditation/recognition from WCPT memberorganisations (18)WCPT guidelines are produced to assist member organisations and others to raise the quality of physica therapy. They may provide guidance on standards criteria or courses of action in areas relevant to physica therapy education research practice or policy. They are not mandatory but designed to assist the implementation of WCPT’s policies.WCPT guideline for standard evaluation process for accreditation/recognition of physical therapist professional entry level education programmesSection 1: Background1.1 IntroductionThe World Confederation for Physical Therapy (WCPT) has produced this guideline to supportits member organisations in developing a process for accrediting/recognising physicaltherapist professional entry level education programmes.This guideline is intended for the following uses:for member organisations and their members who do not currently have a process of accreditation/recognition for their physical therapist professional entry level educationprogrammesfor member organisations and their members who may be making a change in their model of accreditation/recognitionfor member organisations and their members who may require information to review their current process of accreditation/recognitionThe document may also support countries not yet eligible for WCPT membership, but where physical therapy entry level education programmes are being developed to meet WCPT’s guidelines. 1 WCPT recommends that education for entry level physical therapists should be based on university or university-level (ie higher education institution*) studies of a minimum of four years, independently validated and accredited as being at a standard that affordsgraduates full statutory and professional recognition. 1-2In its policy statement on education WCPT states that it will assist national physical therapy associations with the development of appropriate educational standards and with the development of accreditation/recognition processes. 2 WCPT is also interested in supporting physical therapy education programmes running in countries without an establishedprofessional association or one not yet belonging to WCPT.Physical therapy education is a continuum of learning beginning with admission to anaccredited physical therapy school and ending with retirement from active practice. The term accredited is used in relation to physical therapy education to describe a programme which is regularly evaluated according to established educational standards. 1-2A variety of educational, professional, statutory, legislative and cultural drivers affect the extentto which accreditation/recognition of physical therapy professional entry level education programmes exists within member organisations.The document is part of a collection of resources designed to help physical therapisteducation. Other WCPT sources of information with which these guidelines can be considered are:* Throughout this document, “higher education” is used to embrace what is also known as “tertiary education”.Policy statement: Education. 2Policy statement: Reciprocity. 3Policy statement: Regulation of the physical therapy profession. 4WCPT guideline for physical therapist professional entry level education. 1WCPT guideline for qualifications of faculty for physical therapist professional entry level programmes. 5WCPT guideline for the clinical education component of physical therapist professional entry level education. 6WCPT guideline for the development of a system of legislation/regulation/recognition.7 Section 2: Concept of accreditation/recognition2.1 What do we mean by accreditation/recognition?Accreditation/recognition of physical therapist professional entry level education programmes is a process of engagement, reflection, report and review. 8 The satisfactory outcome of this process results in the accreditation/recognition of the programme, which then must be reviewed again at a specified future time. The reviewer of the programme, in the context of accreditation/recognition, is ideally an external, independent organisation.As described above, the terms accreditation/recognition or accredited/recognised programme are used in relation to physical therapy education to describe a programme that is regularly evaluated according to established educational standards. These terms are understood, in many member organisations, to involve a formal quality assurance process that is evaluated by an independent authority. This authority may be governmental or non-governmental and may have a statutory regulatory function. For the purposes of this paper, both terms are considered to represent an independent formal quality assurance review of the physical therapist professional entry level education programme.2.2 Why is accreditation/recognition important?Independent peer-review is important to maintain educational and professional standards in physical therapist professional entry level programmes. Accreditation/recognition is a quality assurance measure that considers the components of the programme, how it is delivered and by whom, and relates the findings to professional expectations and benchmarks. External accreditation/recognition may take place alongside internal institutional quality assurance activities, such as academic departmental and programme reviews, faculty evaluations and research assessment exercises.Evaluating and maintaining the quality of programmes is important for:•students who want to be sure they are selecting a high-quality programme•health service providers who later become employers of graduates•the users of health servicesIn addition, it may help the education institution promote its programme to the external audience. The process of establishing acceptable criteria for programmes provides an opportunity for the profession to contribute to the development of such programmes and to ensure that the programmes reflect the needs and requirements of current and future physical therapist service provision.accreditation/recognition?drives2.3 WhoIdeally, evaluating physical therapy professional entry level education programmes is developed by the physical therapy professional body/organisation. The requirement for accreditation/recognition of these programmes is commonly part of a statutory or legislative framework, and part of the work of a regulatory authority. If there is no regulatory obligation for accreditation/recognition, then eligibility for membership of the professional organisation may be a condition for qualification from an accredited programme. The organisation driving the need for accreditation/recognition may, therefore, be the physical therapy professionalbody/organisation.In countries where a physical therapy professional body/organisation is not yet established, the higher education institutions (HEIs) developing entry level education programmes may seek support from WCPT for a pathway for accreditation/recognition.2.4 When does accreditation/recognition occur?For new physical therapist professional entry level programmes, which have been approved by a government ministry or HEI (or where there is provisional approval, or approval awaiting an external review), accreditation/recognition of the programme may take place: •on an ongoing basis for the first cohort of students entering the programme•for the first and second cohorts of students entering the programme, thereby making sure that (some of) the conditions identified in the first cohort that warranted changehave been addressed in the second cohort•before the programme commencesFor existing programmes, the process of accreditation/recognition may be relatively straight forward, if no substantial changes have occurred in the delivery of the previously accredited programme.2.5 What processes need to be in place for accreditation/recognition?Initially, the process of accreditation/recognition requires the applicant, ie the HEI, to review its programme and, following a period of reflection, prepare an application foraccreditation/recognition. The components of such an application are decided, in advance, by the reviewing body. The requirements of application may be quite prescriptive in parts and less so in other areas. The purpose of the application is to enable the reviewers to decide if the physical therapist professional entry level programme meets the standards expected of the reviewing body. The application may be followed up by a visit to the higher/tertiary education institution by the reviewing body.The generic responsibilities of the higher education institution may include:understanding the reviewing body’s requirements and expectations of an acceptable physical therapist professional entry level education programmeseeking accreditation/recognition from reviewing body or accepting notification of the need for accreditation/recognition or re-accreditation/re-recognition from reviewingbodycompleting a self-evaluation of the programme and other relevant documentation.facilitating visit from reviewing bodyresponding to initial report from reviewing body; corrects inaccuracies and makes changes as requestedif accreditation/recognition is received, notifying reviewing body of any substantial changes in the programmeseeking re-accreditation/re-recognition from reviewing body or accepting notification of the need for re-accreditation/re-recognition from reviewing bodyThe generic responsibilities of the reviewing body may include:establishing policy for accreditation/recognitiondescribing the process and notifies relevant higher/tertiary education institutionsestablishing committee to review the application (including appropriately qualified physical therapists)setting timeframes between review periodsestablishing standards required of physical therapist professional entry level education programmesaccepting application and undertaking reviewreporting back to higher education institution with requirement and/orrecommendationsreviewing feedback and decision of accreditation/recognition committeenotifying relevant executive board of reviewing bodynotifying higher education institutionreviewing information on substantial changes and/or declaration of no such changes in interim period between accreditation/recognition processesaccepting application and undertaking re-accreditation/re-recognition reviewrecommending outcome of the process of accreditation/recognitionSection 3: Models of accreditation/recognitionA review of practice in WCPT member organisations identified three models ofaccreditation/recognition:accreditation/recognition carried out by the professional body/organisation – this may be in the absence of a regulatory authorityaccreditation/recognition carried out by a regulatory authority or external agency qualified to accredit/recognise programmes in close collaboration with, butindependent of, the professional body/organisationaccreditation/recognition carried out by a regulatory authority or external agency qualified to accredit/recognise programmes completely independently of the physicaltherapy professional body/organisationIn countries where there is no physical therapy organisation belonging to WCPT, there may be the need for an additional model: accreditation/recognition carried out by an external agency endorsed by WCPT, qualified to undertake the necessary review in other jurisdictions and recognised by the appropriate authorities. Appendix A provides illustrative details of models in various WCPT member organisations.Section 4: Implementation and review of the accreditation/recognition of professional entry level physical therapy education programmesThe following guidance needs to be considered by:a regulation authority responsible for accrediting a professional entry level physicaltherapy education programmea member organisation assuming responsibility for the implementation ofaccreditation of a professional entry level physical therapy education programme inthe absence of a regulation authorityAppendix A outlines the operational procedures undertaken by both parties involved in the accreditation/recognition process.In the absence of a legal requirement to accredit professional entry level physical therapy education programmes, both the member organisation and HEIs need to agree that accreditation/recognition should take place. The member organisation may need to negotiate and discuss the issue with HEIs in the first instance.Successful implementation of accreditation/recognition of physical therapist professional entry level education programmes by regulation authorities/member organisations suggests that there is:a shared understanding of the purpose of accreditation/recognition and its value inprotecting the welfare and safety of the public by ensuring the maintenance ofprofessional standardsa recognition that the process undertaken and the review of the programmes willprovide programmes with assistance and guidance for future developmentsan awareness that accreditation/recognition of the programmes assists in the development of the profession in the country and ensures its continuing developmenta recognition from both the accrediting body and the HEI that facilitating graduates ofthe programmes to become members of the member organisation is valuablean assurance that the course content and the clinical element of qualifying education are acceptable and fulfil the requirements for licensure/registration/recognition and/or potential membership of the member organisationA collaborative approach between the accrediting body and the HEIs is beneficial, creates a clear understanding of the expectations of the accrediting body and the HEIs and assists in communication of the roles and responsibilities of all participants. Such collaboration requires clear statements defining:the contextual drivers for establishing accreditation/recognitionthe role of the accrediting body in accreditation/recognitionhow committees involved in the accreditation/recognition process will be established and populatedto whom committees will reportthe procedures to be undertaken during the accreditation/recognition procedureThe statement should include details on the review of new and existing courses, the sequence of events and visits for the review and the nature of the documentation to be submitted by theHEI. The standards expected by the accrediting body of the physical therapist professional entry level education programmes should also be clearly stated. 1Section 5: Criteria for accreditation/recognition of physical therapist professional entry level education programmesCriteria for physical therapist professional entry level education programmes include expectations about the academic environment, the clinical education of students, the academic and clinical educators and the academic standards required of the HEI by the accrediting authority. 5-6Note: Examples of standards of proficiency/competencies used in the accreditation/ recognition process are listed in the resources section.5.1 IntroductionThe profession has a critical role in defining the nature of contemporary practice, determining practice expectations and identifying demands placed on graduates, whatever accreditation model is used in a country. Documents that may guide the profession and influence this process of accreditation/recognition include the regulation authority’s Code of Ethics, the member organisation’s Code of Ethics and/or guide for Professional Conduct, the Standards of Practice and any curriculum guide. In addition, WCPT has a number of relevantpolicies/guidelines that include:•Ethical principles.9•Policy statement: Ethical responsibilities of physical therapists and WCPT members.10•Policy statement: Standards of physical therapy practice.11•WCPT guideline for physical therapist professional entry level education.1•WCPT guideline for standards of physical therapy practice.125.2 The profession and the practice environmentThe role of the physical therapist, the nature of physical therapy, and the environments in which they practise are set out in WCPT’s description of physical therapy.13 Where health service settings are mentioned in this document, the World Health Organization definition of health should be considered (ie “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”)14) because it is recognised by WCPT that physical therapists practise in a variety of settings including the community and workplaces.5.3 The nature of physical therapist educationWCPT recommends that education for entry level physical therapists be based on university or university level studies of a minimum of four years, independently validated and accredited as being at a standard that affords graduates full statutory and professional recognition.1WCPT’s policy statement on education states “Physical therapist education is a continuum of learning beginning with admission to an accredited physical therapy programme and ending with retirement from active practice”.2The physical therapist professional entry level education curriculum has two components: the taught or university-based components and the clinical education components. The taught components are designed to provide students with the knowledge, skills, attitudes andbehaviours that are needed for entry into the practice of physical therapy. The clinical education components typically involve experiences in sites away from the HEI. The clinical education learning experiences should account for no less than one third of the curriculum. The clinical education experiences should maximise student learning.5.4 The academic environmentWCPT recognises that there is considerable diversity in the social, economic and political environments in which physical therapy education is conducted throughout the world.1 However, there are basic requirements of the academic environment. It should:be intellectually challenging and foster the acquisition of academic skills and a spirit of scholarship and inquirysupport students in both their personal and academic developmentinvolve those who demonstrate a commitment to meeting the expectations of the higher/tertiary education institution, the students and the professionhelp students become aware of multiple styles of thinking, diverse social concepts, values and ethical behavioursmanifest compatible and mutually supportive missions and values from the higher education institution and the physical therapy programme5.5 The standards required of a quality physical therapist professional entry levelprogrammeThe organisation responsible for the accreditation/recognition of entry level physical therapy programmes should:establish and apply standards that ensure quality and continuous improvement in the professional preparation of physical therapists and reflect the evolving nature ofeducation, research and practiceclearly articulate the criteria used to accredit the physical therapy programmedescribe the process and timing of the review of the criteriaprovide the evaluative criteria for accreditation/recognition of programmes including expectations for the content of the programmeThe HEI providing the physical therapist professional entry level programme seeking accreditation/recognition will provide:the programme contentresources available to support the programme and curriculuma mission and philosophy that are aligned with and supportive of the institutionalmissiondetails of the faculty, including qualifications, commitment to education, scholarship and service5.6 Curriculum plan, evaluation, content and outcomesThe organisation responsible for the accreditation/recognition of physical therapist professional entry level programmes should review the curriculum in its entirety, including the curriculum plan and content and methods for the ongoing evaluation of the curriculum.5.6.1 Curriculum plan and contentA curriculum plan will be provided that is based on:information about the contemporary practice of physical therapystandards of practicecurrent and contemporary literature, documents, publications, and other resources related to the profession, to physical therapy professionaleducation and to educational theoryThe curriculum plan should include:a statement of the philosophy, principles and values of the physicaltherapist professional entry level programmestatements of expected student outcomes at the completion of theprogrammea description of the curriculum model and the educational principles onwhich the curriculum is builta description of courses/modules, with timelines, which should bedesigned to facilitate achievement of expected student outcomescontent/syllabi/programme with learning objectives, stated in coursebehavioural terms that reflect the breadth and depth of the course andthe level of student performance expecteda variety of instructional methods selected to maximise learning andbased on the curriculum philosophy and content, the needs of learnersand the expected student outcomesa variety of evaluation processes used by faculty to determine whetherstudents have achieved the educational objectivesa description of the methods used by the programme to assign studentsto clinical education experiences and assess their performance, ensuringthat that the type and amount of clinical supervision and feedbackprovided are appropriate for students’ experience, ability and point ofprogression in the programme 6evaluation5.6.2 CurricularThe organisation responsible for the accreditation/recognition will:require evidence of ongoing and formal evaluation of the physical therapy curriculumrequire a written curriculum evaluation plan, including individualcourses/modules and the curriculum plan as a wholecollect data from stakeholders, including, at a minimum, programmefaculty, current students, graduates of the programme and at least oneother stakeholder group (eg employers of graduates, consumers ofphysical therapy services, peers or other health professionals)determine strengths and weaknesses of the curriculumdetermine if the practice expectations and specific mission, goals andexpected student outcomes of the curriculum are being met5.7 Institution and programme resources5.7.1 InstitutionA prerequisite for a physical therapist professional entry level programme in a HEI toreceive accreditation/recognition should be evidence that it has been approved toprovide a programme by an appropriate national authority (eg ministry of health,higher education authority, department of education). In addition, the higher educationinstitution should demonstrate that it has academic standards and descriptions offaculty roles, workloads and expectations in place that recognise that physicaltherapist education is made up of both professional and academic disciplines.55.7.2 Physical therapist professional entry level programmeThe physical therapist programme must have statements of mission, goals and expected outcomes in place. It should also demonstrate that it has policies and procedures in each of the following areas:rights, responsibilities, safety, privacy and dignity of:□programme faculty and staff□programme students□patients/clients and other individuals who may be involved with theprogrammestudent recruitment and admissionstudent retention and progression through the physical therapy programmeprotection of clinical education sitesresources5.7.3 HumanThe delivery of the programme is the responsibility of a variety of different staff/faculty(described below). The documentation will:demonstrate the mix of academic qualifications, research competencies,clinical and professional expertise and specialisationprovide evidence to indicate how members of the academic faculty of the physical therapy programme are responsible for the development of theadmissions criteria, curriculum content, nature and content of clinicaleducation, grading and evaluation processes, and expectations ofacceptable professional and ethical behaviours by studentsdescribe how the HEI demonstrates that its recruitment policies andprocedures ensure that there are adequate numbers of physical therapyfaculty to achieve the programme outcomesNote: A variety of individuals may be involved in the delivery of the entry levelphysical therapy programme. Titles and descriptions may vary from country tocountry and the titles given below are examples for descriptive purposes. Further guidance is provided in WCPT’s guideline for qualifications of faculty for physical therapist professional entry level programmes.55.7.3.1 Core academic facultyThe core academic faculty is comprised of members of the academic staffof the HEI’s physical therapy programme. Individual academic faculty shalldemonstrate that they have contemporary expertise in their assignedteaching areas, effective teaching and student evaluation skills, a well-defined scholarly agenda and a record of service consistent with theexpectations of the physical therapy programme and the higher educationinstitution. (For further description of the qualifications appropriate forphysical therapy faculty see WCPT’s guideline for qualifications of facultyfor physical therapist professional entry level programmes.5)5.7.3.2 Programme head/administrator (also referred to asdirector/dean/head of discipline/school)The programme head/administrator is a physical therapist withevidence of an appropriate academic qualification and contemporaryexpertise in management, communication and leadership. He/sheshould demonstrate that he/she has the authority and responsibilityfor:ensuring the regular evaluation of all physical therapy academicfaculty, and afterwards setting out plans for individual facultymembers’ ongoing professional and academic developmentplanning and administering the programme’s financial resources, including short-term and long-term financial planningensuring the evaluation of those faculty associated with theprogramme who are not full-time academic facultyensuring the equitable application of rights and privileges to allindividuals involved in the delivery of the physical therapyprogramme5.7.3.3 Clinical education director/coordinatorThe clinical education director/coordinator is a physical therapist andan academic faculty member, who demonstrates an understanding ofcontemporary practice, quality clinical education, the clinicalcommunity and the health delivery system.6 The clinical educationdirector/coordinator shall:conduct, develop, co-ordinate, manage and evaluate on anongoing basis the clinical education programme that is normallydelivered by physical therapists in the clinical environmentcommunicate all appropriate information about the clinicaleducation programme to all faculty, students and clinical sites ina timely manner。
荷兰腰背痛物理治疗指南
荷兰腰背痛物理治疗指南在过去10年间，循证医学已经越来越得到重视，它对于监督和提高医疗质量十分重要。
在这一过程中各种治疗指南应运而生，目的在于规范医疗专业人员的行为。
腰背痛(low back pain，LBP) 的治疗是其中的经典范例，至少已出版了12种LBP初期治疗指南的版本，但没有1种是明确针对物理疗法的。
本文系统介绍了LBP患者理疗的诊断和治疗程序，以提高LBP 患者治疗的效率和效果。
1. 腰背痛的生物学特征治疗指南中“LBP”的概念是指“非特异性LBP”，即不伴特定身体疾病的腰背部疼痛。
腰背痛者中约90%未确诊。
复发性LBP是指1年内多次发作的LBP，总病程≥6个月。
LBP按持续时间可分为：急性(≤6周)、亚急性(7～12周) 和慢性(>12周) 。
在人群中，有60%～90%曾经历1次LBP发作，其年发病率是5%。
就诊于物理治疗师的所有患者中达27%患有LBP。
物理治疗师用功能缺损、残疾和参与困难等词汇来描述LBP患者的健康问题。
功能缺损是对身体结构或生理和心理功能异常的一种描述，例如肌力降低、疼痛、感觉异常或运动恐惧。
残疾指活动执行困难，例如弯腰、伸展或行走。
参与困难指个人在社会生活(如工作) 方面的障碍。
在传统生物医学模式中，疼痛是病理变化直接导致的结果，而在目前的生物-心理-社会医学模式前景下，在急性LBP转为慢性及慢性LBP中，心理因素被认为尤其重要。
在一开放人群中LBP预后通常是良好的：估计有75%～90%患者在4～6周内背痛会自发消失。
但因背痛而就诊的患者预后会稍差，其中65%在12周后症状缓解。
LBP经常复发，75%就诊患者在1年内至少复发1次。
持续性LBP并不一定提示预后较差。
现在越来越认同的是，残疾的范围及程度在LBP的预后评估中最为重要。
Linton做了一项涉及心理因素和颈、背痛关系的系统综述，内容包括36个前瞻性研究。
基于一些与临床有关且方法得当的研究，Linton推断心理因素与急性疼痛转为慢性的过程及残疾均有密切联系。
下腰背痛——精选推荐
下背痛的物理治疗与康复Physical and Rehabilitation Treatment of Low Back Pain顾新1 下背痛的诊断下背痛是临床非常常见的症状综合征，是腰骶臀部等解剖部位出现的疼痛症状，伴有或不伴有下肢的症状。
下背痛不是疾病的病理诊断，疼痛的起因可能是局部的骨骼、间盘、关节、神经、肌肉、软组织等受到激惹，这些解剖结构引起的下背痛在临床表现方面没有各自的特异性。
尽管医学影像技术已经达到很高的分辨水平，但是很难肯定影像检查的阳性发现是否为真正的疼痛原因。
因此，世界卫生组织仍用下背痛作为标准术语，并逐渐规范下背痛的临床诊断与治疗。
世界上许多国家，如美国、英国、德国、澳大利亚、瑞典等国都有下背痛的临床诊断与治疗指南。
下背痛作为症状综合征，包含以下三种（1）非特异性下背痛：引起疼痛的具体病理部位不能十分肯定，涵盖了以往的腰肌劳损、肌纤维织炎、肌筋膜炎等急慢性腰部病变的各种诊断。
（2）特异性下背痛：肿瘤、感染、骨折等具体的病理变化引起的下背痛。
（3）根性下背痛：又称坐骨神经痛，多数由椎间盘突出引起症状。
在临床工作中面对下背痛的患者，首先需要尽早排除特异性下背痛的可能。
出现下列信号需要在诊断中格外警惕：（1）初次下背痛的发病年龄小于20岁或大于55岁；（2）有明显创伤史，或对有骨质疏松可能的患者有轻微创伤史；（3）伴有胸痛；（4 ）伴有不明原因的体重下降；（5）伴有鞍区麻木或二便异常；（6）伴有进行性肌无力；（7）查体发现多项神经学阳性体征和直腿抬高试验阳性；（8）疼痛进行性发展或持续4 ～6 周以上。
特异性下背痛仅占下背痛的0.2%，它有具体的病理变化，明确诊断后有其各自特殊的治疗方案。
本文下述的下背痛分类、评定和治疗中不含特异性下背痛，而只包括非特异性下背痛和根性下背痛。
世界卫生组织对下背痛的诊断建议和多国的下背痛诊断指南中，非常强调对患者病史采集，注重患者疼痛发生发展的特征、体格检查，尤其关注患者的心理因素。
背痛的香薰护理疗法
背痛的香薰护理疗法
近期，英国一项研究表明，背痛已成为导致现代人离岗的最大原因之一。
越来越多的人正在遭受这一常见疾病的折磨。
背痛的成因较为复杂，包括神经、脊椎、椎间盘、软骨等因素，都可能交互影响，引发背痛症状。
不过患者有极高比例是因为姿势不良、长期缺乏运动，使得部分肌群太弱，局部肌肉过度牵引，加上血液循环不良，形成背痛。
除了适当的医学治疗，亦可以通过香薰精油加以按摩，舒缓痛症。
香薰精油是从具有香味的植物中，萃取出的植物精华，也就是常说的植物荷尔蒙。
近代欧洲发展出的香薰疗法即为一种利用香薰精油呵护身心的方法。
萃取植物之精华的香薰精油不仅具有特殊的香味，而且具有神奇的药效。
通过沐浴、按摩等方式可以平衡及舒缓身体和精神疲劳。
香薰精油具有完全的挥发性，能完全溶于酒精和油，且对皮肤有很好的渗透性，易于吸收。
可对人体产生间接性的促进、提升作用，有利于人体本身正向功能的加强。
精油热敷的主要作用是促使微血管扩张，改善局部血液循环和淋巴循环，帮助缓解肌肉痉挛。
丽丽因为近段时间工作较忙，长期伏案做事，不经意间发觉整个背部沉重酸痛，左肩背特别明显，按压有刺痛感。
咨询芳疗师后，使用红百里香、檀香木以及马克兰香薰精油辅以按摩开背，坚持了约十二天的时间，不仅身心紧张得以舒缓，背部痛感也基本消失。
由此可见，香薰疗法对缓解痛经、风湿痛、腹痛及背痛等有良好的效果。
腰肌劳损物理治疗方法
腰肌劳损物理治疗方法
腰肌劳损是指腰部肌肉受到过度使用或损伤引起的疼痛和不适。
物理治疗常被用于管理腰肌劳损，以下是一些常用的物理治疗方法：
1. 热敷：可以使用热水袋、热毛巾或热水浴来敷在疼痛的腰部，促进血液循环和肌肉放松。
2. 冷敷：冰敷能减轻腰肌劳损引起的肿胀和炎症，可以使用冰袋或冷毛巾敷在疼痛的腰部。
3. 短波治疗：短波治疗是利用高频电磁波对腰部进行热疗，促进血液循环和缓解疼痛。
4. 超声治疗：超声治疗通过使用高频声波来加热软组织，以缓解炎症和促进愈合。
5. 理疗按摩：通过按摩、推拿等手法来缓解肌肉紧张和疼痛，促进血液循环和淋巴排毒。
6. 腰部牵引：腰部牵引是通过施加持续的拉力来缓解腰椎间隙压力，减轻腰肌劳损引起的疼痛和不适。
7. 肌肉强化运动：物理治疗师会根据患者的具体情况设计一系列适当的肌肉强化运动，以改善腰部肌肉的力量和灵活性。
8. 矫正姿势：物理治疗师会指导患者调整坐姿、站姿和行走姿势，以减少腰部受力和防止再次受伤。
需要注意的是，每个人的情况可能不同，应根据个人具体情况来选择适合的物理治疗方法，最好在专业人士的指导下进行治疗。
200805 TKA 推荐指南 中文翻译
TKA术后康复指南推荐一期:家庭/门诊物理治疗(2~3次每周,2~3周)目标:1．提高ROM2．减少水肿与疼痛3．步态训练4．日常生活的独立锻炼：1．坐或卧位，膝关节主动活动（AROM）2．交替踝关节背曲跖曲（ankle pump）3．股四头肌收缩/isometric4．直腿抬高5．绳肌腱收缩/isometric6．站立曲膝7．坐位，伸膝8．辅助单腿站立平衡练习9．重复站立转移练习10．使用辅助用具行走训练物理治疗设备使用（Modalities）:冷疗2~3次每天下肢抬高位20~30分钟达到如下标准者，门诊治疗即可，无需家庭物理治疗：a.膝关节AROM接近90度b.低度疼痛与水肿c.可独立进出家庭环境二期:门诊物理治疗(2~3次每周,4~6周)预热（15~20分钟）1．静态脚踏车15~20分钟，从踏板前后活动无阻力开始，直到达到能够完成踏板循环的膝关节活动度。
座位的可以稍微调低，以达到提高膝关节屈曲活动度的目的。
2．坐或卧位，膝关节主动活动（AROM）/曲&伸3.交替踝关节背曲跖曲（ankle pump）4.被动膝关节伸位牵拉（stretching）5．髌骨与膝关节手法松动（Mobilizations）特定肌力锻炼（10~15分钟），1~3组每组10次1．神经肌肉电刺激（NMES）：增强股四头肌肌肉活动。
参数：2500HZ三角波形交替电流12秒开80秒关2~3秒上升期间，膝关节屈曲60度，10次等容收缩。
强度以病人能耐受为准。
7.6x12.7厘米的大、自粘性电极置于股四头肌的神经入肌点。
2．股四头肌收缩/isometric3．直腿抬高（可辅助，目标为没有伸膝迟滞ext lag）4．侧卧，髋外展5．站立曲膝6．坐位，伸膝7．站立，伸膝45~0度功能练习（10~15分钟）1．踏板/台阶练习5~15分钟2．屈膝0~45度靠墙滑动或座-立练习3．平地背行，踏步或交叉步及侧行上台阶练习4．平地区域障碍步行练习5．步态重点训练足跟触地与足趾离地时跖屈推力耐力训练（5~20分钟）1．步行2．静态脚踏车缓和（冷却）（10分钟）1．冰和包扎必要时2．轻柔牵拉与主动活动2/3达到如下标准者，可进入下一期。
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荷兰腰背痛物理治疗指南查运红1,吴润兰2编译 曹学兵,梅元武校 孙炳照复校【收稿日期】 2004204220【作者简介】 查运红(19782),女,湖北鄂州人,在读硕士,主要从事老年性痴呆方面的研究。
(11华中科技大学同济医学院附属协和医院神经科,湖北武汉430022;21华中科技大学同济医学院附属同济医院康复科,湖北武汉430030) 【摘要】 近年来出现了许多有关腰背痛初期治疗的指南,但尚无物理治疗的指南。
为提高腰背痛患者物理治疗的疗效,本文就荷兰腰背痛物理治疗指南作一介绍。
【关键词】 腰背痛;荷兰;物理治疗;指南【中图分类号】 R441.1 【文献标识码】 A 【文章编号】 10012117(2004)0320115203 在过去10年间,循证医学已经越来越得到重视,它对于监督和提高医疗质量十分重要。
在这一过程中各种治疗指南应运而生,目的在于规范医疗专业人员的行为。
腰背痛(low back pain ,LBP )的治疗是其中的经典范例,至少已出版了12种LBP 初期治疗指南的版本,但没有1种是明确针对物理疗法的。
本文系统介绍了LBP 患者理疗的诊断和治疗程序,以提高LBP 患者治疗的效率和效果。
1 腰背痛的生物学特征治疗指南中“LBP ”的概念是指“非特异性LBP ”,即不伴特定身体疾病的腰背部疼痛。
腰背痛者中约90%未确诊。
复发性LBP 是指1年内多次发作的LBP ,总病程≥6个月。
LBP 按持续时间可分为:急性(≤6周)、亚急性(7～12周)和慢性(>12周)。
在人群中,有60%～90%曾经历1次LBP 发作,其年发病率是5%。
就诊于物理治疗师的所有患者中达27%患有LBP 。
物理治疗师用功能缺损、残疾和参与困难等词汇来描述LBP 患者的健康问题。
功能缺损是对身体结构或生理和心理功能异常的一种描述,例如肌力降低、疼痛、感觉异常或运动恐惧。
残疾指活动执行困难,例如弯腰、伸展或行走。
参与困难指个人在社会生活(如工作)方面的障碍。
在传统生物医学模式中,疼痛是病理变化直接导致的结果,而在目前的生物2心理2社会医学模式前景下,在急性LBP 转为慢性及慢性LBP 中,心理因素被认为尤其重要。
在一开放人群中LBP 预后通常是良好的:估计有75%～90%患者在4～6周内背痛会自发消失。
但因背痛而就诊的患者预后会稍差,其中65%在12周后症状缓解。
LBP 经常复发,75%就诊患者在1年内至少复发1次。
持续性LBP 并不一定提示预后较差。
现在越来越认同的是,残疾的范围及程度在LBP 的预后评估中最为重要。
Linton 做了一项涉及心理因素和颈、背痛关系的系统综述,内容包括36个前瞻性研究。
基于一些与临床有关且方法得当的研究,Linton 推断心理因素与急性疼痛转为慢性的过程及残疾均有密切联系。
Waddell 等就社会因素对背、颈部痛的影响进行了系统综述。
他们提出,尽管许多结果提示社会因素可能与背、颈痛有关,但相关的研究方法质量不高。
2 指南的产生依据“荷兰理疗指南进展”的方法,使得指南得到系统的发展。
腰背痛指南的工作组成员都是LBP 方面有经验的物理治疗师或者是理疗和LBP的研究者。
来自相关学科的1个外部小组的10位专家审查了指南的起草版本,工作组成员和外部成员宣称他们没有利益的冲突。
100位随机选出的物理治疗师和荷兰皇家理疗协会的所有成员被请来填写了1张评估指南草案质量的表格以对其作出评论,工作组对其讨论,必要时对指南进行调整。
如果出现新的证据有悖于指南,在出版后的3～5年内会安排指南的修订。
由计算机协助,对LBP 患者理疗有效性进行调查系统综述或荟萃分析的研究已经开展。
Medline 数据库(1982～2000年9月)、Cinahl (1982～2000年9月)、Cochrane 图书馆(2000年9月3日)和卫生专业联盟荷兰研究所数据库(到2000年9月)被检索,使用以下关键词:back pain,physiotherapy, physical theraphy,behavioural therapy,massage,edu2 cation,mobilization,electrotherapy,laser,ultrasound, thermo therapy,systematic review和meta2analysis.这项研究发表了188篇文章,有英语、德语、法语或荷兰语论文;系统综述或荟萃分析;非特异性LBP患者的干预治疗;荷兰理疗专业领域的干预和患者身体功能预后评价。
包括13篇综述:Ernst, 1999;Hagen等,2000;Hilde和Bo,1998;Tulder, 1996;Van der Heijden等,1995;Van Tulder等, 1997,1999,2000a b;Waddell等,1997。
另外有5篇综述涉及肌肉骨骼疾病患者电疗应用的有效性。
除了科学文献以外,近来的专业学术发展和其他可考虑性建议(如实用性刊物)在这些指南的构建中都起到作用,这些指南与其他的荷兰指南的建议是一致的,包括:荷兰皇家全科医师联盟指南,作业治疗师联盟指南和国际腰背痛指南。
3 荷兰腰背痛物理治疗指南3.1 源自系统回顾的证据 31111 保持活动 2篇综述描述了建议(亚)急性LBP患者保持活动的效果。
它们都认为保持活动能使患者更快回到工作岗位,引起较少的慢性功能障碍和复发,因此保持活动对(亚)急性LBP是有用的。
31112 反对卧床休息 3个系统性回顾描述了卧床休息对急性LBP患者的影响。
最近的回顾包括9个临床试验(其中5个研究质量很高),这些回顾一致表明,卧床休息对急性LBP不利,甚至可导致恢复延迟。
31113 锻练 Van Tulder等(2000a)的系统回顾中包括39项锻炼对LBP的影响的随机对照试验。
在急性LBP患者中,有力的证据表明锻练并不比安慰剂、不活动的其它治疗更有效。
但在慢性LBP中,有力的证据表明锻练与物理疗法(通常包括热包裹、按摩、牵引、运动、短波疗法、超声、牵张、活动操练、提高协调性和电疗)疗效相同且比全科医师提供的常规治疗更有效。
Hide和Bo认为,锻炼方法的质量、剂量和训练的类型是否会影响对慢性LBP的效果尚不清楚,哪种锻炼方法最好也不清楚。
31114 行为疗法 Van Tuder等(2000b)开展了一项关于行为疗法对慢性非特异性LBP的效果的荟萃分析,它包括21项研究,结果显示,行为疗法(与不治疗,对照或安慰剂相比)能中度缓解疼痛,轻度改变患者的一般功能状态和行为结果。
行为疗法的效果与其它治疗相比还不清楚。
没有证据表明哪种行为疗法更有效。
有一些证据表明其与慢性LBP 的常规治疗(物理疗法、多学科治疗、药物治疗)联用对功能状态有短期疗效,而对疼痛程度或行为结果无短期疗效,但对功能状态和行为结果有轻微的长期疗效。
Turher在其荟萃分析中总结了14个有关认知和行为疗法对LBP患者影响的文献资料,认为认知和行为疗法在改善疼痛和功能障碍上优于对照组,但未发现认知和行为疗法与其它积极治疗之间存在疗效差异。
31115 牵引术 在1995年Van der Heijden等就颈、背部疼痛牵引治疗的有效性系统性回顾了17个随机对照试验,其中14个是有关腰部牵引的。
他们认为研究方法质量太低。
Van Tulder等的一个近期系统性回顾也得出类似结果,仅一篇发表于1995年的随机对照试验的方法学质量较高。
此研究没有阐述任何一般情况、疼痛或功能状况的改善。
Van Tulder等认为这有力地表明牵引疗法对慢性LBP 不是一种有效的治疗方法。
31116 生物反馈疗法 Van Tulder等的系统性回顾包括了5项关于慢性LBP患者生物反馈治疗效果的研究,它们的方法学质量都很低。
作者们认为有一定证据表明生物反馈治疗对这些患者无效。
31117 按摩 Ernst等(1999)完成了一份关于LBP患者按摩疗效的综述,包括4个随机试验,其中都把按摩作为对照性治疗且方法构建都很差。
因此按摩对LBP有效的证据不足。
31118 经皮神经电刺激治疗 1999年Tulder等完成了关于经皮神经电刺激疗效的综述,包括2项研究急性LBP患者的试验(其中1项的方法学质量较高)和4项比较经皮神经电刺激与安慰剂对慢性LBP患者疗效的研究(其中3项为高质量试验),结果提示经皮神经电刺激疗效对LBP的效果不确切。
31119 超声治疗 Van der Windt等(1999)系统回顾38项有关肌肉骨骼疾病中运用超声治疗的研究,其中仅1项涉及LBP的风湿性退行性变患者超声治疗效果。
作者们认为证据不足以支持超声在治疗肌肉骨骼疾病中的效用。
这与1995年由G am和Johannsen所作的荟萃分析得出的结论一致。
311110 电疗法 1999年Van der Heijiden等作出的一份对LBP患者进行电疗法的疗效综述,包括11项试验。
电疗法包括直流电疗和交流电疗。
作者认为,和安慰剂比较尚没有足够证据证明电疗的疗效;即便和其它形式的电疗、联合电疗或者其他积极方法比较也是一样。
311111 激光治疗 G am等(1993)作出了一项关于在肌肉骨骼疾病中行低能量激光疗法疗效的荟萃分析,包括23项随机对照试验,其中只有一项试验是针对LBP患者。
作者得出结论:激光治疗对于肌肉骨骼疾病的止痛无效。
De Bie等(1998)完成了一份关于激光(904nm)治疗肌肉骨骼疾病患者的系统性综述,包括25项试验(其中2项针对LBP患者),都不能说明激光治疗有效。
3.2 治疗过程 31211 治疗正常病程的LBP患者 疗程起始于患者深受疾病困扰的时候,在治疗期间因物理治疗师要帮助患者加深对疾病的认识并且进行运动疗法,因此1个疗程时间应该充分。
为了评估功能障碍的过程和处理治疗期间出现的问题,必要时可能再需要1个疗程。
3121111 患者教育 物理治疗师需要向患者解释LBP通常是一种良性病程,同时描述负荷与承重量之间的关系。
事实上逐渐增加的练习活动对于腰部是有益的。
物理治疗师指导患者并鼓励他们继续目前的运动,从而建立全方位的活动和参与体系。
物理治疗师和患者应共同探讨此过程中可能会出现的问题并寻求解决的办法。
3121112 运动疗法 为了支持这项建议,物理治疗师让患者体会适当运动并没有害处,使患者从参与活动中获得正面的日常活动所必需的经验,并且把这些经验推及到日常生活的其它方面。
3.212 治疗异常病程的LBP患者 此时最重要的干预措施是对患者的教育和运动疗法。
3.21211 患者教育 治疗LBP患者的物理治疗师的主要作用就是给予指导,让患者恢复对功能和活动的控制。
为了达到这个目标,物理治疗师需向患者介绍LBP的相关知识、该疾病的本质和病程、负荷与承重之间的关系以及积极生活方式的重要性。