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Behandling og genoptræning
Af patienter med Diskusprolaps




      Martin Melbye, Fysioterapeut Dip MDT
Valg af behandling

Styringsredskaber
Evidensbaseret behandling


                                                             Øge
        Smerte-
                                                          funktions-
       reduktion
                                                            niveau




ef: Staal (2005), Waddell (2005), Gifford (2006), Kool (2007)
Valg af behandling
① Muligt at behandle med
McKenzie?
                                  Nej!
② Muligt at re-aktivere på
aktivitets- og
deltagelsesniveau?
                                  Nope!
③ Muligt at udføre dynamisk
rygtræning?

                                  Nixen bixen!
④ Muligt at udføre ryg-neutrale
øvelser?


⑤ Aflastning og medicinsk
                                  Noooo!
smertebehandling
BIOPSYKOSOCIAL MODEL
                  BIOLOGI                SOCIALT
                  Vævsskade                 Kultur
                 Biomekanisk              Sygerolle
                  fejlfunktion          Omverdenens
                 Neurofysiologi         forventninger
                            PSYKOLOGI
                             Sygdomsadfærd
                              Overbevisning
                                Mestring
                                 Angst
                                 Stress


Ref: Gordon Waddell
McKenzie-behandling
① Muligt at behandle med
McKenzie?


② Muligt at re-aktivere på
aktivitets- og
deltagelsesniveau?

③ Muligt at udføre dynamisk
                                  MCKENZIE vs GENERAL REHAB:
rygtræning?
                                  McKenzie bedre outcome:
④ Muligt at udføre ryg-neutrale   Neurologiske udfald, generalt
øvelser?                          helbred, sygemelding.

⑤ Aflastning og medicinsk         Samme outcome:
smertebehandling                  Smertereduktion, funktionsbesvær.
Hold øje med stivhed!



•Hold øje med
funktionsbesvær

•Analysér respons på
fleksion

Key and Ford (1948), O’Connell (1951),Lotz et al.(2008), Melbye
Funktionel re-aktivering
① Muligt at behandle med
McKenzie?                         •   “Ready-to-go”-tests

② Muligt at re-aktivere på        •   Restriktioner
aktivitets- og
deltagelsesniveau?
                                  •   Deltids-sygemelding
③ Muligt at udføre dynamisk
rygtræning?


④ Muligt at udføre ryg-neutrale
rygøvelser?


⑤ Medicinsk smertebehandling
og aflastning
Gradvis aktivering
           •Hierarki af aktiviteter
           •Gradvis øgning
           •Symptomrespons




Ref: Gifford (2004); Butler
(2007)
Pain is temporary...
             Glory is forever!
•   Inflammatorisk fase: 5-10
    minutter


•   Fibroblastisk fase: 20-30
    minutter


•   Modningsfase: Næste morgen
Case “Frederik”
Frederik
•   Sygemeldt

•   Triathlon-træning

•   Svømme

•   Løbe

•   Græsslåning

•   Max gangdistance 400 mtr
Tilbagefald
Lav ikke om på for meget!
Valg af behandling
① Muligt at behandle med
McKenzie?

② Muligt at re-aktivere på
aktivitets- og
deltagelsesniveau?

③ Muligt at udføre dynamisk
rygtræning?


④ Muligt at udføre ryg-neutrale
rygøvelser?


⑤ Medicinsk smertebehandling
og aflastning
Valg af behandling
① Muligt at behandle med
McKenzie?

② Muligt at re-aktivere på
aktivitets- og
deltagelsesniveau?

③ Muligt at udføre dynamisk
rygtræning?


④ Muligt at udføre ryg-neutrale
øvelser?


⑤ Medicinsk smertebehandling
og aflastning
Case “Peter”
ValG af behandling
① Muligt at behandle med
McKenzie?

② Muligt at re-aktivere på
                                  • Forbedre nattesøvn og hvile
aktivitets- og
deltagelsesniveau?                • Smerte-stigen
③ Muligt at udføre dynamisk       • Højere aktivitetsniveau
rygtræning?
                                  • Re-vurdering efter X uger
④ Muligt at udføre ryg-neutrale
rygøvelser?


⑤ Medicinsk smertebehandling
og aflastning
Forbud er forbudt...

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Behandling og genoptræning

  • 1. Behandling og genoptræning Af patienter med Diskusprolaps Martin Melbye, Fysioterapeut Dip MDT
  • 3. Evidensbaseret behandling Øge Smerte- funktions- reduktion niveau ef: Staal (2005), Waddell (2005), Gifford (2006), Kool (2007)
  • 4. Valg af behandling ① Muligt at behandle med McKenzie? Nej! ② Muligt at re-aktivere på aktivitets- og deltagelsesniveau? Nope! ③ Muligt at udføre dynamisk rygtræning? Nixen bixen! ④ Muligt at udføre ryg-neutrale øvelser? ⑤ Aflastning og medicinsk Noooo! smertebehandling
  • 5. BIOPSYKOSOCIAL MODEL BIOLOGI SOCIALT Vævsskade Kultur Biomekanisk Sygerolle fejlfunktion Omverdenens Neurofysiologi forventninger PSYKOLOGI Sygdomsadfærd Overbevisning Mestring Angst Stress Ref: Gordon Waddell
  • 6. McKenzie-behandling ① Muligt at behandle med McKenzie? ② Muligt at re-aktivere på aktivitets- og deltagelsesniveau? ③ Muligt at udføre dynamisk MCKENZIE vs GENERAL REHAB: rygtræning? McKenzie bedre outcome: ④ Muligt at udføre ryg-neutrale Neurologiske udfald, generalt øvelser? helbred, sygemelding. ⑤ Aflastning og medicinsk Samme outcome: smertebehandling Smertereduktion, funktionsbesvær.
  • 7. Hold øje med stivhed! •Hold øje med funktionsbesvær •Analysér respons på fleksion Key and Ford (1948), O’Connell (1951),Lotz et al.(2008), Melbye
  • 8. Funktionel re-aktivering ① Muligt at behandle med McKenzie? • “Ready-to-go”-tests ② Muligt at re-aktivere på • Restriktioner aktivitets- og deltagelsesniveau? • Deltids-sygemelding ③ Muligt at udføre dynamisk rygtræning? ④ Muligt at udføre ryg-neutrale rygøvelser? ⑤ Medicinsk smertebehandling og aflastning
  • 9. Gradvis aktivering •Hierarki af aktiviteter •Gradvis øgning •Symptomrespons Ref: Gifford (2004); Butler (2007)
  • 10. Pain is temporary... Glory is forever! • Inflammatorisk fase: 5-10 minutter • Fibroblastisk fase: 20-30 minutter • Modningsfase: Næste morgen
  • 12. Frederik • Sygemeldt • Triathlon-træning • Svømme • Løbe • Græsslåning • Max gangdistance 400 mtr
  • 13. Tilbagefald Lav ikke om på for meget!
  • 14. Valg af behandling ① Muligt at behandle med McKenzie? ② Muligt at re-aktivere på aktivitets- og deltagelsesniveau? ③ Muligt at udføre dynamisk rygtræning? ④ Muligt at udføre ryg-neutrale rygøvelser? ⑤ Medicinsk smertebehandling og aflastning
  • 15. Valg af behandling ① Muligt at behandle med McKenzie? ② Muligt at re-aktivere på aktivitets- og deltagelsesniveau? ③ Muligt at udføre dynamisk rygtræning? ④ Muligt at udføre ryg-neutrale øvelser? ⑤ Medicinsk smertebehandling og aflastning
  • 17. ValG af behandling ① Muligt at behandle med McKenzie? ② Muligt at re-aktivere på • Forbedre nattesøvn og hvile aktivitets- og deltagelsesniveau? • Smerte-stigen ③ Muligt at udføre dynamisk • Højere aktivitetsniveau rygtræning? • Re-vurdering efter X uger ④ Muligt at udføre ryg-neutrale rygøvelser? ⑤ Medicinsk smertebehandling og aflastning