Schmerzen und Funktionsstörungen der Lendenwirbelsäule bei lumbalen Bandscheibenvorfällen

In this study we attempted to explore the correlation between lumbar disc herniation and functional disorders of the lumbar spine. Fifty patients with lumbar disc herniation proven by computed tomography underwent a comprehensive functional, neurological and radiological examination. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. Only patients without signs of bone or soft tissue alterations or pregnancy at the time of examination were included into the study. Herniations of the L4-5 disc showed a dysfunction in the same segment in 64% of the cases. There was also a correlation between this segmental dysfunction and pain in the sacrotuberal and iliolumbar ligaments. All patients with segmental dysfunction felt pain in the dorsal ligaments. If there was no segmental dysfunction pain in the dorsal ligaments was encountered just as often as in the control group. Herniations of the L5-S1 disc had a dysfunction in the same segment in only 12% of the cases, but in 35% there was dysfunction of the L4-5 motion segment. In this group pain in the dorsal ligaments did not correlate with segmental movements. Frequency of ligamental pain in L4-5 herniations was equal to that in L5-S1 herniations. With increasing size of the disc herniation, the frequency of segmental dysfunction, paralysis and loss of reflexes also increased, but the pain in the dorsal ligament decreased.Segmental dysfunction is explained by increased muscular tone being provoked by irritation of the sinuvertebral nerve. The differences between L4-5 and L5-S1 movements are probably due to the different functional anatomy of these segments. Ligamental pain may be explained by the fact that these ligaments have the same insertion and the muscles have increased in tone.     

Kraniosakrales System und Funktionsstörungen der oberen HWS bei Säuglingen

Background

It was the aim of this study to find out if the manual -medical treatment of the head joints of KTSS- children with kinematic imbalances due to suboccipital strain (KISS) can cause a change/modificoation of their facial dissymmetry and thus-by this— of the faulty position and function of the bones.

Material and methods

In the surgery 30 infants/babies with functional. disturbances of the head joints and a typical dissymmetry of the face, the skull, and the bearing were examined/treated by means of manual therapy and osteotherapy.

Results

In 20 cases there was a very great or great improvemenat of the facial dissymmetry. The status of 10 children remained unchanged. The dissymmetry of the eyes improved in 23 cases whereas there was no change infor seven 7 children. The cranial dissymmetry became better in 2’1 cases, but remained unchanged in 9 cases.

Conclusion

The effects of manual therapy on infants/Bbabies can be partially understood and explained by eliminating theseas secondary adaptive reactions of the cranio-sacral system in the forim of a torsional lesion of the SBS.     

Stellenwert der Neuromodulation bei Funktionsstörungen der Hand

Manuelle Medizin - Funktionsstörungen der Hand umfassen Bewegungsstörungen und Schmerzen. Die Ursache kann lokal in der Hand, im Arm, im Thoraxbereich, in der Halswirbelsäule, im...     

Schmerzen und Funktionsstörungen des Iliosakralgelenks bei Bandscheibenvorfällen der unteren Lendenwirbelsäule

Back and leg pain in patients with lumbar disc herniation can be caused by various mechanisms. In addition to nerve root compression, functional alterations in the sacroiliac joint, facet joint or the iliolumbar and sacrotuberal ligaments can produce "pseudoradicular" lower back syndrome. The following study attempts to show whether or not pain and functional alterations in the sacroiliac joint (SIJ) correlate with herniations revealed by computed tomography (CT). The study also attempts to determine the correlation between pain and functional changes of the SIJ and the size and level of the disc herniation. Fifty patients with monosegmental disc herniations revealed by CT who showed no signs of bone or soft tissue alterations were included in this study. The average duration of the patients' complaints of leg or back pain was 5.7 years. Ninety-six percent of these patients had received conservative treatment before admission to our hospital. All patients were compared to a control group consisting of 16 healthy subjects of comparable age. All patients underwent a comprehensive functional, neurologic and radiologic examination. The CTs were analyzed by a standardized three-dimensional method. All of the 50 patients had sciatica complaints and a disc herniation revealed by CT. In two cases hemiation of the L3-4 disc was demonstrated, in 14 cases L4-5 disc herniation and in 34 cases a L5-S1 disc herniation. In contrast to the control group of 15 healthy subjects, the patients showed a significant number of functional disorders upon examination. In 84% of all patients, movement of the SIJ was restricted. Painful palpation of the symphysis was demonstrated in 46% of all cases. Thirty-five percent of patients with herniation of L4-5 disc demonstrated SIJ tenderness as opposed to 65% of the patients with herniation of the L5-S1 disc. This SIJ tenderness did not correlate with motion of the SIJ. In addition, SIJ motion and frequency of sensory dysfunction showed no correlation with the size of the disc herniation. Paralysis and loss of reflexes showed a positive correlation with the increasing size of the disc herniation. SIJ tenderness decreased as the size of the herniation increased. Dysfunction of the ipsilateral SIJ is explained by increased muscular tone caused by irritation of the n. sinuvertebralis and its lumbar coupling. Frequency of SIJ tenderness is significantly higher in patients with herniations between L5 and S1. Since the SIJ is innervated by the r. dorsalis of the sacral roots, the increased tenderness can be explained by the change in neurovegetative innervation of the SIJ. Due to the high correlation between lumbar disc herniation and SIJ dysfunction, disc herniation should be considered as a possible cause of sacroiliac-joint syndrome.     

Wirksamkeit klassischer Massagetherapie bei chronischen Rückenschmerzen und Funktionsstörungen im Bewegungssystem

Manuelle Medizin - Klassische Massagetherapie (KMT) ist laut Physiotherapie-Ausbildungs- und Prüfungsverordnung Basis diagnostischer Tastfähigkeit zur Beurteilung von...     

Stand- und Gangst?rungen (Hinken) beim lumbalen Radikul?rsyndrom

Background

During our examination of radicular syndrome (RS), gait disorders, especially limping appeared to be among the most important and frequent symptoms; however, in the literature limping is rarely listed as a symptom in RS. This study, therefore concentrated on limping patients with RS.

Patients and methods

A total of 35 RS patients were examined of which 11 patients (31%) with an average age of 51 years were clearly limping (6??? und 5???). The examination included heel and toe stands, standing on a single leg, leaning to the side in disc herniation patients and particularly limping.

Results

Out of 11 limping RS patients 4 (28%) were disc herniation operation patients and 2 out of the 11 RS patients suffered from a spinal claudication with a possible walking distance of 50?m. Therefore all disc herniation operation patients showed a limping gait. These results are discussed.

Conclusion

Limping is an important disorder in RS. All examined disc herniation operation and spinal claudication (walking distance of 50?m) patients showed a gait disorder (limping). Heel, toe and lateral foot stands are fast muscular tests in RS of the segments L5?CS1 and L4. The single leg stand reveals the Trendelenburg and Duchenne limp in paresis or insufficiency of the M. glutaeus medius. In RS of L4, L5 and S1 certain gait disorders can be observed. Therefore, the localization of RS can be determined by analysis of the gait. Limping prolongs the healing process, the reconvalence phase of RS and downgrades the prognosis. Post-operative pain reduction is a very important component of the healing process of the tissue.     

Klinischer Untersuchungsgang bei Störungen der Lenden-Becken-Hüft-Region

Background

The most common causes of pain in humans are disorders of the musculoskeletal system. In approximately two thirds of the cases the spine is affected and in particular the lower region, namely the lumbar spine, pelvis and hip regions with the most important symptom being lower back pain.

Methods

A diagnostic examination procedure has proven to be very useful for the routine daily practice and by this means the structural disorder and resulting reflective effects can be more closely defined in a relatively short time.     

Kraniomandibuläre Dysfunktion bei Kindern mit Funktionsstörungen im zervikookzipitalen Übergang

The presence of a cross or overbite, teeth grinding and pressing, myofunctional disorders, a deviation in the resting tongue position, sucking habits, jaw pain or headaches, postural disorders, and migraine in children may be first predictors of juvenile craniomandibular disorders (CMD). The cause is usually found in a deviation of postural control development in early childhood. Particularly functional disorders in the upper cervical region can influence jaw position. Already in the first few months of life, the course is set for further development—with effects on the entire body, e.?g., altered statics or non-physiological coordination. The most common postural deficits associated with muscular CMD in children are a forward head posture, hyperlordosis, and genu valgum, as well as scoliosis with uneven shoulders in patients with midline deviations. Children benefit from manual medical therapies, neurofunctional training, speech therapy, and a lot of exercise.     

Funktionsstörung der hypothalamisch-hyphophysär-adrenalen Achse bei Patienten mit akuten, chronischen und intervallartigen Schmerzsyndromen

ZusammenfassungEinleitung Komplexe Störungen der hypothalamisch-hypophysär-adrenalen Achse sind ein Phänomen, deren ätiopathogenetische Bedeutung kontrovers beurteilt wird. Die häufige Koinzidenz mit depressiven Symptomen erschwert zusätzlich die Interpretation.Patienten und Methoden Bei 20 Patienten mit akuten, 27 mit chronischen Schmerzen des lumbalen Bewegungsapparates sowie 44 Patienten mit intervallartig auftretenden Kopfschmerzformen wurde ein Kortisoltagesprofil und daraus der Tagesmittelwert bestimmt und mit differenzierten algesiemetrischen Daten korreliert.Ergebnisse Patienten mit chronischen und intervallartigen Schmerzen hatten signifikant höhere Werte im MPQ und mehr affektive Items als Ausdruck depressiver Symptome als Patienten mit akuten Schmerzen, während sich die 3 Gruppen über die Depressivitätsskala und psychovegetative Beschwerdenliste nicht signifikant unterschieden. Verglichen mit einer altersentsprechenden schmerzfreien Kontrollpopulation (n=17) waren in allen 3 Gruppen neben einzeln erhöhten Tageswerten signifikant erhöhte Kortisoltagesmittelwerte nachweisbar, es konnten aber keine Korrelationen zwischen den Kortisolwerten und sämtlichen algesiemetrischen Daten etabliert werden. Chronische Schmerzpatienten mit hohen Depressionsscores hatten unabhängig von der Schmerzintensität signifikant höhere Kortisolwerte.Diskussion Schmerzen führen zu erhöhten Kortisolwerten im Plasma mit signifikanter Anhebung des Tagesmittelwertes. Während beim akuten Schmerz eine unmittelbare, aber unspezifische, nicht an die Schmerzintensität gekoppelte Stressreaktion wahrscheinlich erscheint, scheint bei chronischen und intervallartigen Schmerzformen eine komplexe, ebenfalls schmerzunabhängige dauerhafte Aktivierung der hypothalamisch-hypophysär-adrenalen Achse mit wahrscheinlicher Assoziation zu depressiven Begleitsymptomen und Störungen der hypothalamisch gesteuerten zirkadianen Freisetzungsrhythmik vorzuliegen.     

Veränderlicher Muskeltonus bei passiver Hüftbeugung und -streckung zur Frühdiagnostik von Bewegungsstörungen in Hüfte und Becken

Background

In the literature, problems of the lower back are widely documented. Numerous authors mention that muscle tone and proprioceptive regulation are important processes in the development of normal stance and optimal mobility in the pelvic region. An increase of muscle tone during passive motions is mostly observed subjectively during diagnostic work-up for functional disorders of soft tissues and joints. Such an evaluation gives unverified qualitative results. To obtain quantitatively measured results of resistance of passive joint motion, it is possible to evaluate the muscle tone. Muscle tone is not a precisely defined value, but changes of muscle tone influence the quality of the joints’ passive motion.

Methods

To determine the joint’s functional state, we measured the muscle resistance during passive motion with different angular velocities in the full range of motion (ROM). We used a computer-monitored isokinetic device (REV 9000 Technogym) that allows passive flexion-extension motion in the hip joints in ROM 100°. The quality of passive hip joint flexion-extension motions depends on the functional state of lumbosacral region. We investigated 38 top sportsmen with normal functional state of the lumbosacral region and different lower back disorders (asymmetric pelvis, spondylitis in the lumbar region, lumbar hyperlordosis). We analyzed the muscle resistance during passive ROM as a resistive torque exchange, which was expressed as the average work done during 15 passive flexion-extension cycles of the hip in a given ROM. Based on these results, we calculated ratio of average work per cycle between agonist and antagonist muscles.

Results

We compared these results to the evaluated functional state of the lumbar and pelvic regions. We found an association between agonist and antagonist muscle tone differences and the functional disorders of the lumbar and pelvic regions. This method could be used for early diagnosis of functional disorders in the lower back.