Značaj kineziterapije u lečenju hroničnog bolnog lumbalnog sindroma - pregled literature

Abstract

Kinesiotherapy, or movement therapy, is the oldest and most significant method in physical medicine. Through purposeful, systematic, and strictly dosed exercises, it can be applied to human health both preventively and therapeutically. Kinesiotherapy aims is to increase strength and improve the function of muscles and joints, which has a positive effect on reducing pain and disability, accelerating recovery, and helping the patient return to regular activities. There are many kinesiotherapy programs, but chronic low back pain remains a persistent medical issue. Numerous clinical studies confirm the importance of kinesiotherapy in the treatment of CLBP. Experimental studies have shown the positive effects of exercise on pain and functionality, compared to passive therapy modalities and rest. However, it remains unclear which exercise program is the most effective, and which combination of exercises is the most beneficial and applicable in clinical practice. An adequate kinesiotherapy program for chronic low back pain should activate and strengthen the stabilizing muscles while protecting the most vulnerable structures (intervertebral discs and facet joints). The most commonly mentioned exercise programs in the literature are those that include lumbar stabilization exercises, also known as core exercises. Panjabi et al. introduced the first concept of the segmental stabilization system, consisting of three subunits: passive, active, and neural. These three subsystems are interdependent, and a dysfunction in one leads to increased functional demands on the others. Bergmark et al. proposed the hypothesis of two primary muscle systems that control movement and contribute to spinal stability: the global and local systems. The global system consists of the primary trunk movers, which do not have a direct impact on stabilization in the lumbar spine. The local system consists of tonic, postural, and stabilizing muscles of the spine: the psoas major, quadratus lumborum, the lumbar portion of the iliocostalis lumborum, lumbar multifidus (LM), internal oblique, and transversus abdominis (TrA) muscles, also known as the muscles of the inner unit. These muscles are shorter and located closer to the axes of rotation. They are directly connected to the vertebrae, allowing them to stabilize spinal movements. Strengthening the inner unit muscles of the lumbar spine and training static muscle contractions properly enhances lumbar segment stability, providing adequate support for the upper portions of the spine. An individually designed and implemented stabilization exercise program is effective in reducing pain and improving the overall functional status of patients with chronic low back pain.