[Possibilities and limits of manual medicine in treatment of low back pain.].
Low back pain is a syndrome when the actual pathological and anatomical diagnosis remains often hidden. The clearly defined findings such as congenital anomalies, degenerative lesion, intervertebral disc protrusion, inflammations, rheumatic diseases, tumours and others should include functional disorders which may be found both in a healthy region and in the region stigmatised in this way. One of the efficient possibilities of the treatment influencing the functional component is manual medicine (sometimes called myoskeletal medicine).The physician acquainted with this method is able to perform a detailed functional examination of individual motoric segments and in a number of cases the treatment may be fast and efficient. This treatment is also cost effective and the number of complications in experienced physicians is minimal. On the other hand it is labour-intensive from the viewpoint of gaining experience and skills. Good results are achived mainly in an acute and sub-acutte condition, worse results have been recorded in chronic pain where a significant role is played apart from functional disorders also be a number of other factors, especially the psychic condition of the patient. Manual medicine deals with a whole range of procedures which have only minimum contraindications and are applicable also in acute pain with antalgic posture. Manipulation is not performed in patients in general poor condition, with circulation disorders, fever diseases, tumours, severe osteoporosis ot the skeleton or acute disc protrusion. The principal contraindication was aptly formulated by Lewit as the application of inadequate technique with regard to the condition of the patient and the local finding. This is also the main risk of otherwise efficient and useful technique of treatment which manual medicine certainly is. Key words: low back pain, manual medicine, diagnosis and treatment.
Hruska
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Subkatedra manuální medicíny IPVZ, Ortopedická klinika IPVZ, Praha.