Harjoittelun vaikuttavuus ja toteutus kroonisen niskakipupotilaan kuntoutuksessa

Abstract

Kroonisen niskakivun syynä on aiemmin pidetty lihasjännitystä, ja siksi hoidot ovat olleet lähinnä passiivisia tai kevyeen lihaskuormitukseen perustuvia harjoitteita. Krooniseen niskakipuun liittyy lihasten aineenvaihdunnan ja rakenteen muutoksia, jotka eivät korjaudu lääkityksellä vaan spesifisellä niskalihaksia vahvistavalla harjoittelulla. Vähintään puolen vuoden ajan toteutettu säännöllinen venyttely ja niska-hartiaseudun nousujohteinen lihasvoimaharjoittelu vähentää kroonista niskakipua, lisää liikkuvuutta ja lihasvoimaa merkitsevästi.

Chronic non-specific neck pain is a common condition affecting about 6% of adults in Finland. Degenerative changes in cervical vertebrae and discs are common even among healthy people and increase with age. The diagnosis of chronic non-specific neck pain is based mainly on symptoms and clinical examination. It is well established that the incidence and severity of spinal degeneration on radiographs and MRI scans are poorly related to the levels of pain and disability. Previously, chronic neck pain was believed to be related to increased tension in neck muscles, and “tension neck” was also a commonly used diagnosis. Thus, passive physical therapies and rest have been commonly used for treatment of chronic non-specific neck pain. However, these have not proved to have significant effect in the long-term. No correlation has been found between neck pain and electrical activity (EMG) in neck muscles, which may well explain the poor results. However, cognitive and multimodal rehabilitation programmes have not been able to produce better results either. Patients with chronic neck pain have been shown to have lower neck strength and endurance compared to healthy controls. This is thought to be related to decreased local muscle circulation and metabolism, which has been demonstrated in controlled studies. Neck muscle atrophy has also been shown to be present in chronic conditions. The results of several randomized studies have shown that exercising involving specific neck muscle training combined with stretching of the neck muscles with adequate support and follow-up are effective rehabilitation methods for patients with chronic non-specific neck pain. Proper intensity, frequency and length of exercise periods are essential to achieve long-term results. At the start some people may also need passive physiotherapy for treatment of severe pain in order to make effective exercising possible. However these therapies cannot be recommended for all patients as they may even slow down the rehabilitation process in some people. The present health care system needs to change as primary health care increasingly refers patients to queues for specialist services provided by public health care, which causes steadily increasing costs. These do not arise from consultations and unnecessary diagnostic imaging alone, but also from sick leave during long waiting times. Moreover, the current practice causes unnecessary suffering due to postponed rehabilitation. Thus it is suggested that direct access to physiotherapy should be implemented in the whole country according to the model of the Central Finland Health Care District.