,osteopathie, rückenschmerz3–3funk7onelle3 ... · pdf...

1"1"

www.fomt.info"[email protected]"

1"

!Osteopathie!

,Osteopathie,"

Rückenschmerz3–3Funk7onelle3Zusammenhänge3aus3osteopathischer3Sicht3

Herzlich"willkommen!"

Stefan3Grundler33

Heimerer3Akademie333

FOMT3Fortbildungen-für-Orthopädische-Medizin-und-

Manuelle-Therapie-

,Osteopathie,"

"

„Nacken,"und"Rücken,

schmerzen"sind"ein"

natürlicher"Teil"des"Lebens.“"

Einführung"

„"

2"2"


2"

!Osteopathie!

,Osteopathie,"

Einführung"–"was"tun???"

Osteopathie"

Massage"

Physiotherapie"Rückenschule"

Sport"

OperaMon"

Medikamente"Psychotherapie"

Ernährung"

,Osteopathie,"

Einführung"–"Algorithmus"zur"Therapie???""

Stanton"2013"

Hat"der"PaMent"Symptome"unterhalb"des"Gesäß"und"Zeichen"einer"Nervenwurzelkompression?"

Nein" Ja"

,  Symptome"unter"16"Tage?",  Keine"Symptome"unterhalb"des"

Knies?""

,  Peripheralisieren"die"Symptome"bei"Bewegungen"in"Extension?"

,  PosiMver"Straight"leg"raise?"

TrakMon"ManipulaMon"

3"3"


3"

!Osteopathie!

,Osteopathie,"

Einführung"–"Erfolg"der"Therapie???""

Stanton"2013,"Norton"2015"

Modifiziert"nach"Norton"et"al.,"2015"

0% 20% 40% 60% 80% 100%

anhaltende medikamentöse Hilfe notwendig 8%

anhaltende therapeutische Hilfe notwendig 8%

anhaltende wechselnde Beschwerden 31%

Erholung 53% Therapie

ärztliches Gespräch

Schmerzmittel

Bildgebung

Schmerzmittel und ärztliche Therapie

,Osteopathie,"

Einführung"–"Von"der"Theorie"zur"Therapie""

FunkMonieren"Subgruppen? ""

Führen"eher"Therapieprinzipien"zur"Therapieplanung?"

Erfassung"des"Status"eines"PaMenten?"

4"4"


4"

!Osteopathie!

,Osteopathie,"

Osteopathische"Prinzipien""

SMll,"Lialejohn,"Delaunois"

•  Philosophische"Grundlage"mit"fünf"biologischen"Prinzipien:"1.  Körper"als"untrennbare"

Einheit"2.  Selbstheilungskräfe"3.  Struktur"und"FunkMon"4.  Die"Durchblutung"als"das"

WichMgste"–"Vorherrschaf"der"Arterie"

5.  Leben"ist"Bewegung"

,Osteopathie,"

FunkMoneller"Zusammenhang""

"

•  PaMentenbeispiel"–  44"jähriger"PaMent,"wenig"Sport,"viel"im"Büro,"subjekMv"gestresst"

–  Anhaltende,"rezidivierende"Rückenschmerzen"mit"Ausstrahlung"in"das"Bein"seit"mehreren"Monaten"

–  Haltungs,"und"belastungsabhängig"

–  Klassisch"manualtherapeuMsch"kein"klarer"Befund,"neurologisch"unauffällig"

–  Ärztliche"Diagnose:"chronisches"LWS,Syndrom"

5"5"


5"

!Osteopathie!

,Osteopathie,"


Tozzi"2012"

Körper3als3Einheit3

Selbstheilungs!kräHe3

Struktur3und3Funk7on3

Durchblutung3 Leben3ist3Bewegung3

Wo"liegt"die"DysfunkMon?",  Parietal",  Visceral",  Craniosacral"

,Osteopathie,"

Der"Körper"als"Einheit""

Binch"2015,"Bake"2012,"Kjaer"2007,"Tozzi"2012,"Bialozewski"2014"

•  Wo"liegt"die"DysfunkMon?"•  Parietal3

•  Verfeaung"der"Muskulatur"•  Einsprossung"von"Nerven"und"Blutgefäßen"in"die"Bandscheibe"

•  Visceral3•  Eingeschränkte"Mobilität"des"gastrointesMnalen"Traktes"

•  Craniosacral3•  Hypertonus"der"paraspinalen"Muskulatur"

6"6"


6"

!Osteopathie!

,Osteopathie,"


Tozzi"2012"






Wo"liegt"das"PotenMal"des"PaMenten?",  Keine"Therapie?"

,  Passive"Therapie?"

,  AkMve"Therapie?"

,  Medi,kamentöse"Therapie?"

,  Psycho,soziale"Therapie?"

"

,Osteopathie,"

Selbstheilungskräfe""

Kamper"2015,"2014,"McPartland"2008,"Gagnier"2014,"van"Tulder"2000,"Haefeli"2006"

•  MulMdisziplinäre"Therapie"klar"überlegen"•  Strukturelle"Komponente"•  Familiäre"Komponente"•  Berufliche"Komponente"

="psychosoziale"Therapie"""

•  Endocannabinoides"System"wird"akMviert?"

Figure 16. Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.1 Pain shortterm.

Figure 17. Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.2 Pain

medium term.

Figure 18. Forest plot of comparison: 2 Multidisciplinary versus physical treatment, outcome: 2.3 Pain long

term.

21Multidisciplinary biopsychosocial rehabilitation for chronic low back pain (Review)

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

7"7"


7"

!Osteopathie!

,Osteopathie,"

Selbstheilungskräfe"Govenden"2014,"Willems"2013"

•  Osteopathischer"Glaube:"•  Vertrauen"in"die"OrganisaMon"der"Natur"

•  „Der"Osteopath"glaubt"an"die"natürlichen"Kräfe"des"Körpers"um"Krankheiten"zu"überwinden!“"

"!3Wir3versuchen3die3Dysfunk7on3auf3jeglicher3Ebene3zu3beheben,3den3Rest3macht3der3Körper3allein.3

,Osteopathie,"


Tozzi"2012"











"

Was"war"zuerst?",  Der"Schmerz"hat"die"Einheit"des"Körpers"verändert?"

,  Die"Veränderung"der"Einheit"des"Körpers"löst"den"Schmerz"aus?"

8"8"


8"

!Osteopathie!

,Osteopathie,"

Struktur"und"FunkMon""

Curran"2015,"van"Niekerk"2012"

•  Wechselwirkung"Struktur"und"FunkMon"

•  Fakten"2016"–  Keine"konsistente"Evidenz"des"Zusammenhanges"Struktur"und"FunkMon"

–  Keine"konsistente"Evidenz"der"Keaentheorien"

,Osteopathie,"

•  GewebereakMon"•  DysfunkMonen"zeigen"zentrale"und"segmentale"Wirkungen"

•  RM"sammelt"und"verteilt"InformaMonen"

•  GewebereakMon"als"verstärkte"oder"verminderte"DrüsenreakMon"

Struktur"und"FunkMon"Delaunois"2010"

Neurodermi7s3

9"9"


9"

!Osteopathie!

,Osteopathie,"


Tozzi"2012"











"



Homöostase?",  Arteriell",  Venös",  D.m.",  Arterio,sklerose"

,  Medikamente"

,Osteopathie,"

Durchblutung""

Nakamura"2014,"Espahbodi"2013,"Sakai"2008,"Korkiakoski"2009,"KurunlahM"2004"

•  Störung"der"Durchblutung"

•  Stenosen"mit"gleichzeiMg"erhöhten"Blurluss,geschwindigkeit"

•  Vermindert"im"Frontalhirn"sowie"präfrontal"

•  Erhöht"im"Kleinhirn"

•  Muskel,Relaxanz"erhöht"die"Durchblutung"der"paraspinalen"Muskulatur"

d""""""""""""""""""""

who had obvious structural alterations and cured with

ordinary orthopedic treatment, and (2) CLBP group clas-sified as pain disorder with the psychiatric classification or

NSLBP [7], whose pain had continued more than 6 months

despite ordinary medical treatment and with indigentstructural abnormalities. We first investigated the brain

blood flow in each group. As expected, the blood flow was

decreased in the prefrontal cortex of the frontal lobe, andwas increased in the posterior lobe of the cerebellum in the

CLBP group. Also, the increased blood flow in thesomatosensory cortex of the parietal lobe was observed,

although there was no statistical difference among the data

in the CLBP group.By comparing the brain MRI in patients with CLBP and

in normal subjects, Apkarian et al. [5] previously have

reported on the mechanism of pain perception and foundthat the frontal cortex was significantly atrophied in the

CLBP group. Recently, the progression of functional neu-

roimaging systems have made it possible to visualize intra-cerebral changes in patients with CLBP. It is common that

functional brain images, such as fMRI or PET, examine the

brain reaction at the time of nociceptive stimuli to thepatients. However, Baliki et al. [11] have reported that the

pain perception and related cortical activation patterns

were similar between CBP patients and controls inresponse to acute noxious thermal stimuli.

Therefore, we performed brain SPECT focusing on the

cortical activities without noxious stimuli. Brain SPECT isan easy-to-use technique and suffers minimum stressors to

the patients that involve only the administration of a

radioisotope through the venous circulation and visualizesthe accumulation of radioisotope by tomographic imaging

[8]. Using brain SPECT (one-tailed view), we have already

reported that the decreased blood flow of prefrontal cortexregions in 15 patients with chronic pain was observed [12].

Loeser proposes ‘‘the multifaceted model of pain’’ that

involves 4 domains of pain phenomena: (1) the detection oftissue damage (nociception), (2) the recognition of noci-

ceptive stimulation by the central nervous system (pain),

(3) the negative affective response to pain (suffering), and(4) what a person does or does not do or say that leads the

observer to infer that the patient is suffering from a noxiousstimulus (pain behavior) [13].

CLBP2 CLBP1

CLBP5

CLBP3

CLBP7 CLBP6 CLBP4

ALBP2 ALBP1 ALBP4

ALBP5 ALBP7 ALBP6

ALBP3

Fig. 3 Each patient data of inferior views of brain blood flow in theCLBP group and the ALBP group. A representative case CLBP5 isshown on the most upper left. Other CLBP1, 2, 3, 4, 6, and 7 cases arealso shown on the upper right sides. A representative case ALBP3 isshown on the most lower left. Other ALBP1, 2, 4, 5, 6, and 7 cases arealso shown on the lower right sides. Note that the CLBP groupshowed significantly increased blood flow in the bilateral posteriorlobe of the cerebellum

CLBP2CLBP1

CLBP5

CLBP3

CLBP7CLBP6CLBP4

ALBP2ALBP1 ALBP4

ALBP5 ALBP7ALBP6

ALBP3

Fig. 4 Each patient data of anterior views of brain blood flow in theCLBP group and the ALBP group. A representative case CLBP5 isshown on the most upper left. Other CLBP1, 2, 3, 4, 6, and 7 cases arealso shown on the upper right sides. A representative case ALBP3 isshown on the lowest left. Other ALBP1, 2, 4, 5, 6, and 7 cases are alsoshown on the lower right sides. Note that the CLBP group showedsignificantly reduced blood flow in the bilateral prefrontal cortex ofthe frontal lobe

388 Y. Nakamura et al.

123

10"10"


10"

!Osteopathie!

,Osteopathie,"

•  Eingeschränkte"Durchblutung"erzeugt"StagnaMon"und"FermentaMon"

"!3Ziel3ist3es3die3Stase3zu3finden3

Die"Durchblutung"als"WichMgstes"Brandt"2005,"Menon"2013,"Zhu"2015,"Kim"2012"

,Osteopathie,"


Tozzi"2012"











"




,  Medikamente"

Ausgleich,strategien?",  10.000"Schriae"am"Tag?"

,  Soziale"Kontakte?"

11"11"


11"

!Osteopathie!

,Osteopathie,"

Leben"ist"Bewegung""

Gesundheitsreport"2015,"Simon"2015,"Hallmann"2015,"2012"

•  57"%"der"Deutschen"schätzen"ihren"Gesundheitszustand"als"gut"oder"sehr"gut"ein...."

!""Nur"11%"erreichen"überhaupt"die"Benchmark"einer"gesunden"Lebensführung..."

Benchmark3 Männer3die3gesunde3Bench3erreichen3

Frauen3die3gesunde3Bench3erreichen3

AkMvität" 56%" 52%"

Ernährung" 40%" 49%"

Rauchen" 74%" 78%"

Alkohol" 82%" 93%"

Stressempfinden" 48%" 56%"

Gesamt3 9%3 14%3

,Osteopathie,"

•  Der"PaMent"steht"im"Fokus,"nicht"die"Krankheit"

•  Betrachtung"des"•  GeneMschen"Erbes"•  Individuelle"Entwicklung"•  Ressourcen"und"Strategien"der"Entwicklung"von"Ressourcen"

!3Grundgedanke:3Der3Körper3adap7ert3zum3bestmöglichen3Überleben3des3Individuums3

Leben"ist"Bewegung"Delaunois"2010"

12"12"


12"

!Osteopathie!

,Osteopathie,"


Tozzi"2012"





Wo"liegt"die"DysfunkMon?",  Parietal",  Visceral",  craniosacral"






"




,  Medikamente"

Ausgleich,strategien?",  10.000"Schriae"am"Tag?"

,  Soziale"Kontakte?"

,  Fitness"in"Gruppe?"

""""""""""""""""""""

FOMT3

Konzept33

,Osteopathie,"

Konzept"der"FOMT""

•  IntegraMon"der"besten"Ergebnisse"•  Subgruppentherapie"wo"erfolgreich"

•  Umfangreiche"Erfassung"des"Status"des"PaMenten"

•  Erlernen"einer"Vielzahl"an"Therapieprinzipien"

•  Strukturierter"Auuau"von"Algorithmen"

•  Osteopath"als"akMver"Manager"des"PaMenten"

Mani,pulaMon"

parietal"visceral"craniosacral"

Heil,prakMker,prüfung"

""

Aku,punktur"

Evidenz,basiertes"Arbeiten"

""

Spaß"am"

Lernen"

13"13"


13"

!Osteopathie!

,Osteopathie,"Vielen"Dank"für"die"Aufmerksamkeit!"

Fragen,"Literaturliste"und"Rehanewsleaer"unter:"

www.heimerer,akademie.de"www.fomt.info"[email protected]"

hap://www.facebook.com/fomt.info"

,osteopathie, rückenschmerz3–3funk7onelle3 ... · pdf...

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