,osteopathie, rckenschmerz3–3funk7onelle3 ... osteopathie!,osteopathie,...

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  • 1"1"

    www.fomt.info"info@fomt.info"

    1"

    !Osteopathie!

    ,Osteopathie,"

    Rckenschmerz33Funk7onelle3Zusammenhnge3aus3osteopathischer3Sicht3

    Herzlich"willkommen!"

    Stefan3Grundler33

    Heimerer3Akademie333

    FOMT3Fortbildungen-fr-Orthopdische-Medizin-und-

    Manuelle-Therapie-

    ,Osteopathie,"

    "

    Nacken,"und"Rcken,

    schmerzen"sind"ein"

    natrlicher"Teil"des"Lebens."

    Einfhrung"

    "

  • 2"2"

    www.fomt.info"info@fomt.info"

    2"

    !Osteopathie!

    ,Osteopathie,"

    Einfhrung""was"tun???"

    Osteopathie"

    Massage"

    Physiotherapie"Rckenschule"

    Sport"

    OperaMon"

    Medikamente"Psychotherapie"

    Ernhrung"

    ,Osteopathie,"

    Einfhrung""Algorithmus"zur"Therapie???""

    Stanton"2013"

    Hat"der"PaMent"Symptome"unterhalb"des"Ges"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"

    www.fomt.info"info@fomt.info"

    3"

    !Osteopathie!

    ,Osteopathie,"

    Einfhrung""Erfolg"der"Therapie???""

    Stanton"2013,"Norton"2015"

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

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

    anhaltende medikamentse Hilfe notwendig 8%

    anhaltende therapeutische Hilfe notwendig 8%

    anhaltende wechselnde Beschwerden 31%

    Erholung 53% Therapie

    rztliches Gesprch

    Schmerzmittel

    Bildgebung

    Schmerzmittel und rztliche Therapie

    ,Osteopathie,"

    Einfhrung""Von"der"Theorie"zur"Therapie""

    FunkMonieren"Subgruppen? ""

    Fhren"eher"Therapieprinzipien"zur"Therapieplanung?"

    Erfassung"des"Status"eines"PaMenten?"

  • 4"4"

    www.fomt.info"info@fomt.info"

    4"

    !Osteopathie!

    ,Osteopathie,"

    Osteopathische"Prinzipien""

    SMll,"Lialejohn,"Delaunois"

    Philosophische"Grundlage"mit"fnf"biologischen"Prinzipien:"1. Krper"als"untrennbare"

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

    WichMgste""Vorherrschaf"der"Arterie"

    5. Leben"ist"Bewegung"

    ,Osteopathie,"

    FunkMoneller"Zusammenhang""

    "

    PaMentenbeispiel" 44"jhriger"PaMent,"wenig"Sport,"viel"im"Bro,"subjekMv"gestresst"

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

    Haltungs,"und"belastungsabhngig"

    Klassisch"manualtherapeuMsch"kein"klarer"Befund,"neurologisch"unauffllig"

    rztliche"Diagnose:"chronisches"LWS,Syndrom"

  • 5"5"

    www.fomt.info"info@fomt.info"

    5"

    !Osteopathie!

    ,Osteopathie,"

    FunkMoneller"Zusammenhang""

    Tozzi"2012"

    Krper3als3Einheit3

    Selbstheilungs!krHe3

    Struktur3und3Funk7on3

    Durchblutung3 Leben3ist3Bewegung3

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

    ,Osteopathie,"

    Der"Krper"als"Einheit""

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

    Wo"liegt"die"DysfunkMon?" Parietal3

    Verfeaung"der"Muskulatur" Einsprossung"von"Nerven"und"Blutgefen"in"die"Bandscheibe"

    Visceral3 Eingeschrnkte"Mobilitt"des"gastrointesMnalen"Traktes"

    Craniosacral3 Hypertonus"der"paraspinalen"Muskulatur"

  • 6"6"

    www.fomt.info"info@fomt.info"

    6"

    !Osteopathie!

    ,Osteopathie,"

    FunkMoneller"Zusammenhang""

    Tozzi"2012"

    Krper3als3Einheit3

    Selbstheilungs!krHe3

    Struktur3und3Funk7on3

    Durchblutung3 Leben3ist3Bewegung3

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

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

    , Passive"Therapie?"

    , AkMve"Therapie?"

    , Medi,kamentse"Therapie?"

    , Psycho,soziale"Therapie?"

    "

    ,Osteopathie,"

    Selbstheilungskrfe""

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

    MulMdisziplinre"Therapie"klar"berlegen" Strukturelle"Komponente" Familire"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"

    www.fomt.info"info@fomt.info"

    7"

    !Osteopathie!

    ,Osteopathie,"

    Selbstheilungskrfe"Govenden"2014,"Willems"2013"

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

    Der"Osteopath"glaubt"an"die"natrlichen"Krfe"des"Krpers"um"Krankheiten"zu"berwinden!"

    "!3Wir3versuchen3die3Dysfunk7on3auf3jeglicher3Ebene3zu3beheben,3den3Rest3macht3der3Krper3allein.3

    ,Osteopathie,"

    FunkMoneller"Zusammenhang""

    Tozzi"2012"

    Krper3als3Einheit3

    Selbstheilungs!krHe3

    Struktur3und3Funk7on3

    Durchblutung3 Leben3ist3Bewegung3

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

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

    , Passive"Therapie?"

    , AkMve"Therapie?"

    , Medi,kamentse"Therapie?"

    , Psycho,soziale"Therapie?"

    "

    Was"war"zuerst?", Der"Schmerz"hat"die"Einheit"des"Krpers"verndert?"

    , Die"Vernderung"der"Einheit"des"Krpers"lst"den"Schmerz"aus?"

  • 8"8"

    www.fomt.info"info@fomt.info"

    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"verstrkte"oder"verminderte"DrsenreakMon"

    Struktur"und"FunkMon"Delaunois"2010"

    Neurodermi7s3

  • 9"9"

    www.fomt.info"info@fomt.info"

    9"

    !Osteopathie!

    ,Osteopathie,"

    FunkMoneller"Zusammenhang""

    Tozzi"2012"

    Krper3als3Einheit3

    Selbstheilungs!krHe3

    Struktur3und3Funk7on3

    Durchblutung3 Leben3ist3Bewegung3

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

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

    , Passive"Therapie?"

    , AkMve"Therapie?"

    , Medi,kamentse"Therapie?"

    , Psycho,soziale"Therapie?"

    "

    Was"war"zuerst?", Der"Schmerz"hat"die"Einheit"des"Krpers"verndert?"

    , Die"Vernderung"der"Einheit"des"Krpers"lst"den"Schmerz"aus?"

    Homostase?", Arteriell", Vens", D.m.", Arterio,sklerose"

    , Medikamente"

    ,Osteopathie,"

    Durchblutung""

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

    Strung"der"Durchblutung"

    Stenosen"mit"gleichzeiMg"erhhten"Blurluss,geschwindigkeit"

    Vermindert"im"Frontalhirn"sowie"prfrontal"

    Erhht"im"Kleinhirn"

    Muskel,Relaxanz"erhht"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 stimu

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