Training zur Behandlung von Rückenschmerzen – ein Überblick zum Stand der Wissenschaft und Perspektiven

Zusammenfassung

Rückenschmerzen sind weit verbreitet und weltweit eine der führenden Ursachen für eine eingeschränkte körperliche Funktion und Belastbarkeit. Training und Bewegung zählen neben kognitiver Verhaltenstherapie und Edukation zu den First-Line-Treatments, vor allem bei chronischen nicht-spezifischen Rückenschmerzen. Die Wirksamkeit von Training kann anhand von Einzelstudien sowie RCTs und Metaanalysen belegt werden. Dabei zeigt sich, dass Training anderen konservativen Behandlungsformen überlegen ist. Evidenz-basiert lässt sich derzeit keine spezifische Trainingsform als am wirksamsten identifizieren. Es zeigt sich jedoch wiederholt, dass vor allem Trainingsprogramme, die sowohl die (senso)motorische Kontrolle und Stabilisationsfähigkeit als auch die Kräftigung des Rumpfes in den Fokus legen, sich als besonders geeignet zur Reduktion der Schmerzen und der damit verbundenen Einschränkungen erweisen. Messbare neuromuskuläre Defizite im Zusammenhang mit Rückenschmerzen untermauern dabei die Bedeutung des Trainings der reaktiven motorischen Kontrolle, vor allem in Situationen mit plötzlichen Lasteinwirkungen. Allerdings lassen sich derzeit evidenz-basierte Empfehlungen zur Dosis-Wirkung nur begrenzt ableiten. Schließlich ist die Notwendigkeit einer möglichen Individualisierung des Trainings zu klären.

Summary

Back pain is common and one of the leading causes of impaired physical function worldwide. Exercise and training, along with cognitive behavioural therapy and education, are among the first-line treatments, especially for chronic nonspecific back pain. The efficacy of training can be demonstrated by single studies, as well as RCTs and meta-analyses. These studies show that training is superior to other conservative forms of treatment. Based on current evidence, no specific form of training can be identified as most effective. However, it is repeatedly shown that training programs that focus on (sensori)motor control and stabilization capabilities as well as strengthening of the trunk are particularly suitable for reducing pain and the associated limitations. Measurable neuromuscular deficits associated with back pain support the importance to train reactive motor control, especially in situations involving sudden load application. However, evidence-based recommendations on dose-response are currently limited. Finally, the need for possible individualization of training needs to be clarified.

Stichworte

Bewegungstherapie - Intervention - Kreuzschmerz - Behandlung.

Key words

Exercise - Intervention - low back pain - treatment.

Publication History

Received: 02 February 2023

Accepted after revision: 07 February 2023

Article published online:
17 April 2023

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