SAMENVATTING REVAKI
LUMBALE WZ & BEKKEN
Paul-Henry Durant
,INHOUDSOPGAVE
REVAKI Theorie .................................................................................................... 6
Klinisch redeneren ..................................................................................................... 6
Risk assessment ...........................................................................................................................6
Interpretatie rode vlaggen (niet eenvoudig) ..............................................................................6
‘Traffic light’ decision rule – klinische implicaties .....................................................................6
Structuur ......................................................................................................................................7
Pijn ..............................................................................................................................................7
Structuuranalyse, onderzoek & behandeling ...................................................................................7
Symptoomlocatie – innervatie.................................................................................................8
Symptoomlocatie – spine-related leg pain ...............................................................................8
Provocatie – reductie............................................................................................................ 10
Subjectief onderzoek (anamnese) .............................................................................. 13
Deductief KR .............................................................................................................................. 13
Patroonherkenning ..................................................................................................................... 13
Typische patronen ...................................................................................................................... 13
Radiculair probleem ............................................................................................................. 13
Hoog-irritabele acute niet-specifieke LRP .............................................................................. 14
Recurrente acute LRP........................................................................................................... 14
Chronische niet-specifieke LRP ............................................................................................ 15
Klinisch (fysiek) onderzoek ........................................................................................ 16
Inspectie .................................................................................................................................... 16
BFO: actief onderzoek ................................................................................................................. 18
Screening heup/andere regio’s (TWZ, knie, …) .............................................................................. 19
Toegevoegd onderzoek lage rug ................................................................................................... 19
Manueel articulair onderzoek ............................................................................................... 19
Manuele therapie voor de LWZ: behandeling .............................................................. 20
Voorbeelden van manuele technieken (zie ook praktijk) ................................................................ 20
Enkele aandachtspunten ............................................................................................................. 21
Evidentie voor manuele therapie bij LRP ....................................................................................... 23
Manuele therapie: meer dan een mechanisch effect ..................................................................... 24
Neurodynamica ........................................................................................................ 25
Three-part system ....................................................................................................................... 25
Nerve sliding ............................................................................................................................... 26
Onderzoek .................................................................................................................................. 27
Neurodynamische testen ............................................................................................................ 28
Testen van mechanosensitiviteit: .......................................................................................... 28
Zenuwpalpatie ............................................................................................................................ 30
Provocatie – Drukprovocatie (via palpatie) (zie ook praktijk) .................................................... 31
Behandeling ............................................................................................................................... 32
Behandelingsoptie: Interface ................................................................................................ 33
Evidentie ............................................................................................................................. 34
Toegevoegd onderzoek SIG ....................................................................................... 34
Inleiding ..................................................................................................................................... 34
1
, Wat is Pelvic girdle pain (PGP)? ............................................................................................. 34
Prevalentie .......................................................................................................................... 34
Overlap in pijnpatronen ........................................................................................................ 35
Differentieel diagnose SIG-klachten via anamnese – klachtenpatroon..................................... 35
Load transfer ....................................................................................................................... 36
Korte anatomische situering ........................................................................................................ 36
Os sacrum – facies articularis ............................................................................................... 36
SIG ...................................................................................................................................... 36
Musculatuur ........................................................................................................................ 37
Functionele biomechanica .......................................................................................................... 37
Osteo- en arthrokinematica .................................................................................................. 37
Beweging vanuit de heup geïnitieerd ..................................................................................... 38
Klinisch onderzoek ...................................................................................................................... 39
Overzicht ............................................................................................................................. 39
Provocatietesten.................................................................................................................. 39
Actieve functietesten ........................................................................................................... 40
PAssieve mobiliteitstesten ................................................................................................... 41
Multidimensionele benadering PGP ...................................................................................... 41
Behandeling ............................................................................................................................... 42
Educatie .............................................................................................................................. 42
Bekkengordel....................................................................................................................... 43
Oefentherapie ..................................................................................................................... 43
Manuele therapie ................................................................................................................. 43
Alle andere bijdragende factoren .......................................................................................... 44
Pathologie......................................................................................................... 45
Algemeen................................................................................................................. 45
Inleiding ..................................................................................................................................... 45
Wat is aspecifieke rugpijn? ................................................................................................... 45
Oorzaken van rugpijn ............................................................................................................ 46
Reflecties bij een acute opstoor van lage rugpijn .................................................................... 46
Rode vlaggen ....................................................................................................................... 46
Psychosociale aspecten en chronische lRp: gele vlaggen ....................................................... 47
Risicofactoren (multifactorieel) ............................................................................................ 47
Behandeling ............................................................................................................................... 48
Anatomie en biomechanica van de lWZ ...................................................................... 48
Bijkomende biomechanische gegevens omtrent de LWZ ........................................................ 51
Specifieke Lage rugpijn ............................................................................................. 51
Acute lumbago ........................................................................................................................... 51
Oorzaken ............................................................................................................................. 51
Spontaan herstel ................................................................................................................. 52
advies ................................................................................................................................. 52
Discuslijden ............................................................................................................................... 52
Discusbulging ...................................................................................................................... 52
discus hernia ....................................................................................................................... 53
Ischialgie .................................................................................................................................... 54
Arthrosis deformans (AD) ............................................................................................................ 55
Algemeen ............................................................................................................................ 55
2
, Klachten .............................................................................................................................. 55
Diagnose ............................................................................................................................. 56
Behandeling ........................................................................................................................ 56
Complicaties van uitgebreide artrose .................................................................................... 56
Facettaire problematiek .............................................................................................................. 57
Spondylolyse – spondylolisthesis ................................................................................................. 57
Spondylolyse ....................................................................................................................... 57
Spondylolisthesis ................................................................................................................ 58
aspecifieke lage rugpijn ............................................................................................ 58
Aanpak ....................................................................................................................................... 58
Onderzoek van de LWZ ................................................................................................................ 58
Testen van myotomen .......................................................................................................... 58
Testen van de dermatomen .................................................................................................. 58
Testen van de reflexen .......................................................................................................... 59
Testen van de radiculaire aantasting ..................................................................................... 59
Testen van Waddell .............................................................................................................. 59
Technische onderzoeken ............................................................................................................. 60
Behandeling ............................................................................................................................... 61
Algemene houding ............................................................................................................... 61
Orthopedie ........................................................................................................ 63
Lage rugpijn ............................................................................................................. 63
Pijntypes .................................................................................................................................... 63
Diagnose .................................................................................................................................... 63
Rx-beelden .......................................................................................................................... 63
Ct-scan ............................................................................................................................... 64
MRI ..................................................................................................................................... 64
Nuclear imaging ................................................................................................................... 64
Discografie .......................................................................................................................... 64
Behandeling LRP ......................................................................................................................... 64
Discusdegeneratie ................................................................................................... 64
Discogene pijn ............................................................................................................................ 64
Behandeling ............................................................................................................................... 65
indicatie voor discusprothese ............................................................................................... 65
Chirurgie technieken ............................................................................................................ 65
Postoperatief ....................................................................................................................... 66
Lumbale discusdegeneratie ...................................................................................... 66
Pathofysiologie ........................................................................................................................... 66
Symptomen ................................................................................................................................ 66
Klinisch onderzoek ...................................................................................................................... 66
Diagnose .................................................................................................................................... 67
MRI ............................................................................................................................................ 67
EMG/SSEP .................................................................................................................................. 67
Behandeling ............................................................................................................................... 67
Complicaties .............................................................................................................................. 68
Spinaal kanaalstenose & degeneratieve instabiliteit ................................................... 69
Epidemiologie ............................................................................................................................. 69
3
LUMBALE WZ & BEKKEN
Paul-Henry Durant
,INHOUDSOPGAVE
REVAKI Theorie .................................................................................................... 6
Klinisch redeneren ..................................................................................................... 6
Risk assessment ...........................................................................................................................6
Interpretatie rode vlaggen (niet eenvoudig) ..............................................................................6
‘Traffic light’ decision rule – klinische implicaties .....................................................................6
Structuur ......................................................................................................................................7
Pijn ..............................................................................................................................................7
Structuuranalyse, onderzoek & behandeling ...................................................................................7
Symptoomlocatie – innervatie.................................................................................................8
Symptoomlocatie – spine-related leg pain ...............................................................................8
Provocatie – reductie............................................................................................................ 10
Subjectief onderzoek (anamnese) .............................................................................. 13
Deductief KR .............................................................................................................................. 13
Patroonherkenning ..................................................................................................................... 13
Typische patronen ...................................................................................................................... 13
Radiculair probleem ............................................................................................................. 13
Hoog-irritabele acute niet-specifieke LRP .............................................................................. 14
Recurrente acute LRP........................................................................................................... 14
Chronische niet-specifieke LRP ............................................................................................ 15
Klinisch (fysiek) onderzoek ........................................................................................ 16
Inspectie .................................................................................................................................... 16
BFO: actief onderzoek ................................................................................................................. 18
Screening heup/andere regio’s (TWZ, knie, …) .............................................................................. 19
Toegevoegd onderzoek lage rug ................................................................................................... 19
Manueel articulair onderzoek ............................................................................................... 19
Manuele therapie voor de LWZ: behandeling .............................................................. 20
Voorbeelden van manuele technieken (zie ook praktijk) ................................................................ 20
Enkele aandachtspunten ............................................................................................................. 21
Evidentie voor manuele therapie bij LRP ....................................................................................... 23
Manuele therapie: meer dan een mechanisch effect ..................................................................... 24
Neurodynamica ........................................................................................................ 25
Three-part system ....................................................................................................................... 25
Nerve sliding ............................................................................................................................... 26
Onderzoek .................................................................................................................................. 27
Neurodynamische testen ............................................................................................................ 28
Testen van mechanosensitiviteit: .......................................................................................... 28
Zenuwpalpatie ............................................................................................................................ 30
Provocatie – Drukprovocatie (via palpatie) (zie ook praktijk) .................................................... 31
Behandeling ............................................................................................................................... 32
Behandelingsoptie: Interface ................................................................................................ 33
Evidentie ............................................................................................................................. 34
Toegevoegd onderzoek SIG ....................................................................................... 34
Inleiding ..................................................................................................................................... 34
1
, Wat is Pelvic girdle pain (PGP)? ............................................................................................. 34
Prevalentie .......................................................................................................................... 34
Overlap in pijnpatronen ........................................................................................................ 35
Differentieel diagnose SIG-klachten via anamnese – klachtenpatroon..................................... 35
Load transfer ....................................................................................................................... 36
Korte anatomische situering ........................................................................................................ 36
Os sacrum – facies articularis ............................................................................................... 36
SIG ...................................................................................................................................... 36
Musculatuur ........................................................................................................................ 37
Functionele biomechanica .......................................................................................................... 37
Osteo- en arthrokinematica .................................................................................................. 37
Beweging vanuit de heup geïnitieerd ..................................................................................... 38
Klinisch onderzoek ...................................................................................................................... 39
Overzicht ............................................................................................................................. 39
Provocatietesten.................................................................................................................. 39
Actieve functietesten ........................................................................................................... 40
PAssieve mobiliteitstesten ................................................................................................... 41
Multidimensionele benadering PGP ...................................................................................... 41
Behandeling ............................................................................................................................... 42
Educatie .............................................................................................................................. 42
Bekkengordel....................................................................................................................... 43
Oefentherapie ..................................................................................................................... 43
Manuele therapie ................................................................................................................. 43
Alle andere bijdragende factoren .......................................................................................... 44
Pathologie......................................................................................................... 45
Algemeen................................................................................................................. 45
Inleiding ..................................................................................................................................... 45
Wat is aspecifieke rugpijn? ................................................................................................... 45
Oorzaken van rugpijn ............................................................................................................ 46
Reflecties bij een acute opstoor van lage rugpijn .................................................................... 46
Rode vlaggen ....................................................................................................................... 46
Psychosociale aspecten en chronische lRp: gele vlaggen ....................................................... 47
Risicofactoren (multifactorieel) ............................................................................................ 47
Behandeling ............................................................................................................................... 48
Anatomie en biomechanica van de lWZ ...................................................................... 48
Bijkomende biomechanische gegevens omtrent de LWZ ........................................................ 51
Specifieke Lage rugpijn ............................................................................................. 51
Acute lumbago ........................................................................................................................... 51
Oorzaken ............................................................................................................................. 51
Spontaan herstel ................................................................................................................. 52
advies ................................................................................................................................. 52
Discuslijden ............................................................................................................................... 52
Discusbulging ...................................................................................................................... 52
discus hernia ....................................................................................................................... 53
Ischialgie .................................................................................................................................... 54
Arthrosis deformans (AD) ............................................................................................................ 55
Algemeen ............................................................................................................................ 55
2
, Klachten .............................................................................................................................. 55
Diagnose ............................................................................................................................. 56
Behandeling ........................................................................................................................ 56
Complicaties van uitgebreide artrose .................................................................................... 56
Facettaire problematiek .............................................................................................................. 57
Spondylolyse – spondylolisthesis ................................................................................................. 57
Spondylolyse ....................................................................................................................... 57
Spondylolisthesis ................................................................................................................ 58
aspecifieke lage rugpijn ............................................................................................ 58
Aanpak ....................................................................................................................................... 58
Onderzoek van de LWZ ................................................................................................................ 58
Testen van myotomen .......................................................................................................... 58
Testen van de dermatomen .................................................................................................. 58
Testen van de reflexen .......................................................................................................... 59
Testen van de radiculaire aantasting ..................................................................................... 59
Testen van Waddell .............................................................................................................. 59
Technische onderzoeken ............................................................................................................. 60
Behandeling ............................................................................................................................... 61
Algemene houding ............................................................................................................... 61
Orthopedie ........................................................................................................ 63
Lage rugpijn ............................................................................................................. 63
Pijntypes .................................................................................................................................... 63
Diagnose .................................................................................................................................... 63
Rx-beelden .......................................................................................................................... 63
Ct-scan ............................................................................................................................... 64
MRI ..................................................................................................................................... 64
Nuclear imaging ................................................................................................................... 64
Discografie .......................................................................................................................... 64
Behandeling LRP ......................................................................................................................... 64
Discusdegeneratie ................................................................................................... 64
Discogene pijn ............................................................................................................................ 64
Behandeling ............................................................................................................................... 65
indicatie voor discusprothese ............................................................................................... 65
Chirurgie technieken ............................................................................................................ 65
Postoperatief ....................................................................................................................... 66
Lumbale discusdegeneratie ...................................................................................... 66
Pathofysiologie ........................................................................................................................... 66
Symptomen ................................................................................................................................ 66
Klinisch onderzoek ...................................................................................................................... 66
Diagnose .................................................................................................................................... 67
MRI ............................................................................................................................................ 67
EMG/SSEP .................................................................................................................................. 67
Behandeling ............................................................................................................................... 67
Complicaties .............................................................................................................................. 68
Spinaal kanaalstenose & degeneratieve instabiliteit ................................................... 69
Epidemiologie ............................................................................................................................. 69
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