Öz
Amaç
Kronik bel ağrısı (KBA), yönetimi en zorlayıcı ve en maliyetli kas-iskelet sistemi rahatsızlıklarından biri olarak kabul edilmektedir. Egzersiz eğitimi, ağrı yönetim stratejileri ve spinal manipülasyon gibi çeşitli terapötik yaklaşımlar bu durumun tedavisinde kullanılmaktadır. Bu yöntemler arasında klinik spinal manipülasyon, hem kısa hem de uzun vadeli faydalar sağlayarak ağrı ve fiziksel kısıtlılığı azaltmada en etkili müdahalelerden biri olarak yaygın şekilde kabul görmektedir. Yüksek hızda uygulanan spinal manipülasyon teknikleri, KBA tedavisinde yaygın olarak tercih edilmekte ve kas aktivitesinde değişikliklerle ilişkilendirilmektedir; ancak bu konuda mevcut kanıtlar çelişkilidir. Bu çalışmanın amacı, KBA’lı bireylerde iki farklı spinal manipülasyon tekniğinin klinik sonuçlar ve kas mekanik özellikleri üzerindeki anlık etkilerini analiz etmektir.
Gereç ve Yöntem
Bu tek-körlemeli, randomize karşılaştırmalı çalışma, ön test–son test desenine sahiptir. Katılımcılar rastgele iki gruba ayrılmıştır: Grup 1, Maitland’ın postero-anterior merkezi vertebral bası tekniğini alırken, Grup 2 ise lumbal roll tekniğine tabi tutulmuştur. Değerlendirmeler, müdahale öncesi ve hemen sonrasında gerçekleştirilmiştir. Kas mekanik özellikleri MyotonPro cihazı ile ölçülmüş; ağrı düzeyi görsel analog skala (VAS) ile değerlendirilmiş; esneklik ise otur-uzan testi ve modifiye Schober testi kullanılarak belirlenmiştir.
Bulgular
Uygulamalar sonrasında her iki grupta da VAS skorları ile otur-uzan testi sonuçlarında anlamlı iyileşmeler gözlenmiştir. Schober testi analizinde, yalnızca Grup 2’de istatistiksel olarak anlamlı bir gelişme saptanmıştır (p<0,001). L3-L4 vertebral düzeyindeki paravertebral kasların mekanik özellikleri, MyotonPro cihazı ile değerlendirilmiş olup, her iki grupta da elastisite (Hz) ve dinamik sertlik (N/m) parametrelerinde anlamlı artışlar görülmüştür. Bununla birlikte, gruplar arasında istatistiksel olarak anlamlı bir fark bulunmamıştır.
Sonuç
Her iki spinal manipülasyon tekniği de, ağrının hafifletilmesi, kas sertliğinin azaltılması ve esnekliğin artırılması açısından etkili bulunmuştur. Elde edilen bulgular doğrultusunda, terapötik etkinliğin en üst düzeye çıkarılması için manipülasyonların semptomatik tarafa uygulanması önerilmektedir.
Anahtar Kelimeler: Kronik bel ağrısı, spinal manipülasyon, mobilizasyon, kas mekanik özellikleri, MyotonPro
Kaynakça
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