Guía sobre la hernia discal, protrusión o abombamiento y fisura

Índice de las referencias

  1. Guías de Práctica Clínica
  2. Causas del dolor
  3. Como aparece el dolor de espalda
  4. Riesgos
  5. Pruebas diagnósticas de imagen
  6. Pruebas neurofisiológicas: electromiograma
  7. Pruebas de provocación o alivio (discografía e infiltraciones facetarias con anestésicos)
  8. Pruebas quiroprácticas de movilidad y palpación vertebral
  9. Dolor e incapacidad
  10. Información al paciente y «Programas educativos breves»
  11. Higiene postural, Escuelas de la Espalda y RPG
  12. Ejercicio
  13. Método fisioterapéutico de «cadenas musculares» o Godelieve-Denys-Struyf (GDS).
  14. Mantener el mayor grado posible de actividad física
  15. Evitar el reposo en cama
  16. Corsés,cinturones lumbares, plantillas y alzas
  17. Tracciones
  18. Fisioterapia (calor y frío, masajes, láser, onda corta, magnetoterapia, ultrasonidos y ondas de choque, corrientes interferenciales)
  19. Corrientes interferenciales
  20. Onda corta
  21. Termoterapia (calor o frío)
  22. Masajes
  23. Laserterapia
  24. Ultrasonido
  25. Neuroestimulación eléctrica percutánea (PENS)
  26. Acupuntura
  27. Manipulaciones vertebrales
  28. Terapia cognitiva multimodal
  29. Cirugía de la columna vertebral
  30. Dispositivos intraespinosos
  31. IDET e IRFT (Electrotermoterapia intradiscal y termocoagulación intradiscal por radiofrecuencia)
  32. Prevención entre la población general y en los trabajadores
  33. Prevención y dolor de espalda en escolares y adolescentes

Referencias

En la elaboración de los contenidos de esta guía se han usado criterios y recomendaciones emanados de las siguientes Guías de Práctica Clínica y publicaciones científicas.

1. Guías de Práctica Clínica

  1. Airaksinen O, Brox JI, Cedraschi I, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal B, Ursin H, Zanoli G. . COST B13 Working Group on Guidelines for Chronic Low Back Pain. European guidelines for the management of chronic non-specific low back pain. Eur Spine J 2006 Mar;15:S192-299
  2. Chou R, Qaseem A, Snow V et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478-91.
  3. Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM; American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.Spine 2009;34(10):1066-77.
  4. Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504
  5. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline.Spine 2009;34(10):1078-93
  6. Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med. 2010;52(4):424-7.
  7. Waddell G, Feder G, McIntosh A, Lewis M, Hutchinson A. Clinical guidelines for the management of acute low back pain. Royal College of General Practitioners, London 1996.
  8. Bigos S, Bowver O, Braen G, Acute low back problems in adults. Clinical Practice Guideline nº 14. AHCPR Publication No. 95-0642. Rockville M: Agency for Health Care Policy and Research, Public Health Service. US. Department of Health and Human Services. December 1994.
  9. María Teresa León, María Dolores Castillo. Prevención, tratamiento y rehabilitación del dolor de espalda.3º edicion. Jaen: Formación Alcalá;2004.
  10. Jens Ivar Brox, Øystein P Nygaard, Inger Holm et al. Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. NCBI. 2010; 69: 1643–1648.

2. Causas del dolor

  1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006 Mar;15 Suppl 2:S192-300
  2. Baras JD, Baker LC. Magnetic resonance imaging and low back pain care for Medicare patients. Health Aff (Millwood) 2009 Nov-Dec;28(6):w1133-40.
  3. Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344(5):363-370.
  4. Hartvigsen J, Foster NE, Croft PR. We need to rethink front line care for back pain. BMJ 2011 May 25;342:d3260.
  5. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 2009 Oct;60(10):3072-3080.
  6. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137:586-597.
  7. Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA2003; 289: 2810–18.
  8. Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine2003; 28: 616–20.
  9. Newman-Toker DE, Pronovost PJ. Diagnostic errors–the next frontier for patient safety. JAMA. 2009;301(10):1060-2.
  10. Savigny P, Kuntze S, Watson P, Underwood M, Ritchie G, Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough,C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. Low Back Pain: early management of persistent non-specific low back pain. Full Guideline. National Institute of Clinical Excellence (NICE), 2009; Disponible en www.nice.org.uk/nicemedia/pdf/CG88fullguideline.pdf, visitada el 9 de agosto de 2013.
  11. Underwood M. Diagnosing acute nonspecific low back pain: time to lower the red flags? Arthritis Rheum 2009;60(10):2855-2857.
  12. Waddell G. The Back Pain Revolution. 2 edition ed. London: Churchill-Livingstone; 2004.

3. Como aparece el dolor de espalda

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  3. Basile S, Khalil Z, Helme RD. Skin vascular reactivity to the neuropeptide substance P in rats with peripheral mononeuropathy. Pain 1993; 52: 217-22.
  4. Birch PJ, Harrison SM, Hayes AG, Rogers H, Tyers MB. The non-peptide NK receptor antagonist (±)CP-96,345, produces antinociceptive and anti-oedema effects in the rat. Br. J. Pharmcol. 1992;105:508-510.
  5. Brodin E, Linderoth B, Cazelius B, Ungerstedt. In vivo release of substance P in cat dorsal horn studied with microdialysis. Neurosci. Lett 1987;76:357-362.
  6. Coderre TJ, Basbaum AI, Levine JD. Neural control of vascular permeability: interactions between primary afferents, mast cells, and sympathetic efferents. J. Neurphysiol. 1989;62:48-58.
  7. Collingridge GL, Bliss TVP. NMDA receptors -their rol in long-term potentiation. TINS 1987; 10: 288-293.
  8. Cook AJ, Woolf CJ, Wall PD, McMahon SB. Dynamic receptive field plasticity in rat spinal dorsal horn following C-primary afferent input. Nature(Lond) 1987; 325: 151-153.
  9. Costa D, Baños JE. Contribución del sistema nervioso central a la fisiopatología del dolor neuropático. Med Clin (Barc) 1993; 101: 591-595.
  10. Cross SA. Pathophysiology of pain. Mayo Clinic Proc 1994; 69:375-383
  11. Cuello AC. Peptides as neuromodulators in primary sensory neurons. Neuropharmacology. 1987;7:971-979.
  12. Cuello C, Kanazawa I. The distribution of substance P immunoreactive fibers in the rat central nervous system. J. Comp. Neurol 1987;178:129-156.
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  14. D’Amour RE, Smith DL. A method for determining loss of pain sensation. J. Pharmacol.  Exp. Therap. 1992;72:74-79
  15. De Koninck Y, Ribeiro da Silva A, Henry JL, Cuello AC. Spiral neurons exhibiting a specific nociceptive response receive abundant substance P-containing synaptic contacts. Proc. Natl. Acad. Sci. USA 1992;89:5073-5077.
  16. Duggan AW, Hendry JA, Morton CR, Hutchison WD, Zhao ZQ. Cutaneous stimuli releasing immunoreactive subtance P in the dorsal horn of the cat. Brain Res. 1988;451:262-265.
  17. Fields HL. Pain. New York: McGraw-Hill, 1987.
  18. Go VLW, Yaksh TL. Release of substance P from the cat spinal cord. J. Physiol (Lond)1987;391:141-167.
  19. Henry JL, Krnjevic K, Morris E. Substance P and spinal neurones. Can J. Phisiol. Pharmacol. 1975;53:423-432.
  20. Henry JL. Effects of substance P on functionally identified units in cat spinal cord. Brain Res. 1976;114:439-451.
  21. Henry JL, Sessle BJ Lucier GE Hu JW. Effects of substance P on nociceptive and non-nociceptive trigeminal brain stem neurons. Pain 1980;8:33-45.
  22. Henry JL. Relation of substance P to pain transmission: neurophysiological evidence. Ciba. Found Symp. 1982;9:206-224.
  23. Henry JL. Substance P antiinflammatory pain: potential of substance P antagonists as analgesics. Agents Actions. 1993; 41 (suppl):75-87.
  24. Hökfelt T, Kellerth O, Nilsson G, Pernow B. Substance P: localitation in the central nervous system and in some primary sensory neurons. Science 1975;190:889-891.
    Korr IM, Thomas PE, Wright HM. Symposium on the functional implications of segmental facilitation. J Amer Ostepath Assoc 1955; 54: 1-18.
  25. Kowalsky ML, SliwinskaKowalska M, Kaliner MA. Neurogenic inflammation, vascular permeability, and mast cells II. Additional evidence indicating that mast cells are not involved in neurogenic inflammation. J Immunol 1990; 145: 1214 – 21.
  26. Kumazawa T, Perl ER. Primate cutaneous receptors with unmyelinated (c) afferent projection to the substantia gelatinosa. J. Physiol Paris 1977;73:287-304.
  27. Lawrence KB, Venepalli BR, Appell KC, Goswami R, Logan ME, Tomczuk BE, Yanni JM. Synthesis and substance P antagonist activity of naphthimidazollum derivatives. J. Med Chem 1992;35:1273-1279.
  28. Lembeck F, Donnerer J, Tsuchiya M, Nagahisa A. The non-peptide tachykinin antagonist, CP-96,345, is a potent inhibitor of neurogenic inflammation. Br. J. Pharmacol. 1992;105:527-530.
  29. Le Vasseur SA, Gibson SJ, Jelme RD. The measurement of capsaicin sensitive sensory nerve fiber function in elderly patients with pain. Pain 1990; 41: 19 – 25.
  30. Light AR, Perl ER. Spinal termination of functionally identified primay afferent neurons with slowly conducting myelinated fibers. J. Comp. Neurol 1979;186:133-150.
  31. Lynn B, Shakhanbeh J. Neurogenic inflammation in the skin of the rabbit. AgentsActions 1988; 25 : 228 – 30.
  32. Mayer EA, Raybould H, Koelbel C. Neuropeptides, inflammation and motility. Dig Dis Sci 1988; 33: 71S – 77S.
  33. Morton CR, Hutchinson WD. Release of sensory neuropeptides in the spinal cord: studies with calcitonin gene-related peptide and galanin. Neuroscience 1989 31: 807 – 15.
  34. Nagahisa A, Y Kanai Y, Suga O, Taniguchi K, Tsuchiya M, Lowe JA. Antiinflammatory and analgesic activity of a non-peptide substance P receptor antagonist. Eur. J. Pharmacol. 1992;217:191-195.
  35. Nicoll RA, Schenker C and Leeman SE. Substance P as a transmitter candidate. Ann Rev. Neurosci 1980;3:227-268.
  36. Nussbaumer JC, Yanagisawa M, Otsuka M. Pharmacological properties of a C-fibre response evoked by saphenous nerve stimulation in an isolated spinal cord-nerve preparation of the newborn rat. Br. J. Pharmacol. 1989;98:373-382.
  37. Otsuka M, Yanagisawa M. Effects of a tachykinin antagonist on a nociceptive reflex in the isolated spinal cord-tail preparation of the newborn rat. J. Physiol. (Lond)1988;395:255-270.
  38. Otsuka M, Yanagisawa. Pain and neurotransmitters. Cell Mol. Neurbiol. 1990;10:293-302.
  39. Pedersen-Bejergaard U, Nielsen LB, Jensen K, Edvinsson L, Jansen I, Olesen J. Algesia and local responses indiced by neurokinin A and substance P in human skin and temporal muscle. Peptides 1989;10:1147-1152.
  40. Pedersen-Bejergaard U, Nielsen LB, Jensen K, Edvinsson L, Jansen I, Olesen J. Calcitonin gene-related peptide, neurokinin a and substance P: Effects on nociception and neurogenic inflammation in human skin and temporal muscle. Peptides 1991;12:333-337.
  41. Piercey MF, Einspahr FJ. Use of substance P partial fragments to characterize substance P receptors of cat dorsal horn neurons. Brain Res. 1980;187:481-486.
  42. Radhakrishnan V, Henry JL. Novel substance P antagonist, CP-96, 345, blocks responses of spinal dorsal horn neurons to noxious cutaneous stimulation and to substance P. Neurosci. Lett. 1991;132:39-43.
  43. Randic M, Miletic V. Effects of substance P in cat dorsal horn neurones activated by noxious stimuli. Brain Res. 1977;128:164-169.
  44. Ruda MA, Bennett, Dubner R. Neurochemistry and neural circuitry in the dorsal horn. In peptides and neurological disease. Prog. Brain Res., Vol 66 (Eds. P. C. Emson, M. Rossoe and M. Tohyama)pp. 219-268, Elsevier Science Publishers, Amsterdam 1986.
  45. Sastry BR, Substance P effects on spinal nociceptive neurones. Life Sci. 1979;24:2169-2178.
  46. Sugiura Y. LeeCL, Perl ER. Central projections of identified, unmyelinated (c) afferent fibers innervating mammalian skin. Science 1986;234:358-361.
  47. Takahashi T, Otsuka M. Regional distribution of substance P in the spinal cord and nerve roots of tha cat and the effect of dorsal root section. Brain Res. 1975;87:1-11.
  48. Theriault E, Otsuka M, Jessell T. Capsaicin-evoked release of substance P from primary sensory neurons. Brain Res. 1979;170:209-213.
  49. Thompson SWN, Woolf CJ. Primary afferent-evoked prolonged potentials in the spinal cord and their central summation :role of the NMDA receptor. In: Bond MR, Charlton JE, Woolf CJ editores. Proceedings of the VIth World Congress on Pain. Amsterdam: Elsevier 1991; 291-297.
  50. Wilcox GL. Excitatory neurotransmitters and pain. En: Bond MR, Charlton JE, Woolf CJ editores.  Proceedings of the Vith World Congress on Pain. Amsterdam: Elsevier, 1991;97-117.
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  52. Yamamoto T, Yaksh TL. Stereospecific effects of a nonpeptidic NKl selective antagonist, CP-96,345: Antinociception in the absence of motor dysfunction. Life Sci. 1991;49:1955-1963.
  53. Yashpal K, Wright DM, Henry JL. Substance P reduces tall-flick latency: implications for chronic pain syndromes. Pain 1982;14:155-167.
  54. Yashpal K, Henry JL. Endorphins mediate overshoot of substance P-induced facilitation of a spinal nociceptive reflex. Can J. Physiol. Pharmacol. 1983;61:303-307.
  55. Yashpal K, Henry JL. Substance P analogue blocks SP-induced facilitation of a spinal nociceptive reflex. Brain Res. Bull 1984;13:597-600.
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4. Riesgos

  1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006 Mar;15 Suppl 2:S192-300
  2. Cheng LFan WLiu BWang XNie L Th17 lymphocyte levels are higher in patients with ruptured than non-ruptured lumbar discs, and are correlated with pain intensity. Injury. 2013 May 13. pii: S0020-1383(13)00187-3. doi: 10.1016/j.injury.2013.04.010. [Epub ahead of print]
  3. Chou R, Huffman LH. Evaluation & Management of Low Back Pain: Evidence Review for the American Pain Society. Oregon Evidence-based Practice Center. Oregon, 2007
  4. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine 2009;34(10):1078-93
  5. Chou RBaisden JCarragee EJResnick DKShaffer WOLoeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine  2009;34(10):1094-109.
  6. Chou R, Shekelle P.Will this patient develop persistent disabling low back pain? JAMA. 2010;303(13):1295-302.
  7. da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ. 2012;184(11):E613-24.
  8. Egeland NGMoen APedersen LMBrisby HGjerstad J. Spinal nociceptive hyperexcitability induced by experimental disc herniation is associated with enhanced local expression of Csf1 and FasL. Pain. 2013 May 24. pii: S0304-3959(13)00273-X. doi: 10.1016/j.pain.2013.05.034. [Epub ahead of print]
  9. Fernandes ESFernandes MAKeeble JE. The functions of TRPA1 and TRPV1: moving away from sensory nerves. Br J Pharmacol. 2012;166(2):510-21.
  10. Förster MMahn FGockel UBrosz MFreynhagen RTölle TRBaron R. Axial low back pain: one painful area – many perceptions and mechanisms. PLoS One. 2013 Jul 2;8(7):e68273.
  11. Hayden JA, Chou R, Hogg-Johnson S, Bombardier C. Systematic reviews of low back pain prognosis had variable methods and results: guidance for future prognosis reviews. J Clin Epidemiol. 2009;62(8):781-796.
  12. Heymans MW, van Buuren S, Knol DL, Anema JR, van Mechelen W, de Vet HCW.  The prognosis of chronic low back pain is determined by changes in pain and disability in the initial period. Spine J 2010;10:847-856.
  13. Kääriä SLaaksonen MRahkonen OLahelma ELeino-Arjas P. Risk factors of chronic neck pain: a prospective study among middle-aged employees. Eur J Pain 2012 Jul;16(6):911-20.
  14. Kasai Y, Takegami K, Uchida A. Change of barometric pressure influences low back pain in patients with vacuum phenomenon within lumbar intervertebral disc. J Spinal Disord Tech. 2002;15(4):290-3.
  15. Konno S, Kikuchi S, Nagaosa Y. The relationship between intramuscular pressure of the paraspinal muscles and low back pain. Spine 1994;19(19):2186-9.
  16. Kovacs FM, Muriel A, Abraira V, et al. The influence of fear avoidance beliefs on disability and quality of life is sparse in Spanish low back pain patients. Spine 2005;30:E676-E682
  17. Kovacs FM, Abraira V, Zamora J, Fernández C and the Spanish Back Pain Research Network. The transition from acute to subacute and chronic low back pain. A study based on determinants of quality of life and prediction of chronic disability. Spine 2005;30(15):1786-1792
  18. Kovacs F, Abraira V, Santos S, et al. A Comparison of Two Short Education Programs for Improving Low Back Pain-Related Disability in the Elderly. A Cluster Randomized Controlled Trial. Spine 2007;32:1053–1059
  19. Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A etal. Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain. Spine (Phila Pa 1976 ) 2007; 32:2915-2920
  20. Kovacs FM, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, Zamora J, Gestoso M, Muriel A, Mufraggi N. The influence of psychological factors on low back pain-related disability in community-dwelling older persons. Pain Med 2008;9(7):871-880.
  21. Kovacs FM, Seco J, Royuela A, Corcoll, J, Peña A, and the Spanish Back Pain Research Network. The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients. A study in routine clinical practice within the Spanish National Health Service [NCT00502333]. Spine J 2012;12:545-555
  22. Kovacs FM, Seco J, Royuela A, Corcoll J, Abraria V and the Spanish Back Pain Research Network. Predicting the evolution of low back pain patients in routine clinical practice. Results from a registry within the Spanish National Health Service.  Spine J 2012;12:1008-1020.
  23. Marty M, Rozenberg S, Duplan B, Thomas P, Duquesnoy B, Allaert F. Quality of sleep in patients with chronic low back pain: a case-control study. Eur Spine J 2008, 17:839-844.
  24. McGorry RWHsiang SMSnook SHClancy EAYoung SL. Meteorological conditions and self-report of low back pain. Spine 1998;23(19):2096-102
  25. McLean SMMay SKlaber-Moffett JSharp DMGardiner E. Risk factors for the onset of non-specific neck pain: a systematic review. J Epidemiol Community Health. 2010 Jul;64(7):565-72.
  26. Merskey HB, Bogduk N. Detailed descriptions of pain syndromes. In: Merskey HB, Bogduk N, eds. Classification of chronic pain. Seattle, WA: IASP Press, 1994:39–58.
  27. O’Donoghue GM, Fox N, Heneghan C, Hurley DA. Objective and subjective assessment of sleep in chronic low back pain patients compared with healthy age and gender matched controls: a pilot study. BMC Musculoskelet Disord 2009 Oct 2;10:122. doi: 10.1186/1471-2474-10-122.
  28. Paksaichol AJanwantanakul PPurepong NPensri Pvan der Beek AJ. Office workers’ risk factors for the development of non-specific neck pain: a systematic review of prospective cohort studies. Occup Environ Med. 2012;69(9):610-8.
  29. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 2002;27:E109-E120.
  30. Schellingerhout JM, Heymans MW, Verhagen AP, Lewis M, de Vet HCW, Koes BW Prognosis of Patients With Nonspecific Neck Pain. Development and External Validation of a Prediction Rule for Persistence of Complaints. Spine 2010;35:E827–E835
  31. Stanton TRHenschke NMaher CGRefshauge KMLatimer JMcAuley JH. After an episode of acute low back pain, recurrence is unpredictable and not  as common as previously thought. Spine 2008;33(26):2923-8.
  32. Valenza MCValenza GGonzález-Jiménez EDe-la-Llave-Rincón AIArroyo-Morales MFernández-de-Las-Peñas C. Alteration in sleep quality in patients with mechanical insidious neck pain and whiplash-associated neck pain. Am J Phys Med Rehabil. 2012;91(7):584-91.
  33. van de Water ATEadie JHurley DA. Investigation of sleep disturbance in chronic low back pain: an age- and gender-matched case-control study over a 7-night period. Man Ther 2011;16(6):550-6.
  34. Waddell G. The Back Pain Revolution. 2 edition ed. London: Churchill-Livingstone; 2004.
  35. Zhang YGZhang FSun ZGuo WLiu JLiu MGuo X. A controlled case study of the relationship between environmental risk factors and apoptotic gene polymorphism and lumbar disc herniation. Am J Pathol. 2013;182(1):56-63.

5. Pruebas diagnósticas de imagen

  1. Arana E, Royuela A, Kovacs FM, Estremera A, Sarasíbar H, Amengual G, Galarraga I, Martínez C, Muriel A, Abraria V, Gil del Real MT, Zamora J, Campillo C. Agreement in the interpretation of 1.5T Magnetic Resonance images of the lumbar spine using the Nordic Modic Consensus Group Classification form. Radiology 2010; 254:809–817
  2. Arana E, Royuela A, Kovacs FM, Estremera A, Sarasíbar H, Amengual G, Galarraga I, Martínez C, Muriel A, Abraria V, Zamora J, Campillo C. The influence of nomenclature in the interpretation of lumbar disk contour on MRI: A comparison of the agreement using the Combined Task Force and the Nordic nomenclatures. AJNR Am J Neuroradiol 32:1143– 48 _ Jun-Jul 2011.
  3. Arana E, Kovacs FM, Royuela A, Estremera A, Asenjo B, Sarasíbar H, Amengual G, Galarraga I, Alonso A, Casillas C, Muriel A, Montoya J, Ordóñez C, Martínez C, Zamora J, Campillo C, Abraira V. Modic changes and associated features in Southern European chronic low back pain patients. Spine J 2011;11:402-411
  4. Arana E, Kovacs FM. Enfermedades dolorosas del raquis: precaución y oportunidades con las técnicas de imagen. Radiologia 2012;54:287
  5. Arana E, Ruiz-España S, Kovacs FM, Moratal D. Computer-assisted diagnosis of degenerative lumbar spine MR imaging. Neuroradiology 2012;54:S75
  6. Aprill C, Bogduk N High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 1992; 65(773): 361-9.
  7. el Barzouhi A, Vleggeert-Lankamp C, à Nijeholt GJ,Van der Kallen BF, van den Hout WB, Jacobs W,  Koes BW, Peul W, for the Leiden–The Hague Spine Intervention Prognostic Study Group. Magnetic Resonance Imaging in Follow-up Assessment of Sciatica. N Engl J Med 2013;368:999-1007.
  8. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72(3): 403-8.
  9. Boos N, Lander PH Clinical efficacy of imaging modalities in the diagnosis of low-back pain disorders. Eur Spine J 1996;5(1): 2-22.
  10. Borkan J, Reis S, Werner S, Ribak J, Prath A. Guidelines for treating low back pain in primary care (Hebrew; available in English). The Israeli Low Back Pain Guideline Group. Harfuah 1996; 130: 145-151.
  11. Carragee EJ, Hannibal M. Diagnostic evaluation of low back pain. Orthop Clin North Am. 2004; 35(1): 7-16.
  12. Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 2009; 373: 463–72.
  13. Danish Institute for Health Technology Assessment: Low back pain. Frequency, management and prevention from an HTA perspective. Danish Health Technology Assessment 1999.
  14. Deyo RA, Diehl AK. Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1998;3(3): 230-8.
  15. Dolan AL, Ryan PJ, Arden NK, Stratton R, Wedley JR, Hamann W, Fogelman I, Gibson T. The value of SPECT scans in identifying back pain likely to benefit from facet joint injection. Br J Rheumatol 1996; 35(12): 1269-73.
  16. Endean A, Palmer TK, Coggon D. Potential of Magnetic Resonance Imaging Findings to Refine Case Definition for Mechanical Low Back Pain in Epidemiological Studies. A Systematic Review. Spine 2011;36:160–169
  17. Flynn TW, Smith B, Chou R. Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good. J Orthop Sports Phys Ther. 2011;41(11):838-46.
  18. Gilbert FJ, Grant AM, Gillan MG, Vale L, Scott NW, Campbell MK, Wardlaw D, Knight D, McIntosh E, Porter RW. Does early imaging influence management and improve outcome in patients with low back pain? A pragmatic randomised controlled trial. Health Technol Assess, 2004;8(17): III, 1-131.
  19. Gilbert FJ, Grant AM, Gillan MG, Vale LD, Campbell MK, Scott NW, Knight DJ, Wardlaw D. Low back pain: influence of early MR imaging or CT on treatment and outcome–multicenter randomized trial. Radiology 2004:231(2): 343-51.
  20. Gillan MG, Gilbert FJ, Andrew JE, Grant AM, Wardlaw D, Valentine NW, Gregori AC. Influence of imaging on clinical decision making in the treatment of lower back pain. Radiology 2001;220(2): 393-9.
  21. Graves JM, Fulton-Kehoe D, Jarvik JG, Franklin GM. Early Imaging for Acute Low Back Pain.One-Year Health and Disability Outcomes Among Washington State Workers.Spine 2012 ; 37 : 1617 – 1627
  22. Gron P, Olerud HM, Einarsson G, Leitz W, Servomaa A, Schoultz BW, Hjardemaal O. A Nordic survey of patient doses in diagnostic radiology. Eur Radiol 2000;10(12): 1988-92
  23. Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, Bogduk N.  Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 2007;16:1539–1550
  24. Hollingworth W, Gray DT, Martin BI, Sullivan SD, Deyo RA, Jarvik JG. Rapid magnetic resonance imaging for diagnosing cancer-related low back pain. J Gen Intern Med 2003: 18(4): 303-12.
  25. Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA. The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine 2001; 26(10): 1158-66.
  26. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 2002; 137: 586-97.
  27. Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, Robinson D, Staiger T, Wessbecher F, Sullivan SD, Kreuter W, Deyo RA. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 2003; 289: 2810-8.
  28. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331(2): 69-73.
  29. Jensen TS, Karppinen J, Sorensen JS, et al. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 2008;17:1407-22.
  30. Joines JD, McNutt RA, Carey TS, Deyo RA, Rouhani R. Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. J Gen Intern Med 2001; 16(1): 14-23.
  31. Kanmaz B, Collier BD, Liu Y, Uzum F, Uygur G, Akansel G, Gunes I, Krasnow AZ, Hellman RS, Isitman AT, Carrera G. SPET and three-phase planar bone scintigraphy in adult patients with chronic low back pain. Nucl Med Commun 1998; 19(1): 13-21.
    Kanno H, Endo T, Ozawa H, Koizumi Y, Morozumi N, Itoi E, Ishii Y. Axial Loading During Magnetic Resonance Imaging in Patients With Lumbar Spinal Canal Stenosis. Does It Reproduce the Positional Change of the Dural Sac Detected by Upright Myelography? .Spine 2012 ; 37 : E985 – E992.
  32. Keller A, Boyle E, Skog TA, Cassidy JD, Bautz-Holter E. Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain? Eur Spine J. 2011 Aug 12. [Epub ahead of print]
  33. Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. Br Med J 2001; 322: 400-5.
  34. Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial. Health Technol Assess 2001;5(30): 1-69.
  35. Kent DL, Haynor DR, Larson EB, Deyo RA. Diagnosis of lumbar spinal stenosis in adults: a metaanalysis of the accuracy of CT, MR, and myelography. AJR Am J Roentgenol 1992; 158(5): 1135-44.
  36. Kerry S, Hilton S, Patel S, Dundas D, Rink E, Lord J. Routine referral for radiography of patients presenting with low back pain: is patients’ outcome influenced by GPs’ referral for plain radiography? Health Technol Assess 2000; 4(20): i-iv, 1-119.
  37. Kerry S, Hilton S, Dundas D, Rink E, Oakeshott P. Radiography for low back pain: a randomised controlled trial and observational study in primary care. Br J Gen Pract 2002; 52(479): 469-74.
  38. Kleinstück F, Dvorak J, Mannion AF. Are “Structural Abnormalities” on Magnetic Resonance Imaging a Contraindication to the Successful Conservative Treatment of Chronic Nonspecific Low Back Pain? Spine 2006;31:2250–2257
  39. Kovacs FM, Royuela A, Jensen TS, Estremera A, Amengual G, Muriel A, Galarraga I, Martinez C, Arana E, Sarasibar H, Salgado RM, Abraira V, López O, Campillo C, Gil del Real MT, Zamora J. Agreement in the interpretation of magnetic resonance images of the lumbar spine. Acta Radiol 2009;50(5):497-506.
  40. Kovacs FM, Arana E, Royuela A, Estremera A, Asenjo B, Sarasíbar H, Galarraga I, Alonso A, Casillas C, Muriel A, Martínez C, Abraira V. Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects. A case control study [NCT00479063]. AJNR Am J Neuroradiol 2012;33:1519-1524.
  41. Kovacs FM, Abraira V, Arana E, Royuela E, Álvarez-Galovich L, Bagó J, Peul WC, Schoene ML, Corbin TP. Concerns over the usefulness of Modic changes for recommending total disc arthroplasty. Spine 2012;11(37):1014–1015
  42. Kovacs FM, Abraira V, Arana V, Royuela A, Estremera A, Asenjo B, Sarasíbar H, Amengual G, Galarraga I, Alonso A, Casillas C, Muriel A, Montoya J, Ordóñez C, Martínez C, Zamora J, Campillo C. Re: Kääpä E, Luoma K, Pitkäniemi J, et al. Correlation of size and type of modic types 1 and 2 lesions with clinical symptoms: a descriptive study in a subgroup of patients with chronic low back pain on the basis of a university hospital patient sample. Spine;37:134-9. Spine 2012;13:1184
  43. Kovacs FM, Martínez C, Arana E, Royuela A, Estremera A, Amengual G, Asenjo B, Sarasíbar H, Galarraga I, Alonso A, Casillas C, Muriel A, Abraria V. Uncertainties in the measurement of lumbar spinal stenosis on MRI. Are they clinically relevant? Radiology 2012;2:310-311
  44. Kovacs FM, Arana E, Royuela A, Cabrera A, Casillas C, Piñero P, Vega M, Estremera A, Amengual G, Sarasíbar H, Ferrer P, Manjarrés A, Zamarro J, Bravo-Rodríguez F, Paniagua JC, Mota J, Sánchez-Sagrado T, Abraira V. Appropriateness of lumbar spine magnetic resonance imaging in Spain. Eur J Rad 82 (2013) 1008–1014
  45. Kosuda S, Kaji T, Yokoyama H, Yokokawa T, Katayama M, Iriye T, Uematsu M, Kusano S  Does bone SPECT actually have lower sensitivity for detecting vertebral metastasis than MRI? J Nucl Med 1996;37(6): 975-8.
  46. Lidar Z, Behrbalk E, RegevGJ, Salame K, Keynan O, Schweiger CH, Appelbaum L, Levy Y, Keidar A. Intervertebral Disc Height Changes After Weight Reduction in Morbidly Obese Patients and Its Effect on Quality of Life and Radicular and Low Back Pain. Spine 2012 ; 37 : 1947 – 1952
  47. Littenberg B, Siegel A, Tosteson AN, Mead T Clinical efficacy of SPECT bone imaging for low back pain. J Nucl Med 1995; 36(9): 1707-13.
  48. Miller P, Kendrick D, Bentley E, Fielding K. Cost-effectiveness of lumbar spine radiography in primary care patients with low back pain. Spine 2002; 27(20): 2291-7.
  49. Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, Rehm S Vertebral osteomyelitis: assessment using MR. Radiology 1995; 157(1): 157-66.
  50. Modic MT, NA  Obuchowski, JS Ross, Brant-Zawadzki MN, PN Grooff, DJ Mazanec, EC Benzel. Acute Low Back Pain and Radiculopathy: MR Imaging Findings and Their Prognostic. Role and Effect on Outcome1. Radiology 2005; 237:597–604
  51. Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology 2007;1:43-61
  52. Pitkanen MT, Manninen HI, Lindgren KA, Sihvonen TA, Airaksinen O, Soimakallio S. Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography. Clin Radiol  2002; 57(7): 632-9.
  53. Rankine JJ, Gill KP, Hutchinson CE, Ross ER, Williamson JB. The clinical significance of the high-intensity zone on lumbar spine magnetic resonance imaging. Spine 1999; 24(18): 1913-9; discussion 20.
  54. Roland M, van Tulder M. Should radiologists change the way they report plain radiography of the spine? Lancet 1998;352:229-230.
  55. Saal JS. General principles of diagnostic testing as related to painful lumbar spine disorders: a critical appraisal of current diagnostic techniques. Spine 2002; 27(22): 2538-45; discussion 46.
  56. Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J 1997; 6(2): 106-14.
  57. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine 1994; 19(10): 1132-7.
  58. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N.The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 1994;58(2): 195-200.
  59. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1995; 20(17): 1878-83.
  60. Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis 1995;54(2): 100-6.
  61. Schwarzer AC, Wang SC, O’Driscoll D, Harrington T, Bogduk N, Laurent R. The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine 1995; 20(8): 907-12.
  62. Smith BM, Hurwitz EL, Solsberg D, Rubinstein D, Corenman DS, Dwyer AP, Kleiner J. Interobserver reliability of detecting lumbar intervertebral disc high-intensity zone on magnetic resonance imaging and association of high-intensity zone with pain and anular disruption. Spine 1998; 23(19): 2074-80.
  63. Stadnik TW, Lee RR, Coen HL, Neirynck EC, Buisseret TS, Osteaux MJ.  Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology 1998; 206(1): 49-55.
  64. Takatalo J, Karppinen J, Niinimäki J, Taimela S, Mutanen P, Blanco Sequeiros R, PhD, Näyhä S, Järvelin MR, Kyllönen E, Tervonen O. Association of Modic Changes, Schmorl’s Nodes, Spondylolytic Defects, High-Intensity Zone Lesions, Disc Herniations, and Radial Tears With Low Back Symptom Severity Among Young Finnish Adults. Spine 2012 ; 37 : 1231 – 1239.
  65. van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK Evidence against the use of lumbar spine radiography for low back pain. Clin Radiol 2004;59(1): 69-76.
  66. van Tulder MW, Assendelft WJJ, Koes BW, Bouter LM. Spinal radiographic findings and nonspecific low back pain: a systematic review of observational studies. Spine 1997; 22: 427-34.
  67. Waris E, Eskelin M, Hermunen H, et al. Disc Degeneration in Low Back Pain. A 17-Year Follow-up Study Using Magnetic Resonance Imaging. Spine 2007;32:681–684
  68. Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 1998; 209(3): 661-6.
  69. Yamato M, Nishimura G, Kuramochi E, Saiki N, Fujioka M. MR appearance at different ages of osteoporotic compression fractures of the vertebrae. Radiat Med 1998; 16(5): 329-34.
  70. Yoshida H, Fujiwara A, Tamai K, Kobayashi N, Saiki K, Saotome K. Diagnosis of symptomatic disc by magnetic resonance imaging: T2-weighted and gadolinium-DTPA-enhanced T1-weighted magnetic resonance imaging. J Spinal Disord Tech 2002;15(3): 193-8

6. Pruebas neurofisiológicas: electromiograma

  1. De Luca CJ (1993) Use of the surface EMG signal for performance evaluation of back muscles. Muscle Nerve, 16: 210-6.
  2. Elfving B, Dedering A, Nemeth G (2003) Lumbar muscle fatigue and recovery in patients with long-term low-back trouble–electromyography and health-related factors. Clin Biomech (Bristol, Avon), 18(7): 619-30.
  3. Fisher MA (2002) Electrophysiology of radiculopathies. Clin Neurophysiol, 113(3): 317-35.
  4. Floyd WF, Silver PH (1955) The function of the erectores spinae muscles in certain movements and postures in man. J Physiol, 129(1): 184-203.
  5. Geisser ME, Haig AJ, Wallbom AS, Wiggert EA (2004) Pain-related fear, lumbar flexion, and dynamic EMG among persons with chronic musculoskeletal low back pain. Clin J Pain, 20(2): 61-9.
  6. Haig AJ (2002) Paraspinal denervation and the spinal degenerative cascade. Spine J, 2(5): 372-80.
  7. Haig AJ, Tong HC, Yamakawa KSJ, Quint DJ, Hoff JT, Chiodo A, Miner JA, Choksi VR, Geisser ME. The Sensitivity and Specificity of Electrodiagnostic Testing for the Clinical Syndrome of Lumbar Spinal Stenosis. SPINE 2005 Volume 30, Number 23, pp 2667–2676.
  8. Hodges PW (2003) Core stability exercise in chronic low back pain. Orthop Clin North Am, 34(2): 245-54.
  9. Hodges PW, Moseley G (2003) Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol, 13(4): 361-70.
  10. Mannion AF, Connolly B, Wood K, Dolan P (1997) The use of surface EMG power spectral analysis in the evaluation of back muscle function. J Rehab Res Devel, 34(4): 427-39.
  11. Mannion AF, Junge A, Taimela S, Muntener M, Lorenzo K, Dvorak J (2001a) Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy. Spine, 26(8): 920-9.
  12. Mannion AF, Taimela S, Muntener M, Dvorak J (2001b) Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength. Spine, 26(8): 897-908.
  13. Mohseni-Bandpei MA, Watson MJ, Richardson B (2000) Application of surface electromyography in the assessment of low back pain: a literature review. Physical Therapy Reviews, 5(2): 93-105.
  14. Pullman SL, Goodin DS, Marquinez AI, Tabbal S, Rubin M (2000) Clinical utility of surface EMG: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology, 55(2): 171-7.
  15. Travlos A, Trueman S, Eisen A (1995) Monopolar needle evaluation of paraspinal musculature in the cervical, thoracic, and lumbar regions and the effects of aging. Muscle Nerve, 18(2): 196-200.
  16. van Dieen JH, Selen LP, Cholewicki J (2003) Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol, 13(4): 333-51.

7. Pruebas de provocación o alivio (discografía e infiltraciones facetarias con anestésicos)

  1. Carragee EJ, Hannibal M. Diagnostic evaluation of low back pain. Orthop Clin North Am. 2004; 35(1): 7-16.
  2. Dreyfuss PH, Dreyer SJ, Herring SA. Lumbar zygapophysial (facet) joint injections. Spine 1995, 20(18): 2040-7.
  3. Manchikanti L (1999) Facet Joint Pain and the Role of Neural Blockade in Its Management. Curr Rev Pain 1999, 3(5): 348-58
  4. Revel M, Poiraudeau S, Auleley GR, Payan C, Denke A, Nguyen M, Chevrot A, Fermanian J (1998) Capacity of the clinical picture to characterize low back pain relieved by facet joint anesthesia. Proposed criteria to identify patients with painful facet joints. Spine 1998, 23(18): 1972-6; discussion 7.
  5. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine 1994; 19(10): 1132-7.
  6. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N.The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 1994;58(2): 195-200.
  7. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N.The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 1994;58(2): 195-200.
  8. Schwarzer AC, Wang SC, Bogduk N, McNaught PJ, Laurent R. Prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis 1995;54(2): 100-6.
  9. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine 1995; 20(17): 1878-83.
  10. Yoshida H, Fujiwara A, Tamai K, Kobayashi N, Saiki K, Saotome K. Diagnosis of symptomatic disc by magnetic resonance imaging: T2-weighted and gadolinium-DTPA-enhanced T1-weighted magnetic resonance imaging. J Spinal Disord Tech 2002;15(3): 193-8

8. Pruebas quiroprácticas de movilidad y palpación vertebral

  1. Hestbaek L, Leboeuf-Yde C. Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A systematic critical literature review. J Manipulative Physiol Ther 2000; 23(4): 258-75.
  2. Seffinger MA, Najm WI, Mishra SI, Adams A, Dickerson VM, Murphy LS, Reinsch S  Reliability of spinal palpation for diagnosis of back and neck pain: a systematic review of the literature. Spine 2004;29(19): E413-25.

 9. Dolor e incapacidad

  1. Hiskisson EC. Measurement of pain. Lancet 1974;2:1127-1131″
  2. Kovacs FM, Llobera J, Gil del Real MT, Abraira V, Gestoso M, Fernández C and the Kovacs-Atención Primaria Group. Validation of the Spanish version of the Roland Morris Questionnaire. Spine 2002;27:538-542.
  3. Kovacs FM, Abraira V, Zamora J, Gil del Real MT, Llobera J, Fernández C, and the Kovacs-Atención Primaria Group. Correlation between pain, disability and quality of life in patients with common low back pain. Spine: 2004;29(2):206-210.
  4. Kovacs FM, Muriel A, Abraira V, Medina JM, Castillo MD, Olabe J, and Spanish Back Pain Research Network. The influence of Fear Avoidance Beliefs on Disability and Quality of Life is sparse in Spanish low back patients. Spine 2005;30(22):E676-E682
  5. Kovacs FM. El uso del cuestionario Roland-Morris en los pacientes con lumbalgia asistidos en atención primaria. SEMERGEN 2005;31(7):331-5.
  6. Kovacs FM, Fernandez C, Cordero A, Muriel A, González-Luján L and the Spanish Back Pain Research Network. Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management. BMC Health Serv Res 2006 May 17;6:57
  7. Kovacs FM, Muriel A, Abraira V, Medina JM, Castillo MD, Olabe J, and Spanish Back Pain Research Network. Psychometric characteristics of the Spanish version of the FAB Questionnaire. Spine 2006; 31 (1): 104-110.
  8. Kovacs FM, Abraira V, Cano A, Royuela A, Gil del Real MT, Gestoso M, Mufraggi N, Muriel A, Zamora J., Spanish Back Pain Research Network. Fear avoidance beliefs do not influence disability and quality of life in Spanish elderly subjects with low back pain. Spine 2007;32:2133-2138
  9. Zamora J, Kovacs F, Abraira V, Fernández C, Lázaro P, The Spanish Back Pain Research Network. The social tariff of EQ-5D is not adequate to assess health-related Quality of Life in patients with low back pain. Qual Life Res 2007, Apr; 16(3): 523-531
  10. Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, Muriel A, Zamora J, Gil del Real MT, Gestoso M, Mufraggi N, Spanish Back Pain Research Network. Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain. Spine 2007; 32 (25): 2915-2920.
  11. Kovacs FM, Muriel A, Castillo Sánchez MD, Medina JM, Royuela A and the Spanish Back Pain Research Network. Fear avoidance beliefs influence duration of sick leave in Spanish low back pain patients. Spine 2007;32 (16):1761-1766.
  12. Kovacs FM, Noguera J, Abraira V, Royuela A, Cano A, Gil del Real MT, Zamora J, Gestoso M, Muriel A, Mufraggi N. The influence of psychological factors on low back pain-related disability in community-dwelling older persons. Pain Med 2008;9(7):871-880
  13. Kovacs FM, Bagó J, Royuela A, Seco J, Giménez S, Spanish Back Pain Research Network. Psychometric characteristics of the Spanish version of instruments to measure neck pain disability. Biomed Central Musculoskeletal 2008. 9:42 doi:10.1186/1471-2474-9-42 http://www.biomedcentral.com/1471-2474/9/42
    Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomás M, Mir MA, Cano A, Muriel A, Zamora J, Gil del Real MT, Gestoso M, Mufraggi N. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskeletal Disorders 2008, 9:43 doi:10.1186/1471-2474-9-43. http://www.biomedcentral.com/1471-2474/9/43.
  14. Kovacs FM, Seco J, Royuela A, Peña A, Muriel A and the Spanish Back Pain Research Network. The correlation between pain, catastrophizing and disability in subacute and chronic low back pain. A study in the routine clinical practice of the Spanish National Health Service. Spine 2011;36:339–345
  15. Kovacs FM, Seco J, Royuela A, Corcoll, J, Peña A, and the Spanish Back Pain Research Network. The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients. A study in routine clinical practice within the Spanish National Health Service [NCT00502333]. Spine J (in press)
  16. Moix J, Kovacs FM, Martín A, Plana MN, Royuela A, and the Spanish Back Pain Research Network. Catastrophizing, state-anxiety, anger and depressive symptoms do not correlate with disability when variations of trait-anxiety are taken into account. A study of chronic low back pain patients treated in Spanish pain units [NCT00360802]. Pain Medicine 2011; 12: 1008–1017
  17. Pincus T, Burton AK, Vogel S, Field AP (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine, 27(5): E109-20.
  18. Roland M, Morris R. A study of the natural history of back pain: Part I. Spine 1983;8:141-144

10. Información al paciente y «Programas educativos breves»

  1. ACC and the National Health Committee. New Zealand Acute Low Back Pain Guide. Wellington, New Zealand, 1997.
  2. Bigos S, Bowyer O, Braen G et al. Acute low back problems in adults. Clinical practice guideline no. 14. AHCPR publication no. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.
  3. Buhrman M, Faltenhag S, Strom L, Andersson G (2004) Controlled trial of Internet-based treatment with telephone support for chronic back pain. Pain, 111(3): 368-77.
  4. Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine 1999; 24: 2484-91.
  5. Engers A, Jellema P, Wensing M, van der Windt DAWM, Grol R, van Tulder MW. Individual patient education for low back pain. Cochrane Database of Systematic Reviews2008, Issue 1.
  6. Faas A, Chavannes AW, Koes BW, Van den Hoogen JMM, Mens JMA, Smeele IJM, Romeijnders ACM, Van der Laan JR. Clinical practice guidelines for low back pain. (Dutch, available in English). Huisarts Wet 1996;39:18-31.
  7. Frost H, Lamb SE, Doll HA, Carver PT, Stewart-Brown S (2004) Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ, 329(7468): 708.
  8. Hagen EM, Eriksen HR, Ursin H (2000) Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine, 25(15): 1973-6.
  9. Haines T, Gross A, Burnie SJ, Goldsmith CH, Perry L. Patient education for neck pain with or without radiculopathy. Cochrane Database of Systematic Reviews 2009, Issue 1.
  10. Indahl A, Haldorsen EH, Holm S, Reikeras O, Ursin H (1998) Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine, 23(23): 2625-30
  11. Karjalainen K, Malmivaara A, Pohjolainen T, Hurri H, Mutanen P, Rissanen P, Pahkajarvi H, Levon H, Karpoff H, Roine R (2003) Mini-intervention for subacute low back pain: a randomized controlled trial. Spine, 28(6): 533-40; discussion 40-1.
  12. Karjalainen K, Malmivaara A, Mutanen P, Roine R, Hurri H, Pohjolainen T (2004) Mini-intervention for subacute low back pain: two-year follow-up and modifiers of effectiveness. Spine, 29(10): 1069-76.
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11. Higiene postural, Escuelas de la Espalda y RPG

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12. Ejercicio

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  94. Van Tulder MW, Koes BW, Bouter LM (1997) Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine, 22(18): 2128-56.
  95. van Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for non-specific low back pain (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
    White AW (1966) Low back pain in men receiving workmen’s compensation. Can Med Assoc J, 95(2): 50-6.
  96. van Tulder MW, Koes B (2003) Low back pain and sciatica: chronic. Clin Evid, (9).
  97. van Tulder MW, Malmivaara A, Esmail R, al. e (2003)Exercise therapy for low back pain., The Cochrane Library: Oxford.
  98. Waller B, Lambeck J,  Daly D.  Therapeutic aquatic exercise in the treatment of low back pain: a systematic review. Clinical Rehabilitation 2009; 23: 3–14
  99. White AW (1969) Low back pain in men receiving workmen’s compensation: a follow-up study. Can Med Assoc J, 101(2): 61-7

13. Método fisioterapéutico de «cadenas musculares» o Godelieve-Denys-Struyf (GDS).

  1. Díaz Arribas M, Ramos Sánchez M, Pardo Hervás P, López Chicharro J, Angulo Carreré T, Ortega Molina P, Astasio Arbiza P. Effectiveness of the physical therapy Godelieve Denys-Struyf method for nonspecific low back pain: primary care randomized control trial. Spine 2009; 34(15): 1529-1538.

14. Mantener el mayor grado posible de actividad física

  1. ACC and the National Health Committee. New Zealand Acute Low Back Pain Guide. Wellington, New Zealand, 1997.
  2. Bekkering GE, van Tulder MW, Hendriks HJM, Oostendorp RAB, Koes BW, Ostelo RWJG, Thomassen J. Dutch physiotherapy guideline for low back pain. (KNGF richtlijn lage rugpijn) Ned Tijdschr Fysiother 2001;111 (Suppl. 3): 1-24.
  3. Bigos S, Bowyer O, Braen G et al. Acute low back problems in adults. Clinical practice guideline no. 14. AHCPR publication no. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.
  4. Borkan J, Reis S, Werner S, Ribak J, Prath A. Guidelines for treating low back pain in primary care (Hebrew; available in English). The Israeli Low Back Pain Guideline Group. Harfuah 1996; 130: 145-151.
  5. Burton AK, Waddell G, Tillotson KM, Summerton N. 1999. Information and advice to patients with back pain can have a positive effect: a randomized controlled trial of a novel educational booklet in primary care. Spine 24: 2484-2491.
  6. Danish Institute for Health Technology Assessment: Low back pain. Frequency, management and prevention from an HTA perspective. Danish Health Technology Assessment 1999.
  7. Faas A, Chavannes AW, Koes BW, Van den Hoogen JMM, Mens JMA, Smeele IJM, Romeijnders ACM, Van der Laan JR. Clinical practice guidelines for low back pain. (Dutch, available in English). Huisarts Wet 1996;39:18-31.
  8. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000; 25: 1973-6.
  9. Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low back pain and sciatica (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
  10. Keel P, Perini Ch, Schutz-Petitjean D, et al Chronicisation des douleurs du dos: problematique, issues. Rapport final du Programme National de Recherche No 26B. Bale: Editions EULAR 1996.
  11. Keel P, Weber M, Roux E, et al. Kreuzschmerzen: Hintergründe, prävention, behandlung. Basisdokumentation. Verbindung der Schweizer Ärzte (FMH), Bern, 1998.
  12. Malmivaara A, Kotilainen E, Laasonen E, Poussa M, Rasmussen M, Clinical Practice Guidelines: diseases of the low back. (Finnish, available in English) The Finnish Medical Association Duodecim 1999.
  13. Moix J, Kovacs FM,  Martín A, Plana M, Royuela A, and The Spanish Back Pain Research Network. Catastrophizing, State Anxiety, Anger, and Depressive Symptoms Do Not Correlate with Disability when Variations of Trait Anxiety Are Taken into Account. A Study of Chronic Low Back Pain Patients Treated in Spanish PainUnits. Pain Medicine 2011; 12: 1008–1017
  14. Royal College of General Practitioners. Clinical Guidelines for the Management of Acute Low Back Pain. London, Royal College of General Practitioners, 1996 and 1999.
  15. Rozenberg S, Delval C, Rezvani Y, et al. Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial. Spine 2002; 27: 1487-93.
  16. Shu-Mei Chen, Mei-Fang Liu, Jill Cook, Shona Bass, Sing Kai Lo .Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health (2009) 82:797–806
  17. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of th art. Pain 2000;85(3)::317-32
  18. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997; 47: 647-52.

15. Evitar el reposo en cama

  1. ACC and the National Health Committee. New Zealand Acute Low Back Pain Guide. Wellington, New Zealand, 1997.
  2. Bekkering GE, van Tulder MW, Hendriks HJM, Oostendorp RAB, Koes BW, Ostelo RWJG, Thomassen J. Dutch physiotherapy guideline for low back pain. (KNGF richtlijn lage rugpijn) Ned Tijdschr Fysiother 2001;111 (Suppl. 3): 1-24.
  3. Bigos S, Bowyer O, Braen G et al. Acute low back problems in adults. Clinical practice guideline no. 14. AHCPR publication no. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.
  4. Borkan J, Reis S, Werner S, Ribak J, Prath A. Guidelines for treating low back pain in primary care (Hebrew; available in English). The Israeli Low Back Pain Guideline Group. Harfuah 1996; 130: 145-151.
  5. Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6.
  6. Danish Institute for Health Technology Assessment: Low back pain. Frequency, management and prevention from an HTA perspective. Danish Health Technology Assessment 1999.
  7. Faas A, Chavannes AW, Koes BW, Van den Hoogen JMM, Mens JMA, Smeele IJM, Romeijnders ACM, Van der Laan JR. Clinical practice guidelines for low back pain. (Dutch, available in English). Huisarts Wet 1996;39:18-31.
  8. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain? Spine 2000; 25: 1973-6.
  9. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low back pain and scitatica (Cocrhane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software.
  10. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Reposo en cama para el dolor lumbar y la ciática agudos (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, número 3, 2008. Oxford, Update Software Ltd. Disponible en: http://www.update-software.com. (Traducida de The Cochrane Library, Issue . Chichester, UK: John Wiley & Sons, Ltd.).
  11. Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for low back pain and sciatica (Cochrane Review). In: The Cochrane Library, Issue 1, 2004. Chichester, UK: John Wiley & Sons, Ltd.
  12. Keel P, Perini Ch, Schutz-Petitjean D, et al Chronicisation des douleurs du dos: problematique, issues. Rapport final du Programme National de Recherche No 26B. Bale: Editions EULAR 1996.
  13. Keel P, Weber M, Roux E, et al. Kreuzschmerzen: Hintergründe, prävention, behandlung. Basisdokumentation. Verbindung der Schweizer Ärzte (FMH), Bern, 1998.
  14. Koes BW, van den Hoogen HMM. Efficacy of bed rest and orthoses of low back pain. A review of randomized clinical trials. Eur J Phys Med Rehabil 1994; 4: 86-93.
  15. Malmivaara A, Häkkinen U, Aro T, Heinrichs M, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V, Hernberg S. The treatment of acute low back pain; bed rest, exercises or ordinary activity? N Engl J Med 1995;332:351-355.
  16. Malmivaara A, Kotilainen E, Laasonen E, Poussa M, Rasmussen M, Clinical Practice Guidelines: diseases of the low back. (Finnish, available in English) The Finnish Medical Association Duodecim 1999.
  17. Moyal College of General Practitioners. Clinical Guidelines for the Management of Acute Low Back Pain. London, Royal College of General Practitioners, 1996 and 1999.
  18. Rozenberg S, Delval C, Rezvani Y, et al. Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial. Spine 2002; 27: 1487-93.
  19. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997; 47: 647-52.

16. Corsés,cinturones lumbares, plantillas y alzas

  1. Calmels P, Fayolle-Minon I (1996) An update on orthotic devices for the lumbar spine based on a review of the literature. Rev Rhum Engl Ed, 63(4): 285-91.
  2. Jellema P, van Tulder MW, van Poppel MN, Nachemson AL, Bouter LM (2001) Lumbar supports for prevention and treatment of low back pain: a systematic review within the framework of the Cochrane Back Review Group. Spine, 26(4): 377-86.
  3. Koes BW, Hoogen HMM van den. Efficacy of bed rest and orthoses of low back pain. Eur J Phys Med Rehabil 1994;4:86-93.
  4. McGill SM (1993) Abdominal belts in industry: a position paper on their assets, liabilities and use. Am Ind Hyg Assoc J, 54(12): 752-4.
  5. Negrini, MD, Minozzi, MD, Josette Bettany-Saltikov, Fabio Zaina, MD, Nachiappan Chockalingam, Theodoros B. Grivas, Tomasz Kotwicki,, Toru Maruyama, Michele Romano, and Elias S. Vasiliadis, Braces for Idiopathic Scoliosis in Adolescents. Cochrane systematic review. SPINE Volume 35, Number 13, pp 1285–1293. 2010.
  6. T Sahar, MJ Cohen, V Ne’eman, L Kandel, DO Odebiyi, I Lev, M Brezis, A Lahad. Insoles for prevention and treatment of back pain. Cochrane Database of Systematic Reviews 2007, Issue 4
  7. van Duijvenbode ICD, Jellema P, van Poppel MNM, van Tulder MW. Soporte lumbar para la prevención y el tratamiento del dolor lumbar (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2008 Número 2.

17. Tracciones

  1. Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJMG, Bronfort G, Bouter LM. Tracción para el dolor lumbar con o sin ciática (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2007 Número 4.
  2. Coxhead CE, Inskip H, Meade TW, North WR, Troup JD (1981) Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet, 1(8229): 1065-8.
  3. Larsson U, Choler U, Lidstrom A, Lind G, Nachemson A, Nilsson B, Roslund J (1980) Auto-traction for treatment of lumbago-sciatica. A multicentre controlled investigation. Acta Orthop Scand, 51(5): 791-8.
  4. Mathews JA, Hickling J (1975) Lumbar traction: a double-blind controlled study for sciatica. Rheumatol Rehabil, 14(4): 222-5.
  5. Mathews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Mathews W, Scott CM, Sittampalam Y (1987) Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. Br J Rheumatol, 26(6): 416-23.
  6. Pal B, Mangion P, Hossain MA, Diffey BL (1986) A controlled trial of continuous lumbar traction in the treatment of back pain and sciatica. Br J Rheumatol, 25(2): 181-3.
  7. Reust P, Chantraine A, Vischer TL (1988) [Treatment of lumbar sciatica with or without neurological deficit using mechanical traction. A double-blind study]. Schweiz Med Wochenschr, 118(8): 271-4.
  8. van den Hoogen HM, Koes BW, van Eijk JT, Bouter LM (1995) On the accuracy of history, physical examination, and erythrocyte sedimentation rate in diagnosing low back pain in general practice. A criteria-based review of the literature. Spine, 20(3): 318-27.
  9. van der Heijden GJ, Bouter LM, Terpstra-Lindeman E (1970) De effectiviteit van tractie bij lage rugklachten: de resultaten van een pilotstudy. Ned T Fysiotherapie, 2: 117-21.
  10. van der Heijden GJ, Beurskens AJ, Koes BW, Assendelft WJ, de Vet HC, Bouter LM (1995) The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther, 75(2): 93-104.
  11. Walker L, Svenkerud T, Weber H (1982) Traksjonsbehandling ved lumbago-ischias: en kontrollert undersolske med Spina-trac. Fysioterapeuten, 48: 161-3.

18. Fisioterapia (calor y frío, masajes, láser, onda corta, magnetoterapia, ultrasonidos y ondas de choque, corrientes interferenciales)
Serrano-Aguilar P, Kovacs FM, Cabrera-Hernández JM, Ramos-Goñi JM, García-Pérez L. Avoidable costs of physical treatments for chronic back, neck and shoulder pain within the Spanish National Health Service: a cross-sectional study

19. Corrientes interferenciales

  1. Werners R, Pynsent PB, Bulstrode CJ (1999) Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting. Spine, 24(15): 1579-84

20. Onda corta

  1. Airaksinen O, Brox JI, Cedraschi I, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal B, Ursin H, Zanoli G. . COST B13 Working Group on Guidelines for Chronic Low Back Pain. European guidelines for the management of chronic non-specific low back pain. Eur Spine J 2006 Mar;15:S192-299
  2. Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, Carragee EJ, Grabois M, Murphy DR, Resnick DK, Stanos SP, Shaffer WO, Wall EM; American Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society.Spine 2009;34(10):1066-77.

21. Termoterapia (calor o frío)

  1. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006.

22. Masajes

  1. Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk TJ, Street J, Deyo RA (2001) Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med, 161(8): 1081-8.
  2. Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, Johnson E, Erro J, Delaney K, Deyo RA. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011 Jul 5;155(1):1-9.
  3. Ernst E (1999) Massage therapy for low back pain: A systematic review. J Pain Symptom Manage, 17: 65-9.
  4. Franke A, Gebauer S, Franke K, Brockow T (2000) [Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers–a randomized controlled clinical trial in a 2 x 2 factorial design]. Forsch Komplementarmed Klass Naturheilkd, 7(6): 286-93.
  5. Furlan AD, Brosseau L, Imamura M, Irvin E (2002) Massage for low-back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine, 27(17): 1896-910.
  6. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low back pain: an updated systematic review within the framework of the Cochrane Back Review Group. Spine 2009;34(16):1669-84.
  7. Hernandez-Reif M, Field T, Krasnegor J, Theakston H (2001) Lower back pain is reduced and range of motion increased after massage therapy. Int J Neurosci, 106(3-4): 131-45.
  8. Hoehler FK, Tobis JS, Buerger AA (1981) Spinal manipulation for low back pain. Jama, 245(18): 1835-8.
  9. Hsieh CY, Phillips RB, Adams AH, Pope MH (1992) Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled trial. J Manipulative Physiol Ther, 15(1): 4-9.
  10. Hsieh LL, Kuo CH, Yen MF, Chen TH (2004) A randomized controlled clinical trial for low back pain treated by acupressure and physical therapy. Prev Med, 39(1): 168-76.
  11. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA (2001) Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine, 26(13): 1418-24.
  12. Melzack R, Vetere P, Finch L (1983) Transcutaneous electrical nerve stimulation for low back pain. A comparison of TENS and massage for pain and range of motion. Phys Ther, 63(4): 489-93.
  13. Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, Peloso PM. Massage for mechanical neck disorders Cochrane Database Syst Rev. 2012 Sep 12;9:CD004871. doi: 10.1002/14651858.CD004871.pub4.
  14. Pope MH, Phillips RB, Haugh LD, Hsieh CY, MacDonald L, Haldeman S (1994) A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine, 19(22): 2571-7.
  15. Preyde M (2000) Effectiveness of massage therapy for subacute low-back pain: a randomized controlled trial. Cmaj, 162(13): 1815-20.
  16. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain Eur Spine J. 2011 Jan;20(1):19-39. doi: 10.1007/s00586-010-1518-3. Epub 2010 Jul 18.
  17. Walach H, Guthlin C, Konig M Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med, 2003;9(6): 837-46

23. Laserterapia

  1. Basford JR, Sheffield CG, Harmsen WS (1999) Laser therapy: a randomized, controlled trial of the effects of low-intensity Nd:YAG laser irradiation on musculoskeletal back pain. Arch Phys Med Rehabil, 80(6): 647-52.
  2. Bjordal JM, Couppe C, Chow RT, Tuner J, Ljunggren EA (2003) A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiother, 49(2): 107-16.
  3. de Bie RA, Verhagen A, de Vet HCW, Lenssen T, van den Wildenberg FAJM, Kootstra A, Knipschild PG (1998) Efficacy of 904 nm laser therapy in musculoskeletal disorders. Physical Therapy Reviews, 3: 1-14.
  4. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. Lancet 2009;374:1897–1908. [Erratum in: Lancet 2010; 13;375:894.].
  5. Djavid G, Mehrdad R, Ghasemi M, Hasan-Sadeh H, Sotoodeh-Manesh A, Pouryaghoub G. Low level laser therapy in chronic low back pain. Aust J Physiother 2007; 53:155–160.
  6. Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ (2003) Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers Surg Med, 32(3): 233-8.
  7. Klein RG, Eek BC (1990) Low-energy laser treatment and exercise for chronic low back pain: double-blind controlled trial. Arch Phys Med Rehabil, 71(1): 34-7.
  8. Konstantinovic LM, Kanjuh ZM, Milovanovic AN, et al; Acute low back pain with radiculopathy: a double-blind, randomized, placebo-controlled study. Photomed Laser Surg 2010;28:553–560.
  9. Longo L, Tamburini A, Monti A. Treatment with 904 nm and 10600 nm laser of acute lumbago – double blind control-laser. J Eur Med Laser Ass 1991;3:16–19.
  10. Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub-acute low back pain. Eur Med Phys 2004;40:263–268.
  11. Soriano F, Rios R (1998) Gallium Arsenide Laser Treatment of chronic low back pain: a prospective randomised and double blind study. Laser Therapy, 10: 175-80.
  12. Toya S, Motegi M, Inomata K, Ohshiro T, Maeda T (1994) Report on a computer-randomized double-blind clinical trial to determine the effectiveness of the GaAIA (830 nm) diode laser for attenuation in selected pain groups. Laser Therapy, 6: 143-8
  13. Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther 2008; 31: 191–198.
  14. Yousefi-Nooraie R, Schonstein E, Heidari K, Rashidian A, Akbari-Kamrani M, Irani S, Shakiba B, Mortaz Hejri Sa, Mortaz Hejri So, Jonaidi A. Terapia con láser de baja intensidad para el dolor lumbar inespecífico (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2007 Número 4.

24. Ultrasonido

  1. Kovacs F, Seco S, Urrutia G. Time to cease the use of ultrasounds for treating low back pain. Annals of Family Medicine. March/April 2013, 11 (2). Published March 25, 2013
  2. John C. Licciardone, Dennis E. Minotti, Robert J., Cathleen M. Kearns, and Karan P. Singh. Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: A Randomized Controlled Trial. Ann Fam Med March/April 2013 11:122-129; doi:10.1370/afm.1468
  3. Seco J, Kovacs FM, Urrutia G. The efficacy, safety, effectiveness, and cost/effectiveness of ultrasound and shock wave therapies for low back pain: A systematic review. Spine J 2011:11:966-77
  4. Seco J, Kovacs FM, Urrútia G. Recommendations on ultrasound for low back pain: profit-driven or evidence-based? Spine J 2012;12:360 24. Estimulación eléctrica transcutánea (TENS)
  5. Al-Smadi J, Warke K, Wilson I, Cramp AF, Noble G, Walsh DM, Lowe-Strong AS (2003) A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis. Clin Rehabil, 17(7): 742-9.
  6. Brosseau L, Milne S, Robinson V, Marchand S, Shea B, Wells G, Tugwell P (2002) Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a meta-analysis. Spine, 27(6): 596-603.
  7. Cochrane Database of Systematic Reviews. (TENS) versus placebo for chronic low-back pain. 2008, Issue 4.
  8. Hsieh RL, Lee WC (2002) One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Am J Phys Med Rehabil, 81(11): 838-43.
  9. Jette AM, Delitto A (1997) Physical therapy treatment choices for musculoskeletal impairments. Phys Ther, 77(2): 145-54.
  10. Khadilkar A, Milne S, Brosseau L, Robinson V, Saginur M, Shea B, Tugwell P, Wells G.. Neuroestimulación eléctrica transcutánea (TENS) para el dolor lumbar crónico (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2007 Número 4
  11. Kroeling P, Gross A, Goldsmith CH, Houghton PE, Cervical Overview Group. Electroterapia para los trastornos cervicales (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2007 Número 4.
  12. Lehmann TR, Russell DW, Spratt KF, Colby H, Liu YK, Fairchild ML, Christensen S (1986) Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Pain, 26(3): 277-90.
  13. Milne S, Welch V, Brosseau L, Saginur M, Shea B, Tugwell P, Wells G (2001) Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. Cochrane Database Syst Rev, (2): CD003008.
  14. Philadelphia (2001) Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther, 81(10): 1641-74.
  15. Sherry E, Kitchener P, Smart R (2001) A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain. Neurol Res, 23(7): 780-4.
  16. Tsukayama H, Yamashita H, Amagai H, Tanno Y (2002) Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial. Acupunct Med, 20(4): 175-80.
  17. Yokoyama M, Sun X, Oku S, Taga N, Sato K, Mizobuchi S, Takahashi T, Morita K (2004) Comparison of percutaneous electrical nerve stimulation with transcutaneous electrical nerve stimulation for long-term pain relief in patients with chronic low back pain. Anesth Analg, 98(6): 1552-6

25. Neuroestimulación eléctrica percutánea (PENS)

  1. Ghoname EA, Craig WF, White PF, Ahmed HE, Hamza MA, Henderson BN, Gajraj NM, Huber PJ, Gatchel RJ (1999a) Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. Jama, 281(9): 818-23.
  2. Ghoname ES, Craig WF, White PF, Ahmed HE, Hamza MA, Gajraj NM, Vakharia AS, Noe CE (1999b) The effect of stimulus frequency on the analgesic response to percutaneous electrical nerve stimulation in patients with chronic low back pain. Anesth Analg, 88(4): 841-6.
  3. Hamza MA, Ghoname EA, White PF, Craig WF, Ahmed HE, Gajraj NM, Vakharia AS, Noe CE (1999) Effect of the duration of electrical stimulation on the analgesic response in patients with low back pain. Anesthesiology, 91(6): 1622-7.
  4. Hsieh RL, Lee WC (2002) One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects. Am J Phys Med Rehabil, 81(11): 838-43.
  5. Weiner DK, Rudy TE, Glick RM, Boston JR, Lieber SJ, Morrow LA, Taylor S (2003) Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults. J Am Geriatr Soc, 51(5): 599-608.
  6. White PF, Ghoname EA, Ahmed HE, Hamza MA, Craig WF, Vakharia AS (2001) The effect of montage on the analgesic response to percutaneous neuromodulation therapy. Anesth Analg, 92(2): 483-7.
  7. Yokoyama M, Sun X, Oku S, Taga N, Sato K, Mizobuchi S, Takahashi T, Morita K (2004) Comparison of percutaneous electrical nerve stimulation with transcutaneous electrical nerve stimulation for long-term pain relief in patients with chronic low back pain. Anesth Analg, 98(6): 1552-6.

26. Acupuntura

  1. Berman BM (2001) Clinical applications of acupuncture: an overview of the evidence. J Altern Complement Med, 7 Suppl 1: S111-8.
  2. Bruegger A (1990) Gesunde Koerperhaltung im Alltag. Zuerich: Bruegger Verlag.
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27. Manipulaciones vertebrales

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28. Terapia cognitiva multimodal

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29. Cirugía de la columna vertebral

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  33. Keeney BJ, Fulton-Kehoe D,. Turner JA, Wickizer TM, Chan KCh, Franklin GM. Early Predictors of Lumbar Spine Surgery After Occupational Back Injury. Results From a Prospective Study of Workers in Washington State. SPINE 2013, Volume 38, Number 11, pp 953–964
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  41. McAfee PC, Fedder IL, Saiedy S, Shucosky EM, Cunningham BW (2003b) SB Charite disc replacement: report of 60 prospective randomized cases in a US center. J Spinal Disord Tech, 16(4): 424-33.
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  44. Oliver Rivero-Arias, Helen Campbell, Alastair Gray, Jeremy Fairbank, Helen Frost, James Wilson- MacDonald for the Spine Stabilisation Trial Group. Surgical stabilisation of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomised controlled trial. BMJ, doi:10.1136/bmj.38441.429618.BF (published 23 May 2005)
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  47. Peul WC, van Houwelingen HC, van de Hout W, Brand R, Eekhol JAH, Tans JTJ, Thomeer RTWM, Koes BW Surgery versus Prolonged Conservative Treatment for Sciatica. N Engl J Med 2007;356:2245-56.
  48. Peul WC, Van den Hout WB, Brand R, Thomeer RT, Koes BW, for the Leiden-The Hague Spine-Intervention-Prognostic-Study Group. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 2008;10.1136/bmj.a143.
  49. Rihn JA, Radcliff K, Hilibrand AS, Anderson DT, Zhao W, Lurie J, Vaccaro AR, Freedman MK, Albert TJ, Weinstein JN.Does Obesity Affect Outcomes of Treatment for Lumbar Stenosis and Degenerative Spondylolisthesis?. Analysis of the Spine Patient Outcomes Research Trial (SPORT)Spine 2012 ; 37 : 1933 – 1946.
  50. Sasso RC, Kitchel SH, Dawson EG (2004) A prospective, randomized controlled clinical trial of anterior lumbar interbody fusion using a titanium cylindrical threaded fusion device. Spine, 29(2): 113-22; discussion 21-2.
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  52. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE (1997) 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine, 22(24): 2813-22.
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  55. Weinstein JN, Tosteson TD, Lurie JD, Tosteson ANA, Hanscom B, Skineer JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation. The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial JAMA. 2006;296:2441-2450
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30. Dispositivos intraespinosos

  1. Grant Skidmore, Stacey J. Ackerman, Christopher Bergin, Dan Ross, Jesse Butler, Manish Suthar, Joshua Rittenberg. Cost-effectiveness of the X-STOP® Interspinous Spacer for Lumbar Spinal Stenosis. A Comparison with Conservative Care and Laminectomy. SPINE 2011, Volume 36, Number 5, pp E345–E356.
  2. Kim DH, Shanti N, Tantorski ME, Shaw JD, Li L, Martha JF, Thomas AJ, Parazin SJ, Rencus TC, Kwon B. Association between degenerative spondylolisthesis and spinous process fracture after interspinous process spacer surgery. Spine J. 2012 Jun;12(6):466-72. Epub 2012 May 22.
  3.  Kondrashov DG, Hannibal M, Hsu KY, Zucherman JF. Interspinous Process Decompression With the X-STOP Device for Lumbar Spinal Stenosis. A 4-Year Follow-Up Study. J Spinal Disord Tech _ Volume 19, Number 5, July 2006
  4. Miller LE, Block JE. Interspinous spacer implant in patients with lumbar spinal stenosis: preliminary results of a multicenter, randomized, controlled trial. Pain Res Treat. 2012;2012:823509. Epub 2012 Feb 7.
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    PMID: 22484765Wouter A. Moojen, Mark P. Arts, Ronald H. M. A. Bartels, Wilco C. H. Jacobs, Wilco C. Peul.
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  6. Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR II, Skidmore GA, Vessa PP, Dwyer JW, Puccio ST, Cauthen JC, Ozuna RM. A Multicenter, Prospective, Randomized Trial Evaluating the X STOP Interspinous Process Decompression System for the Treatment of Neurogenic Intermittent Claudication Two-Year Follow-Up Results. SPINE 2005.Volume 30, Number 12, pp 1351–1358

31. IDET e IRFT (Electrotermoterapia intradiscal y termocoagulación intradiscal por radiofrecuencia)

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  8. Freeman BJ, Walters RM, Moore RJ, Fraser RD (2003a) Does intradiscal electrothermal therapy denervate and repair experimentally induced posterolateral annular tears in an animal model? Spine, 28(23): 2602-8.
  9. Freeman BJC, Fraser RD, Cain CMJ, Hall DJ (2003b) A randomised, double-blind, controlled efficacy study: intradiscal electrotheraml therapy (IDET) versus placebo for the treatment of chronic discogendic low back pain. Eur Spine J, 12(Suppl 1): S23.
  10. Karasek M, Bogduk N (2000) Twelve-month follow-up of a controlled trial of intradiscal thermal anuloplasty for back pain due to internal disc disruption. Spine, 25(20): 2601-7.
  11. Kleinstueck FS, Diederich CJ, Nau WH, Puttlitz CM, Smith JA, Bradford DS, Lotz JC (2003) Temperature and thermal dose distributions during intradiscal electrothermal therapy in the cadaveric lumbar spine. Spine, 28(15): 1700-8; discussion 9.
  12. Oh WS, Shim JC (2004) A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain. Clin J Pain, 20(1): 55-60.
  13. Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N (2004) A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J, 4(1): 27-35.
  14. Saal JA, Saal JS (2002) Intradiscal electrothermal treatment for chronic discogenic low back pain: prospective outcome study with a minimum 2-year follow-up. Spine, 27(9): 966-73; discussion 73-4.
  15. Urrutia G, Kovacs FM, Nishishinya B, Olabe J. Percutaneous thermocoagulation intradiscal techniques for discogenic low back pain. A systematic review. Spine 2007;32(10):1146–1154
  16. Wetzel FT, McNally TA, Phillips FM (2002) Intradiscal electrothermal therapy used to manage chronic discogenic low back pain: new directions and interventions. Spine, 27(22): 2621-6

32. Prevención entre la población general y en los trabajadores.

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33. Prevención y dolor de espalda en escolares y adolescentes

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Autor sin avatar

Pablo Padrón

Dietista y creador de RealFitness. Practico powerlifting y halterofilia y soy un apasionado del entrenamiento de fuerza, la nutrición y la salud. Entreno desde los 17 años, los primeros años caí en la mayoría de mitos del mundo del fitness, por ello, a principios de 2013 me decidí a crear esta web con la que yo mismo he podido aprender mucho mientras trato de ofrecer información de calidad con un enfoque científico.

Últimos comentarios

  1. Raul

    En el arcticulo os centrais solo en la hernia/protusion discal lumbar:
    «El dolor de espalda y la afectación sobre el recorrido del nervio ciático son los primeros síntomas»
    existiendo tambien la cervical lo que hace que estos sintomas sean totalmente diferentes…

  2. rosbert

    me sacaron de bastantes dudas gracias

  3. Vanessa Gidgett Jimenez

    Buenos dias tengo una hernia discal localizada en la L4 y L5 el doctor dice q no es necesario operar aun. Mi pregunta es si puedo tomar colágeno para recuperarme y además de eso que puedo hacer en estos momentos no estoy caminando porque se me refleja un dolor fuerte que recorre toda la pierna hasta llegar al dedo gordo por favor déjenme sus comentarios

  4. Pepito

    Una consulta, practicaba levantamiento de pesas, luego dejé de entrenar y me vino una protusión … Luego de finalizado el tratamiento se puede volver a entrenar ;(?

    • RealFitness

      Por supuesto, que se puede y se debe, pero deberías acudir a un buen fisioterapeuta y entrenador deportivo titulado con experiencia que puedan ayudarte y asesorarte para que puedas corregir tus posibles disfunciones, depurar tu técnica en los movimientos, etc.

  5. JESUS

    Tengo una protusión L4-L5. Quisiera comprar un buen libro para pacientes (no para profesionales) sobre higiene postural, ejercicios de fortalecimiento, estiramientos, etc. Se que todo ello debe ser supervisado por un profesional (de hecho todos los ejercicios que hago en el gimnasio han sido indicados por un monitor), pero me gustaría tener un libro bueno sobre la espalda.

  6. Martha Alicia Garcia Rodriguez

    al parecer y por mi resonancia tengo abombamiento de discos… acudo a la clínica del dolor una vez por mes… me aplican medicamentos… pero no veo resultados… me dicen que puedo durar así hasta 5 años… habrá un proceso más rápido?

    • David

      Busca un buen quiropráctico, en mi caso me ha ayudado bastante.Yo tengo hernia discal hace ya dos años L4 y L5 y no podía ni andar,después de buscar mucha información opté por no operarme y hasta el día de hoy casi hago vida normal. En tu caso como sólo es protrusión y aún no ha roto el anillo así que será más fácil que se recupere. El quiropráctico al que yo voy es especialista en columna vertebral y lo que hace es volver a darle movilidad a la columna. No duele, y tendrías que ir a varias sesiones…

      • Nicolas

        David donde vives o donde vive ese quiropráctico, donde consulta, muchas gracias tengo protusion L4 L5 y hernia subligamentaria posterolateral derecha en L5 S1

      • elian

        Hola David quisiera saber que tanto te ha ayudado el quiropráctico yo tengo una protusion L4 L5 y una hernia tipo extrusion osea el disco ya se reventó en L5 S1 me duele mucho mi pierna izquierda no aguanto ni a orinar mucho menos ir al baño te agradecería me ayudaras con tu informaron te dejo mi correo electrónico eliangue@gmail.com gracias te saludo desde guatemala

  7. carlos

    Hola, me diagnosticaron hernial discal 5v.1s. el unico dolor que tenia era en el gluteo derecho, cuando estaba sentado o ocostado insoportable , hace dos semana q estoy con tratamiento de un remedio llamado arcoxia 90mg.y faja aballenada , reposo ( nada de mov.raros ) practique durante 7 años aerobox …. podre volver a practicar sin llegar a una operacion ….. ahora no me duele solo una pequeña molestia pequeña nada mas .. gracias

  8. jorge olivera travieso

    Tengo dos hernias discales en l4 y l5 s1 y se me produjo por realizar ejercicios físicos con pesas y adoptar un mala postura después de varios años de ejercicios llevo 4 semanas tomando antiinflamatorios y me mandaron tratamiento de ozonoterapia rectar, llevo 9 sesiones y he mejorado pero a veces tengo dolor lumbar al levantarme o al sentarme y se me irradia dolor hacia una pierna y a veces hacia la otra por cambiar a veces una pierna y a veces la otra he estado haciendo ejercicios levantando la pierna acostado de forma lateral y levanto las piernas acostado boca arriba estirándolas hacia delante sin dolor para recuperar la fuerza perdida en la pierna izquierda que se me mantiene entumecida los 5 dedos de los pies y no puedo pararme en la punta de los pies que me aconsejan por favor después de ser corredor de 1 hora diaria y ejercicios físico he perdido la fuerza en una de las piernas.

    • RealFitness

      Lo primero que debes de hacer es ponerte en manos de un buen fisioterapeuta con titulación y experiencia y comenzar a resolver todos tus problemas de raíz. Los antiinflamatorios y la ozonoterapia no resolverán nada, solo conseguirán paliar tu dolor, pero no resolverán tus problemas. Y desde aquí no te puedo recomendar una fórmula mágica que vaya a solucionarlos, se necesita una evaluación profesional por parte de un buen fisioterapeuta y la prescripción de trabajo diario, supervisado y asistido. Fortalecer el core, mejorar la movilidad, la estabilidad lumbopélvica, higiene postural, revisión de la técnica de ejercicios de musculación o fuerza con cargas, revisión de la técnica de carrera…

      Saludos, espero tu pronta recuperación.

  9. Raquel

    Gracias ante todo,

    yo tengo una protrusión a nivel L4 y L5. Hace un par de meses me dolió bastante y se me irradio hacia abajo, también cuando empecé pilates, con ciertos estiramientos de los piramidales (por lo que me pregunto si tales estiramientos serán buenos para personas con hiperlordosis y malos en el caso de que la desviación de la vertebra vaya en sentido contrario, yo de hecho tendría hipolordosis si tal termino existiese).
    Pero mi duda principal se refiere a la conducción, tengo que traer un vehículo desde Europa a España, y me preocupa que eso pueda empeorar mi estado, el medico me dice que el dolor se me pasaria con ibuprofeno, pero a mi no me preocupa que me duela un par de días, sino que se me empeore la protrusión.

    Dados los muchos kilometros que tendría que recorrer, lo mínimo que haría seria 6-7 horas en 3 días.

    Claro que si me doliera mucho pararia mas dias, y por supuesto iria parando cada hora o dos horas a descansar.

    Pero lo que mas me preocupa es que dañe aun mas esa zona por una conducción extensiva prolongada de varios días.

    Gracias de antemano por su respuesta

    • RealFitness

      La gran mayoría de las degeneraciones de disco se suelen producir en la parte inferior de la columna vertebral en los niveles L4-L5 o L5-S1. Estás son sin duda las zonas más conflictivas de la columna. Pero es muy común tener fisuras o pequeñas protrusiones en la columna, ello no tiene porque implicar ningún dolor, la estructura no lo es todo, también es importante la función. ¿Cuándo se originó por primera vez el dolor? ¿Al levantarte de la cama? ¿Un mal gesto? ¿Levantando una carga pesada? ¿Haciendo algún ejercicio físico? ¿Permaneciendo durante mucho tiempo de pie?

      Lo contrario, de la hiperlordosis sería la hipercifosis.

      Un buen profesor de pilates debe saber guiarte sobre los ejercicios más adecuados en tu caso para fortalecer el core. El core está conformado por los abdominales, iliopsoas, lumbares, cadena posterior (glúteos, piriforme e isquiotibiales).

      Acabo de añadir una imagen al comienzo del artículo con un esquema de las curvas fisiológicas normales de la columna, cerciórate si de verdad tu fisiología no sigue ese esquema.

      Sinceramente, el ibuprofeno no va a solucionar tu problema, simplemente va a enmascararlo, necesitas fisioterapia y fortalecer toda la zona de la espalda, así como evaluar posibles disfunciones entre músculos agonistas-antagonistas, inactivación del glúteo, inestabilidad lumbopélvica… Por lo tanto, te recomiendo encarecidamente que consultes con un buen fisioterapeuta tu caso.

      Sin duda, un viaje tan largo sentada en la misma posición conduciendo no te va a favorecer nada y seguramente podrías sentir bastante incomodidad incluso dolor… Antes de hacerlo podrías acudir a un buen fisioterapeuta y comenzar tu recuperación y pedirle consejo para esta situación.

      La solución no va a ser inmediata, y pasaría por un planteamiento de fortalecimiento de esa musculatura y activación de los glúteos unidos a un elongamiento de los isquiotibiales que podrían estar acortados, gran parte de los dolores en la zona lumbar pueden deberse también a puntos gatillos en el glúteo. Por lo que estirar este o incidir con masajes miofasciales sobre este con una bola de lacrosse o foam roller puede ser interesante. También puede ser interesante incluir ejercicios como elevaciones de cadera: glute barbell bridge, hip thrust, puentes de glúteo a una pierna…

      Un saludo, espero que te recuperes, cualquier duda, seguimos por aquí.

  10. Han

    Hola elanye año pasado me detectaron.una protrusion en la.L4-L5, con fisioterapia se me paso el.dolo, empeze a practicar cheerleading y no me había dolido nada hasta ahora (luego de casi un año entrando) la postura que utilizo al levantar a las niñas es de espalda recta y solo fuerza de piernas hsta tenerla a una altura en donde el.peso lo tengo yo con otra compañera. Mi duda es si puedo seguir practicando esto pork de verdad me gusta mucho, y si es recomendable entrenar con alguna faja? En estos momentos estoy con dolor.que los estoy tratando por médicamentos y calor, no son dolores tan grave.

  11. René Murgueytio

    Me parece muy interesante y profesional la explicación brindada en este artículo.

    Muchas gracias.

  12. Rosa

    Gracias por la información es muy importante, ya que tengo una visión mas clara de la hernias discales. Tengo 3 y conseguí mucha ayuda e igualmente comparo con los resultados que tengo de varios examines y los informes médicos.

  13. Nelly

    Hace 9 meses me detectaron una protrusión L4-L5 y tenia mucho dolor mi traumatólogo me dijo que no necesitaba cirugía y me recetaba la gabapentina pero solo la tomé 1 mes porque me di cuenta que estaba embarazada ahorita tengo 8 meses y no siento dolor o molestia alguna.

    • RealFitness

      Probablemente, estés recuperada.

  14. Patricia

    Hace 12 días que estoy con protusion discal lateral foraminal izquierdo con desplazamiento posterior de la raíz.
    El dolor en la pierna izquierda es insoportable. Me han tratado ibuprofeno y flexsicamin B12. Solo mejora alivia ligeramente el dolor pero no lo elimina por completo.
    He caminado para mantenerme activa pero después de un viaje en avión de 6 horas quede en cama no soporto el dolor. Hasta me desmaye.
    Por lo que he leído aquí trataré de no llegar a la cirugía
    MI pregunta es: CÓMO ALIVIAR EL DOLOR.
    Gracias

  15. Orlando

    buen dia tengo hernia discal en L5/S1la cual no m duele casi acostado pero al levantarme 1minuto m da un fuerte calambre insoportable q recorre la pierna posterior del ciatico hasta la pantorrilla … he estado investigando sobre la terapia intradiscal con ozono q al desidratar el nucleo reduce la presion de la hernia … ahora mi inquietud es saber q uds creen q pasaria a futuro x la perdida d este colchon pulposo q originalmente traemos d fabrica ? originaria mas presion a largo plazo? o algun otro trastorno irreversible ocasionado x dicha terapia q al final valla ser peor el remedio q la enfermedad ??? … q m recomiendan ? agradezco sus comentarios x favor please

  16. Jose manuel

    Buenas noches, hace casi 8 meses que me operaron de una hernia discal en l5-s1 con una discectomia, ademas tengo otra hernia mas pequeña en l4-l5 ademas de discopatia degenerativa en l4-l5-s1, ya me encuentro mejor que antes de la operacion aunque aun tengo dolores en la espalda a todas horas casi, me gustaria saber que puedo realizar en el gimnasio ya que supongo que fortaleciendo toda la zona seria mejor para todo, gracias de antemano

    • Osvaldo

      Hola, cómo te ha ido con la enfermedad ?

  17. Amanda Lopez

    Tengo una hernia discal entré la dorsal 7 y 8 y esta tocando la médula, se me duermen las manos y aveces todo el brazo, cuando estoy sentada muchas veces se me duerme la espalda y otras veces si estoy en una cilla dura se duerme la parte de atrás por las caderas y donde le llaman el hueso de la alegría los últimos discos, al caminar me duelen mucho la parte de las plantas de los pies y los músculos de las piernas me pesan y me duelen y siento que los músculos me queman y un día me metieron una aguja en el músculo de una pierna y vi el mismísimo diablo del dolor, no me puedo parar encima de una piedrecita o algo así parecido por qué me hace mucho daño, doy un pequeño paseo y me dan muchas ganas de orinar. Me han hecho resonancia y dicen que tengo abobamiento en los discos L4y L5 y múltiples hernias dorsales la más grande es la que está tocando la médula D7 yD8.

  18. luchiano Ascua

    Hola ,tras un MRI me encontraron que tengo 3 bulging disc 2 hernias en cervical una extrusion y 2 bulging en lumbar,el dolor es insoportable a veces y lo peor es el malestar general que esto me produce,dolores desde elcuello hasta la cabeza y se extiende hasta los brazos,en la parte cervical,en la lumbar el punto del dolor es mas fuerte en el centro y va hacia los costados de las caderas,despues de unos meses de tratamientos,epidurales y quiropracticos,masages, a falta de cambios,el doctor clinico sugirio cirugia,al hablar con el cirujano y un brevee examen fisico mas ver el MRI,encontro con que no era necesaria la cirugia,el dolor continua igual cada dia,aveces intenso,a veces muy intenso….que podria hacer para mejorar el dolor???

  19. Ricardo arevalo

    Tengo problemas en mi columna discopatia del L5 al s1 me produce una esteonosis que desplaza a la raiz de s1 que puedo aser despierto muy mal y mucho dolor

  20. Alejandro

    Hola !! Buenas tardes … Me han detectado una protuberancia discal L5-S1… Llevo 20 días con dolores y tratándomelo con profesionales pero me gustaría saber si sabéis lo que suelen durar estas lesiones para poder a volver a entrenar al 100% . Gracias

  21. Ximena Diaz Barrera

    Hola me detectaron hernia discal en L5 que me afecto muy agresivamente la pierna derecha me operaron y a los 3 meses exactos me volvió a aparecer comprimiéndome la raíz del nervio de la pierna de nuevo tan fuerte como la primera vez y me volvieron a operar.
    Por que me habrá vuelto a aparecer y q puedo hacer para q no vuelva de nuevo
    Atte
    Ximena

  22. Paqui Gaitan

    Estoy operada de artrodesis L4 S1 15 meses despues sufro dolor y un fortisimo tiron y el resultado del tac dice que vuelve haber protususion en L4,es esto posible? A que se debe? Tendre que pasar por quirofano otra vez? La medicacion ya no hace efecto

  23. Nancy Velandia

    Mil gracias por esta información completa, me saco de las dudas sobre los ejercicios que puede realizar.

  24. Héctor Carbone

    Tengo una gran satisfacción de haber encontrado este material médico especializado en enfermedades de la columna que tanto afecta el cuerpo humano. Es que siendo abogado y en reclamaciones de daños y perjuicios uno se encuentra a menudo con estas situaciones y un vocabulario técnico especializado, que nos resulta chino y muy dificil de interpretar para determinar a priori hasta donde puede llegar la afección y el daño que se produce y por consiguiente el monto a reclamar por el daño causado (Me refiero a la Ley de Riesgos del Trabajo).- Muy bueno y muy apreciado estos artículos. Exitos. Atte, Dr. Héctor Carbone

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