TY  - JOUR
T1  - Non-Spesifik Bel Ağrılı Hastalarda Konvansiyonel  Fizyoterapinin Ağrı, Esneklik, Denge ve Fiziksel  Kapasite Üzerine Etkinliğinin İncelenmesi
TT  - Investigation of The Effectiveness of Conventional  Physiotherapy on Pain, Flexibility, Balance and  Physical Capacity in Patients with  Non-Specific Back Pain
AU  - Altın, Fatma Nur
AU  - Öztop, Mücahit
AU  - Şekeröz, Serbay
AU  - Aslan Telci, Emine
AU  - Yağcı, Nesrin
AU  - Sarsan, Ayşe
PY  - 2025
DA  - April
Y2  - 2025
DO  - 10.47115/jshs.1446033
JF  - Samsun Sağlık Bilimleri Dergisi
JO  - JSHS
PB  - Ondokuz Mayıs Üniversitesi
WT  - DergiPark
SN  - 2791-9722
SP  - 67
EP  - 80
VL  - 10
IS  - 1
LA  - tr
AB  - Amaç: Bel ağrısı kalıcı fonksiyonel kayıplara neden olabilen ve insanların yaklaşık %84'ünü hayatında en az bir kez etkilediği bilinen küresel sağlık sisteminin en sık karşılaştığı problemlerden biridir. Bu çalışmada, non-spesifik bel ağrısı yaşayan hastalarda konvansiyonel fizyoterapinin ağrı, esneklik, denge ve fiziksel kapasite üzerine etkisini incelemeyi amaçladık. Yöntem: Bu çalışma, hastaneye fizyoterapi ve rehabilitasyon için başvuran non-spesifik bel ağrılı 190 hasta üzerinde gerçekleştirildi. Çalışmaya dahil edilen tüm hastalara Hotpack, TENS, Terapötik Ultrasondan oluşan konvansiyonel fizyoterapi ve hastaya özel egzersiz programı üç hafta boyunca uygulandı. Fizyoterapi öncesi ve sonrasında kişilerin ağrı şiddeti Görsel Analog Skala, esneklikleri Modifiye Schober testi ve Lateral Fleksiyon testi, statik dengeleri Tek Ayak Üstünde Durma testi, fonksiyonel kapasiteleri ise Zamanlı Kalk Yürü testi ile değerlendirildi. Değerlendirmeler tedavi öncesi ve sonrası olarak iki defa gerçekleştirildi. Bulgular: Çalışmaya katılan kişilerin konvansiyonel fizyoterapi programı sonucunda GAS ile değerlendirilen aktivite ve istirahat ağrı değerlerinde, Modifiye Schober ve sağ ve sol taraf için Lateral Fleksiyon Esneklik testi ile değerlendirilen esneklik değerlerinde ve Zamanlı Kalk Yürü Testi ile değerlendirilen fonksiyonel kapasitelerinde anlamlı iyileşme görüldü (p  < 0.05). Tek Ayak Üzerinde Durma Testi ile değerlendirilen göz açık ve göz kapalı denge skorlarında ise belirgin bir iyileşme sağlanmadı (p > 0.05).   Sonuçlar ve Öneriler: Çalışmanın sonuçları konvansiyonel fizyoterapi ve spinal stabilizasyon egzersiz programının ağrı, esneklik ve fonksiyonel kapasitede anlamlı iyileşmeler sağladığını göstermiştir. Konvansiyonel fizyoterapi ve hastaya özel egzersizlerin uzun dönem etkileri ilerleyen çalışmalarda incelenmelidir.
KW  - Bel ağrısı
KW  - Konvansiyonel fizyoterapi
KW  - Egzersiz
KW  - Esneklik
KW  - Denge
N2  - Aim: Low back pain is one of the most common issues faced by the global healthcare system, known to affect approximately 84% of people at least once in their lifetime and potentially leading to persistent functional impairments. In this study, we aimed to examine the effect of conventional physiotherapy on pain, flexibility, balance and physical capacity in patients experiencing non-specific low back pain.  Method: This study was conducted on 190 patients with non-specific low back pain who presented to the hospital for physiotherapy and rehabilitation. All participants in the study underwent a conventional physiotherapy program consisting of Hotpack, TENS, and Therapeutic Ultrasound, as well as a patient specific exercise program for three weeks. Pain intensity was assessed using the Visual Analog Scale, flexibility was evaluated with the Modified Schober test and Lateral Flexion test, static balance was measured using the One-Leg Stand Test, and functional capacity was assessed using the Timed Up and Go Test before and after physiotherapy. All evaluations were made two times as before and after treatment. Results: Significant improvements were observed in the activity and rest pain scores assessed with the GAS, flexibility values assessed with the Modified Schober test and the right and left Lateral Flexion Flexibility tests, and functional capacity evaluated with the Timed Up and Go Test (p  < 0.05) in participants who underwent the conventional physiotherapy program. However, no significant improvement was observed in the balance scores evaluated with the One-Leg Stand Test, both with eyes open and eyes closed (p > 0.05). Conclusions and Suggestions: The results of the study demonstrated that the conventional physiotherapy and spinal stabilization exercise program provided significant improvements in pain, flexibility, and functional capacity. The longterm effects of conventional physiotherapy and patient specific exercise should be investigated in future studies.
CR  - Airaksinen, O., Brox, J. I., Cedraschi, C., Hildebrandt, J., Klaber-Moffett, J., Kovacs, F., ... & COST B13 Working Group on Guidelines for Chronic Low Back Pain. (2006). European guidelines for the management of chronic nonspecific low back pain. European Spine Journal, 15(Suppl 2), s192. https://doi.org/10.1007/s00586-006-1072-1
CR  - Akyol, Y., Durmuş, D., Alayli, G., Tander, B., Ulus, Y., & Cantürk, F. (2009). Lomber Spinal Stenozlu Hastalarda Fizik Tedavi Ajanlarının Etkinliği. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, 55(4). https://ftrdergisi.com/uploads/sayilar/232/buyuk/141-1462.pdf.
CR  - Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), 482-491. https://doi.org/10.1016/S0140-6736(11)60610-7
CR  - Briggs, R. C., Gossman, M. R., Birch, R., Drews, J. E., & Shaddeau, S. A. (1989). Balance performance among noninstitutionalized elderly women. Physical Therapy, 69(9), 748-756. https://doi.org/10.1093/ptj/69.9.748
CR  - Bennie, S., Bruner, K., Dizon, A., Fritz, H., Goodman, B., & Peterson, S. (2003). Measurements of balance: comparison of the ‘Time Up and Go’ test and Functional Reach test with the Berg Balance Scale. Journal of Physical Therapy Science, 15(2), 93-97. https://doi.org/10.1589/jpts.15.93
CR  - Campbell, T. S., Johnson, J. A., & Zernicke, K. A. (2020). Gate control theory of pain. In Encyclopedia of behavioral medicine (pp. 914-916). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-39903-0_1134
CR  - Chen, H. M., Wang, H. H., Chen, C. H., & Hu, H. M. (2014). Effectiveness of a stretching exercise program on low back pain and exercise self-efficacy among nurses in Taiwan: a randomized clinical trial. Pain Management Nursing, 15(1), 283-291. https://doi.org/10.1016/j.pmn.2012.10.003
CR  - Chou, R., Côté, P., Randhawa, K., Torres, P., Yu, H., Nordin, M., ...Cedraschi, C. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low-and middle-income communities. European Spine Journal, 27, 851-860. https://doi.org/10.1007/s00586-017-5433-8
CR  - Coşkun, G., & Can, F. (2012). Kronik bel ağrısında dinamik ve statik stabilizasyon egzersizlerinin ağrı ve fonksiyonel düzeye etkileri. Fizyoterapi Rehabilitasyon, 23(2), 65-72. https://dergipark.org.tr/tr/download/article-file/138072
CR  - Demoulin, C., Distree, V., Tomasella, M., Crielaard, J. M., & Vanderthommen, M. (2007, November). Lumbar functional instability: a critical appraisal of the literature. In Annales De Readaptation Et De Medecine Physique, Vol. 50, No. 8, pp. 677-684. https://doi.org/10.1016/j.annrmp.2007.05.007
CR  - Ebadi, S., Ansari, N. N., Henschke, N., Naghdi, S., & van Tulder, M. W. (2011). The effect of continuous ultrasound on chronic low back pain: protocol of a randomized controlled trial. BMC musculoskeletal disorders, 12, 1-6. http://www.biomedcentral.com/1471-2474/12/59
CR  - Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ...  Woolf, A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383. https://doi.org/10.1016/S0140-6736(18)30489-6
CR  - Gur Kabul, E., Basakci Calik, B., Oztop, M., & Cobankara, V. (2021). The efficacy of manual soft‐tissue mobilization in ankylosing spondylitis: A randomized controlled study. International Journal of Rheumatic Diseases, 24(3), 445-455. https://doi.org/10.1111/1756-185X.14072
CR  - Haladay, D. E., Miller, S. J., Challis, J., & Denegar, C. R. (2013). Quality of systematic reviews on specific spinal stabilization exercise for chronic low back pain. Journal of orthopaedic & sports physical therapy, 43(4), 242-250.  https://www.jospt.org/doi/10.2519/jospt.2013.4346
CR  - Hoy, D., March, L., Brooks, P., Woolf, A., Blyth, F., Vos, T., & Buchbinder, R. (2010). Measuring the global burden of low back pain. Best Practice & Research Clinical Rheumatology, 24(2), 155-165. https://doi.org/10.1016/j.berh.2009.11.002
CR  - Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., ... Buchbinder, R. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals Of The Rheumatic Diseases, 73(6), 968-974. https://doi.org/10.1136/annrheumdis-2013-204428
CR  - John, J. N., Ugwu, E. C., Okezue, O. C., Ekechukwu, E. N. D., Mgbeojedo, U. G., John, D. O., & Ezeukwu, A. O. (2023). Kinesiophobia and associated factors among patients with chronic non-specific low back pain. Disability and Rehabilitation, 45(16), 2651-2659. https://doi.org/10.1080/09638288.2022.2103747
CR  - Jordan, J. L., Konstantinou, K., & O'Dowd, J. (2011). Herniated lumbar disc. BMJ Clinical Evidence. 2011, 1118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275148/
CR  - Jorgensen, J. E., Afzali, T., & Riis, A. (2018). Effect of differentiating exercise guidance based on a patient’s level of low back pain in primary care: a mixed-methods systematic review protocol. BMJ Open, 8(1), e019742. https://doi.org/10.1136/bmjopen-2017-019742
CR  - Khadilkar, A., Milne, S., Brosseau, L., Wells, G., Tugwell, P., Robinson, V., ... & Saginur, M. (2005). Transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a systematic review. Spine, 30(23), 2657-2666. DOI: 10.1097/01.brs.0000188189.21202.0f
CR  - Kulaber, A., Yılmaz, H., & Yavuzer, M. G. (2019). Kronik Bel ağrılı Hastalarda Fizyoterapi Uygulamalarının Etkinliği. Haliç Üniversitesi Sağlık Bilimleri Dergisi, 2(1), 17-28 https://dergipark.org.tr/en/pub/husagbilder/issue/43841/435132
CR  - Luoto, S., Aalto, H., Taimela, S., Hurri, H., Pyykkö, I., & Alaranta, H. (1998). One-footed and externally disturbed two-footed postural control in patients with chronic low back pain and healthy control subjects: A controlled study with follow-up. Spine, 23(19), 2081-2089. https://doi.org/10.1097/00007632-199810010-00008
CR  - Macrae, I. F., & Wright, V. (1969). Measurement of back movement. Annals of the rheumatic diseases, 28(6), 584. https://doi.org/10.1136/ard.28.6.584
CR  - Marshall, L. M., Litwack-Harrison, S., Cawthon, P. M., Kado, D. M., Deyo, R. A., Makris, U. E., ... & Study of Osteoporotic Fractures (SOF) Research Group. (2016). A prospective study of back pain and risk of falls among older community-dwelling women. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 71(9), 1177-1183. https://doi.org/10.1093/gerona/glv225
CR  - Meziat Filho, N., Coutinho, E. S., & Azevedo e Silva, G. (2015). Association between home posture habits and low back pain in high school adolescents. European Spine Journal, 24, 425-433. https://doi.org/10.1007/s00586-014-3571-9
CR  - Mordeniz, C., & Sıvacı, R. (2010). Kronik bel ağrısında medikal tedavi (Derleme). Kocatepe Tıp Dergisi, 11(1), 43-55. https://doi.org/10.18229/ktd.88204
CR  - Nieminen, L. K., Pyysalo, L. M., & Kankaanpää, M. J. (2021). Prognostic factors for pain chronicity in low back pain: a systematic review. Pain reports, 6(1), e919. https://doi.org/10.1097/PR9.0000000000000919
CR  - Ocak, F. D. M., Karaaslan, M., Tutar, İ., Konuralp, N., Guzelant, A., & Özgüzel, H. (2007). Lomber Disk Hernilerinde Konservatif Tedavi Etkinliğinin Klinik Parametreler ve Manyetik Rezonans Görüntüleme Yöntemi İle Değerlendirilmesi. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, 53(3). https://research.ebsco.com/c/jsxlxs/viewer/pdf/37ziol57zb
CR  - Otman, S. A., & Köse, N. (2008). Antropometrik Ölçümler: Tedavi Hareketlerinde Temel Değerlendirme Prensipleri. Yücel Ofset Yayınları, Ankara.
CR  - Panjabi, M. M. (1992). The stabilizing system of the spine. Part I. Function, dysfunction, adaptation, and enhancement. Journal of Spinal Disorders, 5, 383-383. https://doi.org/10.1097/00002517-199212000-00001
CR  - Picavet, H. S. J., & Schouten, J. S. A. G. (2003). Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC3-study. Pain, 102(1-2), 167-178 https://doi.org/10.1016/s0304-3959(02)00372-x
CR  - Quittan, M. (2002). Management of back pain. Disability and Rehabilitation, 24(8), 423-434. https://doi.org/10.1080/09638280110108850
CR  - Rasmussen-Barr, E., Nilsson-Wikmar, L., & Arvidsson, I. (2003). Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. Manual Therapy, 8(4), 233-241. https://doi.org/10.1016/S1356-689X(03)00053-5
CR  - Sadler, S. G., Spink, M. J., Ho, A., De Jonge, X. J., & Chuter, V. H. (2017). Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskeletal Disorders, 18, 1-15. https://doi.org/10.1186/s12891-017-1534-0
CR  - Sakulsriprasert, P., Vachalathiti, R., & Kingcha, P. (2021). Association among pain, disability, and functional capacity in patients with chronic non-specific low back pain: A cross-sectional study. Journal of Back and Musculoskeletal Rehabilitation, 34(1), 149-157. https://doi.org/10.3233/BMR-200168
CR  - Shahbandar, L., & Press, J. (2005). Diagnosis and nonoperative management of lumbar disk herniation. Operative Techniques in Sports Medicine, 13(2), 114-121. https://doi.org/10.1053/j.otsm.2005.08.002
CR  - Sikiru, L., & Hanifa, S. (2010). Prevalence and risk factors of low back pain among nurses in a typical Nigerian hospital. African Health Sciences, 10(1), 26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895788
CR  - Stankovic, A., Lazovic, M., Kocic, M., Dimitrijevic, L., Stankovic, I., Zlatanovic, D., & Dimitrijevic, I. (2012). Lumbar stabilization exercises in addition to strengthening and stretching exercises reduce pain and increase function in patients with chronic low back pain: randomized clinical open-label study. Turkish Journal of Physical Medicine & Rehabilitation/Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi, 58(3). DOI: 10.4274/tftr.22438
CR  - Suni, J. H., Oja, P., Miilunpalo, S. I., Pasanen, M. E., Vuori, I. M., & Bös, K. (1998). Health-related fitness test battery for adults: associations with perceived health, mobility, and back function and symptoms. Archives Of Physical Medicine And Rehabilitation, 79(5), 559-569 https://doi.org/10.1016/S0003-9993(98)90073-9
CR  - Sung, P. S. (2003). Multifidi muscles median frequency before and after spinal stabilization exercises. Archives of Physical Medicine And Rehabilitation, 84(9), 1313-1318. https://doi.org/10.1016/S0003-9993(03)00139-4
CR  - Şahin, N., Albayrak, İ., Karahan, A. Y., & Uğurlu, H. (2011). Kronik bel ağrılı hastalarda fizik tedavinin etkinliği. Genel Tıp Derg, 21(1), 17-20. https://research.ebsco.com/c/jsxlxs/viewer/pdf/ztby24yuy5
CR  - Tariq, N., Khan, Z., & Veqar, Z. (2023). Effect of whole-body vibration on balance or proprioception in nonspecific chronic low back pain: A systematic review. Journal of Chiropractic Medicine, 22(4), 284-293. https://doi.org/10.1016/j.jcm.2023.04.006
CR  - Teixeira, A. L. S., da Silva, N. F., & da Silva Filho, E. M. (2017). Evaluation of functional disability and pain in patients with chronic low back pain submitted to physiotherapy. Manual Therapy, Posturology & Rehabilitation Journal, 14, 0-0. http://dx.doi.org/10.17784/mtprehabjournal.2016.14.374
CR  - Van Tulder, M. W., Koes, B. W., & Bouter, L. M. (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), 2128-2156. https://journals.lww.com/spinejournal/fulltext/1997/09150/Conservative_Treatment_of_Acute_and_Chronic.12.aspx
CR  - Van Tulder, M., Koes, B., & Bombardier, C. (2002). Low back pain. Best Practice & Research. Clinical Rheumatology, 16(5), 761–775. https://doi.org/10.1053/berh.2002.0267
CR  - Wertli, M. M., Eugster, R., Held, U., Steurer, J., Kofmehl, R., & Weiser, S. (2014). Catastrophizing—a prognostic factor for outcome in patients with low back pain: a systematic review. The Spine Journal, 14(11), 2639-2657. https://doi.org/10.1016/j.spinee.2014.03.003
CR  - Yağcı, N., Cavlak, U., Baskan, E., & Öztop, M. (2020). Geriatrik bireylerde bel ağrısı riski. Cukurova Medical Journal, 45(2), 421-427. https://doi.org/10.17826/cumj.641324
CR  - Yilmaz Yelvar, G. D., Çırak, Y., Dalkılınç, M., Parlak Demir, Y., Guner, Z., & Boydak, A. (2017). Is physiotherapy integrated virtual walking effective on pain, function, and kinesiophobia in patients with non-specific low-back pain? Randomised controlled trial. European Spine Journal, 26, 538-545. https://doi.org/10.1007/s00586-016-4892-7
UR  - https://doi.org/10.47115/jshs.1446033
L1  - https://dergipark.org.tr/tr/download/article-file/3767559
ER  -