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前言： 脊柱学校源自1970年，第一所腰椎疾病学校在瑞典成立。它是由Danderyl医院的Zarichsson-Forsel开发，后来被称为瑞典后背学校，旨在帮助严重腰椎受伤的工人重返工作岗位。在北美洲盛行，传承并发展至今，迄今54年…… 在中国北京脊柱学校在2023年开设了第一家，它传承了传统的脊柱学校集教育和培训的项目，并经过了不断更新迭代，脊柱学校包含了运动（包括锻炼、体力活动和物理治疗）、知识教育、瑜伽、动手操作、中医等多学科交叉，由医生、物理治疗师、瑜伽老师、中医等为客户提供服务课程，提供个性化订制服务，通过自我学习与有效治疗干预达到自我管理脊柱健康的目的。
下背痛一年的首次发病率在6.3%到15.3%之间，一年全部发病率为1.5%-36%，下腰痛是世界范围内活动受限和工作缺勤的首要原因，并且造成巨大的经济负担。另外造成活动受限的下腰痛经常复发，复发率在24%-33%之间，慢性下腰痛发病率尤其明显女性较男性发病趋势更高，年龄增大与下腰痛发病率增高相关，下腰痛的的严重程度随年龄的增加而增加，60-65整体发病率增加，教育水平较低与下腰痛发病率相关，病程延长和预后不良有关，职业的不同与发病率有差异
美国物理治疗师协会骨科物理治疗学院与ICF分类发布的急性与腰痛干预措施：2021年修订版下腰痛临床实践指南（提供诊断、检查、干预指南） 分类中把下腰痛分为： 急性或亚急性下背痛伴随活动受限(b7101几个关节的活动度) 急性、亚急性或慢性下腰痛伴随协调性运动障碍(b7601控制复杂的自主活动) 急性下腰痛伴发相关(牵涉痛)下肢疼痛(b28015下肢疼痛) 急性、亚急性或慢性的下腰痛伴随放射痛(b2804节段性或区域性的放射痛) 急性或亚急性下腰痛伴随相关感觉障碍(b2703对刺激物的敏感度，b1522关节活动度，b1608思维功能，特指把身体症状关联到认知/设想方面的原因，b1528情感功能，特指把身体症状关联到情感方面的原因) 慢性下腰痛伴随相关的广泛性疼痛。(b2800广泛性疼痛，b1520情感适当性，b1602思想内容)
本文主要讲述的是急性亚急性下腰痛伴放射痛的诊断检查以及干预 下腰痛伴随放射痛：
腰椎间盘的髓核向后方移位，压迫神经根，导致腰部和下肢的疼痛。疼痛通常沿坐骨神经放射，从臀部经过大腿后方，向小腿和足部放射。疼痛可能会加重或缓解，取决于腰椎间盘突出的程度和位置。 急性1个月内，亚急性1-3个月 在急性期与亚急性期通常会有一些不同的症状 急性下腰痛伴放射痛临床症状： 影像学：
对于有严重的或进行性的神经功能缺损的患者，建议及时检查 CT 与 MRI，因为治疗延迟与不良预后相关。另外，如果病人可能行手术或硬膜外注射类固醇治疗，MRI(或CT，如无法行 MRI)可能有帮助。在没有这些检查时，也没有证据表明常规影像学检查会影响治疗决策或疗效。 特殊检查：
直腿抬高, 35°神经拉紧 slump测试
是一种神经张力测试，用于检测改变的神经动力学或神经组织敏感性 slump测试 直腿抬高及slump测试时可诱发或加重下肢的根性症状 急性下腰痛伴有放射痛的身体功能结构损伤和症状同样可在患有急性下腰痛伴有下肢放射痛（牵涉痛）的患者中出现，在亚急性期在中等范围下，中背部，下背部，下腰部和背部相关放射痛或感觉异常会出现，在终末范围运动时会加重，在测试时可能有下肢感觉，力量或反射的减弱伴随神经的异常。 干预 急性期： 手法治疗 Ⅰ级证据脊柱推拿手法对于患者的有些症状起到了立竿见影的效果，症状持续时间低于16天，没有膝关节以下的症状，防止功能障碍加重或者症状反复，平均接受10次能有限的减少情况恶化，且多半的可能获得满意的手法治疗效果。 A级证据 物理治疗师应使用推力或非推力关节松动来减轻急性腰痛患者的疼痛和残疾。 B级证据 物理治疗师可以使用按摩或软组织松动来缓解急性腰痛患者的短期疼痛。 对于急性下腰痛和背部相关的臀或者腿部的疼痛和功能障碍，临床医师可考虑应用推拿手法减轻疼痛和功能障碍，手法治疗推拿和松动术也可应用于急性亚急性慢性背部相关的下肢痛的患者上，促进脊柱和髋部的灵活性，减少疼痛和功能障碍 HVLA（高速低振幅） 中心化和定向练习 A级建议 应考虑在确定的方向使用重复运动、训练及规程程序，以促进集中反应，改善灵活性，以减少急性下腰痛患者的症状与相关的下肢疼痛 麦肯基（McKenzie）疗法相关文章：对90%腰痛有效的麦肯基疗法 中心化以及边缘化 牵引： D级证据 是否有疗效尚未可知，证据有相互矛盾的地方
有神经根受压的迹象，并伴有外周/末梢（神经）症状或交叉直腿抬高试验阳性的患者，它们将受益于俯卧位间歇性腰部牵引。 俯卧位牵引 下肢神经松动术： C级证据 对于亚急性和慢性下腰痛和放射痛的患者，使用下肢神经松动术以减轻疼痛和功能障碍 运动训练： 物理治疗师可以使用运动训练干预措施，包括加强躯干肌肉和耐力以及激活特定的躯干肌肉，以减轻伴有腿部疼痛的急性腰痛患者的疼痛和残疾。 动态神经肌肉稳定 患者教育和咨询： B级证据 不应该利用相关的病人教育和辅导策略直接或间接地增加与下腰疼痛相关的威胁或恐惧感，教育和辅导策略诸如: (1)提倡延长卧床休息❌❌❌ (2)提供关于病人的下腰痛具体原因的深入病理解剖方面的解释。❌❌❌ 下腰痛患者的教育和辅导策略，应强调: (1)促进了解人体脊柱的解剖/结构强度 (2)应用神经系统科学解释疼痛的感知 (3)下腰痛总体预后良好 (4)使用积极的心理应对策略减少恐惧和疼痛加剧 (5)即使正在经历痛苦，也要尽早恢复正常或职业活动(6)活动水平改善的重要性，而不只是疼痛缓解。 脊柱学校 
在大多数情况下单一的治疗对于腰痛的管理很难持久，短期缓解，长期疗效甚微，脊柱学校对于客户多方位管理腰痛提供了捷径，了解它，才能掌控它。
我们是物理治疗师，我们拒绝标准化“食谱”式的治疗，每个患者情况都是不同的，对于康复的反应也是不同的，每位患者都是独立的个体，任何康复计划都应该以患者目标为中心。物理治疗师是运动专家，我们会根据您的身体情况个性化定制诊疗方案。
SPTA致力于通过物理治疗师的实践，教育和研究，提高社会对物理治疗在国家医疗保健系统中作用的认识和理解，从而践行物理治疗行业愿景，改善人类健康和生活质量。 想要了解更多关于诊疗服务、健康科普以及术后恢复，请持续关注我们 相关文献：
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