Fala Dan,

Bem interessante esse post. O que me chamou a atenção foi em relação ao tratamento propostoino grupo que realizou a fisioterapia. Como ele não dá detalhes nesse estudo e apenas informa que foi publicado previamente, busquei a referência que ele indicou: Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.

O tratamento realizado pelos fisioterapeutas foi praticamente o de estímulo ao movimento, ou seja, me parece a reeducação do movimento normal e quebra do engrama motor alterado. Essa abordagem focou principalmente a cinesiofobia. Segue a descrição:

Patients allocated to the cognitive intervention and exercises group were treated at the Physiotherapy Department at the Rikshospitalet University Hospital. This rehabilitation program has been described previously (Brox et al., 1999, 2003). The average duration of the program was about 25 h per week for 3 weeks. During the first week, a specialist in physical medicine and rehabilitation gave a presentation to the patients describing pain receptors in the discs, facet joints, and muscles, the reflexive interplay between various structures, and the ability to suppress and reinforce various peripheral stimuli. Patients were assured that they could not do any harm to the disc (back) by engaging in ordinary activities of daily life and were told to use their backs and to not be too cautious (Indahl et al., 1995). They were challenged in physical activities previously labeled as not recommended, such as vacuum cleaning, jumping, lifting, and ball games. Patients were told to bend their back while lifting light objects and to bend their knees while lifting heavy objects. Endurance and coordination exercises were also recommended, not necessarily with the goal of increasing aerobic capacity and trunk muscle strength, but to gain confidence towards engaging in ordinary activities of daily life. An additional exercise that specifically trains the co-contraction of the deep abdominal muscles with lumbar multifidus was performed according to principles outlined by O’Sullivan et al. (1997).

Seguem as referências:
Brox JI, Friis A, Holm I, Grundnes O, Sørensen R, Lange JE, et al. Patients with chronic degenerative spinal disease–can conservative treatment reduce the waiting list for surgery? Tidsskr Nor Lægeforen 1999;119:1784–7.

Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003;28:1913–21.

o que sempre observo em vários estudos desse tipo , e nesse especificamente, é que os participantes são orientados a não realizar atividades/posturas que possam molestar o disco. Ora, isso é o que o Jeremy Lewis chama de " repouso relativo ". o que para mim muitas vezes ( e pro Jeremy tb ) é o fator principal na redução dos sintomas. Não elimino òbviamente a influencia de outras variáveis nos desfechos benéficos.