Back pain treatment is one of the most common problems in medical practice. The paper presents the theoretical and practical bases of physical therapy for people experiencing pain in the back and neck, considers in detail the main kinesiotherapy techniques used in modern rehabilitation, analyzes the principles of their selection for the most effective recovery of locomotor activity and for reduction of the severity of pain syndrome, and discusses the modes of motor activity. Hardware techniques that facilitate the implementation of complex therapeutic movements are considered separately. A rationale is provided for the importance of increasing motor activity and muscular strength and normalizing muscle tone, by restoring blood circulation and by reducing inflammation and pathological impulses from the affected spine. The possibilities of kinesiotherapy for acute and chronic nonspecific back pain, discogenic radiculopathy, and lumbar stenosis are discussed.

Low back pain is one of the most common reasons for seeking medical attention. Musculoskeletal (nonspecific) pain is the most common (90%) cause of chronic pain. Depressive and anxiety disorders, sleep disorders, mainly in the form of insomnia, which negatively affect the course of the disease, are often encountered as comorbid disorders in patients with chronic musculoskeletal low back pain (CMLBP). When managing patients, it is effective to use an integrated approach: drug therapy, kinesitherapy and psychological methods. Kinesitherapy uses various types of exercise and walking; it is important that they are performed regularly under the supervision of a specialist, excluding excessive physical and static loads. Cognitive-behavioral therapy is the most effective psychological effect in CMLBP, which should be directed not only to pain, but also to insomnia, depression and anxiety disorders. Non-steroidal anti-inflammatory drugs (NSAIDs) are used as drugs for chronic pain. It is important to take into account the presence of risk factors, concomitant diseases, interactions with other drugs. The use of etoricoxib (Arcoxia) for chronic low back pain is discussed. The author presents his own experience in managing 71 patients (average age 55) with CMLBP using kinesitherapy, psychological methods, and NSAIDs. As a result of treatment after 3 months, a significant decrease in VAS was achieved from 8 (6-8) to 2 (0-4) points (p < 0.0001), the depression decreased from 7 (5-9) to 4 (3-6) points in HADS (p = 0.002), the anxiety from 7 (5-10) to 5 (3-7) points in HADS (p = 0.0003), a decrease in disabilities according to the Oswestry question-naire from 46 (34-57.77) to 11.11 (4.44-26) percent (p < 0.0001), increase in physical activity according to IPAQ-SF from 11 (7-16) to 23 (15-26 ) points (p = 0.0002), decrease insomnia according to ISI from 12 (7-15) to 6 (2-10) points (p < 0.001), improvement in sleep quality according to PSQI from 9 (7-13) points up to 4 (2-9) points (p < 0.001). The widespread introduction of complex treatment of patients with CMLBP is of great medical and social importance.

In chronic nonspecific low back pain (CNLBP), an integrated approach is effective, which must include kinesitherapy. Unfortunately, in our country, kinesitherapy is not always used in CNLBP, ineffective methods of therapy are often used. The article presents an observation of a 55-year-old female patient who suffered from CNLBP. Magnetic resonance imaging of the lumbar spine revealed protrusions up to 4 mm at the level of L4-L5, L5-S1 segments, which were regarded as the cause of back pain. The patient was prescribed non-steroidal anti-inflammatory drugs (NSAIDs), ointments at the place of residence, limitation of physical activity was recommended, which did not have a significant positive effect. In a specialized neurological center, during manual examination, the patient showed signs of lesion of the right sacroiliac joint (SIJ), and with diagnostic and treatment blockade (with anesthetics and corticosteroids) of the right SIJ, an almost complete temporary regression of pain was noted. The patient was explained the causes of pain, the role of SIJ lesions, prolonged physical inactivity and static loads as the causes of CNLBP, the safety and effectiveness of kinesitherapy. Movalis® (meloxicam) was used as an NSAID at 15 mg per day. The patient underwent exercises to activate the gluteal muscles, rectus abdominis muscles, strengthen the back of the thigh, relieve tension from the square muscles of the lower back, and relax the hip flexor muscles. Techniques for controlling the neutral position of the spine and the walking pattern were worked out. Within 10 days, the pain completely disappeared, functional disorders on the Oswestry scale decreased from 34% to 10%. Over the next 3 months, the patient regularly performed therapeutic exercises, avoided static loads, her physical activity increased from 10 to 26 points, back pain did not bother her. The issues of the effectiveness of kinesitherapy in CNLBP are discussed. It is noted that in CNLBP, regularity of physical exercises, exclusion of abrupt and excessive movements, and static loads are of leading importance. Walking represent a highly effective method of treatment and prevention of CNLBP and should be combined with other methods of kinesitherapy. The efficacy and low risk of complications from the use of meloxicam in patients with CNLBP not only from the gastrointestinal tract, but also from the cardiovascular system are noted. The use of kinesitherapy in complex therapy can help many patients with CNLBP, in whom it has not been previously used.

The aim of this study was to evaluate the effectiveness of physical therapy (kinesiotherapy or KT) for chronic non-specific low back pain (CNSLBP) in managing pain, improving functional and emotional state, and overall physical activity. Materials and methods. The study included 71 patients (17 men and 54 women) aged 1875 years (mean age 55.09 13.0 years) with CNSLBP, of whom 34 patients received standard KT and 37 patients received enhanced KT. Patients were asked to complete the Numeric Pain Rating Scale (NPRS), the Oswestry Low Back Pain Disability Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ-SF) at baseline, after 7 days and 90 days. Results. In patients who received treatment, we observed a reduction in pain intensity as measured by the NPRS, from a score of 8 at baseline (68) to 3 (24) points after 7 days and down to 2 (04) after 3 months (p 0.0001). Depression severity decreased from 7 (59) points to 5 (37) after 7 days (p = 0.002) and 4 (36) points after 90 days (p = 0.002). Anxiety decreased from 7 (510) to 6 (48) after 7 days (p = 0.0003) and 5 (37) points after 90 days (p = 0.0003). The Oswestry Low Back Pain Disability Questionnaire score decreased from 46% (3457.77) to 28% (1235.55) after 7 days (p 0.0001), and then to 11.11% (4.4426) after 90 days (p 0.0001). Physical activity as measured by the IPAQ-SF increased from 11 (716) to 16 (1319) points after 7 days (p = 0.001) and to 23 (1526) points after 90 days (p = 0.0002). The patient group receiving enhanced KT had a more significant reduction in pain as measured by the NPRS after 7 days and 3 months (p = 0.02 and p = 0.055, respectively), depression as measured by the HADS (p 0.05), and disability as measured by the Oswestry Questionnaire (p = 0.015), accompanied by an increase in physical activity as measured by the IPAQ-SF after 90 days (p = 0.0002), as compared to the patient group receiving standard KT. Conclusion. KT not only reduces pain but also improves the functional and emotional state, and increases physical activity in patients with CNSLBP. Enhancing KT by using a personalized approach and educational programmes improves long-term treatment outcomes.

Introduction. Kinesitherapy (KT) – one of the leading areas of patient care with chronic nonspecific (musculoskeletal pain) low back pain. For chronic lumbar pain, a standard KT is commonly used, that includes group sessions with a medical specialist. Often not taking into account the individual characteristics of patients, their attitude to KT, does not use a backpain education program in combination with KT (extended KT). Physical activity and hypodynamia are compared in patients with chronic nonspecificlow back pain in standard KT and extended KT.Aim of study is to assess the effectiveness of the standard and extended KT in the enhancement of physical activity.Materials and methods. 71 patients were observed (17 men and 54 women, average age 55.09 ± 13 years) with chronic nonspecific low back pain. Patients received non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. 34 patients received a standard KT, 37 patients – an extended KT. Patients were asked to complete the Numeric Pain Rating Scale (NPRS), the Oswestry Low Back Pain Disability Questionnaire, and the International Physical Activity Questionnaire (IPAQ) at baseline, after 7 days and 90 days.Results and discussion. In the extended KT group, physical activity increased from 11 (7–16) points to 16 (13–19) points after 7 days (p = 0.001) and up to 23 (15–26) points after 3 months (p = 0.0002). There has been a statistically significant decrease in the proportion of patients with hypodynamy (p = 0.0015). There is no statistically significant increase in physical activity in the standard therapy group. The use of NSAIDs in non-specific low back pain is discussed, the effectiveness of the use of dexketoprofen (Dexalgin) during lumbar pain is noted.Conclusion. In the case of nonspecific low back pain, the extended KTimprovesphysical activity and reduce hypodynamy.