{"id":6427,"date":"2023-06-06T14:41:49","date_gmt":"2023-06-06T14:41:49","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/differentiating-inflammatory-and-mechanical-back-pain-fr\/"},"modified":"2023-06-06T14:45:32","modified_gmt":"2023-06-06T14:45:32","slug":"differentiating-inflammatory-and-mechanical-back-pain-fr","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/fr\/differentiating-inflammatory-and-mechanical-back-pain-fr\/","title":{"rendered":"Diff\u00e9rencier les maux de dos d\u2019origine inflammatoire des maux de dos d\u2019origine m\u00e9canique"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\"> <b>\u00c9ditrice originale <\/b>&#8211;  <a href=\"\/User:Jess_Bell\" title=\"User:Jess Bell\">Jess Bell<\/a> <b>Principaux contributeurs<\/b>  &#8211;  <a href=\"\/User:Jess_Bell\" class=\"mw-userlink\" title=\"User:Jess Bell\"><bdi>Jess Bell<\/bdi><\/a>,  <a href=\"\/User:Kim_Jackson\" class=\"mw-userlink\" title=\"User:Kim Jackson\"><bdi>Kim Jackson<\/bdi><\/a>,  <a href=\"\/User:Tarina_van_der_Stockt\" class=\"mw-userlink\" title=\"User:Tarina van der Stockt\"><bdi>Tarina van der Stockt<\/bdi><\/a>,  <a href=\"\/User:Lucinda_hampton\" class=\"mw-userlink\" title=\"User:Lucinda hampton\"><bdi>Lucinda Hampton<\/bdi><\/a> et <a href=\"\/User:Ewa_Jaraczewska\" class=\"mw-userlink\" title=\"User:Ewa Jaraczewska\"><bdi>Ewa Jaraczewska<\/bdi><\/a><\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input type=\"checkbox\" role=\"button\" id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display:none\"><\/p>\n<div class=\"toctitle\" lang=\"en\" dir=\"ltr\">\n<h2 id=\"mw-toc-heading\">Contenu<\/h2>\n<p><span class=\"toctogglespan\"><label class=\"toctogglelabel\" for=\"toctogglecheckbox\"><\/label><\/span><\/p>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduction<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Red_Flags\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">Les drapeaux rouges<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-3\"><a href=\"#Subjective_Assessment\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">\u00c9valuation subjective<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-4\"><a href=\"#Timeline_of_Pain\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">La chronologie de la douleur<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Aggravating_or_Easing_Factors\"><span class=\"tocnumber\">3.2<\/span> <span class=\"toctext\">Les facteurs aggravants ou att\u00e9nuants<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-6\"><a href=\"#24_Hour_Pain_Pattern\"><span class=\"tocnumber\">3.3<\/span> <span class=\"toctext\">Le sch\u00e9ma de la douleur sur 24 heures<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-7\"><a href=\"#Family_History\"><span class=\"tocnumber\">3.4<\/span> <span class=\"toctext\">L&rsquo;histoire familiale<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-8\"><a href=\"#Other_Issues\"><span class=\"tocnumber\">3.5<\/span> <span class=\"toctext\">Autres questions<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-9\"><a href=\"#Biopsychosocial_Model\"><span class=\"tocnumber\">3.6<\/span> <span class=\"toctext\">Le mod\u00e8le biopsychosocial<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-10\"><a href=\"#Objective_Assessment\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">\u00c9valuation objective<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-11\"><a href=\"#Summary\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">R\u00e9sum\u00e9<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-12\"><a href=\"#References\"><span class=\"tocnumber\">6<\/span> <span class=\"toctext\">R\u00e9f\u00e9rences<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span class=\"mw-headline\" id=\"Introduction\">Introduction<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=1\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=1\" title=\"Edit section: Introduction\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Le mal de dos (y compris les <a href=\"\/Neck_Pain:_Clinical_Practice_Guidelines\" title=\"Neck Pain: Clinical Practice Guidelines\">douleurs cervicales<\/a>, <a href=\"\/Thoracic_Back_Pain\" title=\"Thoracic Back Pain\">thoraciques<\/a> et <a href=\"\/Low_Back_Pain\" title=\"Low Back Pain\">lombaires<\/a>) est une condition fr\u00e9quemment rencontr\u00e9e dans la pratique de la physioth\u00e9rapie. Les douleurs cervicales et lombaires ont \u00e9t\u00e9 identifi\u00e9es comme la principale cause d&rsquo;invalidit\u00e9 globale en 2015 dans la plupart des pays. <sup id=\"cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\">(1)<\/a><\/sup> La pr\u00e9valence de la lombalgie au cours de la vie est estim\u00e9e \u00e0 84 %, tandis que la pr\u00e9valence de la lombalgie chronique est d&rsquo;environ 23 %. De plus, entre 11 et 12 % de la population est consid\u00e9r\u00e9e comme handicap\u00e9e par la lombalgie.<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\">(2)<\/a><\/sup><\/p>\n<p>La majorit\u00e9 des patients pr\u00e9sentant des maux de dos seront class\u00e9s comme souffrant de maux de dos m\u00e9caniques non sp\u00e9cifiques<sup id=\"cite_ref-:0_3-0\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><sup id=\"cite_ref-4\" class=\"reference\"><a href=\"#cite_note-4\">(4)<\/a><\/sup> (c&rsquo;est-\u00e0-dire de douleur au niveau de la colonne vert\u00e9brale), les <a href=\"\/Intervertebral_disc\" title=\"Intervertebral disc\">disques intervert\u00e9braux<\/a> et les tissus mous environnants &#8211; comprenant <a href=\"\/Muscle_Strain\" title=\"Muscle Strain\">claquage musculaire<\/a>, <a href=\"\/Disc_Herniation\" title=\"Disc Herniation\">hernie discale<\/a>, <a href=\"\/Lumbar_Spondylosis\" title=\"Lumbar Spondylosis\">spondylose lombaire<\/a>, <a href=\"\/Spondylolisthesis\" title=\"Spondylolisth\u00e9sis\">spondylolisth\u00e9sis,<\/a> <a href=\"\/Insufficiency_Fracture\" title=\"Insufficiency Fracture\">fractures par compression vert\u00e9brale<\/a>, etc.)<sup id=\"cite_ref-:4_5-0\" class=\"reference\"><a href=\"#cite_note-:4-5\">(5)<\/a><\/sup> Cependant, il est essentiel de pouvoir identifier les patients qui n&rsquo;entrent pas dans cette cat\u00e9gorie, y compris ceux qui souffrent de maux de dos d&rsquo;origine inflammatoire.<sup id=\"cite_ref-:0_3-1\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup> Cette page met en \u00e9vidence certaines caract\u00e9ristiques cl\u00e9s qui peuvent aider \u00e0 diff\u00e9rencier les maux de dos d&rsquo;origine m\u00e9canique des conditions inflammatoires. Elle aborde \u00e9galement d&rsquo;autres caract\u00e9ristiques qui constituent des <a href=\"\/The_Flag_System\" title=\"The Flag System\">drapeaux rouges<\/a> et qui doivent toujours \u00eatre prises en compte.<\/p>\n<h2><span class=\"mw-headline\" id=\"Red_Flags\">Drapeaux rouges <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=2\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Red Flags\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=2\" title=\"Edit section: Red Flags\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Lors de l&rsquo;\u00e9valuation des patients souffrant de maux de dos, il est n\u00e9cessaire d&rsquo;examiner d&rsquo;abord s&rsquo;il existe des drapeaux rouges.<sup id=\"cite_ref-:0_3-2\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup> Seul un pour cent environ de toutes les pr\u00e9sentations musculo-squelettiques en soins primaires sera d\u00fb \u00e0 une pathologie grave (telle qu&rsquo;une infection rachidienne, un <a href=\"\/Cauda_Equina_Syndrome\" title=\"Syndrome de la queue de cheval\">syndrome de queue de cheval<\/a>, une fracture vert\u00e9brale ou une <a href=\"\/Spinal_Malignancy\" title=\"Tumeurs malignes au niveau de la colonne vert\u00e9brale\">tumeur maligne<\/a>).<sup id=\"cite_ref-:1_6-0\" class=\"reference\"><a href=\"#cite_note-:1-6\">(6)<\/a><\/sup> Toutefois, comme le souligne Finucane, ces pathologies doivent \u00eatre consid\u00e9r\u00e9es comme diagnostics diff\u00e9rentiels lorsque des personnes se pr\u00e9sentent avec des maux de dos, en particulier si le patient ne r\u00e9agit pas comme pr\u00e9vu ou si son \u00e9tat commence \u00e0 s&rsquo;aggraver.<sup id=\"cite_ref-:1_6-1\" class=\"reference\"><a href=\"#cite_note-:1-6\">(6)<\/a><\/sup><\/p>\n<p>Les <a href=\"\/An_Introduction_to_Red_Flags_in_Serious_Pathology\" title=\"Une introduction aux drapeaux rouges pour les pathologies graves\">drapeaux rouges<\/a> sont d\u00e9finis comme suit : \u00ab\u00a0des signes et des sympt\u00f4mes qui font suspecter une pathologie grave de la colonne vert\u00e9brale\u00a0\u00bb. <sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup> Ils sont identifi\u00e9s lors de l&rsquo;\u00e9valuation subjective et objective d&rsquo;un patient.<\/p>\n<p>Les drapeaux rouges les plus courants sont les suivants <sup id=\"cite_ref-:1_6-2\" class=\"reference\"><a href=\"#cite_note-:1-6\">(6)<\/a><\/sup><\/p>\n<ul>\n<li>\u00c2ge sup\u00e9rieur \u00e0 50 ans<\/li>\n<li>Sympt\u00f4mes progressifs<\/li>\n<li><a href=\"\/Thoracic_Back_Pain\" title=\"Thoracic Back Pain\">Douleur thoracique<\/a><\/li>\n<li>Ant\u00e9c\u00e9dents de <a href=\"\/Cancer_Pain\" title=\"Cancer Pain\">cancer<\/a><\/li>\n<li>Perte de poids<\/li>\n<li><a href=\"\/Intraveneous_Drug_Abuse\" title=\"Intraveneous Drug Abuse\">Abus de drogues<\/a><\/li>\n<li>Douleur nocturne<\/li>\n<li>Malaise syst\u00e9mique (fi\u00e8vre)<\/li>\n<li>Sueurs nocturnes<\/li>\n<\/ul>\n<p>D&rsquo;autres points importants sont \u00e0 prendre en consid\u00e9ration :<\/p>\n<ul>\n<li>La pr\u00e9sence ou l&rsquo;absence de traumatisme &#8211; peut-il y avoir une <a href=\"\/Fracture\" title=\"Fracture\">fracture<\/a> ou un risque de fracture <a href=\"\/Osteoporotic_Vertebral_Fractures\" title=\"Osteoporotic Vertebral Fractures\">ost\u00e9oporotique <\/a>?<\/li>\n<li>La douleur peut-elle provenir des organes visc\u00e9raux ? Un <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/physio-pedia.com\/Abdominal_Aortic_Aneurysm\">an\u00e9vrisme de l&rsquo;aorte abdominale<\/a> ou un probl\u00e8me au <a href=\"\/Chronic_Kidney_Disease\" title=\"Chronic Kidney Disease\">rein<\/a> peuvent, par exemple, tous deux provoquer une lombalgie. <sup id=\"cite_ref-:0_3-3\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/li>\n<\/ul>\n<p>Bien qu&rsquo;elle s&rsquo;adresse aux m\u00e9decins, la vid\u00e9o suivante r\u00e9sume les principaux drapeaux rouges dans les situations de lombalgie.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\" style=\"\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/NM9wJpC6X7M?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"true\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\">(8)<\/a><\/sup><\/p>\n<ul>\n<li>Pour plus d&rsquo;informations sur les drapeaux rouges, <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/www.physio-pedia.com\/An_Introduction_to_Red_Flags_in_Serious_Pathology\">cliquez ici<\/a>.<\/li>\n<li>Pour plus d&rsquo;informations sur les tumeurs malignes de la colonne vert\u00e9brale, <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/physio-pedia.com\/Spinal_Malignancy\">cliquez ici<\/a>.<\/li>\n<\/ul>\n<h2><span class=\"mw-headline\" id=\"Subjective_Assessment\">\u00c9valuation subjective <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=3\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Subjective Assessment\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=3\" title=\"Edit section: Subjective Assessment\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Il est essentiel de proc\u00e9der \u00e0 une anamn\u00e8se subjective approfondie afin de s&rsquo;assurer que vous \u00eates en mesure de faire la distinction entre les douleurs m\u00e9caniques, inflammatoires et les autres types de douleurs pr\u00e9sentes au niveau du dos. Les \u00e9l\u00e9ments sp\u00e9cifiques qui devraient \u00eatre inclus dans une \u00e9valuation subjective sont examin\u00e9s ci-dessous.<\/p>\n<h3><span class=\"mw-headline\" id=\"Timeline_of_Pain\">La chronologie de la douleur <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=4\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Timeline of Pain\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=4\" title=\"Edit section: Timeline of Pain\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Comprendre la chronologie de la <a href=\"\/Pain_Assessment\" title=\"L'\u00e9valuation de la douleur\">douleur d<\/a> &lsquo;un patient aidera le clinicien \u00e0 \u00e9valuer si la douleur est inflammatoire ou m\u00e9canique. Questions sp\u00e9cifiques qui devraient \u00eatre incluses :<sup id=\"cite_ref-:0_3-4\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>Y a-t-il eu un traumatisme r\u00e9cent ou la douleur est-elle apparue insidieusement ?<\/li>\n<li>Depuis combien de temps le patient souffre-t-il de douleurs ?<\/li>\n<li>A quel \u00e2ge ses douleurs sont-elles apparues ?<\/li>\n<li>Cette douleur est-elle r\u00e9currente ?<\/li>\n<\/ul>\n<p>La douleur inflammatoire est plus susceptible d&rsquo;appara\u00eetre de mani\u00e8re insidieuse et de durer plus longtemps (c&rsquo;est-\u00e0-dire plus de trois mois), tandis que la douleur m\u00e9canique a tendance \u00e0 \u00eatre plus aigu\u00eb et peut souvent \u00eatre li\u00e9e \u00e0 une blessure.<sup id=\"cite_ref-:2_9-0\" class=\"reference\"><a href=\"#cite_note-:2-9\">(9)<\/a><\/sup><\/p>\n<p>L&rsquo;\u00e2ge d&rsquo;apparition des sympt\u00f4mes est \u00e9galement un facteur tr\u00e8s important, car la spondylarthropathie touche les jeunes adultes (c&rsquo;est-\u00e0-dire les moins de 45 ans), alors que d&rsquo;autres affections d\u00e9g\u00e9n\u00e9ratives (telles que les <a href=\"\/Degenerative_Disc_Disease\" title=\"Degenerative Disc Disease\">discopathies d\u00e9g\u00e9n\u00e9ratives<\/a>, les modifications des <a href=\"\/Facet_Joints\" title=\"Facet Joints\">facettes articulaires<\/a> ou l&rsquo;<a href=\"\/Osteoarthritis\" title=\"Arthrose\">arthrose de<\/a> la colonne vert\u00e9brale) ont tendance \u00e0 s&rsquo;aggraver avec l&rsquo;\u00e2ge. <sup id=\"cite_ref-:0_3-5\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h3><span class=\"mw-headline\" id=\"Aggravating_or_Easing_Factors\">Les facteurs aggravants ou att\u00e9nuants <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=5\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Aggravating or Easing Factors\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=5\" title=\"Edit section: Aggravating or Easing Factors\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Comprendre les facteurs qui aggravent ou soulagent les maux de dos d&rsquo;un patient peut \u00e9galement vous aider \u00e0 distinguer les douleurs m\u00e9caniques des douleurs inflammatoires. Questions subjectives importantes \u00e0 poser : <sup id=\"cite_ref-:0_3-6\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>La douleur survient-elle au repos ou la nuit ?<\/li>\n<li>La douleur s&rsquo;att\u00e9nue-t-elle avec le mouvement ?<\/li>\n<\/ul>\n<p>Une r\u00e9ponse affirmative \u00e0 ces questions indique un \u00e9tat inflammatoire, car la douleur m\u00e9canique a tendance, au contraire, \u00e0 s&rsquo;aggraver avec le mouvement et \u00e0 s&rsquo;att\u00e9nuer avec le repos.<sup id=\"cite_ref-:2_9-1\" class=\"reference\"><a href=\"#cite_note-:2-9\">(9)<\/a><\/sup><\/p>\n<h3><span class=\"mw-headline\" id=\"24_Hour_Pain_Pattern\">Le sh\u00e9ma de douleur sur 24 heures <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=6\" class=\"mw-editsection-visualeditor\" title=\"Edit section: 24 Hour Pain Pattern\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=6\" title=\"Edit section: 24 Hour Pain Pattern\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>La douleur inflammatoire pr\u00e9sente g\u00e9n\u00e9ralement certaines caract\u00e9ristiques sur une p\u00e9riode de 24 heures. Questions \u00e0 poser : <sup id=\"cite_ref-:0_3-7\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>Avez-vous des douleurs nocturnes ?<\/li>\n<li>Vous r\u00e9veillez-vous dans la seconde moiti\u00e9 de la nuit ?<\/li>\n<li>Votre douleur s&rsquo;att\u00e9nue-t-elle lorsque vous vous levez le matin et que vous commencez \u00e0 bouger ?<\/li>\n<li>Souffrez-vous d&rsquo;une raideur associ\u00e9e \u00e0 votre douleur qui dure plus de 30 minutes ?\n<ul>\n<li>NB : les maux de dos d&rsquo;origine m\u00e9canique peuvent provoquer des raideurs, mais celles-ci tendent \u00e0 s&rsquo;att\u00e9nuer apr\u00e8s quelques minutes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Des r\u00e9ponses positives \u00e0 ces questions sugg\u00e8rent une condition inflammatoire.<sup id=\"cite_ref-:0_3-8\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h3><span class=\"mw-headline\" id=\"Family_History\">L&rsquo;histoire familiale <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=7\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Family History\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=7\" title=\"Edit section: Family History\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Une forte composante <a href=\"\/Genetic_Disorders\" title=\"Genetic Disorders\">g\u00e9n\u00e9tique<\/a> a \u00e9t\u00e9 identifi\u00e9e chez les personnes atteintes de spondylarthropathie. <sup id=\"cite_ref-10\" class=\"reference\"><a href=\"#cite_note-10\">(10)<\/a><\/sup> Il est donc important, lors de l&rsquo;\u00e9valuation subjective, de savoir si le patient a des ant\u00e9c\u00e9dents familiaux de spondylarthropathie.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\" style=\"\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/Ym7O8ReXI4E?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"true\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\">(11)<\/a><\/sup><\/p>\n<h3><span class=\"mw-headline\" id=\"Other_Issues\">Autres questions <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=8\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Other Issues\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=8\" title=\"Edit section: Other Issues\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Puisque les spondylarthropathies pr\u00e9sentent d&rsquo;autres manifestations extra-articulaires,<sup id=\"cite_ref-12\" class=\"reference\"><a href=\"#cite_note-12\">(12)<\/a><\/sup><sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup><sup id=\"cite_ref-14\" class=\"reference\"><a href=\"#cite_note-14\">(14)<\/a><\/sup><sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup><sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup> il est n\u00e9cessaire de savoir si le patient a d&rsquo;autres probl\u00e8mes m\u00e9dicaux, notamment des probl\u00e8mes intestinaux, oculaires ou cutan\u00e9s.<sup id=\"cite_ref-:0_3-9\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>De m\u00eame, les spondylarthropathies peuvent affecter d&rsquo;autres articulations p\u00e9riph\u00e9riques, des <a href=\"\/Tendon_Anatomy\" title=\"Tendon Anatomy\">tendons <\/a>et des <a href=\"\/Ligament\" title=\"Ligament\">ligaments.<\/a> <sup id=\"cite_ref-:3_17-0\" class=\"reference\"><a href=\"#cite_note-:3-17\">(17)<\/a><\/sup> La recherche d&rsquo;autres probl\u00e8mes musculo-squelettiques peut donc contribuer \u00e0 la d\u00e9tection de la condition inflammatoire.<sup id=\"cite_ref-:0_3-10\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup> Par exemple, il est utile de demander au patient s&rsquo;il souffre d&rsquo;enth\u00e9site (par exemple, au niveau du talon de <a href=\"\/Achilles_Tendinopathy\" title=\"Achilles Tendinopathy\">tendinopathie achill\u00e9enne<\/a>, ou encore d&rsquo;\u00e9picondylalgie lat\u00e9rale). Une r\u00e9ponse positive \u00e0 ces questions peut indiquer la pr\u00e9sence d&rsquo;une situation inflammatoire syst\u00e9mique.<sup id=\"cite_ref-:0_3-11\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>NB : L&rsquo;enth\u00e9site est d\u00e9finie comme une inflammation du site o\u00f9 les tendons et ligaments s&rsquo;ins\u00e8rent dans l&rsquo;os.<sup id=\"cite_ref-18\" class=\"reference\"><a href=\"#cite_note-18\">(18)<\/a><\/sup><\/p>\n<h3><span class=\"mw-headline\" id=\"Biopsychosocial_Model\">Le mod\u00e8le <a href=\"\/Biopsychosocial_Model\" title=\"Biopsychosocial Model\">biopsychosocial <\/a><\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=9\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Biopsychosocial Model\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=9\" title=\"Edit section: Biopsychosocial Model\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>La douleur est un processus complexe qui peut \u00eatre influenc\u00e9 par de nombreux facteurs, notamment les diff\u00e9rents \u00e9tats motivationnels, \u00e9motionnels et cognitifs.<sup id=\"cite_ref-19\" class=\"reference\"><a href=\"#cite_note-19\">(19)<\/a><\/sup> Plut\u00f4t que de consid\u00e9rer uniquement l&rsquo;\u00e9tat pathologique, il existe aujourd&rsquo;hui un consensus g\u00e9n\u00e9ral sur le fait que la sant\u00e9 et la maladie r\u00e9sultent de l&rsquo;interaction entre des facteurs biologiques, psychologiques et sociaux, repr\u00e9sent\u00e9e par le mod\u00e8le biopsychosocial.<sup id=\"cite_ref-20\" class=\"reference\"><a href=\"#cite_note-20\">(20)<\/a><\/sup><\/p>\n<p>Essentiellement, le mod\u00e8le biopsychosocial se concentre non pas sur la maladie, mais sur le comportement qui alimente les croyances ou les attitudes susceptibles de perp\u00e9tuer les probl\u00e8mes associ\u00e9s \u00e0 la maladie. Par exemple, une personne peut ressentir des sensations telles que des douleurs, des naus\u00e9es ou des palpitations cardiaques diff\u00e9remment d&rsquo;une autre. Cette variation de perception doit \u00eatre consid\u00e9r\u00e9e dans le contexte psychologique et social du patient.<sup id=\"cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\">(21)<\/a><\/sup><\/p>\n<p>Le mod\u00e8le biopsychosocial est abord\u00e9 plus en d\u00e9tail <a href=\"\/Biopsychosocial_Model\" title=\"Biopsychosocial Model\">ici<\/a> et <a href=\"\/Chronic_Pain\" title=\"Chronic Pain\">ici<\/a>. Il est utile de comprendre le contexte social, psychologique et biologique de votre patient lorsque vous cherchez \u00e0 diff\u00e9rencier les maux de dos d&rsquo;origine m\u00e9canique des maux de dos d&rsquo;origine inflammatoire. <sup id=\"cite_ref-:0_3-12\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup> Cela vous permettra de mieux comprendre la nature de sa douleur.<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\" style=\"\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/qtTZ5Ujky-k?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"true\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup><\/p>\n<h2><span class=\"mw-headline\" id=\"Objective_Assessment\">\u00c9valuation objective <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=10\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Objective Assessment\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=10\" title=\"Edit section: Objective Assessment\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Pour plus d&rsquo;informations sur l&rsquo;\u00e9valuation objective des cas de lombalgie, cliquez <a rel=\"nofollow\" class=\"external text\" href=\"https:\/\/physio-pedia.com\/Lumbar_Assessment\">ici<\/a>. Il est essentiel de faire la distinction entre les maux de dos inflammatoires et m\u00e9caniques d\u00e8s le d\u00e9but du processus de diagnostic, car la prise en charge et le traitement de ces deux types de maux de dos sont tr\u00e8s diff\u00e9rents. <sup id=\"cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\">(23)<\/a><\/sup> Pour diff\u00e9rencier les maux de dos d&rsquo;origine m\u00e9canique des maux de dos d&rsquo;origine inflammatoire, il est utile d&rsquo;\u00e9valuer les \u00e9l\u00e9ments suivants :<\/p>\n<ul>\n<li><a href=\"\/Gait\" title=\"Patron de marche\">Le patron de marche<\/a> &#8211; est-il antalgique ou sym\u00e9trique ? <sup id=\"cite_ref-24\" class=\"reference\"><a href=\"#cite_note-24\">(24)<\/a><\/sup><\/li>\n<li><a href=\"\/Posture\" title=\"Posture\">La posture<\/a> &#8211; le patient pr\u00e9sente-t-il une alt\u00e9ration de sa posture, comme porter sa t\u00eate en avant, la perte de lordose lombaire ou une augmentation de la cyphose thoracique ? <sup id=\"cite_ref-25\" class=\"reference\"><a href=\"#cite_note-25\">(25)<\/a><\/sup><\/li>\n<li>L&rsquo;expansion thoracique &#8211; le patient pr\u00e9sente-t-il une restriction de l&rsquo;expansion au niveau de son thorax ?<\/li>\n<li>L&rsquo;amplitude des mouvements &#8211; y a-t-il une r\u00e9duction de l&rsquo;amplitude de mouvement au niveau de sa colonne vert\u00e9brale ou encore de la rigidit\u00e9 ?<\/li>\n<li>La palpation &#8211; y a-t-il une sensibilit\u00e9 \u00e0 la palpation de la colonne vert\u00e9brale et des <a href=\"\/Sacroiliac_Joint\" title=\"Sacroiliac Joint\">articulations sacro-iliaques <\/a>?<\/li>\n<li>Les points d&rsquo;enth\u00e8se &#8211; y a-t-il des douleurs \u00e0 la palpation de ces points ?<\/li>\n<\/ul>\n<p>Les patients atteints de spondylarthropathie, en particulier de spondylarthrite axiale, pr\u00e9sentent souvent des douleurs, une raideur et une perte de mobilit\u00e9 du dos, ainsi qu&rsquo;une posture anormale, de l&rsquo;enth\u00e9site et un sch\u00e9ma pulmonaire restrictif d\u00fb \u00e0 une diminution de l&rsquo;expansion de la paroi thoracique et de la mobilit\u00e9 de la colonne vert\u00e9brale.<sup id=\"cite_ref-:3_17-1\" class=\"reference\"><a href=\"#cite_note-:3-17\">(17)<\/a><\/sup><\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\" style=\"\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/2srdrtCYYSc?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"true\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-26\" class=\"reference\"><a href=\"#cite_note-26\">(26)<\/a><\/sup><\/p>\n<div class=\"row\">\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\" style=\"\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/SumtVr5c1Qg?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"true\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-27\" class=\"reference\"><a href=\"#cite_note-27\">(27)<\/a><\/sup><\/p>\n<\/div>\n<div class=\"col-md-6\">\n<div class=\"thumb embedvideo autoResize\" style=\"width: 258px;\">\n<div class=\"embedvideo autoResize\" style=\"\">\n<div class=\"embedvideowrap\" style=\"width: 250px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/c-IeFZkPEoE?\" width=\"250\" height=\"141\" frameborder=\"0\" allowfullscreen=\"true\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-28\" class=\"reference\"><a href=\"#cite_note-28\">(28)<\/a><\/sup><\/p>\n<\/div>\n<\/div>\n<p>Comme pour toute \u00e9valuation, les r\u00e9sultats objectifs ne sont pas toujours concluants. Un patient peut avoir une amplitude de mouvement raisonnable ou sembler avoir une posture normale. C&rsquo;est en consid\u00e9rant l&rsquo;\u00e9valuation objective en conjonction avec l&rsquo;\u00e9valuation subjective qu&rsquo;il est possible d&rsquo;obtenir une image plus claire de la nature de la douleur du patient.<sup id=\"cite_ref-:0_3-13\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h2><span class=\"mw-headline\" id=\"Summary\">R\u00e9sum\u00e9<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=11\" class=\"mw-editsection-visualeditor\" title=\"Edit section: Summary\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=11\" title=\"Edit section: Summary\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>Les maux de dos sont fr\u00e9quents en pratique clinique. Bien que la majorit\u00e9 des patients aient tendance \u00e0 souffrir de maux de dos m\u00e9caniques non sp\u00e9cifiques, il est important d&rsquo;examiner s&rsquo;il existe des signes ou sympt\u00f4mes associ\u00e9s \u00e0 des douleurs inflammatoires ou d&rsquo;autres drapeaux rouges.<\/p>\n<p>Une \u00e9valuation subjective et objective approfondie vous permettra de mieux distinguer les maux de dos d&rsquo;origine m\u00e9canique des maux de dos d&rsquo;origine inflammatoire.<\/p>\n<p>Les principales diff\u00e9rences entre les maux de dos m\u00e9caniques et inflammatoires sont r\u00e9sum\u00e9es dans le tableau suivant :<\/p>\n<table class=\"wikitable\">\n<tbody>\n<tr>\n<th>Maux de dos d&rsquo;origine m\u00e9canique<\/th>\n<th>Maux de dos d&rsquo;origine inflammatoire<\/th>\n<\/tr>\n<tr>\n<td>Survient \u00e0 tout \u00e2ge<\/td>\n<td>\u00c2ge d&rsquo;apparition &lt; 45 ans<\/td>\n<\/tr>\n<tr>\n<td>D\u00e9but plus aigu<\/td>\n<td>Dur\u00e9e de la douleur &gt; 3 mois<\/td>\n<\/tr>\n<tr>\n<td>D&rsquo;apparition variable &#8211; peut \u00eatre caus\u00e9e par un \u00e9v\u00e9nement sp\u00e9cifique<\/td>\n<td>D\u00e9but insidieux<\/td>\n<\/tr>\n<tr>\n<td>Peut s&rsquo;aggraver avec le mouvement \/ l&rsquo;exercice<\/td>\n<td>S&rsquo;am\u00e9liore avec le mouvement \/ l&rsquo;exercice<\/td>\n<\/tr>\n<tr>\n<td>S&rsquo;am\u00e9liore avec le repos<\/td>\n<td>Ne s&rsquo;am\u00e9liore pas avec le repos<\/td>\n<\/tr>\n<tr>\n<td>Peu ou pas de raideur matinale<\/td>\n<td>Raideur matinale qui dure &gt; 30 minutes<\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td>Douleur nocturne pouvant r\u00e9veiller le patient<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><sup id=\"cite_ref-:0_3-14\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3) <\/a><\/sup><sup id=\"cite_ref-:2_9-2\" class=\"reference\"><a href=\"#cite_note-:2-9\">(9)<\/a><\/sup><\/p>\n<h2><span class=\"mw-headline\" id=\"References\">R\u00e9f\u00e9rences<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;veaction=edit&amp;section=12\" class=\"mw-editsection-visualeditor\" title=\"Edit section: References\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a href=\"\/index.php?title=Differentiating_Inflammatory_and_Mechanical_Back_Pain&amp;action=edit&amp;section=12\" title=\"Edit section: References\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-1\">\u2191<\/a><\/span> <span class=\"reference-text\">GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. 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