| BackgroundBack muscle fasciitis is a common disease of the waist, back muscle fasciitis refers to one or both sides or waist pain of the disease occurred in the middle, etc., is both a symptom of many diseases, but also as an independent disease seen in modern medicine called kidney disease, rheumatism, rheumatoid arthritis, spine and back muscles fasciitis trauma, gynecological and other diseases. The main symptoms of lumbar or lumbosacral pain, recurrent pain or fatigue can vary the degree of climate change, and change, when light weight, lingering diseases. Waist can have a wide range of tenderness, no abnormal spine activities and more. Acute onset, symptoms were significantly increased, and there are muscle spasms, scoliosis and functional activity limitation. Back muscle fasciitis is a common clinical syndromes, a high incidence of back pain is a common promise total symptoms. According to statistics,100%of adults have suffered from back pain, due to the accelerated pace of life, the intense competition in the social, human tissue for long-term, repeated, sustained life of oppression against friction posture is not correct, such as stress reaction, tissue hypertrophy and hyperplasia, for compensation, accumulated from persistent chronic lumbar muscle strain, acute injury without timely and proper treatment, can also be persistent chronic injury, the lesion appeared tissue congestion, edema, proliferative changes, granulation tissue formation and pathological changes in adhesion, etc. the disease mostly occurs in young adults, there was fatigue, injury history and waist trauma. The disease clinical treatment more difficult, there is no effective therapy, chronic low back muscle fasciitis species changed a long time, affecting the normal life of the patient, working to bring a lot of trouble, some patients around the doctor, recurrent, painful unbearable, even psychological cast a shadow.Back muscle fasciitis is a protraction, you need to adhere to a long-term disease treatment. Clinical method for the treatment of low back muscle fasciitis lot, but no single treatment effect is absolute. This requires that we continually look for new treatments in order for the treatment of low back muscle fasciitis have a new breakthrough. We found that in years of clinical practice, tendons therapy for back muscle fasciitis outstanding results, the clinical effect of the proposed research for clinicians Reference.Tendons medicine has a long history, has long been documented in the classic " Nei Jing". Is the treasure house of traditional Chinese medicine in a wonderful work. But in the long slow process of historical development, economic development has stalled tendons medicine, but the experience of deep technical entities in the private sector, as important as human tendons, large solid organ; in physiology, pathology, diagnosis and treatment, have a unique and important role and deep in meaning. In clinical practice, especially in the modern sense was considered for a long time doctors unhealed pain, arthralgia, diseases, etc.; has a unique and unexpected therapeutic effect is good. This is the traditional medical experience can be passed on to today’s great value and role of lies.This study is to observe the tendons back muscle fasciitis therapy treatment, and compared with the traditional manual therapy, in order to further promote the tendons therapy, provide clinical evidence; fasciitis treatment for the lower back muscles, providing a effective treatment.PurposeTo evaluate the clinical efficacy of therapy tendons back muscle fasciitis, a reference for clinicians in order to provide a new approach for the treatment of low back muscle fasciitis.Method1study Object 120cases of patients with low back muscle fasciitis, from acupuncture, Nanfang Hospital, Southern Hospital rehabilitation, orthopedic, Hong Kong Chinese Medicine tendons.(1) Diagnostic criteria:According to the Ministry of Health developed "in the People’s Republic of China pharmaceutical industry standards· Clinical Medicine Syndrome Diagnostic Criteria" to develop diagnostic criteria.①may have post-traumatic improper treatment, such as fatigue or exogenous cold history;②lower back pain, muscle stiffness hair plate, there is a heavy feeling, pain often associated with changes in the weather related, rainy days and after exertion can aggravate the symptoms;③lower back has a fixed point tenderness or tenderness is more extensive, back muscle stiffness, walking along the row direction of the erector spinae often touched streak changes are mostly back to normal functional activities, X-ray examination no positive signs.(2) the inclusion criteria:①meet back muscle fasciitis above diagnostic criteria;②between the ages of20-75years old;③course of more than three weeks by;④according to plan and adhere to treatment completers;(3) Exclusion criteria:①with the diagnostic criteria and those who do not meet the inclusion criteria;②with severe heart, liver, kidney, brain and hematopoietic system of primary vascular diseases, and the impact of the study of other diseases (such as:diabetes, bone tuberculosis, bone tumor, severe osteoporosis, peripheral neuropathy,;) psychiatric patients;③patients blind, deaf, dumb, etc. with disabilities;④suspected or confirmed alcohol, drug abusers, such as history;⑤pregnant or lactating women, the symptoms of severe menopausal syndrome;⑥severely physically weak;⑦reluctant to experiment with people who do not sign the informed consent form;⑧while other treatments were applied.(4) remove and falling standards:①cases of poor compliance of subjects, serious adverse events, the occurrence of complications or special physiological changes should not continue to accept the experimenter;②not reach1/2courses were.(5) abort test criteria:disease progression during the test, serious complications, or serious adverse reactions should discontinue the test, more than1/2of treatment were included in the efficacy of statistics; trials were suspended due to adverse reactions included cases of adverse reactions statistics.2. Study DesignA randomized controlled trial, subjects will be qualified in a1:1ratio allocated to the tendons and traditional acupuncture group therapy group,60cases in each group.3. Randomization methodCases grouped using simple random method. Specific methods of randomized clinical researchers by operating SAS (Statistical Analysis System) software random number drawn and made randomly assigned cards, plus envelopes sealed envelope the same serial number and card number. Eligible patients entered the study, according to their order of entry, open the same number of envelopes, the inner envelope card by grouping prescribed treatment.4Treatment(1) tendons therapy group:Tendons therapy:The first step:full sun tendons therapy:the patient prone, the doctor uses the tip of the elbow (olecranon), blunt (humeral condyle), hard (forearm ulnar side), soft (forearm side) four positions along the line from full sun tendons direction across the board by foot to the head, rubbing, point, push, pull and other loose tendon playing tendon, heel tendon junction emphasis push, kick outside the tendon junction (gastrocnemius), the popliteal tendon junction (hamstring), thigh tendon junction (biceps femoris), hip tendon junction (gluteus maximus), the thigh tendon junction (iliac rib muscle), Jiaji tendon junction (Erector, waist three transverse points5or L5lumbar sacral spinous process between1) lesions, such as tendon junction point so full sun tendon release is better across the board. Step two:Foot Shaoyang tendons therapy:Patients lateral position, a small pillow between the knees pads, elbow healer sharp, blunt, hard, soft four sites along the foot Shaoyang tendons from the foot to the head direction across the board loose tendon tendon, focusing release enough times toe tendon junction (hallucis longus), fibular tendon junction (peroneus longus, peroneal nerve), outside knee tendon junction (shares four lateralis muscle), V rabbit muscle Results (b semimembranosus, sartorius), the thigh tendon junction (iliac muscle bundles, tensor fascia lata), Tajiri tendon junction (piriformis) lesions, such as tendon junction point; with side reset method. Around the1st. The third step:Meridian tendon therapy:the patient supine, healer along with elbow and thumb tendons Meridian direction from the foot to the head line of loose tendons tendon. Focus release dorsal tendon junction (in the three-toed), the thigh tendon junction (medial quadriceps muscle), air impact tendon junction (inguinal femoral nerve, femoral artery points), the abdominal muscle knot (psoas muscle) and other foci, click the stocks to have a better impact on the heat to the lower extremity arterial. Treatment time about30minutes.(2) traditional methods Group:Traditional methods:①patients prone or lateral position, healer stand beside it, double or single palm palm repeatedly rubbing lumbosacral and two buttocks several times.②dual thumb or tip of elbow, rubbing lumbosacral five lines (Du and full sun one, two lateral line, Du to press the intervertebral space-based)3to5times; Tap shen, chi room, waist Yang Guan, Dachangshu, loin, eight Liao, Ashi.③thumb or tip of elbow rubbing cutaneous nerve route rationalization and projection sore point at the piriformis, repeated treatments3-5times; tap the jump ring, rank edge points.④get rubbed the lower extremity of3to5times.⑤tip of elbow rubbing the back of the thigh full sun to rationalize routes; emphasis rubbing Cheng Fu, Yin door, Venezuela, Cheng Shan, Kunlun, springs. Treatment time about30minutes.Two groups of patients were treated and instruct patient warm and avoid exertion, once daily treatment, continuous treatment six times for a course of two courses (two weeks). After the end of each course of treatment, rest one day5. OUTCOME MEASURES(1) Pain-simplify McGill ScaleComprehensive assessment of pain before and after treatment:a description of the use of internationally recognized measure of simplification McGill Pain Scale for evaluation. Scale is divided into three parts:(1) pain rating index (PRI): contains11words and four sensory emotional words were divided into none, mild, moderate and severe four, respectively,0,1,2,3indicates, calculate the PRI sensory points, score points and emotions;(2) visual analogue scale (VAS):is a10cm long straight ends represent painless and pain, patients in whom draw lines to indicate the degree of pain;(3) the existing pain intensity (PPI):points painless, mild discomfort, discomfort, uncomfortable, terrible pain, very painful six, respectively,0,1,2,3,4,5, said.(2) Evaluation Function①dysfunction questionnaire (Roland-Morris):These problems include low back pain patients walking, standing, bending, work, bed, sleeping, dressing, often only living skills, etc., scores for each question1minute, answered "yes"1point, the answer is " no"0points, each question on the unweighted score points, will answer "yes" to each question is the last actual cumulative score score, the lowest score0points, the highest score of24points, the higher the score, the more severe dysfunction.②Disability Index (Oswestry Disability Index):quantification dysfunction questionnaire, scores O～5minutes, Oswestry Disability Index Questionnaire (ODI) is composed of10questions, including pain intensity, self-care, to mention objects, walking, sitting, standing, sleep interference, sexual life, social life, travel and other10areas, six options for each question, the maximum score is5points for each question, choose the first option a score of0points, choose the last option a score of5points, if there are10quiz questions are done, the score is:the actual score/50(the highest possible score)×100%, if there is a question not answered, the scoring method is:Actual score/45(the highest possible score)×100%, as higher indicate more serious dysfunction.(3) The total efficacy evaluationBased on " the People’s Republic of China pharmaceutical industry standards Syndrome Diagnostic efficacy of the standard ZY/T001.1.-94"[42] The results were divided into treatment①cure:low back pain symptoms, waist freedom of movement;②improved:back pain relief, lumbar activity function was restored;③healed:symptoms do not improve.6. Observation methods(1) to two treatment regimens for the observation period;(2) Clinical symptoms and signs after treatment and prior to each recording time.7. Data processingAll statistical data using SPSS13.0statistical software for statistical analysis. According to observations of different pointers and data, measurement data using mean±standard deviation (x±s) said, and the distribution of normality and homogeneity of variance test between the two groups were compared using analysis of variance, the number of the groups were compared by paired t test, count data comparison using chi-square test, test level. P<0.05was considered statistically significant.Result(1) Case interrupt and shedding120cases of patients with low back muscle fasciitis treatment observation group,60cases in which traditional practices, tendons therapy group,60patients were observed without shedding process, removed.(2) baseline indicatorsTwo groups of patients’gender, age, duration, the difference was not statistically significant (P>0.05), comparable.(3) McGill Comparison ScaleMcGill-PRI comparison①PRI compare two groups before treatment:traditional practices before treatment PRI (x±s) was10.57±3.397, tendons therapy group therapy before PRI (x±s) was9.70±2.431, by independent samples t-test, two groups of patients before treatment PRI was no significant difference (t=1.607, P=0.111, P>0.05).②After treatment, PRI comparison:the traditional approach group after treatment PRI (x±s) was4.43±1.095, tendons therapy group after treatment PRI (x±s) was2.63±1.221, by independent samples t-test, two groups of patients after treatment PRI there was a significant difference (t=8.502, P=0.000, P<0.05).③PRI compare before and after treatment in both groups:the traditional approach group before treatment PRI (x±s) was10.57±3.397, after treatment PRI (x±s) was4.43±1.095, by paired samples t-test, traditional practices PRI group after treatment and before treatment there was a significant difference (t=13.629, P=0.000, P<0.05); tendons therapy group therapy before PRI (x±s) was9.70±2.431, after treatment PRI (x±s) was2.63±1.221, by paired sample t-test, a relatively former PRI and treatment of muscle therapy group after treatment was significant difference (t=22.107, P=0.000, P<0.05).McGill-VAS comparison①two groups before treatment VAS comparison:the traditional approach group before treatment VAS (x±s) was6.42±1.907, tendons therapy group before treatment VAS (x±s) was6.97±2.066, by independent samples t-test, two groups of patients before treatment VAS difference was not statistically significant (t=-1.515, P=0.132, P>0.05).②After treatment, VAS comparison:the traditional approach group after treatment VAS (x±s) was2.47±1.049, tendons therapy group after treatment VAS (x±s)was0.92±0.829, by independent samples t-test, two groups of patients after treatment VAS there was a significant difference (t=8.978, P=0.000, P<0.05).③VAS before and after treatment comparison:the traditional approach group before treatment VAS (x±s) was6.42±1.907, after treatment VAS (x±s) was2.47±1.049, by paired samples t-test, traditional practices and treatment group after treatment VAS ago there was a significant difference (t=14.793, P=0.000, P<0.05); tendons therapy group before treatment VAS (x±s) was6.97±2.066, after treatment VAS (x±s) was0.92±0.829, by paired sample T-test, a relatively VAS before therapy and treatment after tendon significant difference between the treatment group (t=20.822, P=0.000, P<0.05).McGill-PPI comparison①two groups before treatment PPI comparison:the traditional approach group before treatment PPI (x±s) was4.15±1.459, tendons therapy group before treatment PPI (x±s) was4.10±1.602, by independent samples t-test, two groups of patients before treatment PPI difference was not statistically significant (t=0.179, P=0.858, P>0.05).②After treatment, PPI comparison:the traditional approach group after treatment PPI (x±S) was2.40±1.108, tendons therapy group after treatment PPI (x±s) was0.95±0.769, by independent samples t-test, two groups of patients after treatment there was a significant difference (t=8.330, P=0.000, P<0.05) PPI.③the two groups before and after treatment PPI comparison:traditional practices before treatment PPI (x±s) was4.15±1.459, after treatment PPI (x±s) was2.40±1.108, by paired samples t-test, traditional practices group before and after treatment with PPI therapy there was a significant difference (t=7.650, P=0.000, P <0.05); tendons therapy group before treatment PPI (x±s) was4.10±1.602, after treatment PPI (x±s) was0.95±0.769, by paired sample t-test, there are more treatment before and after PPI therapy group therapy tendons significant difference (t=13.069, P=0.000, P<0.05).(4) Roland-morris Scale①two groups before treatment Roland-morris comparison:the traditional approach group before treatment Roland-morris (x±s) was11.07±3.025, tendons therapy group therapy before Roland-morris (x±s) was11.72±4.005, by independent samples t-test, two groups of patients before Roland-morris no significant difference (t=-1.003, P=0.318, P>0.05).②After treatment, Roland-morris comparison:the traditional approach group after treatment Roland-morris (x±s) was7.12±2.092, tendons therapy group after treatment Roland-morris (x±s) was4.93±1.876, by independent samples t-test, more Roland-morris significant difference (t=6.018, P=0.000, P<0.05) after treatment, both groups of patients.③before and after treatment Roland-morris comparison:the traditional approach group before treatment Roland-morris (x±s) was11.07±3.025, after treatment, Roland-morris (x±s) was7.12±2.092, by paired samples t-test, traditional practices group there after treatment before Roland-morris and treatment of more significant difference (t=8.336, P=0.000, P<0.05); premenstrual (x±s) muscle therapy group therapy was11.72±4.005, after treatment, Roland-morris (x±s) was4.93±1.876, by paired samples t-test, Roland-morris there was a significant difference (t=11.890tendons therapy group after treatment compared with before treatment, P=0.000, P<0.05).(5) ODI Scale①ODI compare two groups before treatment:traditional practices before treatment ODI (x±s) was32.17±7.088, tendons therapy group before treatment ODI (x±s) was30.70±7.358, by independent samples t-test, two groups of patients before treatment ODI difference was not statistically significant (t=1.112, P= 0.268, P>0.05).②After treatment ODI comparison:the traditional approach group after treatment ODI (x±S) was23.45+7.643, tendons therapy group after treatment ODI (x±S) was16.60±5.459, by independent samples t-test, two groups of patients after treatment ODI there was a significant difference (t=5.649, P=0.000, P<0.05).③ODI before and after treatment comparison:the traditional approach group before treatment ODI (x±s) was32.17±7.088, after treatment ODI (x±s) was23.45±7.643, by paired samples t-test, traditional practices and treatment after treatment before ODI there was a significant difference (t=6.214, P=0.000, P<0.05); premenstrual (x±s) muscle therapy group therapy was30.70±7.358, after treatment ODI (±s) was16.60±5.459, by paired samples t testing, a relatively former ODI tendon therapy and treatment group after treatment was significant difference (t=11.035, P=0.000, P<0.05).(6) Total comparative efficacyTraditional methods Group:cure8,20markedly effective in14,18invalid, the total efficiency of70.00%; tendons treatment groups:13were cured,24markedly effective in17,6, the total efficiency of90.00%, after two independent samples rank and inspection, Zis-2.271, P value of0.023(P<0.05).ConclusionThis preliminary study showed that the tendon back muscle fasciitis therapy efficacy, after two courses of treatment, for the McGill scale score, Roland-morris scale integration, improve ODI scale score is more obvious than the traditional approach; while comparing the total effect, tendons therapy group and the group was significantly better than traditional methods. |
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