Efficacy Of Polarized Light And Massage On Young And Middle-aged Population With Chronic Low Back Pain Measured By MyotonPRO: A Randomized Controlled Trial

Background and introductionChronic low back pain(CLBP)is common.It not only seriously affects the physical and psychological functions of patients,but also imposes a heavy burden on the society and family.Due to the change of working style and living environment,the incidence of low back pain is becoming younger.Among them,the prevalence of young and middle-aged patients with CLBP is about 37%.However,in young and middle-aged patients with CLBP,most of the etiology remains unclear,and only 47%of patients have abnormal imaging changes.Therefore,in clinical practice,there is an urgent need to develop a simple and easy to operate objective method for the evaluation of lumbar muscle function in patients with CLBP.MyotonPRO has been reported to objectively quantify the elasticity,stiffness,and tension of muscles and tendons in healthy individuals,but it has rarely been used in young and middle-aged patients with CLBP.Therefore,it is necessary to further test the reliability and validity of the MyotonPRO in patients with CLBP,so as to provide objective scientific basis for clinical practice.Although many advances have been made in the treatment of CLBP,it is efficacy in relieving pain and improving the dysfunction of daily living remains unsatisfactory Studies have shown that massage has been widely used to treat low back pain,and it is easy to accept by most patients.However,massage mainly relieves pain in the short-term,and the long-term effect is not clear.In addition,massage therapy can promote the formation of lactic acid,which leads to some patients with severe pain after massage.Studies have shown that infrared polarized light can alleviate acute pain,not only can make the body produce immune regulation,promote vessel expansion and change the activity and metabolic rate of enzymes,but also affect nerve fiber conduction.Based on this,we speculate that infrared polarized light combined with massage may be better for the treatment of CLBP in young and middle-aged patients.After searching the literature,relevant reports are rare so far.Therefore,the purpose of this study is:(1)To examine the reliability and validity of the MyotonPRO in the evaluation of young and middle-aged patients with CLBP;(2)Efficacy of polarized light and massage on young and middle-aged population with CLBP measured by MyotonPRO,in order to provide a new method and scientific basis for the treatment and efficacy monitoring of young and middle-aged patients with CLBP.MethodPart I Research on the reliability and validity of the MyotonPRO in the evaluation of young and middle-aged patients with CLBP1.Research method72 young and middle-aged patients with CLBP were selected to participate in the study of reliability and validity of the MyotonPRO,of which 3 patients withdrew from the study for personal reasons,and finally 69 patients were collected.The hardness of the bilateral erector spinae and multifidus muscles of 69 young and middle-aged patients with CLBP used by MyotonPRO measure by trained raters A and B,respectively,and 38 patients repeated by rater A on the 1st and 7th days.Measure and analyze the reliability of the raters;raters A and B will measure the patients within 24 hours and analyze the reliability of the raters.At the same time,the visual analogue scale(VAS)and Roland-Morris disability questionnaire(RMDQ)were used for evaluation,and the validity of the correlation criterion was analyzed.The SPSS25.0 statistical software package was used for statistical analysis,the interclass correlation coefficient(ICC)and Bland-Altman graph were used for reliability analysis,and the Spearman correlation coefficient was used for validity analysis.2.ResultsICC on the left side and ICC on the right side were 0.800 and 0.806 respectively,ICC=0.914 on the left,and ICC=0.891 on the right among the assessors.In multifidus assessors,ICC=0.881 on the left,ICC=0.892 on the right,ICC=0.892 on the left,ICC=0.926 on the right among assessors;Bland-Altman analysis shows that the MyotonPRO measures muscle stiffness in assessors.There is good consistency within and among raters.Bilateral erector spinae muscle stiffness is highly positively correlated with VAS(r=0.705～0.729,P<0.01),and highly positively correlated with Roland-Morris disability questionnaire scale score(r=0.621～0.648,P<0.01);both Multifidus lateral muscle stiffness is low to moderately positively correlated with VAS score(r=0.244～0.290,P<0.05),and is moderate positively correlation with Roland-Morris disability questionnaire scale score(r=0.310～0.407,P<0.01).Part Ⅱ Efficacy of polarized light and massage on young and middle-aged population with chronic Low back pain used by MyotonPRO measure:A randomized controlled trial1.Research methodsFrom October 2019 to June 2020,90 patients with CLBP were selected in the rehabilitation department of Qingyuan Chronic Disease Prevention and Treatment Hospital,and 76 of them met the selection criteria and entered the research program.According to the odd and even numbers of the medical card number,they were randomly divided into the study group and the control group.The control group was received massage,for 20 minutes each time,7 days a week for 2 weeks.The research group used infrared polarized light combined with massage,selected 8 points of continuous output intensity,positioned at the lumbar 3 sympathetic ganglia,and irradiated the left and right sides for 10 minutes.The treatment time was 20 minutes each time,once a day,7 days a week for 2 weeks.Before treatment,the MyotonPRO was used to measure muscle stiffness and muscle tension,and VAS and Roland-Morris disability questionnaire were used to assess the degree of pain and daily dysfunction respectively.The same method was used to evaluate the curative effect on the second day after the treatment.The SPSS25.0 statistical software package was used for statistical analysis.The chi-square test and independent sample t test were used to compare the differences in general information,baseline data and after treatment between the two groups of patients.A paired t test was used to compare the differences of the stiffness and tension of the erector spinalis muscle and multifidus muscle between the two groups before and after treatment,and the difference of VAS score and Roland-Morris dysfunction scale before and after treatment,setting P<0.05 as the difference is statistically significant.2.Result2.1 General information and baseline dataThere was no significant difference in body mass index(BMI),age and gender between 2 groups by T-Test and chi-square test(P>0.05).At baseline,VAS,Roland-Morris disability questionnaire and MyotonPRO were used to measure the stiffness and tension ratio(left/right)of bilateral erector spinalis muscle and multifidus muscle,there was no significant difference(P>0.05)throuth independent sample t-test significance(P>0.05).2.2 Changes in the scores of the two groups of patients on the VAS and Roland-Morris disability questionnaire after treatmentAfter 2 weeks of treatment,the VAS scores of the two groups were improved compared to before treatment,and the difference was statistically significant(P<0.05);but the study group was better than the control group,and the difference was statistically significant(P<0.05).The Roland-Morris disability questionnaire of the two groups were improved compared with before treatment,and the difference was statistically significant(P<0.05);but the study group was better than the control group,and the difference was statistically significant(P<0.05).2.3 After treatment,The MyotonPRO measured the changes in muscle stiffness and muscle tension of the two groups of patientsAfter 2 weeks of treatment,the hardness values of the bilateral erector spinae and multifidus muscles of the two groups of patients were improved after 2 weeks of treatment compared to before treatment,the difference was statistically significant(P<0.05);but the hardness of bilateral erector spinalis muscle in the study group was significantly lower than that in the control group(P<0.05);However,the reduction of bilateral multifidus muscle stiffness in the study group was superior to that in the control group,but the difference was not statistically significant(P>0.05).The muscle tension values of the bilateral erector spinae and multifidus muscles of the two groups of patients were improved after 2 weeks of treatment compared with before treatment,and the difference was statistically significant(P<0.05);However,the bilateral erector spinae muscle tension in the study group was significantly lower than that in the control group(P<0.05);however,although the numerical value of the multifidus muscle tension of the study group was better than that of the control group,the difference was not statistically significant(P>0.05).2.4 Adverse eventsInfrared polarized light in the process of treatment,the researchers found no patients had skin allergies,breakage,burns,lower limb cold adverse events,such as found in the massage group 2 patients respectively in the treatment of 3 days,7 days a pain degree aggravate adverse events,the symptoms can be relieved after local hot compress,continue to complete the study.ConclusionThe MyotonPRO has good reliability and validity in the evaluation of young and middle-aged patients with CLBP.Compared with simple massage,the treatment of young and middle-aged CLBP patients with infrared polarized light irradiation of lumbar 3 symoathetic ganglion combined with massage can better reduce the erector spinal muscle hardness and muscle tension,relieve pain,and imorove the dysfunction of daily life.