| According to IASP (The International Association for the Study of Pain’s),the definition of pain " is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Low back pain (CLBP) is one of the most common complain for the patients who attending to orthopedic clinic. There are20%of patients maintain persistent back pain and substantial limitations in activity after an acute episode, for CLBP management, it’s very important to measure the pain and disability quantitatively. But it’s not easy to quantify the extent of CLBP. There are some options are available for evaluation and quantitative analyses low back pain, but still lack consensus tools on appropriate clinical evaluation and management of low back pain.Several literatures have mentioned the correlation between the soft tissue tension and spondylosis. According to these researches, neck pain point and normal point can be diagnosed objectively and accurately with soft tissue tension measuring.The etiology and pathogenic mechanisms of CLBP and cervical spondylosis are similar. From there studies we can reasonably infer that there are relativity between the soft tissue tension and CLBP. In the presence of unbalanced relationship between tendon and joint of lumber spine, it will lead to spinal dysfunction and soft tissue lesion, cause pain and protective muscle spasms, cause local soft tissue tension rise, the influence of the normal function of the coordination and balance. But there still lack such researches so far.The purpose of Research1. By studying on the soft tissue tension characters to understand the distinction of the soft tissue tension between the normal people’s and the CLBP patient’s and to investigate the correlations between the soft tissue tension characters and CLBP symptoms.2Through comparative study of the effective rate of two different treatments which are silver needle diathermy and Chinese medical steaming therapy on CLBP patients, to monitor and analyze the relations between the change of soft tissue tension and the change of symptoms&physical sign before and after the treatment.3. To explore the new method to be used to evaluate the curative effects of treatment of CLBP based on above mentioned studies. Main Research ContentsFirst,30health people and30CLBP patients have been selected as candidates for soft tissue tension test meanwhile the VAS and the RMDQ of the candidates have been tested respectively. And based on test results we made the comparative analysis on the difference of soft tissue tension characters between normal people’s and CLBP patients’, and the comparative analysis on the difference of soft tissue tension characters between the affected side and contralateral side of CLBP patients’. We design the FDD (force-displacement distance) and S (the percentage of energy absorbed by local soft tissue account for the totally work done) to be the sign of soft tissue tension.To explore the feasibility of soft tissue tension test as the diagnostic method of evaluating the symptom degree of CLBP.2.60CLBP patients were included and were randomly assigned to two groups. Thereof,30patients (group A) underwent silver needle diathermy while30patients (group B) underwent Chinese medical steaming. And VAS, RMDQ(Roland-Morris disability questionnaire), degree of tenderness and soft tissue tension of those CLBP patients were monitored at4visit points at before treatment,1-week post-treatment,6-week post-treatment and3-month post-treatment respectively.We compared the changes of soft tissue tension and the changes of symptoms signs of those CLBP patients before and after treatment, within the same group and between the two groups respectively.Result:1. Research One:Comparison of soft tissue tension test between CLBP and normal people.1.1Comparison of FDD between the CLBP group and normal group.Within the CLBP group, the FDD of the multifidus and the erector spinae muscles on the affected sides were higher significantly than contralateral sides(P<0.01) while the dates of the multifidus and the erector spinae muscles on same sides show similar tension(P>0.05).Between the two groups, the muscle’s FDD on the affected side of CLBP group appeared significantly higher(P<0.01) while the FDD of the normal sides between the two groups showed no significant different(P>0.05).1.2Comparison of S between the CLBP group and normal group.Within the CLBP group, the S by the affected sides were higher significantly than contralateral sides(P<0.01) while the S of two muscles by the same sides showed similar tension(P>0.05).Between the two groups, the S by the affected sides of CLBP group appeared significantly higher(P<0.01) while the S by the normal sides of the two group showed no significant different(P>0.05).2. Research Two. The contrast study of CLBP treated by two therapies2.1Comparison of baseline between two groupsThe age, gender, height, weight, course of disease, VAS, RMDQ, FDD, S, degree of tenderness showed no significant difference between two groups before treatment.2.1Comparison of effective rateAt the2th visit point (1-week post-treatment), the total effective rate of Silver needle group is96.67%while the Chinese medical steaming group is90%. Statistic shows significant difference between the two groups, the silver needle group is better.At the4th visit point (3-month post-treatment), the total effective rate of Silver needle group is87.67%while the Chinese medical steaming group is63.33%. Statistic shows significant difference between the two groups, the silver needle group is better.2.2Comparison of VAS scoresCompared with that of pro-treatment, both group’s VAS scores appeared significantly decrease1-week,6-week and3-month post-treatment respectively. As time went by, the VAS of6-week and3-month visit point gradually increased than1-week visit point. At the same visit point, the silver needle group have lower VAS than Chinese medical steaming group (P<0.05); At the3th and4th visit point, the difference of VAS between two groups increase gradually.2.3Comparison of RMDQ scoresCompared with that of pro-treatment, the tendency of RMDQ shows the similar curve as VAS score’s in both groups at1-week,6-week and3-month post-treatment respectively.Similar to the VAS score, the RMDQ scores of the silver needle group are lower RMDQ than Chinese medical steaming group at the same time (P<0.05)2.4Comparison of soft tissue tension sign2.4.1Comparison of FDD with Pro-treatment at each groupWithin the silver needle group,1-week post-treatment, the FDD increased significantly than pro-treatment on both side’s multifidus and the affected side’s multifidus muscles (P<0.01), the erector spinae muscles on the normal side was higher but no significantly difference compare with pro-treatment(P>0.05).Three month later, the FDD of erector spinae muscles on both sides increased significantly than1-week post-treatment(P<0.01) while multifidus of affected sides decreased slightly but was still significantly higher than pro-treatment(P<0.05).Within the Chinese medical steaming group, the FDD1-week post-treatment were increased significantly than pro-treatment on both sides(P<0.05); Three month later, the FDD by both sides decreased, especially on the affected sides, it was no significantly difference compare with pro-treatment(P>0.05).2.4.2Comparison of FDD between the two groups.1-week post-treatment, the affected side’s FDD of silver needle group was increase significantly (P<0.05) than Chinese medical steaming group while normal side’s FDD shows no significant difference between the two groups(P>0.05).3-month post-treatment, both side’s FDD of silver needle group was significantly higher than another group (P<0.01).2.4.3Comparing of S with Pro-treatment within each groupWithin the silver needle group, the S on1-week post-treatment increased significantly than pro-treatment on both sides (P<0.05); Three month later, the S by both sides increased continually, statistic shows very significant difference than pro-treatment(P<0.01).Within the Chinese medical steaming group,1-week post-treatment, the S increased significantly than pro-treatment on both side’s multifidus and the affected side’s erector spinae muscles (P<0.05), the S of multifidus muscles on the normal sides was higher but no significantly difference compare with pro-treatment (P>0.05).Three month later, the S by both sides decreased than1-week post-treatment, statistic shows no significant difference than pro-treatment(P>0.05).2.4.4Comparison of S between the two groups.1-week post-treatment, both side’s S were no significantly difference (P>0.05);3-month post-treatment, both side’s S of silver needle group were significantly higher than another group (P<0.01).2.5Comparison of tenderness between the two groupsComparing to pro-treatment, both group’s tenderness degree appeared significantly decrease at1-week,6-week and3-month post-treatment respectively.1-week post-treatment, there was no significant difference between the two groups (P>0.05);3-month post-treatment, the silver needle group has lower tenderness degree than Chinese medical steaming group (P<0.05) 3. Correlation analysis of the soft tissue tension sign, VAS and RMDQ.1-week post-treatment, the D-value of FDD, S, VAS, and RMDQ before and after treatment has been calculated, and was evaluated to approximately follow the normal distribution. To analyzing the correlation of D-value of FDD, S, VAS, and RMDQ, We found the FDD,S of multifidus and erector spinae by affected sides were correlated with the VAS and RMDQ, the correlation coefficient R was0.517,0.811,0.746and0.625;3months later,statistic shows the R was0.551,0.382,0.445å'Œ0.678respectively.all the significance tests were statistically significant. So it safely proves that the change of soft tissue tension has similar trends correlated to change of syndrome, functional situation, quality of life of CLBP.Conclusion1. Compare with normal person, the soft tissue tension of LBP patients is higher. For the LBP patients, the soft tissue tension of the affected side is higher than the normal side. It will be easy to distinguish the LBP patients from normal people with soft tissue tension test, besides, it can also be used to identify which is the affected side.2. The treatment of LBP significantly changes the sign of soft tissue tension. As time goes by, the FDD, S, VAS and RMDQ, which reflect the sign of soft tissue tension, the degree of pain and lumber dysfunction respectively, appear the similar trends and identify to be correlated. The measurement of soft tissue tension may help to identify the pain and dysfunction of LBP objectively.3. Both the silver needle diathermy and Chinese medical steaming can improve the pain and dysfunction of LBP. Through3month follow up, the effect of silver needle diathermy is proved to be more endurable and stability, this may due to the silver needle diathermy change the soft tissue tension. |
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