| In clinical guidlines issued by many countries, low back pain is classified into three types:①onspecific low back pain(NLBP);②specific(red flag)low back pain which is caused by tumor, infection or fracture;③sciatica/nerve roots syndrome. In fact, about85percent of patients with isolated low back pain cannot given a precise pathoanatomical diagnosis. The most accurate diagnosis for those patients should be spontaneous or nonspecific low back pain. NLBP refers to a kind of low back pain neither whose cause are decided through physical examination nor whose histopathological changes are found through laboratory, X-ray, CT and MRI examinations, such as lumbar sprain or lumbar muscle strain, different diagnosis can be made in different departments with little or none scientific evidence to support them. Although the pathogenesis of NLBP are complex and diverse, the main clinical symptoms is including painful sensation in the waist, sacrum, muscle spasms and lumbar activity limitation, which was particularly serious in the acute phase. NLBP is belong waist tendon disorders in TCM.《Nei Jing》 says:"when tendons disease occurs, then treatment should be there", the Kneading manipulation of TCM is the most common and effective therapy for waist tendon disorders. The mechanical effects of Kneading manipulation has been the focus of the studies. With the development of bio-mechanics, electrophysiology and other interdisciplinaries, the objective quantifiable and real-time measurement of mechanics related indicators of muscle and soft tissue were increasingly accurate. which provides a possible way for the in-depth study in mechanical effects such as loosen tendon adhesions, relieve painful and recover normal physiological electrical activities. Based on the literature review and clinical research. In this paper, we study the patients with acute non-specific low back pain, through the tissue hardness/algometer combo(OE-220) and surface EMG(JE-TB0810) to measure the soft tissue hardness, pain threshold and sEMG indicators on the paraspinal muscles. By comparison between groups and self-control methods before and after therapy, to observe the characteristics of the NLBP paraspinal muscle and the mechanical effects of the kneading manipulation of TCM.Objective1To observe the soft tissue hardness, pain threshold characteristics in the prone position under relaxed state and measure paraspinal muscle surface EMG sigals during lumbar flexion and extension in patients with acute non-specific low back pain.2To observe the changes of indicators recoerded before and after the kneading manipulation treatment, and try to explain the mechanical effects of the kneading manipulation of TCM in acute non-specific low back pain.Methods35yong women patients with nonspecific low back pain were included respectively by medical history, symptoms, physical examination and imagings, while20healthy adults matched with sex, age, height, and body weight, were enrolled as normal control group. All subjects were measured and recorded the soft tissue dardness and pain threshold in the prone position on both paraspinal sides near the third lumbar transverse; using surface EMG measured and recorded the surface EMG of paraspinal muscles when lumbar flexion movement, select the recovery while maintaining maximum flexion and dorsiflexion movement average EMG. When measurement ended, the kneading manipulation of TCM therapy was used on the NLBP patients, measured above indicators once again after treatment. SPSS17.0statistical software was used, those from the normal distribution, denoted by the mean plus or minus standard deviation, to test the difference of lumbar muscle on both sides within a group, data of two groups were analyzed by paired t test; to test the difference of lumbar muscle in different groups, were analyzed by two independent sample t test, the difference between the index before and after treatment with the Pearson correlation analyzed. When P value less than0.05, it Was considered significant.Results1When test the control group paraspinal muscles comparison:hardness, pain threshold, full flexion AEMG, dorsiflexion AEMG, FER comparison, were all P>0.05, the difference was no statistically significant.2NLBP group compared with the contralateral side symptoms:the tissue hardness was higher than the opposite; pain threshold is lower than the contralateral, both P <0.05, there is significant difference; when flexion and extension, dorsiflexion AEMG, FER compared within both sides, both P>0.05, the difference was not statistically significant.3NLBP symptoms side group and the control group:the hardness values higher; pain threshold is lower than the control group; NLBP group dorsiflexion muscles full flexion AEMG higher; dorsiflexion AEMG lower than the control group; FER high in the control group, all P<0.05, the difference was statistically significant.4NLBP group of symptoms before and after treatment side approach:pre-treatment hardness values than the treatment decreases; pre-treatment pain threshold than the increase; dorsiflexion muscle full flexion compared with treatment before AEMG reduced; pre-FER compared with treatment reduced both P<0.05, the difference was statistically significant. Dorsiflexion AEMG and after treatment before treatment, P>0.05, the difference was not statistically significant.5Correlation analysis before and after treatment each of the above index difference:the difference between hardness and pain threshold difference correlation coefficient:0.359, P<0.05, showed a negative correlation; full flexion AEMG difference and the difference of FER inter-correlation coefficient:0.727, P<0.01, significant positive correlation; correlation coefficient and the difference between dorsiflexion AEMG FER difference is:-0.711, P<0.01, significant negative correlation, No significant difference between the remaining indicators, both P>0.05.Conclusions1Patients with non-specific low back pain showed increased hardness of the soft tissue, Lower pain threshold, flexion relaxation phenomenon missing, dorsiflexion muscle contraction force decreases and other mechanical changes. 2The kneading manipulation of TCM in acute non-specific low back pain can significantly improve paraspinal muscle spasm, reduce local pain threshold improve muscle contraction abnormalities and dysfunction... |
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