康复学报 (Feb 2019)
Clinical Study on Lumbar Disc Herniation Treated by Sling and Tuina Exercise Technique
Abstract
Objective:To explore the clinical effect of sling and tuina exercise technique on lumbar disc herniation(LDH)and the changes of thickness of local core stable muscles including transversus abdominal muscle and multifidus muscle, and to explain the therapeutic advantages of sling and tuina exercise technique for LDH.Methods:A total of 84 LDH patients who were outpatient and admitted to the rehabilitation center of the Second Affiliated Hospital in Shandong University of Traditional Chinese Medicine were collected. The eligible patients were divided into tuina treatment group, sling exercise therapy group, and sling and tuina exercise technique group by random number table method, with 28 cases in each group. All three groups received health education including activity mode adjustment, bed rest and braking, prevention and correction of bad posture, bad habits of daily life, and self-training of waist and abdomen core strength during recovery. The tuina treatment group was given rubbing, pressing, plucking and other manipulations to relax the tense muscles and myofascia chain of the waist. The sling exercise therapy group performed active movement of the open-closed chain in the supine position and the prone position. Patients in the sling and tuina exercise technique group were plucked the meridian sinews and loosened the myofascia and combined with the open-closed chain active movement in the lateral position and the prone position. All the above groups were treated for 30 minutes, once a day, 5 times per week for 4 weeks. Japanese Orthopaedic Association Scores(JOA)and VisualAnalogue Score(VAS)were used to evaluate the clinical efficacy before treatment and four weeks after treatment. Short-term pain improvement in the three groups was assessed by VAS scale after one week of treatment. Before and four weeks after treatment, musculoskeletal ultrasonography(MSUS)was used to detect the changes in thickness of local core stable muscles including transversus abdominal muscle and multifidus muscle. The recurrence rates of the three groups were counted at six months'follow-up.Results:The cure rate of the sling and tuina exercise technique group was higher than that of the other two groups(P<0.05). After four weeks of treatment, the JOA scores of the three groups were all higher than those before treatment(P<0.05), and the sling and tuina exercise technique group was superior to the other two groups(P<0.05). After one and four weeks of treatment, VAS scores were all decreased(P<0.05), and the sling and tuina exercise technique group were better than the other two groups(P<0.05)respectively. The thickness of transverse abdominal muscle and multifidus muscle measured by MSUS had changed, and the sling and tuina exercise technique group was better than the other two groups(P<0.05). After six months'rehabilitation visit it found that the recurrence rate of the sling and tuina exercise technique group was significantly lower than that of the other two groups(P<0.05).Conclusion:Sling and tuina exercise technique for the treatment of LDH is easier to activate the core stabilizing muscle than simple tuina therapy and sling exercise therapy. It has the advantages of good clinical efficacy and low recurrence rate, and is worthy of clinical application.
