经筋灸法联合核心稳定训练对慢性非特异性下腰痛疼痛、功能及肌耐力的影响
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摘要
目的:观察经筋灸法结合核心稳定训练治疗慢性非特异性下腰痛的临床疗效。方法:将138例慢性非特异性下腰痛患者,随机分为经筋组、训练组、结合组,每组46例。经筋组采用经筋灸法,首先对患者触诊标记,每次选取8～12个结筋病灶点,以艾条温和灸,30 min/次;训练组借助瑞士球,按端坐、双桥、屈膝双桥、反桥和俯卧撑的顺序,每个动作持续30 s,每次间隔休息1 min,重复3次。结合组采用先经筋灸法,后核心稳定训练的方法。3组均1次/d,5 d为1个疗程。连续治疗4个疗程后观察3组治疗前后VAS、RMDQ分值、静、动态肌耐力评估,并评价疗效。结果:(1)结合组疗效明显优于经筋组和训练组(P<0.05),经筋组疗效优于训练组(P<0.05);(2)与治疗前相比,3组患者治疗后VAS、RMDQ评分明显降低(均P<0.05),腰部静、动态肌耐力评估值明显增强(均P<0.05);(3)治疗后,与经筋组、训练组相比,结合组VAS、RMDQ评分明显降低(P<0.05),腰部静、动态肌耐力评估值明显增强(P<0.05);(4)治疗后,与经筋组相比,训练组VAS评分差异不显著(P>0.05),RMDQ评分明显降低(P<0.05),腰部静、动态肌耐力评估值明显增强(P<0.05)。结论:经筋灸法结合核心稳定训练可以明显改善慢性非特异性下腰痛患者疼痛、腰部功能,并明显增强静、动态腰部肌耐力,疗效显著。
Objective: To observe the clinical efficacy of chronic non-specific low back pain treated by tendon-moxibustion combined with core stability training. Methods: A total of 138 patients with chronic non-specific low back pain were randomly divided into tendons group(46 cases), training group(46 cases)and combination group(46 cases). The patients of tendons group were marked the leslies firstly. Then eight to twelve lesions were selected each time to moxibustion. The patients of training group were took the Swiss ball, followed by the order of sitting, double bridge, the double knee bridge, the anti-bridge and the push-up. Each action took thirty seconds and the interval was one minute and repeated three times. The combination group combines the two treatments above. The three groups were both once a day, and five days were a course of treatment. After four courses of treatment, VAS and RMDQ scores, static and dynamic muscle endurance assessment, and efficacy evaluation were observed before and after. Results:(1)The efficacy of the combination group was significantly better than that of the gluten group and the training group(P<0.05). The effect of the fascia group was better than that of the training group(P<0.05).(2)The VAS after treatment in the three groups compared with before treatment. The RMDQ score was significantly lower(both P<0.05), and the evaluation of lumbar static and dynamic muscle endurance was significantly increased(both P<0.05).(3)After treatment, compared with the menstrual group and the training group, the combined group's VAS and RMDQ scores were significantly lower(P<0.05), and the evaluation of lumbar static and dynamic muscle endurance was significantly increased(P<0.05).(4)After treatment, there was no significant difference in VAS scores between the training group and the menstrual group(P>0.05). The RMDQ score was significantly lower(P<0.05), and the evaluation of lumbar static and dynamic muscle endurance was significantly increased(P<0.05). Conclusion: The combination of gluten moxibustion and core stability training can significantly improve the pain and lumbar function of patients with chronic non-specific low back pain, and significantly enhance the static and dynamic lumbar muscle endurance.
Objective: To observe the clinical efficacy of chronic non-specific low back pain treated by tendon-moxibustion combined with core stability training. Methods: A total of 138 patients with chronic non-specific low back pain were randomly divided into tendons group(46 cases), training group(46 cases)and combination group(46 cases). The patients of tendons group were marked the leslies firstly. Then eight to twelve lesions were selected each time to moxibustion. The patients of training group were took the Swiss ball, followed by the order of sitting, double bridge, the double knee bridge, the anti-bridge and the push-up. Each action took thirty seconds and the interval was one minute and repeated three times. The combination group combines the two treatments above. The three groups were both once a day, and five days were a course of treatment. After four courses of treatment, VAS and RMDQ scores, static and dynamic muscle endurance assessment, and efficacy evaluation were observed before and after. Results:(1)The efficacy of the combination group was significantly better than that of the gluten group and the training group(P<0.05). The effect of the fascia group was better than that of the training group(P<0.05).(2)The VAS after treatment in the three groups compared with before treatment. The RMDQ score was significantly lower(both P<0.05), and the evaluation of lumbar static and dynamic muscle endurance was significantly increased(both P<0.05).(3)After treatment, compared with the menstrual group and the training group, the combined group's VAS and RMDQ scores were significantly lower(P<0.05), and the evaluation of lumbar static and dynamic muscle endurance was significantly increased(P<0.05).(4)After treatment, there was no significant difference in VAS scores between the training group and the menstrual group(P>0.05). The RMDQ score was significantly lower(P<0.05), and the evaluation of lumbar static and dynamic muscle endurance was significantly increased(P<0.05). Conclusion: The combination of gluten moxibustion and core stability training can significantly improve the pain and lumbar function of patients with chronic non-specific low back pain, and significantly enhance the static and dynamic lumbar muscle endurance.
引文
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[4] 杨诚,彭宝淦.腰痛的治疗方法[J].中华全科医师杂志,2011,10(2):82-85.
[5] Peter Kent,Mj sund HL,Petersen Ditte.Does targeting manual therapy and/or exercise improve patient outcomes in nonspecific low back pain?A systematic review[J].BMC Med,2010(8):22.
[6] Hirschberg GG,Froetscher L,Naeim F. Iliolumbar syndrome as a common cause of low back pain: diagnosis and prognosis[J]. Arch Phys Med Rehabil,1979,60(9):415-419.
[7] He L, Hu X, Tang Y, et al. Efficacy of coblation annuloplasty in discogenic low back pain: a prospective observational study [J]. Medicine (Baltimore), 2015,94(19):e846.
[8] 高明暄,刘兴炎.中文版Roland-Morris腰痛失能问卷可靠性评定[J].实用医学杂志,2005,21(24):2755-2756.
[9] 邱丹.青少年腰背肌力量耐力及左右侧对称性测评方法的研究[D].北京:北京体育大学,2012.
[10] 国家中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:216.
[11] DelPB, Hernández Mocholí MA, Adsuar JC, et al. Effects of whole body vibration therapy on main outcome measures for chronic non-specific low back pain: a single-blind randomized controlled trial[J]. Journal of Rehabilitation Medicine, 2011, 43(8):689-694.
[12] 苏鑫童,马晓晶,薛立功,等.论经筋痹痛[J].中国中医基础医学杂志,2015,21(4):381-382.
[13] 孔安安.经筋理论发展源流及特殊筋病的证治考源[D].北京:北京中医药大学,2013.
[14] 刘元石.非特异性下腰痛结筋病灶点经筋分布规律及超声下病变特点的研究[D].北京:中国中医科学院,2013.
[15] 王琼,赵琴,胡幼平.浅析《灵枢》“解结”之法[J].安徽中医药大学学报,2013,32(1):6-7.
[16] 董宝强,张书剑,韩煜.艾灸循经筋阿是穴治疗膝骨性关节炎的临床研究[J].中华中医药学刊,2013,31(9):1839-1840.
[17] Sung DH, Yoon SD, Park GD. The effect of complex rehabilitation training for 12 weeks on trunk muscle function and spine deformation of patients with SCI [J]. J Phys Ther Sci, 2015, 27(3): 951-954.
[18] 范星月,闫博馨,丁家喻,等.呼吸训练对非特异性腰痛的疗效[J].中国康复理论与实践,2018,24(1):93-96.
[19] 王雪强.核心稳定训练对非特异性腰痛患者神经肌肉功能的作用[D].上海:上海体育学院,2016.
[20] Akuthota V, Ferreiro A, Moore T,et al. Core stability exercise principles [J].Curr Sports Med Rep,2008,7(1):39-44.
[21] Kim SG, Yong MS, Na SS.The effect of trunk stabilization exercises with a swiss ball on core muscle activation in the elderly[J].J Phys Ther Sci,2014,26(9):1473-1474.
[22] 李瑞杰,董宝强,林星星,等.经筋刺法结合核心稳定训练治疗慢性非特异性腰痛临床观察[J].辽宁中医药大学学报,2018,20(6):60-63.
[23] 李小金,韩秀兰,成守珍.下肢生物力学矫正联合脊柱区核心肌群训练治疗慢性非特异性下腰痛[J].中国骨科临床与基础研究杂志,2014,6(4):233-237.
[2] Borenstein DG. Epidemiology, etiology, diagnostic evaluation,and treatment of low back pain [J]. Curr Opin Rheumatol,2011,13(2):128-134.
[3] 郭险峰,张大成,陶莉.216例慢性非特异性腰痛患者的康复疗效观察[J].中国康复理论与实践,2010,16(6):556-559.
[4] 杨诚,彭宝淦.腰痛的治疗方法[J].中华全科医师杂志,2011,10(2):82-85.
[5] Peter Kent,Mj sund HL,Petersen Ditte.Does targeting manual therapy and/or exercise improve patient outcomes in nonspecific low back pain?A systematic review[J].BMC Med,2010(8):22.
[6] Hirschberg GG,Froetscher L,Naeim F. Iliolumbar syndrome as a common cause of low back pain: diagnosis and prognosis[J]. Arch Phys Med Rehabil,1979,60(9):415-419.
[7] He L, Hu X, Tang Y, et al. Efficacy of coblation annuloplasty in discogenic low back pain: a prospective observational study [J]. Medicine (Baltimore), 2015,94(19):e846.
[8] 高明暄,刘兴炎.中文版Roland-Morris腰痛失能问卷可靠性评定[J].实用医学杂志,2005,21(24):2755-2756.
[9] 邱丹.青少年腰背肌力量耐力及左右侧对称性测评方法的研究[D].北京:北京体育大学,2012.
[10] 国家中医药管理局.中医病症诊断疗效标准[S].南京:南京大学出版社,1994:216.
[11] DelPB, Hernández Mocholí MA, Adsuar JC, et al. Effects of whole body vibration therapy on main outcome measures for chronic non-specific low back pain: a single-blind randomized controlled trial[J]. Journal of Rehabilitation Medicine, 2011, 43(8):689-694.
[12] 苏鑫童,马晓晶,薛立功,等.论经筋痹痛[J].中国中医基础医学杂志,2015,21(4):381-382.
[13] 孔安安.经筋理论发展源流及特殊筋病的证治考源[D].北京:北京中医药大学,2013.
[14] 刘元石.非特异性下腰痛结筋病灶点经筋分布规律及超声下病变特点的研究[D].北京:中国中医科学院,2013.
[15] 王琼,赵琴,胡幼平.浅析《灵枢》“解结”之法[J].安徽中医药大学学报,2013,32(1):6-7.
[16] 董宝强,张书剑,韩煜.艾灸循经筋阿是穴治疗膝骨性关节炎的临床研究[J].中华中医药学刊,2013,31(9):1839-1840.
[17] Sung DH, Yoon SD, Park GD. The effect of complex rehabilitation training for 12 weeks on trunk muscle function and spine deformation of patients with SCI [J]. J Phys Ther Sci, 2015, 27(3): 951-954.
[18] 范星月,闫博馨,丁家喻,等.呼吸训练对非特异性腰痛的疗效[J].中国康复理论与实践,2018,24(1):93-96.
[19] 王雪强.核心稳定训练对非特异性腰痛患者神经肌肉功能的作用[D].上海:上海体育学院,2016.
[20] Akuthota V, Ferreiro A, Moore T,et al. Core stability exercise principles [J].Curr Sports Med Rep,2008,7(1):39-44.
[21] Kim SG, Yong MS, Na SS.The effect of trunk stabilization exercises with a swiss ball on core muscle activation in the elderly[J].J Phys Ther Sci,2014,26(9):1473-1474.
[22] 李瑞杰,董宝强,林星星,等.经筋刺法结合核心稳定训练治疗慢性非特异性腰痛临床观察[J].辽宁中医药大学学报,2018,20(6):60-63.
[23] 李小金,韩秀兰,成守珍.下肢生物力学矫正联合脊柱区核心肌群训练治疗慢性非特异性下腰痛[J].中国骨科临床与基础研究杂志,2014,6(4):233-237.