悬吊推拿运动技术联合肌内效贴治疗腰肌筋膜炎的临床观察
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摘要
目的:观察悬吊推拿运动技术联合肌内效贴对腰肌筋膜炎的临床疗效及表面肌电信号频域指标MPF值的变化,探讨该综合康复方案治疗腰肌筋膜炎的作用机理。方法:将60例山东中医药大学第二附属医院康复中心门诊收治的腰肌筋膜炎患者按照随机数字表法分为治疗组和对照组,每组各30例。治疗组应用悬吊推拿运动技术联合肌内效贴治疗。患者于悬吊状态下进行局部的循经弹拨、松解筋膜,并结合仰卧位、俯卧位的开闭链主动运动,每次30 min,治疗结束后进行肌内效贴贴扎治疗。肌内效贴治疗时,贴扎方式遵循"痛阈提高、促进循环、缓解疲劳"的原则,患者处合适体位予以"X"形和"爪"形贴布贴扎治疗,每天1次,每次保持24 h。对照组仅接受肌内效贴贴扎治疗。2组治疗均每天1次,5次为1个疗程,疗程间休息2 d,共治疗4个疗程。治疗前后采用McGill简化量表评定患者疼痛程度,应用表面肌电(sEMG)中的频域指标(MPF)评定痛侧多裂肌、竖脊肌的肌肉易疲劳程度;治疗结束3个月后进行康复回访,并统计复发率。结果:治疗4个疗程后,2组McGill简化量表评分均较治疗前明显降低,且治疗组降低幅度较对照组更明显(P<0.05);2组痛侧多裂肌、竖脊肌平均功率频率(MPF)较治疗前明显降低,且治疗组MPF值降低幅度较对照组更明显(P<0.05);4个疗程结束后治疗组好转率高于对照组(P<0.05);治疗结束3个月后康复回访发现,治疗组复发率低于对照组(P<0.05)。结论:悬吊推拿运动技术联合肌内效贴治疗腰肌筋膜炎效果较单纯贴扎肌内效贴更佳,且长期效果优于单纯肌内效贴治疗。该综合康复方案操作简便,复发率低,值得临床推广应用。
Objective: To observe the clinical effect of Siling and Tuina exercise technique combined with kinesiology tape(KT)on lumbar muscle fasciitis and explore the changes of MPF in the frequency domain of surface electromyography, and explain the mechanism of this comprehensive rehabilitation program on the improvement of lumbar muscle fasciitis. Methods: A total of 60 lumbar muscle fasciitis patients treated in the outpatient department of the rehabilitation center of the second affiliated hospital of Shandong University of Traditional Chinese Medicine were collected. The eligible patients were divided into treatment group and control group by random number table method, with 30 cases in each group. The treatment group was treated with Siling and Tuina exercise technique combined with KT, while the control group was only treated with KT. In the suspension state, the patients in the treatment group underwent local meridian stretch and rib rectification, combined with the open and closed chain active movement in the supine position and prone position for 30 minutes. Then the patients in the treatment group received KT, which followed the principle of "improving pain threshold, promoting circulation, and relieving fatigue". The patients were given sticking with shapes of "X" and "claw" KT under appropriate position for 24 hours, once a day. The same KT was performed in the control group. The above two groups were treated once a day, five times for a course of treatment, two days rest between courses, and a total of four courses of treatment. Before and after the treatment, McGill simplified scale was used to assess the changes in pain degree of patients, and the changes in frequency domain index(MPF) in s EMG were used to assess the changes in the fatigue degree of bilateral multifidus muscle and vertical spine muscle. Rehabilitation follow-up was conducted three months after the end of treatment, and the recurrence rate was calculated. Results: After four courses of treatment, the scores of McGill simplified scale of two groups were lower than those before treatment, and the decrease was more obvious in the treatment group than that in the control group(P<0.05); the MPF value of the dorsalis multifidus and erector spinalis were decreased in both groups, but the MPF value decreased more significantly in the treatment group than that in the control group(P<0.05); the recovery rate of the treatment group was higher than that of the control group(P<0.05); the recurrence rate in the treatment group was lower than that in the control group(P<0.05). Conclusion: The treatment of lumbar muscle fasciitis with Siling and Tuina exercise technique combined with KT is more effective than that of simple KT, and the long-term effect is better than that of simple KT. This comprehensive rehabilitation program has the advantages of simple operation and low recurrence rate, and is worthy of clinical promotion and application.
Objective: To observe the clinical effect of Siling and Tuina exercise technique combined with kinesiology tape(KT)on lumbar muscle fasciitis and explore the changes of MPF in the frequency domain of surface electromyography, and explain the mechanism of this comprehensive rehabilitation program on the improvement of lumbar muscle fasciitis. Methods: A total of 60 lumbar muscle fasciitis patients treated in the outpatient department of the rehabilitation center of the second affiliated hospital of Shandong University of Traditional Chinese Medicine were collected. The eligible patients were divided into treatment group and control group by random number table method, with 30 cases in each group. The treatment group was treated with Siling and Tuina exercise technique combined with KT, while the control group was only treated with KT. In the suspension state, the patients in the treatment group underwent local meridian stretch and rib rectification, combined with the open and closed chain active movement in the supine position and prone position for 30 minutes. Then the patients in the treatment group received KT, which followed the principle of "improving pain threshold, promoting circulation, and relieving fatigue". The patients were given sticking with shapes of "X" and "claw" KT under appropriate position for 24 hours, once a day. The same KT was performed in the control group. The above two groups were treated once a day, five times for a course of treatment, two days rest between courses, and a total of four courses of treatment. Before and after the treatment, McGill simplified scale was used to assess the changes in pain degree of patients, and the changes in frequency domain index(MPF) in s EMG were used to assess the changes in the fatigue degree of bilateral multifidus muscle and vertical spine muscle. Rehabilitation follow-up was conducted three months after the end of treatment, and the recurrence rate was calculated. Results: After four courses of treatment, the scores of McGill simplified scale of two groups were lower than those before treatment, and the decrease was more obvious in the treatment group than that in the control group(P<0.05); the MPF value of the dorsalis multifidus and erector spinalis were decreased in both groups, but the MPF value decreased more significantly in the treatment group than that in the control group(P<0.05); the recovery rate of the treatment group was higher than that of the control group(P<0.05); the recurrence rate in the treatment group was lower than that in the control group(P<0.05). Conclusion: The treatment of lumbar muscle fasciitis with Siling and Tuina exercise technique combined with KT is more effective than that of simple KT, and the long-term effect is better than that of simple KT. This comprehensive rehabilitation program has the advantages of simple operation and low recurrence rate, and is worthy of clinical promotion and application.
引文
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[15]韩国栋,谭洁,蒋再秩,等.肌内效贴贴扎疗法治疗姿势性腰痛的临床观察[J].中国康复医学杂志,2014,29(9):857-859.
[16]郑悦承.软组织贴扎技术[M].中国台湾:合记图书出版社,2009:27-87.
[17] CASTRO-SANCHEZ A M,LARAPALOMO I C,GUILLERMO A. MATARAN-PENARROCHA G A,et al. Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain:a randomized trial[J]. Journal of Physiotherapy,2012,58(2):89-95.
[18]李丽,冯梓芸,孙敬龙.悬吊循经弹拨法治疗腰椎间盘突出症临床观察[J].康复学报,2015,25(4):10-13.
[19] FONTANA T L,RICHARDSON C A,STANTON W R. The effect of weight-bearing exercise with low frequency,whole body vibration on lumbosacral propfioception:a pilot study on normal subjects[J]. Aust J Physiother,2005,51(4):259-263.
[20] GOLDFARB A H,JAMARTAS A Z. Beta-endorphin response to exercise:an update[J]. Sport Med,1997,24(1):8-16.
[21]李非,李丽,许强强,等.悬吊运动联合弹拨经筋治疗腰背肌筋膜炎的临床观察[J].康复学报,2017,27(3):18-22.
[22]卢六沙.经络实质探析[J].中国针灸,1996,16(4):20-22.
[23]王春雷,吴金鹏,王军,等.筋膜学说解读中医经络实质及针灸作用机制[J].中国中医基础医学杂志,2008,14(4):312-314.
[2] LIU L,HUANG Q M,LIU QG,et al. Effectiveness of dry needlingfor myofascial trigger points associated with neck and shoulderpain:A systematic review and meta-analysis[J]. Arch PhysMed Rehabil,2015,96(5):944-955.
[3] RATHBONE ATL,KUMBHARE D A. Signsand symptoms of myofascial pain:A international survey of pain management providers and proposed preliminary set of diagnostic criteria[J]. Pain Med,2015,16(1):1794-1805.
[4]国家中医药管理局.中医病证诊断疗效标准[M].北京:中国医药科技出版社,2012:212-213.
[5]顾忠平.针刺结合水针治疗腰背肌筋膜炎临床观察[J].上海针灸杂志,2007,26(1):22-23.
[6] MELZACK R. The short-form McGill pain questionnaire[J].Pain,1987,30(2):191-197.
[7]白硕,葛瑞东.电针委中穴缓解腰背肌疲劳的表面肌电研究[J].中国康复医学杂志,2016,31(12):1350-1354.
[8]黄帝内经素问[M].北京:人民卫生出版社,2015:32-33.
[9]灵枢经[M].北京:人民卫生出版社,2016:56-57.
[10]张峻峰,吴耀持,宓轶群.“以痛为腧”治疗肌筋膜疼痛综合征疗效观察[J].中国针灸,2009,29(9):717-720.
[11] YU S H,KIM H J. Electrophysiological characteristics according to activity level of myofascial trigger points[J]. Journal of Physical Therapy Science,2015,27(19):2841-2843.
[12] GERDLE B,LARSSON B,SLOPEARLSSON S,et al. Criterionvalidation of surface EMG variables as fatigue indicators using pea-slope torque:a study of repetitive maximum isokinetic knee extensions[J]. J Electromyogr Kinesiol,2000,10(4):225-232.
[13] VITHOULKA I,BENEKA A,MALLIOU P,et al. The effects of kinesiotaping on quadriceps strength during isokinetic exercise in healthy non athlete women[J]. Isokinet Exerc Sci,2010,18(1):1-6.
[14]范斌,刘琳,朱欢.肌内效贴对肌筋膜疼痛综合征疼痛治疗效果的Meta分析[J].中国康复理论与实践,2018,24(3):347-352.
[15]韩国栋,谭洁,蒋再秩,等.肌内效贴贴扎疗法治疗姿势性腰痛的临床观察[J].中国康复医学杂志,2014,29(9):857-859.
[16]郑悦承.软组织贴扎技术[M].中国台湾:合记图书出版社,2009:27-87.
[17] CASTRO-SANCHEZ A M,LARAPALOMO I C,GUILLERMO A. MATARAN-PENARROCHA G A,et al. Kinesio Taping reduces disability and pain slightly in chronic non-specific low back pain:a randomized trial[J]. Journal of Physiotherapy,2012,58(2):89-95.
[18]李丽,冯梓芸,孙敬龙.悬吊循经弹拨法治疗腰椎间盘突出症临床观察[J].康复学报,2015,25(4):10-13.
[19] FONTANA T L,RICHARDSON C A,STANTON W R. The effect of weight-bearing exercise with low frequency,whole body vibration on lumbosacral propfioception:a pilot study on normal subjects[J]. Aust J Physiother,2005,51(4):259-263.
[20] GOLDFARB A H,JAMARTAS A Z. Beta-endorphin response to exercise:an update[J]. Sport Med,1997,24(1):8-16.
[21]李非,李丽,许强强,等.悬吊运动联合弹拨经筋治疗腰背肌筋膜炎的临床观察[J].康复学报,2017,27(3):18-22.
[22]卢六沙.经络实质探析[J].中国针灸,1996,16(4):20-22.
[23]王春雷,吴金鹏,王军,等.筋膜学说解读中医经络实质及针灸作用机制[J].中国中医基础医学杂志,2008,14(4):312-314.