Manipulation treatment of lumbar disc herniation based on the model of muscles and bones assessment
Objective To explore the effectiveness of manipulation treatment for lumbar disc herniation(LDH)based on the model of muscle and bone assessment.Methods From May 2022 to August 2023,using the methods single-center random-ized controlled in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,72 patients were treated with LDH and divided into muscle and bone assessment model manipulation group and the two step seven gimmick group according to the random number table method,the muscle and bone assessment model manipulation group fall off in 1 case,the two step seven gimmick group falls off in 2 cases.There were 35 cases in the muscle and bone assessment model manipulation group,including 12 males and 23 females;The age was 27 to 48 years old with an average of(37.77±7.63)years old.The course of disease was 35 to 180 days with an average of(83.68±69.01)days.The patients were treated with manual therapy under the guidance of muscle and bone assessment model,twice a week for 4 weeks.There were 34 cases in the two step seven gimmick group including 12 males and 22 females;The age was 26 to 49 years old with an average of(37.59±7.43)years old;The course of disease was 40 to 175 days with an average of(82.15±68.87)days.The patients were treated with two step seven gimmick method,2 times a week,for 4 weeks.The visual analogue scale(VAS)and Oswestry disability index(Oswestry dis-ability index,ODI)questionnaire,muscle tension and lumbar spine angle and the straight leg-raising activities were compared between two groups before and 4 weeks after treatment.Results The VAS of the muscle and bone assessment model manipula-tion group and the two step seven gimmick group(6.51±0.61)and(6.62±0.56)before treatment decreased to 2.40±0.81 and 3.18±0.78 after 4 weeks of treatment,respectively,and the muscle and bone assessment model manipulation group was signifi-cantly lower than the two step seven gimmick group(P＜0.01).The ODI of the muscle and bone assessment model manipulation group and the two step seven gimmick group were(64.57±5.11)and(65.02±5.18)before treatment,decreased to(18.60±2.27)and(24.70±2.14)after4 weeks of treatment,and the ODI of the muscle and bone assessment model manipulation group was significantly lower than that of the two step seven gimmick group(P＜0.01).Before the treatment,side erector spinae,glu-teus medius,and gastrocnemius muscle tension were(59.95±2.60),(62.59±2.51),(49.97±2.01)in the muscle and bone as-sessment model manipulation group and(60.39±3.84),(62.47±3.27),(49.55±1.27)in the two step seven gimmick group;Af-ter4 weeks of treatment,the muscle tension of erector spinae,gluteus medius and gastrocnemius on the affected side were(56.58±2.71),(60.44±2.31)and(49.19±1.57)in the muscle and bone assessment model manipulation group,(58.28±3.79),(60.11±2.87),(48.55±0.90)in the two step seven gimmick group,the differences had statistical significance before and after treatment of two groups(P＜0.01).The muscle and bone assessment model manipulation group was better than the two step sev-en gimmick group in improving the erector spinae muscle tension on the affected side(P＜0.05),and there was no significant difference in the rest(P＞0.05).Before the treatment,lumbar proneness,stretch,subject to lateral flexion and lateral angle of the straight leg-raising on the affected side were(46.00±8.89)°,(13.57±3.75)°,(12.29±3.50)°,(43.71±7.98)° in the mus-cle and bone assessment model manipulation group,(45.14±6.24)°,(12.23±3.75)°,(12.66±2.98)° and(44.18±3.50)° in the two step seven gimmick group.After 4 weeks of treatment,the angles of lumbar flexion,extension,flexion on the affected side and straight leg raising on the affected side were(76.29±4.43)°,(20.00±1.71)°,(22.43±2.81)°,(70.41±7.59)° in the muscle and bone assessment model manipulation group,and(75.75±6.38)°,(16.43±3.36)°,(20.19±3.52)°,(65.42±6.15)° in the two step seven gimmick group.The difference had statistical significance before and after treatment in two groups(P＜0.01),a comparison between groups,after 4 weeks of treatment,the angles of lumbar flexion and extension,affected side flex-ion,and lower limb straight leg elevation in the muscle and bone assessment model manipulation group were better than those in the two step seven gimmick group(P＜0.05).Before the treatment,pelvic tilt,lumbar lordosis angle were(2.71±1.01)mm,(37.63±3.35)° in the muscle and bone assessment model manipulation group,and(2.69±0.97)mm,(36.98±3.73)° in the two step seven gimmick group;After 4 weeks of treatment,the pelvic tilt and lumbar lordosis angle were(0.84±0.36)mm and(41.64±2.96)° in the muscle and bone assessment model manipulation group,and those in the method of two step seven gim-mick group were(1.18±0.75)mm and(41.70±3.14)°.There were significant differences before and after treatment in both groups(P＜0.0 1),and the improvement of pelvic tilt in the muscle and bone assessment model manipulation group was better than that in the method of two step seven gimmick group after 4 weeks of treatment(P＜0.05).Conclusion The manipulation under the guidance of the muscle and bone assessment model can effectively improve the pain and dysfunction of LDH pa-tients,and has a better effect than the two-step seven-method manipulation group in improving the muscle tension,lumbar mo-tion function and posture.
Muscles and bones evaluationLumbar disc herniationManipulationEvaluation
万方数据
维普
