Efficacy Evaluation of Manual Therapy for Cervical Spondylotic Radiculopathy Using Semg Frequency Domain and Nonlinear Analysis

doi:10.12114/j.issn.1007-9572.2026.0013

Abstract

Abstract:

Background

Manual therapy is a standard conservative treatment for cervical spondylotic radiculopathy (CSR); however, clinical electrophysiological evidence regarding its efficacy in improving neuromuscular function in CSR patients remains insufficient.

Objective

This study aimed to elucidate the electrophysiological effects of cervical rotation-traction manipulation and tendon-regulating manipulation on the affected muscles of CSR patients using frequency-domain and nonlinear analysis of surface electromyography (sEMG).

Methods

Sixty patients with CSR admitted to Wangjing Hospital, China Academy of Chinese Medical Sciences, from April 2024 to April 2025 were enrolled and randomly assigned to either the cervical rotation-traction manipulation group or the tendon-regulating manipulation group (n=30 each). Electrophysiological characteristics-frequency-domain indices [median frequency (MDF), mean power frequency (MNF)] and nonlinear index [sample entropy (SampEn)]-of the affected wrist flexors, wrist extensors, biceps brachii, triceps brachii, and deltoid muscles were measured at pre-treatment (T0), mid-treatment (T1), and post-treatment (T2). Independent samples t-tests and analysis of variance (ANOVA) were employed to evaluate the treatment effects.

Results

At T1 and T2, the MDF of the biceps and triceps brachii in the cervical rotation-traction manipulation group were significantly higher than those in the tendon-regulating manipulation group (P<0.05). At T1, the MNF of the biceps and triceps brachii in the cervical rotation-traction manipulation group were higher than those in the tendon-regulating manipulation group (P<0.05); at T2, only the MNF of the biceps brachii was higher in the cervical rotation-traction manipulation group (P<0.05). At T1, the SampEn values of the biceps and triceps brachii in the cervical rotation-traction manipulation group were significantly higher than those in the tendon-regulating manipulation group (P<0.05). Within the cervical rotation-traction manipulation group, MDF, MNF, and SampEn showed statistically significant differences among muscles at all time points (T0-T2) (P<0.05), with effect sizes (η²) ranging from 0.308-0.413 for MDF and MNF, and 0.090-0.107 for SampEn. In the tendon-regulating manipulation group, significant differences among muscles were observed for MDF and MNF at all time points (P<0.001, η²=0.108-0.164), whereas no significant differences were found for SampEn (P>0.05, η²=0.036-0.051).

Conclusion

The electrophysiological regulation effect of cervical rotation-traction manipulation on the affected muscles of CSR patients is superior to that of tendon-regulating manipulation, particularly in improving the frequency-domain and nonlinear indices of key muscle groups (biceps and triceps brachii), providing an objective basis for clinical selection of manual therapies.

Key words: Cervical spondylosis, Cervical spondylotic radiculopathy, Cervical rotation-traction manipulation, Electromyography, Frequency domain analysis, Nonlinear analysis

摘要：

背景

手法作为神经根型颈椎病（CSR）保守治疗的常用手段，目前尚缺乏其改善CSR患者神经肌肉功能的电生理临床依据。

目的

本研究旨在运用表面肌电（sEMG）的频域及非线性分析方法，阐明旋提与理筋手法对CSR患者患侧肌肉群的电生理学影响。

方法

选择2024年4月—2025年4月中国中医科学院望京医院门诊及病房收治的CSR患者60例，按随机数字表法分配至旋提手法组、理筋手法组，各30例。采集并计算患侧腕屈肌、腕伸肌、肱二头肌、肱三头肌、三角肌在治疗前（T0）、治疗中期（T1）及治疗结束后（T2）的肌电频域[中位频率（MDF），平均功率频率（MNF）]及非线性指标[样本熵（SampEn）]分析差异。采用独立样本t检验及方差分析检验评估治疗效果。

结果

T1和T2时间点，旋提手法组肱二头肌、肱三头肌的MDF均高于理筋手法组（P<0.05）。在T1时间点，旋提手法组肱二头肌、肱三头肌的MNF均高于理筋手法组（P<0.05）；在T2时间点，旋提手法组仅肱二头肌的MNF高于理筋组（P<0.05）。在T1时间点，旋提手法组肱二头肌、肱三头肌的SampEn值高于理筋手法组（P<0.05）。旋提手法组MDF、MNF及SampEn指标在T0~T2时间点均存在统计学意义（P<0.05），其中MDF与MNF的效应量（η²）为0.308~0.413，SampEn的η²为0.090~0.107；理筋手法组各时间点MDF与MNF的肌群间差异均有统计学意义（P<0.001，η²为0.108~0.164）,但SampEn在各时间点肌群间差异均无统计学意义（P>0.05，η²为0.036~0.051）。

结论

旋提手法对CSR患者患侧肌群的电生理调节效应优于理筋手法，尤其是在改善关键肌群（肱二、三头肌）的频域及非线性特征方面更具优势，为临床手法选择提供客观依据。

关键词: 颈椎病, 神经根型颈椎病, 旋提手法, 表面肌电图, 频域分析, 非线性分析

CLC Number:

R 274.9

LI Jing,ZHENG Jiacheng,LI Hongtao, et al. Efficacy Evaluation of Manual Therapy for Cervical Spondylotic Radiculopathy Using Semg Frequency Domain and Nonlinear Analysis[J]. Chinese General Practice, 2026, 29(22): 3168-3174. DOI: 10.12114/j.issn.1007-9572.2026.0013.
李静,郑家丞,李红桃等. 基于表面肌电频域及非线性分析评估手法治疗神经根型颈椎病的疗效研究[J]. 中国全科医学, 2026, 29(22): 3168-3174. DOI: 10.12114/j.issn.1007-9572.2026.0013.

Figures/Tables 5

References 33

[1]	程继嗣, 关涛, 李军, 等. 神经根型颈椎病的诊断与中医药治疗进展[J]. 中国中医药现代远程教育, 2025, 23(7): 193-195.
[2]	Eren T, Ayhan Kuru Ç. Bilateral sensorimotor dysfunction in the upper extremities in unilateral cervical radiculopathies: a level-specific approach[J]. J Back Musculoskelet Rehabil, 2025, 38(6): 1485-1496.
[3]	Alcan V, Zinnuroğlu M. Current developments in surface electromyography[J]. Turk J Med Sci, 2023, 53(5): 1019-1031.
[4]	刘建, 邹任玲, 张东衡, 等. 表面肌电信号特征提取方法研究发展趋势[J]. 生物医学工程学进展, 2015, 36(3): 164-168.
[5]	陈江西. 基于GRA方法的递增负荷运动时sEMG指标的疲劳评价效果研究[D]. 长春：吉林大学，2025.
[6]	方武. 基于表面肌电与步态信号的下肢肌肉疲劳性分析[D]. 杭州: 杭州电子科技大学, 2023.
[7]	周昌元, 毛志贤. 肌电信号的采集技术与应用发展现状和展望[J]. 传感器世界, 2024, 30(5): 1-7.
[8]	赵翠莲, 马双驰, 柳叶潇. 基于样本熵和个体化阈值的表面膈肌肌电信号起点检测[J]. 生物医学工程学杂志, 2018, 35(6): 852-859. DOI: 10.7507/1001-5515.201804026.
[9]	许全盛, 白茹雪, 李世明. 力量训练负荷和肌肉疲劳对表面肌电非线性参数的双重调节[J]. 中国体育科技, 2022, 58(8): 83-90.
[10]	中国康复医学会颈椎病专业委员会. 颈椎病诊治与康复指南(2010版) [S]. 北京: 中国康复医学会, 2010.
[11]	李双, 郝明, 谢瑞. 旋提手法联合颈2方治疗气滞血瘀证神经根型颈椎病的临床观察[J]. 世界中西医结合杂志, 2025, 20(8): 1565-1569. DOI: 10.13935/j.cnki.sjzx.250812.
[12]	国家中医药管理局中医师资格认证中心. 中医骨伤科学[M]. 北京: 中国中医药出版社, 316.
[13]	彭博辰, 韩昶晓, 刘广伟, 等. 旋提手法联合针刺治疗颈源性头痛的临床研究[J]. 北京中医药, 2025, 44(10): 1271-1274.
[14]	艾民康. 中医理筋手法治疗脊髓型颈椎病术后轴性症状的临床疗效观察[D]. 南昌: 江西中医药大学, 2024.
[15]	王乐军, 邵企能, 马国强, 等. 基于灰色关联度的自行车间歇训练诱发股直肌疲劳的肌电评价效果研究[J]. 体育科学, 2019, 39(9): 60-67. DOI: 10.16469/j.css.201909007.
[16]	王舒润. 基于表面肌电信号的上肢运动状态感知及外骨骼助力控制[D]. 合肥: 合肥工业大学, 2024.
[17]	Aberson C L. Applied power analysis for the behavioral sciences[M]. Abingdon: Routledge, 2019.
[18]	Chai G Z, Wang Y H, Wu J F, et al. Study on the recognition of exercise intensity and fatigue on runners based on subjective and objective information[J]. Healthcare (Basel), 2019, 7(4): 150.
[19]	Park S Y, Park C H. Diagnosis of muscle fatigue using surface electromyography and analysis of associated factors in type 2 diabetic patients with neuropathy: a preliminary study[J]. Int J Environ Res Public Health, 2021, 18(18): 9635. DOI: 10.3390/ijerph18189635.
[20]	Hou X, Wang X L, Griffin L, et al. Immediate and delayed effects of cupping therapy on reducing neuromuscular fatigue[J]. Front Bioeng Biotechnol, 2021, 9: 678153. DOI: 10.3389/fbioe.2021.678153.
[21]	Wang X H, Luo Z C, Zhang M X, et al. The interaction between changes of muscle activation and cortical network dynamics during isometric elbow contraction: a sEMG and fNIRS study[J]. Front Bioeng Biotechnol, 2023, 11: 1176054.
[22]	顾铭钰. 基于Visual 3D软件建模的旋提手法治疗神经根型颈椎病的机制研究[D]. 长春：长春中医药大学, 2023.
[23]	王旭, 王海美, 陈松浩, 等. 旋提手法治疗神经根型颈椎病的应力及椎间孔形态学特征：三维有限元分析[J]. 中国组织工程研究, 2025, 29(3): 441-447. DOI: 10.12307/2025.104.
[24]	林东鑫. 颈椎斜扳与旋提手法的生物力学效应及颈椎体位影响分析[D]. 广州：南方医科大学，2025.
[25]	Xu X L, Ling Y. Manual therapy for cervical radiculopathy: effects on neck disability and pain–a systematic review and network meta-analysis[J]. J Pain Res, 2025, 18: 2035-2045.
[26]	王槐旌, 王平, 李嘉钰, 等. 旋提手法治疗颈椎病临床效果和安全性的Meta分析[J]. 实用中医内科杂志, 2021, 35(9): 29-33, I0009, I0010. DOI: 10.13729/j.issn.1671-7813.Z20201194.
[27]	Thimjon C, Olewnik Ł, Iwanaga J, et al. C6 and not C5 nerve fibers more commonly contribute most to deltoid muscle innervation: anatomical study with application to better diagnosing cervical nerve injuries[J]. Neurosurg Rev, 2022, 45(3): 2401-2406.
[28]	Zancolli P, Johnston B R, Martinez E F, et al. Proximal forearm nerve branching patterns: an anatomical study and its clinical significance[J]. J Neurosurg Spine, 2023, 39(4): 593-599.
[29]	Jiang J, Tian S L, Tian Y, et al. Transient abnormal signal acquisition system based on approximate entropy and sample entropy[J]. Rev Sci Instrum, 2022, 93(4): 044702. DOI: 10.1063/5.0073423.
[30]	Cui W X, Chen X, Cao S, et al. Muscle fatigue analysis of the deltoid during three head-related static isometric contraction tasks[J]. Entropy, 2017, 19(5): 221. DOI: 10.3390/e19050221.
[31]	Keter D L, Bialosky J E, Brochetti K, et al. The mechanisms of manual therapy: a living review of systematic, narrative, and scoping reviews[J]. PLoS One, 2025, 20(3): e0319586.
[32]	Gelley G M, Passmore S R, Glazebrook C M, et al. Effect of spinal manipulation on eye and head movement performance in participants with chronic neck pain: an observational study[J]. J Manip Physiol Ther, 2025, 48(1/2/3/4/5): 137-148.
[33]	Prasad K. Why there are so many measures of effect size (relative merits and demerits)?[J]. Neurol India, 2020, 68(3): 654-656.

组别	例数	性别（男/女）	年龄（±s，岁）	身高（±s，cm）	体质量（±s，kg）	BMI（±s，kg/m²）
旋提手法组	30	13/17	45.5±7.4	167.30±9.45	83.83±32.78	29.74±11.04
理筋手法组	30	16/14	45.8±7.7	171.10±7.73	76.80±20.69	26.13±6.50
t（χ²）值		0.601^a	0.153	1.706	-0.994	-1.541
P值		0.438	0.879	0.094	0.325	0.129

组别	例数	性别（男/女）	年龄（±s，岁）	身高（±s，cm）	体质量（±s，kg）	BMI（±s，kg/m²）
旋提手法组	30	13/17	45.5±7.4	167.30±9.45	83.83±32.78	29.74±11.04
理筋手法组	30	16/14	45.8±7.7	171.10±7.73	76.80±20.69	26.13±6.50
t（χ²）值		0.601^a	0.153	1.706	-0.994	-1.541
P值		0.438	0.879	0.094	0.325	0.129

组别	例数	T0					T1
组别	例数	腕屈肌	腕伸肌	肱二头肌	肱三头肌	三角肌	腕屈肌	腕伸肌
旋提手法组	30	122.31±37.21	124.85±26.50	74.14±20.47	110.40±36.38	88.50±12.70	118.29±45.63	124.50±25.47
理筋手法组	30	117.74±60.30	131.07±26.79	81.22±28.42	105.29±30.51	90.55±15.09	110.40±67.72	133.03±27.48
t值		0.49	-1.20	-1.28	0.68	-0.72	0.68	-1.57
P值		0.628	0.233	0.205	0.498	0.472	0.498	0.119
组别	T1			T2
组别	肱二头肌	肱三头肌	三角肌	腕屈肌	腕伸肌	肱二头肌	肱三头肌	三角肌
旋提手法组	92.03±32.21	117.70±31.20	90.58±15.70	125.64±42.55	121.93±21.02	95.33±37.07	119.13±36.49	87.24±15.61
理筋手法组	75.03±22.43	102.75±25.98	92.07±20.34	109.87±57.87	122.51±27.35	73.07±14.85	105.48±26.57	88.46±16.11
t值	-3.23	2.64	-0.38	1.39	-0.11	-4.02	2.04	-0.32
P值	0.002	0.010	0.709	0.169	0.915	<0.001	0.044	0.748

组别	例数	T0					T1
组别	例数	腕屈肌	腕伸肌	肱二头肌	肱三头肌	三角肌	腕屈肌	腕伸肌
旋提手法组	30	122.31±37.21	124.85±26.50	74.14±20.47	110.40±36.38	88.50±12.70	118.29±45.63	124.50±25.47
理筋手法组	30	117.74±60.30	131.07±26.79	81.22±28.42	105.29±30.51	90.55±15.09	110.40±67.72	133.03±27.48
t值		0.49	-1.20	-1.28	0.68	-0.72	0.68	-1.57
P值		0.628	0.233	0.205	0.498	0.472	0.498	0.119
组别	T1			T2
组别	肱二头肌	肱三头肌	三角肌	腕屈肌	腕伸肌	肱二头肌	肱三头肌	三角肌
旋提手法组	92.03±32.21	117.70±31.20	90.58±15.70	125.64±42.55	121.93±21.02	95.33±37.07	119.13±36.49	87.24±15.61
理筋手法组	75.03±22.43	102.75±25.98	92.07±20.34	109.87±57.87	122.51±27.35	73.07±14.85	105.48±26.57	88.46±16.11
t值	-3.23	2.64	-0.38	1.39	-0.11	-4.02	2.04	-0.32
P值	0.002	0.010	0.709	0.169	0.915	<0.001	0.044	0.748

组别	例数	T0					T1
组别	例数	腕屈肌	腕伸肌	肱二头肌	肱三头肌	三角肌	腕屈肌	腕伸肌
旋提手法组	30	143.70±38.89	143.91±24.22	92.58±26.16	136.87±30.90	103.40±16.30	139.48±47.48	145.09±21.06
理筋手法组	30	135.88±66.56	150.79±24.68	101.23±29.54	130.54±24.18	106.84±19.18	128.33±75.80	153.70±24.83
t值		0.77	-1.45	-1.28	0.68	-0.95	0.88	-1.84
P值		0.445	0.150	0.205	0.498	0.346	0.380	0.069
组别	T1			T2
组别	肱二头肌	肱三头肌	三角肌	腕屈肌	腕伸肌	肱二头肌	肱三头肌	三角肌
旋提手法组	115.53±37.91	140.05±28.56	107.59±16.60	146.31±47.01	142.02±19.54	108.43±35.87	141.58±35.07	104.95±15.01
理筋手法组	91.15±23.55	127.26±25.04	110.94±22.80	131.16±64.18	145.04±21.68	89.71±24.73	131.22±25.26	109.61±20.89
t值	-3.87	2.42	-0.77	1.39	-0.11	-3.21	1.62	-0.32
P值	<0.001	0.017	0.443	0.169	0.915	0.002	0.109	0.748