Conservative traditional Chinese medicine (TCM) treatment has clinically proven to have a clear curative effect on lumbar disc herniation (LDH) , and its mechanism of action and biomechanical effects are the hot spots in current research.
To perform a wearable inertial sensors-based gait analysis in LDH patients with qi-stagnation and blood-stasis before and after treatment, and to verify the advantages of comprehensive TCM therapy by biomechanical methods.
This study selected 40 inpatients with an admission diagnosis of LDH treated with comprehensive TCM therapy from Tuina Department, the Affiliated Hospital of Changchun University of Chinese Medicine from June 2020 to December 2021. The patients' age, gender, the lower limb with pain, baseline body mass index, hospitalization time and pre- and post-treatment scale scores for low back pain were collected. Gait parameters were collected by wearable inertial sensors at pre- and post-treatment.
Among the 40 patients, 18 were males and 12 were females. Eighteen patients had pain in the left lower limb, 8 had pain in the right lower limb, and the other 14 had pain in both lower limbs. Patients had a mean age of (52.3±15.2) years, a mean body mass index of (25.2±4.2) kg/m2, and a mean length of hospitalization of (17.5±6.2) days. The treatment was effective or marketed effective in 35 cases, ineffective in 5 cases, achieving an overall response rate of 87.5%. The Visual Analogue Scale score and Oswestry Disability Index decreased, and the Japanese Orthopaedic Association Score increased after treatment compared with the baseline levels (P<0.05) . After treatment, the patient's cadence, speed, stride length, gait cycle, swing phase percentage, shank and foot shock impact increased, and the stance phase percentage decreased (P<0.05) . The range of motion of hip abduction and adduction, hip rotation, knee varus and valgus, knee rotation and ankle rotation decreased (P<0.05) . Increased pelvic obliquity index, pelvic tilt index, hip abduction and adduction degrees, hip flexion and extension degrees, hip rotation index, knee rotation index, ankle inversion and eversion degrees, ankle flexion and extension index, and ankle rotation index were also found after treatment (P<0.05) . No toxic or adverse events occurred during the treatment. Five cases had repeated symptoms or were rehospitalized during the follow-up.
Comprehensive TCM therapy can obviously relieve the pain, improve functional disorders and increase the gait dynamic stability in patients with LDH due to qi-stagnation and blood-stasis, which is a safe and effective conservative treatment option.
Adolescent idiopathic scoliosis (AIS) is a progressive three-dimensional skeletal deformity that affects spinal mobility and trunk symmetry. It was previously believed that AIS was not accompanied with pain, but recent studies have shown that approximately 31.5% of the patients complain of low back pain, which may due to factors such as paravertebral muscle imbalance and fatigue.
To observe morphological changes of paravertebral multifidus muscles at the top of the main curvature after high energy laser therapy (HILT) combined with physiotherapy scoliosis specific exercise (PSSE) in AIS patients with low back pain by using musculoskeletal ultrasound. and evaluate the clinical effect of treatment on the correction of paravertebral muscle imbalance.
A total of 30 patients with AIS RigoE1 admitted to the Scoliosis Correction Center of the Fifth Hospital of Harbin from December 2020 to December 2021 were selected for a randomized single-blind controlled trial and divided into the experimental group (n=15) and control group (n=15) , the experimental group was treated with HILT combined with PSSE, and the control group was only treated with HILT. Musculoskeletal ultrasound, visual analogue scale (VAS) scores, range of motion of the patient's lumbar joints and Roland-Morris lumbar spine dysfunction questionnaire (RDQ) were performed before and 4 weeks after treatment in both groups. Pearson correlation analysis was used to investigate whether there was a correlation between the changes in the multifidus muscles after treatment and the treatment effect.
The cross-sectional area of the convex side of multifidus muscles, anterior flexion, left lateral flexion, left rotation and right rotation of the experimental group were higher than those of the control group after treatment (P<0.05) , the cross-sectional area and thickness of multifidus muscles on the concave side, the cross-sectional area and thickness ratios of multifidus muscles on the concave and convex sides, extension after treatment were higher than those before treatment in the experimental group (P<0.05) . VAS scores and RDQ scores after treatment were lower than those before treatment, and anterior flexion, left lateral flexion, right lateral flexion, left rotation and right rotation were higher than those before treatment (P<0.05) in both two groups. The extension after treatment was lower than that before treatment in the control group (P<0.05) . Pearson correlation analysis showed that the cross-sectional area ratio of multifidus muscles on the concave and convex sides was negatively related with right rotation of the lumbar spine after treatment in the experimental group (r=-0.660, P<0.01) , the thickness ratio of the concave and convex sides of multifidus muscles was negatively related with right flexion of the lumbar spine (r=-0.614, P<0.05) .
HILT combined with PSSE can change the morphology of the multifidus muscles on the concave side of the parietal vertebrae of scoliosis, reduce low back pain, increase lumbar spine mobility, reduce lumbar spine dysfunction and improve activities of daily living; the use of HILT alone can effectively relieve low back pain caused by scoliosis, although it has no significant effect on the morphological changes of the multifidus muscles. Balancing the morphology of the multifidus muscles on both sides of the spine has a positive effect on improving the lateral flexion and rotation of the lumbar spine.
