| Lumbar disc herniation(LDH)is common in clinic.LDH is caused by nerve root compression caused by rupture of annulus fibrosus and protrusion of nucleus pulposus caused by a variety of internal and external factors.The main manifestation of this disease is low back pain with or without radiation pain of one or both lower limbs.The number of patients with lumbar disease in China is more than 200 million,and about 15.2%of them are patients with lumbar disc herniation at present.The peak age of onset of the disease is 30～50 years old.Related studies have shown that low back pain caused by intervertebral disc degenerative diseases such as LDH is the most common complaint in primary health care institutions,and it is also the second leading cause of chronic pain.Most lumbar disc herniation can disappear naturally through conservative treatment and the passage of time without surgery.Conservative treatment has the advantages of non-trauma and high safety.Conservative treatment can be adopted as the first choice for patients with LDH without significant nerve damage.As a therapeutic measure of conservative treatment,the clinical effectiveness of functional exercise has been confirmed in many studies and recommended by clinical guidelines.Moderate exercise can protect the spine,slow matrix degeneration,relieve pain and improve body function.Targeted and individualized exercise therapy under the guidance of rehabilitation medicine professionals has a positive effect on LDH.However,we should also note that there is still a lack of high-quality research on the long-term efficacy of functional exercise.Lumbar exercise method originated from the national intangible cultural heritage"Qinggongzhenggu",and is now included in the "Qinggongzhenggu manipulation Atlas" edited by Professor Sun Shuchun.Lumbar exercise method has the effect of dredging channels and collaterals,reconciling Qi and blood,strengthening the body,strengthening muscles and bones,and effectively preventing and treating neck,shoulder,waist and leg pain.It is a set of lumbar functional exercise method combined with lumbar physiological function,physiological state and the characteristics of lumbar disease.However,we should also note that there is still a lack of high-quality research on the long-term efficacy of functional exercise.At the same time,the change of muscle strength of lumbar muscles is not clear in the process of functional exercise.As a consequence,the clinical part of this study studies the improvement effect of lumbar training method on pain,function and quality of life of patients with lumbar disc herniation through random control,which has a certain clinical significance for the prevention and treatment of lumbar disc herniation.At the same time,the basic research part tries to solve the problem of the limitation of obtaining the motion data of the muscles around the lumbar vertebrae in the in vivo experiment.The kinematic data of the lumbar exercises are collected by the motion capture system,and the movements of the lumbar exercise method are standardized.The obtained data are imported into the simulation software OpenSim for modeling,and the lumbar muscles are biomechanically analyzed by OpenSim software.This study intends to explore the biomechanical changes of lumbar muscles in the process of Qinggongzhenggu lumbar exercise method,reverse analyze the movement law of lumbar muscles,further explain the movements of lumbar exercise method,and then analyze the applicable objects of lumbar exercise method.Appropriate exercise suggestions are given to improve the pertinence of patients’ lumbar functional exercise.11.Clinical researchClinical study on intervention of lumbar intervertebral disc herniation by Qinggongzhenggu lumbar exercise method.1.1 PurposeTo study the effect of Qinggongzhenggu lumbar exercise method on pain,function and quality of life in patients with lumbar disc herniation.1.2 MethodsAccording to the inclusion and exclusion criteria,70 patients with lumbar disc herniation(non-acute phase)were recruited and randomly divided into 2 groups.Under the premise of basic treatment,the control group was given lumbar spine health education,and the experimental group was given lumbar exercises.Before the intervention and 1 week,2 weeks,4 weeks,2 months and 3 months after the intervention,observe the evaluation indicators(VAS,ODI and SF-12),follow up regularly,and analyze the data conduct statistical analysis.1.3 ResultsThere was no significant difference in gender,age,BMI,and duration of disease between the two groups(P>0.05),and there was no difference in VAS score,ODI index,SF-12 PCS score,and SF-12 MCS score between the two groups.Statistically significant and comparable.①VAS score:comparison between groups,the difference was not statistically significant;time difference was statistically significant,and each follow-up time point was compared with before intervention,the difference was statistically significant(P>0.05);②ODI score:comparison between groups,between groups The difference was statistically significant,so the experimental group was better than the control group in the improvement of ODI;repeated measurement time comparison results:the time difference was statistically significant;each follow-up time point was compared with that before intervention,the difference was statistically significant(P>0.05),and the effect became more obvious with the prolongation of time;③SF-12 MCS score:the difference between groups was statistically significant,so the experimental group was better than the control group in the improvement of SF-12 MCS.Repeated measurement time comparison results:the time difference was statistically significant;after the intervention,each follow-up time point was compared with that before the intervention,and the difference was statistically significant(P=0.000<0.05).Psychological state,and the effect is more significant with the prolongation of time;④SF-12 PCS score:comparison between groups,the difference is statistically significant,the experimental group is better than the control group;repeated measurement time comparison results,the time difference is statistically significant;intervention After each follow-up time point was compared with that before the intervention,the difference was statistically significant(P=0.000<0.05).The patient’s body function could be effectively improved within 3 months after the intervention,and the longer the time,the better the curative effect.1.4 ConclusionLumbar exercise can improve the function of patients with non-acute lumbar disc herniation,improve the quality of life of patients,and with the continuation of exercise time,the better the functional improvement;at the same time,lumbar exercise are safe.2.Basic research2.1 PurposeFirstly,the kinematics data during the exercise is collected through the dynamic capture system;secondly,the kinematics data is imported into the simulation software OpenSim,and the biomechanical analysis of the lumbar muscle group is carried out to explore the biomechanical changes and movement rules of the lumbar muscle group during the exercise process.2.2 Methods2.2.1 Dynamic capture and quantitative research on lumbar exerciseTen healthy volunteers were recruited,and all volunteers were excluded from the history of lumbar spine disease and lumbar surgery.Optitrack Motive is activated by the subject wearing a fitted motion capture bodysuit and standing in the center of the field.According to the characteristics of the movements,the subjects choose the lying position or standing position,look straight ahead,move slowly and smoothly,and complete the movements of the lumbar exercise method in turn,staying at the limit position of each movement for 1～2 seconds,and adjust the Marker point as needed during the measurement process.The position of the marker is saved and recorded by the Optitrack Motive.Complete data were collected 3 times for each subject.2.2.2 Biomechanical analysis of lumbar muscles based on OpenSimBiomechanical analyses were performed using OpenSim 4.2 software and based on Raabe’s model.The model is scaled by the scaling tool,so that the length and quality parameters of the model match the actual research object,and the kinematics collected in the first part of the experiment are imported in turn.Then,the biomechanical analysis of the lumbar muscle group is carried out,and the joint torque and muscle contraction force are simulated and calculated.2.3 Results2.3.1 Dynamic capture and quantitative research on lumbar exerciseAction 1:The lumbar flexion angle is(18.69±6.00)°,the back extension angle is(13.17±3.91)°,the left flexion angle is(11.69±3.63)°,and the right flexion angle is(11.72±3.39)°;The forward flexion displacement of the waist is(117.65±24.36)mm,the back extension displacement is(75.42±18.91)mm,the left flexion displacement is(83.70±51.67)mm,and the right flexion displacement is(95.97±49.27)mm;Action 2:The exercise time is based on the time interval between when the subject starts flexing and when the body is completely flat,and the statistical result is(6.21 ± 1.57)s;the angle parameter and displacement parameter refer to the angle,Displacement(change relative to the initial lay-flat phase).The results are as follows:the lumbar flexion angle is(12.09±4.35)°,the hip flexion angle is(49.13±7.23)°,the knee flexion angle is(91.81±10.24)°;the vertical head displacement is(592.56±47.03)mm,the vertical displacement of the knee is(329.00±49.78)mm,and the vertical displacement of the ankle is(158.28±56.56)mm;Action 3:The action is decomposed into 3 stages.In the first stage,only the upper body is lifted,and the waist extension angle is(11.98±5.25)°,the vertical displacement of the head was(206.47±54.96)mm;in the second stage,only the lower limbs were lifted,the back extension angle of the waist was(12.22±5.41)°,and the vertical displacement of the ankle was(302.09±43.33)mm;In the third stage,the upper body and both legs are extended back at the same time,the body forms a natural arc line,the back extension angle of the waist is(12.16±5.25)°,the vertical displacement of the head is(220.37±57.00)mm,and the vertical displacement of the ankle is(260.26±56.06)mm.2.3.2 Biomechanical analysis of lumbar muscles based on OpenSim softwareIn terms of torque:① Action 1,the torque on the coronal axis gradually increased during the posterior extension,and the sagittal axis torque basically did not change;then the right flexion,the sagittal axis torque increased,and the coronal axis torque became negative;followed by forward flexion.,the coronal axis torque increases,and then decreases after a period of time,and the sagittal axis torque is close to zero;finally,the left flexion action is performed,the sagittal axis torque increases,and after the body stands upright,the torque falls back to the initial value;the coronal axis(flexion and extension movement)On the sagittal axis(lateral flexion motion),the waist torque is similar when the left and right lateral flexion is performed;the torque of the 10 volunteers in the"knee-tuck" state(N·m)is 102.04 ± 26.43;②"Action 2:During the "rocking chair" action,the moment of the waist gradually increases,and it is maintained in the "tuck knee" state,and then the body gradually falls and returns to the initial state,when the body just falls,the torque first rises,then falls,and finally falls back to the initial value;③ Action 3:In the first stage,the torque rises rapidly,and then rapidly decreases after maintaining a plateau period;in the second stage,the torque is small;in the third stage,the torque rises rapidly,slightly After falling back,it maintains for a period of time,and then decreases;the magnitude of the moment in the first and third stages is relatively close.In terms of muscle strength:① Action 1:In the rear extension position,the internal oblique muscle provides the largest muscle contraction force to maintain the stability of the body;in the forward flexion,the iliocostalis and the longissimus provide the main contraction force;in the lateral During flexion,the iliocostalis,longissimus,external oblique,and internal oblique provide the main contractile force;② in the lumbar flexion phase of Action 2,the body rises,and the internal oblique,rectus and external oblique muscle contractile force It rises to provide the main muscle contraction force for body flexion;in the knee-tuck stage,the contraction force of the internal oblique,external oblique and rectus abdominis decreases slightly and maintains stability;then the body gradually lies flat.The contraction force of the internal oblique muscle,rectus abdominis and external oblique muscle increased slightly and then gradually decreased until it returned to the level before exercise;③ Action 3,in the first stage,keep both legs still,slowly lift the head and upper body,slightly Stop for a while and then fall.In this stage,the longissimus and iliocostalis are the main contracting muscles.The muscle contraction force first increases,and then decreases after a short period of time.In the second stage,the upper body is still,and the legs are together and slowly lifted.After a short pause lay down.At this stage,the gluteus maximus and gluteus medius provide the main muscle contraction force.The contraction force of the gluteus medius increases when the legs are raised,and the contraction force of the gluteus medius decreases when the legs are lowered.In the third stage,the upper body and both legs are raised at the same time,and the gluteus maximus,gluteus medius,longissimus and iliocostalis are the main contracting muscles;then the upper body and both legs are lowered,and the contraction force first increases and then decreases,and the contraction force of each muscle The peak value is slightly larger than that of the first stage.2.4 ConclusionAccurate dynamic tracing and kinematic analysis of lumbar exercise through dynamic capture technology,obtained the kinematic parameters during the exercise of lumbar exercise,and summarized the movement characteristics of "gentleness,not too hasty and excessive force";During the training process,you should follow the principle of step by step,master the appropriate range,and move from small to large,from slow to fast.The lumbar exercise can strengthen the waist and abdominal muscles,increase the stability of the spine,and improve the bad posture of the spine.The three movements of the lumbar exercise method mainly train the trunk and hip muscles in the sagittal plane and coronal plane,and lack the training in the horizontal plane,so it is necessary to increase the rotation of the trunk on the vertical axis on this basis. |
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