| The thesis is divided into three parts.The first part is the biomechanical research of lumbar protrusion,the second part is the clinical research,and the third part is the mechanism research of Tuina intervention,aiming to strengthen the waist according to the theory of "muscles and bones imbalance,tendon first" Understanding of intervertebral disc herniation,accurate clinical treatment of lumbar intervertebral disc herniation,Tuina program,and discussing the problem of Tuina to improve the key muscle control of lumbar intervertebral disc herniation.Part 1 Study on the Activation Mode of Key Muscle Groups in Lumbar Disc HerniationObjective: To observe the kinematics and dynamics changes of subjects with lumbar protrusion during walking and sitting activities,and to analyze erector spinae,multifidus,gluteus medius,gluteus maximus,rectus femoris and biceps femoris The activation mode of the long head during sitting and standing.Methods: Using three-dimensional motion capture,force plate and surface electromyography,the biomechanical data of 20 healthy controls and 20 subjects with lumbar protrusion were collected,and the differences in joint range of motion and internal torque between the two groups were compared through statistical parameter mapping,using Muscles Synergistic analysis of the activation mode of key muscle groups in subjects with lumbar protrusion.Results: 1)Compared with subjects without low back and leg pain in walking,subjects with lumbar protrusion had no statistical difference in the angle of motion and internal moment of hip,knee,and ankle joints in the sagittal and coronal planes;2)In the sitting test,the lumbar spine flexion and extension range and hip abduction angle were significantly restricted in subjects with lumbar protrusion(p<0.05),and the hip flexion angle increased(p<0.05);3)Lumbar protrusion subjects The extension moment of the lumbar spine has a downward trend,while the flexion moment when standing is significantly increased(p<0.05);the maximum adduction moment of the hip joint increases(p<0.05),and the abduction moment at the initial stage of standing is also significantly lower than without waist The leg pain group was large(p<0.05);4)During the sitting and standing process,subjects with lumbar protrusion had three main synergistic activation modes of muscles.From standing to sitting,the activation time of the gluteus medius on the affected side was significantly longer.The non-affected side was late(p<0.05),and the peak activation lasted longer;from sitting to standing,the erector spinae and multifidus muscles on the affected side also tended to activate later.Conclusion: The lumbar spine flexion and hip abduction function is limited in subjects with lumbar protrusion during sitting and standing.The lumbar spine load can be reduced by reducing the flexion angle and extension moment of the lumbar spine to compensate for the hip joint flexion activity and adduction moment.Increase to complete functional tasks;and in order to maintain the stability of the lumbar pelvis in the early stage of standing,the abduction moment continues to increase.EMG signal analysis further confirmed that the activation of the gluteus medius muscle was significantly restricted,and the erector spinae multifidus muscle also had a restricted activation trend.Part 2 Evaluation of the Therapeutic Effect of Tuina on the Treatment of Lumbar Disc Herniation Based on Key Muscle GroupsObjective: Based on the impact of key muscle groups on lumbar protrusion,optimize the specific plan of Tuina treatment of lumbar protrusion and conduct clinical verification research.Methods: 116 patients with lumbar protrusion were randomly divided into the experimental group(Tuina optimization group)and the control group(conventional Tuina group),and the pain and dysfunction of patients with lumbar protrusion after treatment were compared between the two groups.And changes in joint angles and moments in sitting and standing functional tasks.Results: 51 cases in the experimental group were included in the analysis and 7 cases were dropped;52 cases in the control group were included in the analysis,and 6 cases were dropped.After treatment,1)both the optimized Tuina group and the conventional Tuina group can significantly reduce the patient’s pain score(p<0.001),and the optimized group has better efficacy(p<0.05);2)both groups can significantly reduce the patient’s dysfunction index(p<0.001),the therapeutic effect of the optimized Tuina group was better(p=0.006);3)In terms of the angle of joint movement,both groups could improve the subjects’ spine range of motion and reduce the compensatory activities of the hip joint.The optimized Tuina group was in There was a statistical difference before and after treatment(p<0.05);4)In terms of internal joint torque,both groups showed a tendency to improve the compensatory motion of the subjects,and the optimized Tuina group was statistically significant in improving hip adduction torque(p=0.047).Conclusion: Both the optimized Tuina group and the conventional Tuina group can improve the symptoms of lumbar protrusion subjects.Among them,in terms of pain and dysfunction,the optimized Tuina therapy is significantly better than the conventional Tuina therapy,and it can treat the subjects’ joints in functional tasks.The improvement of activity and internal torque is better,which can significantly improve the muscle activity of the hip abductors.Part 3 Study on the Activation Effect of Tuina to Improve the Key Muscle Groups of Lumbar Disc HerniationObjective: From the changes in activation of key muscle groups,to explore the biomechanical mechanism of Tuina intervention in lumbar process dysfunction and muscle pain,and to provide a scientific basis for the biomechanical basic research of lumbar process muscle injury theory.Method: Using flexion relaxation and rapid arm-raising test,from the spatial and temporal activation changes of lumbar stabilizing muscles,observe the improvement in neuromuscular control of lumbar process subjects by Tuina,including the control of muscle contraction adjustment and expected posture Adjustment.Results: 1)Compared with the group without low back and leg pain,during the flexion relaxation,the flexion angle of the spine and hip joint of subjects with lumbar protrusion disease was significantly limited(p<0.001),and the spine extension torque was significantly reduced(p= 0.029),hip abduction torque increased significantly(p<0.05);2)In addition to erector spinae and multifidus flexion and relaxation,gluteus medius also showed similar performance,and the flexion and relaxation of lumbar process patients disappeared;3)After Tuina treatment,the flexion angle of the spine and hip joint of subjects with lumbar protrusion disease increased significantly(p<0.05),the hip adduction torque increased significantly(p=0.041),and the spine extension torque also increased;the flexion relaxation ratio Improved,especially the multifidus muscle(p<0.05),but the flexion relaxation did not recover;4)The pre-activation of erector spinae and multifidus muscle was significantly improved in the case of the sudden disturbance of the internal posture of subjects with lumbar process(p<0.001).Conclusion: During flexion,subjects with lumbar protrusion have limited spinal movement.In order to avoid pain,reduce the stress on the spine extensor muscles,and increase the activity of the hip abductors to maintain the posture stability of the lumbar spine and pelvis.After the precise intervention of the gluteus medius by Tuina,the muscle contraction activities of the erector spinae,multifidus and gluteus medius in the flexion and extension activities of the lumbar process patients were improved,and the neuromuscular function was restored.And under the disturbance of the internal posture,the control of the trunk muscles can be improved,which shows that Tuina can achieve effective treatment purposes by improving the neuromuscular control of the key muscle groups of lumbar process and improving the stability of the lumbar spine. |
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