| Non-specific low back pain, NLBP, featuring no specific histopathological changes, cannot be explained through examining objective indicator, and the condition of lower back muscles and its feedback for manipulation vary with the fluctuating course of disease. So further studies on the different effects of manipulation on different subgroups of NLBP are urgently needed to explicit the window of manipulation intervene and its indications. The main disease location of NLBP, lumbar soft tissue, belong to tendon and muscle in TCM, which had been treated in TCM for long, with pulling manipulation being one of the most important methods. The mechanism of alleviating pain, releasing spasm and restoring function of pulling manipulation, has been key point of study. In this study, we examined the soft tissue tenderness and lumbar flexion range of patients with NLBP, and showing the internalspine stress-strain and changes in biomechanics characteristic digitally by finite element analysis, hoping to explain the mechanical effects of tendon-regulating method of TCM on acute, sub-acute and chronic NLBP based on muscle tissue biomechanics and subjective assessment of patients.Objectives:1 To observe the hardness number, threshold of pain and lumbar flexion range of relaxed vertebral side muscle tissue of patients in acute, sub-acute and chronic NLBP groups.2 To explicit the window of manipulation intervene and its indications by comparing changes of indicators above before and after tendon-regulating treatment.3 To preliminarily investigate the mechanism of pulling manipulation digitally.Methods:1 The clinical research90 patients with NLBP, including acute stage (25 cases), sub-acute stage (29 cases) and chronic (36 cases) were involved. OE-220 soft tissue hardness/tenderness meter were used to determine hardness value of soft tissue and pain thresholdin the prone position on both sides of the vertebral side muscle relaxation state; whilelumbar flexion range value was detected. Measurement were taken before and after waist tendon-regulating treatment. All data were processedwith SPSS17.0 statistical software, and those obeying normal distribution were averaged±standard deviation. Using paired t test, independent sample t-test; Correlation between the index difference before and after the treatment with Pearson correlation coefficient, with P< 0.05 means that it is a statistically significant.2 Basic researchMRI tomography (ct) images, collectedform normal Chinese man volunteers with Mimics10.01 software directly read Dicom format MRI fault image to calculate 3 dimension model, by using Solidworks software 3 dimension modeling capabilities with Mimics intervertebral disc-using ADAMS software refinement model is set up to complete the lumbar the establishment of simulation model and using ABAQUS6.12 dynamic simulation analysis of lumbar seat rotation technique model of the structure under the action of stress and displacement distribution.Results:1 Gender composition between the three groups were examined usingX2 testwith X2= 0.216, P= 0.898, suggesting there is no significant difference. Age, height, weight, and IBM were examined usingF test, with P values> 0.05, indicating the baseline data of three groups had no significant difference, thus were comparable.2 General factors influence on pain threshold and hardness value.Average pain threshold were 25.71±5.34 and 25.29±5.46 for 35 men and 55female, respectively.Independent sample t test showed t= 0.354, P= 0.724, meaning that there was no significant differencein pain threshold in different genders.Independent sample t test for hardness value,48.57±48.57 for men and 47.07±5.97 for women showed t= 0.126, p= 0.12, meaning there was no significant difference inhardness value in different gender.3 F test of pain thresholdof patients in acute, sub-acute, and chronic NLBP groupsbefore and after treatment showed, F= 8.077, P= 0.254> 0.05, no significant difference; Technique between groups after treatment by the F test, F= 9.172, P= 0.031< 0.05, significant difference. Compared before and after treatment group, the paired t test, acute and sub-acute groups after manipulation treatment pain threshold value are higher than before treatment, p= 0.024< 0.05 and p= 0.015< 0.05, significantly different; Methods after treatment than before treatment chronic group was increased, with p= 0.248> 0.05, no significant difference. Massage the pain threshold before and after difference size of sub-acute group, acute and chronic group, pain threshold difference comparison between groups, according to the results of sub-acute group compared with acute and chronic group, P= 0.027< 0.05 and P= 0.036< 0.05, the difference was statistically significant. Acute and chronic group compared, P=0.036<0.05, the difference was statistically significant.4 Methods before and after treatment of acute, sub-acute, and chronic comparison between groups of three groups of hardness value between; The F test, hardness value between technique in the first three way to compare the F test, P= 0.08> 0.05, there was no statistically significant difference; Methods after hardness value between the three way to compare the F test, P= 0.01< 0.05, the difference was statistically significant; Comparison group, the paired t test, acute and subacute groups after manipulation treatment hardness value values are higher than before treatment, p= 0.029< 0.05 and p= 0.022< 0.05, there is a significant difference; Methods after treatment than before treatment chronic group was increased, p= 0.056> 0.05, but there was no significant difference; Difference comparison between groups, gimmick difference size before and after the treatment of subacute group, acute and chronic groups, hardness value difference comparison, through the multiple comparison test, subacute group compared with acute and chronic group, P= 0.030< 0.05 and P= 0.000< 0.01, the difference is statistically significant; Acute and chronic group compared, P= 0.024< 0.05, the difference is statistically significant.5 Methods before and after treatment of acute, subacute, and chronic LFR value comparison between groups between the three groups:the F test, before the technique P= 0.083> 0.05, no significant difference between the three groups. Methods after LFR value between the three way to compare the F test, P= 0.032< 0.05, there are significant differences between the three way; Comparison group, the paired t test, acute and subacute groups after manipulation treatment LFR values are higher than before treatment, p= 0.03< 0.05 and p= 0.021< 0.05, there is a significant difference; Methods after treatment than before treatment chronic group was increased, p= 0.14> 0.05, there was no significant difference; Methods LFR difference size before and after the treatment of subacute group, acute and chronic groups, through the multiple comparison test conclusion subacute group compared with acute and chronic group, P= 0.034< 0.05 and P= 0.012< 0.05, the difference was statistically significant; Acute and chronic group compared, P= 0.042< 0.05, the difference was statistically significant.6 With torque effect time, the torque transmitted by L1 vertebral body to S1 vertebral body, lead to the vertebral articular process between the contact stress increases, the maximum stress was eventually in L3 and L4 vertebral body contact of the joint surface, the maximum stress is 9.92 MPa.7 Each fiber ring the high stress area is mainly focused on fiber ring back (to the right), as a result of the torque applied at the same time, make lumbar joint contact on the left side of the joint decrease and gradually lose bearing capacity and slightly on the right side tilt, vertebral body of the fiber ring on the right side of the pressure increases significantly, thus the fiber ring a maximum stress basic appeared in the fiber ring on the left side of the rear.Conclusion:1 Richard reinforcement technique in treatment of acute, subacute, and chronic nonspecific low back pain, the pain threshold methods compared before and after treatment, the acute phase and subacute phase obvious change; Hardness value technique plays a significant role in comparison before and after the treatment of subacute phase change. So the technique of nonspecific low back pain in mechanics, subacute nonspecific low back pain has high sensitivity and specificity, have improve muscle spasm, reduce soft tissue tension, increase pain threshold.2 Richard reinforcement technique in treatment of acute, subacute, and chronic nonspecific low back pain, lumbar spine mobility technique compared before and after treatment, the acute phase and subacute phase after treatment markedly improved. Confirmed that the technique of mitigation activities barrier effect is good, patients will then describe the proneness activity obviously improved.3 Lumbar seat in the process of spinning technique, intervertebral disc maximum stress value is lower than the rear part of the vertebral bodies the maximum stress value structure, can be thought of as the technique at least not cause intervertebral disc trailing edge damage, so lumbar seat rotation technique of intervertebral disc is safe.4 Lumbar seat in the process of spinning technique, joints, joint is the high stress area and the torque effect time, relative slip occurs between the articular cartilage, lumbar activity increased. Most likely this technique for joints of motion to improve treatment effect.5 Throw technique of intervertebral disc internal pressure increases rapidly and the increase of lumbar spinal motion, may be the mechanism of action of manipulation treatment of low back pain. |
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