A Comparative Study On The Efficacy Of Fu’s Subcutaneous Needling And Iastm Technique Combined With Sling-exercise-therapy In Patients With Chronic Non-specific Low Back Pain

Objective: Chronic non-specific low back pain(CNLBP)is a common problem worldwide.In this study,the functional exercise and rehabilitation treatment of CNLBP patients were carried out by combining Fu’s subcutaneous needling therapy and Instrument-assisted soft tissue mobilization(IASTM)technique with suspension training,and the degree of improvement of patients with CNLBP by Sling-Exercise-Therapy Training alone,Fu’s subcutaneous needling therapy combined with Sling-Exercise-Therapy Training and IASTM technique combined with Sling-Exercise-Therapy Training was investigated.The aim was to provide new treatment ideas for the rehabilitation of patients with CNLBP and to provide a theoretical basis for the efficacy of functional exercise combined with fascial theory.Methods: Thirty-six CNLBP patients aged 18～25 years were selected as subjects and randomly divided into three groups: the Sling-Exercise-Therapy Training treatment group alone(group S,12);the Fu’s subcutaneous needling therapy combined with Sling-Exercise-Therapy Training treatment group(group F+S,12);and the IASTM technique combined with Sling-Exercise-Therapy Training treatment group(group J+S,12).(1)Group S only performed Sling-Exercise-Therapy Training,including supine "double bridge" training,supine "single bridge" training,lateral "bridge" training and prone position training,3 times a week for 4 weeks;(2)In the F+S group,Fu’s subcutaneous needling intervention was performed after Sling-Exercise-Therapy Training.Fu’s subcutaneous needling intervention was carried out around the pressure points of the affected muscles,with sweeping treatment and blood flow reperfusion activities,3 times a week for 4 weeks;(3)In the J+S group,IASTM technique was performed after Sling-Exercise-Therapy Training.The myofascial trigger points(MTr Ps)were selected,focusing on the erector spinae,lumbar square and iliacus muscles,3 times a week for 4 weeks.All three groups underwent health education prior to the intervention,with some simple static stretching after appropriate warm-up activities.All subjects were assessed before,2weeks and 4 weeks after the intervention using the Visual Analogue Scale(VAS)to assess pain perception,healing rate and immediate outcome before and after the intervention;the Oswestry disability index(ODI)to assess lumbar spine dysfunction;the Range The David Spine Rehabilitation System was used to assess the maximum isometric strength of the lumbar spine and abdominal and back muscle endurance.Statistical data were analysed and processed using SPSS25.0 software.One-way analysis of variance(F-test)and rank sum test were used to analyse the results.Results:(1)VAS scores: Within-group comparison: VAS scores decreased in both combined groups after 2 weeks of intervention compared to pre-intervention(p<0.05);VAS scores decreased in all three groups after 4 weeks of intervention(p<0.001).VAS scores were lower in the S group after 4 weeks compared to 2 weeks of intervention(p<0.05).Comparison between groups: after 2 weeks of intervention,VAS scores were lower in the two combined groups than in the S group(P<0.05).(2)ODI scores: ODI scores decreased in both combined groups after 2 weeks of intervention compared to pre-intervention(p<0.05).ODI scores decreased in all three groups after 4 weeks of intervention(P<0.05).Comparison between groups: ODI scores were lower in the F+S group than in the S group after 2 weeks of intervention(P<0.05).ODI scores were lower in the two combined groups than in the S group after 4 weeks of intervention(P<0.05).(3)ROM: Compared to pre-intervention,after 2 weeks of intervention,ROM in forward flexion,left and right lateral flexion and left and right lateral rotation improved in the two combined groups(P<0.01);left and right lateral flexion and left and right lateral rotation ROM improved in the S group(P<0.05);after 4 weeks of intervention,ROM improved in all directions in all three groups(P<0.05).Posterior extension ROM increased in all three groups after 4 weeks of intervention compared to 2 weeks of intervention(P<0.05).Comparison between groups: after 2 weeks of intervention,ROM in forward flexion and left and right lateral flexion was better in the F+S group than in the S group;after 4 weeks of intervention,ROM in forward flexion and left and right lateral rotation was better in the two combined groups than in the S group.(4)Maximum isometric muscle strength of the lumbar back muscles: compared with the pre-intervention period,after 2 weeks of intervention,left and right lateral rotation muscle strength increased in the F+S group(P<0.05);right side rotation muscle strength increased in the J+S group(P<0.05);forward flexion and left side rotation muscle strength increased in the S group(P<0.05).Compared with the pre-intervention period,after 4 weeks of intervention,left and right lateral rotation muscle strength increased in the F+S group(P<0.05);forward flexion and left and right lateral rotation muscle strength increased in the J+S and S groups(P<0.05).(5)Abdominal and dorsal muscle endurance: compared with the pre-intervention period,abdominal muscle endurance increased in the S group after 2 weeks of intervention(P<0.05).Compared with pre-intervention,after 4 weeks of intervention,back muscle endurance increased in the F+S group(P<0.05);abdominal and back muscle endurance increased in the J+S and S groups(P<0.05).(6)Maintenance time of immediate efficacy: compared with after the 1st intervention,there was a significant increase in the maintenance time of pain relief in the F+S group after the 5th and 6th interventions(P<0.001);there was a significant increase in the maintenance time of pain relief in the J+S group after the 3rd,4th,5th and 6th interventions(P<0.001).Compared to after the 2nd intervention,there was a significant increase in pain relief maintenance time after the 6th intervention in the F+S group(P<0.001);and a significant increase in pain relief maintenance time after the 4th,5th and 6th intervention in the J+S group(P<0.001).Comparing between groups,the maintenance time of pain relief was higher in the F+S and J+S groups than in the S group after each intervention(P<0.001).(7)Immediate efficacy scores before and after the intervention: compared with the pre-intervention period,subjects in both groups had significantly lower immediate efficacy scores after each of the first six interventions(P<0.001).Conclusion:(1)Fu’s subcutaneous needling intervention combined with Siling-ExerciseTherapy,IASTM technique combined with Sling-Exercise-Therapy Training and Sling-Exercise-Therapy Training alone after 4 weeks of intervention showed significant improvements in pain,functional impairment,lumbar mobility,muscle strength and muscle endurance levels in patients with CNLBP.(2)After 2 weeks of intervention,the two combined groups were significantly better than the Sling-Exercise-Therapy only group in terms of improvement in pain;after 4 weeks of intervention,the two combined groups were significantly better than the Sling-Exercise-Therapy only group in terms of improvement in functional impairment and forward flexion mobility.(3)Both Fu’s subcutaneous needling intervention combined with the Sling-Exercise-Therapy group and the IASTM technique combined with the Sling-Exercise-Therapy group had better immediate results,and the IASTM technique combined with the Sling-Exercise-Therapy group was better than the Fu’s subcutaneous needling intervention combined with the Sling-Exercise-Therapy group in terms of maintenance of immediate efficacy.