| BackgroundSpine is composed of vertebrae, intervertebral vertebrae disc, the connection and protection around the function of ligament, spinal cord, spinal nerve and related arteriovenous around vertebrae. With the development of society and constantly changing of the lifestyle, the incidence of spinal disease disease increased year by year. When the balance of the spine is broken, intervertebral joint dislocation, soft tissue injury and along with the age growth in degenerative diseases, under the certain condition of incentive, directly or indirectly to the nerve root, vertebral arteriovenous, spinal cord, or sympathetic nerve stimulation or oppression, neck, shoulder, waist and (or) dominated the viscera related symptoms. In addition to the mechanical spinal pain, some inflammatory diseases such as ankylosing spondylitis can also cause spinal pain and disorder, not only directly cause inflammatory low back pain but also indirectly damaged spinal balance caused by mechanical spinal pain. The treatment ways available, including drug therapy are only temporary back pain relief, not to consider the stability of the spine in the long run, Surgery is inevitably breaking the spinal original biomechanics, applying only to patients with severe spinal pain. So lumbar segmental stability is very important to stabilization of the prevent the recurrence of spinal pain, most of the time within the spinal balance stable often upset by degeneration and other reasons, while the outer balance structure of spine, spinal muscle degeneration will also be taking place around the spine around muscle strength decreased, but unlike the irreversible degeneration of intervertebral disc, through exercise muscle power around the spine can restore stability and strengthen the compensatory, inside and outside so that the spine reaching a new equilibrium. Gravational muscle groups are important part of the balance system of the spine,which is made up of many whole body muscles as important muscle system.The most one of the main function is to maintain the body posture.In spine pain related diseases, gravational muscle dysfunction is a pathological result of the disease and also the cause of the disease, together with a series of bad habits in our daily life, forming into the shortening-contracture-shortening vicious cycle. For gravational muscle exercise can not only maintain the balance of the position, stretching the shortening muscles,but also make the forward protruding mandible and head to the back of the spine center, which in turn prevent thoracic convex back to the original track, and to improve the spine physiological activity degree of bending, restore the original position,making pelvic and whole spine back to the original position. Studies have shown that functional exercise also reduces inflammation by playing an anti-inflammatory effect and easing pain. In this study we selected the ankylosing spondylitis, cervical spondylotic radiculopathy, lumbar intervertebral disc protrusion---the three most common spine related diseases by using graviational muscle group exercises, through selecting the appropriate control group, to explore the preliminary clinical effect.Objective1.1Ankylosing Spondylitis is a common inflammatory rheumatic disease which infects axis joints, cauing inflammatory low back pain and leading to damage and function damage of spinal structure followed by a life quality impairment. AS is commonly seen in teenagers and young adults with a ratio of2:1in males to females,and males tend to have more serious condition and structure damage.AS possesses a high misdiagnosis rate and for incomplete knowledge to this ailment. Functional exercise has been proven to treat AS and has a equal state with pharmacy treatment and its efficacy is well documented worldwide. It is remain unclear whether radiographic progress and structure damage could be controlled by drugs, therefore positive functional exercise plays a crucial role to promote AS. Some studies showed that muscles contracted in Ankylosing Spondylitis due to enthesitis and followed ossification,causing spinal disturbance and balance dysfunction and leading to final spinal deformation and disability.Functional exercise could prevent this process exacerbation, and furthermore functional exercise could make anti-inflammation effects on some rheumatic disease like ankylosing spondylitis to relieve inflammation,promote range of motion,aerobic exercise ability and life quality. The scope of this study was to explore the effect of gravational muscles stretching and strengthening exercise on the AS patients in presence of active dysfunction by using random assignment method.Paired t and Student t test were utilized for intra and inner groups respectively, α=0.05was regarded as the examine levels by utilizing SPSS21.0software.1.2Lumbar Disc Herniation is a common disease in clinical rehabilitation characterized by one or more nerve roots compression。 The radiating pain and unique lower limb pain are classic symptoms of lumbar disc herniation, and restriction of lumbar activity and weakness of lower limbs occur at times.Current treatment methods only focus on the transient pain relieving rather then the lumbar spine stability in the long run. Stability of spine for a long period depends on the support of internal and external balance system. The gravational muscles groups are important components of external system of spine which are compromised of groups of muscles in the whole body are functions mainly as posture maintaining system. Studies have shown that the contraction of gravational muscles play crucial roles in the pathogenesis and aggravation of spine relative diseases.This study was designed to enroll65LHD patients from our hospital,Department of TCM orthopedics,aiming at stretching and strengthening the gravational muscle groups to evaluate the function rehabilitation and pain by using Quebec Back Pain Disability Scale, QBPDS and numerical rating scale, NPRS to explore the preliminary effect of this method.1.3Cervical spondylotic radiculopathy is a group of clinical syndrome characterized by regional pain of cervical and shoulder and radiating pain of upper limbs which affects health substantially.According to the statistics, cervical spondylosis possesses highest morbidity in orthopedics and cervical spondylotic radiculopathy accounts for50%～60%。 Post-contraction relax training is a sort of treatment way combined with stretching and resistance exercise yet not forming into a systemic way in China.To explore its efficacy,we divided69cervical spondylotic radiculopathy patients from Nanfang hospital into experimental group using the treantment way above and control group applying contraction to observe the treatment results.2.Method2.137ankylosing spodylitis patients with exercise dysfunction,including33males and4females with average (22.1±3.2) years of age and (4.1±2.7) years of illness duration were enrolled into our study who met the criteria of1984modified diagnosis.They were randomized into experimental group(19cases and controlled group (18cases).Numeration table randomizaton was used for group dividing methods。37Patients were divided into experimental group and controlled group according to the New York Diagnosis Criterion. Conventional exercise method was used in the controlled group whereas stretching and strengthening exercise method was designated to the shortened gravational muscles which affect the posture. The trial lasted3month and BASMI, BASDAI and BASFI were applied respectively to evaluate the treatment effect.Paired t and Student t test were utilized for intra and inner groups respectively, α=0.05was regarded as the examine levels.2.265consecutive subjects diagnosed with L4～5and/or L5～S1LDH in our hospital were recruited in the study. The subjects were divided into the study group (n=32) and the control group (n=33) using random number table.The subjects in the study group were conducted with gravational muscle exercise, while the subjects in the control group were given lumbar traction combined with caudal injection therapy. The symptom duration of each patient was recorded before the intervention. The Quebec Back Pain Disability Scale (QBPDS) and the Numeric Pain Rating Scale (NPRS) were used for evaluation at the start, in the middle, and at the end of the treatment, with specific time points as follows:day1(T1), day15(T2), day45(T3), day60(T4), and day90(T5). The subjects in the study group were not given any other treatment. Paired t-test or(and) Wilcoxon single rank test were used for intra-group and inter-group comparisons. Paired t and Student t test were utilized for intra and inner groups respectively, α=0.05was regarded as the examine levels.2.369patients diagnosed with cervical radiculopathy were randomized into2groups with the treatment group(36patients) using post-contraction relax method whereas the controlled group(33patients) applying contraction during15days. The condition were respectively recorded on and15days. The ROM and VAS assessment were used to evaluate the effect. Paired t and Student t test were utilized for intra and inner groups respectively, α=0.05was regarded as the examine levels.3Results 3.1BASMI index of two groups before exercise pillow wall distance, modified Schober test, cervical rotation, lumbar flexion and ankle distance comparison, there were no statistically significant difference (all P>0.05); Comparison between the test group after group pillow wall is apart from the relative control group (t=2.796, P=0.01), the modified Schober test (t=2.225, P=0.033), cervical rotation (t=2.236, P=2.236), lumbar flexion degree (t=2.182, P=0.037), ankle spacing (t=2.144, P=2.144), the differences were statistically significant. Group is compared before and after exercise in control group, only pillow wall distance, lumbar flexion degree difference was statistically significant (P<0.001and P<0.001); Experimental comparison before and after exercise, the difference had statistical significance (P<0.05). BASFI, BASDAI total integral in the two groups before exercise BASFI, BASDAI total integral comparison, there were no statistically significant difference (P>0.05); After comparison, BASFI total score difference was statistically significant (P=0.039). Control group BASFI, BASDAI total integral comparison before and after exercise, there were no statistically significant difference (P=0.443and P=0.054); Experimental comparison before and after exercise, the difference had statistical significance (P<0.001).3.265Patients with23-74years old, the experimental group and control group have no significant difference in average age, gender, BMI and disc herniation levels (P>0.05), data comparable. For L4/5interverbebral disc highlight of17cases (26%), L4/5+L5/SI intervertebral disc herniation in16cases (25%), the largest number of L5/SI intervertebral disc herniation in32cases (49%). QBPDS scores in experimental group rating scale average score from (52.8±25.0) to (11.2±10.4) points, each record score improve relative before significant differences for each group (P<0.05); NPRS score from the start (5.7±2.1) to (1.2±1.0) points, each score improvement before relatively significant differences (P<0.05). Control group in Quebec lumbago dysfunction rating scale average score from (51.5±22.7) to (20.5±17.8) points, each record score improve relative before significant differences for each group (P<0.05); Experimental digital average pain rating score from the start (5.7±2.1) to (1.2±1.0) points, each score improvement before relatively significant differences (P<0.05) between group comparison, QBPDS and NPRS in T2control efficacy relative experimental group had significant difference (t=2.887, P=0.005and t=3.018, P=0.004), T3when there was no significant difference in (t=0.475, P=0.636and t=0.664, P=0.509), but on time of T3and T4QBPDS score and NPRS pain score has no obvious difference (P>0.05),in T5the QBPDS score and NPRS pain score in experimental group have obvious difference than control group (t=2.569, P=0.013and t=2.102, P=0.041).3.3There was no significant difference in two groups of patients with baseline data comparison(P>0.05). Two groups of patients before symptoms grading composition was no significant difference (degree of numbness:x2=0.702, P=0.873; attack frequency time:x2=2.708, P=0.439; limb muscle strength:x2=0.344, P=0.952; restricted joint activities:x2=1.194, P=0.754), and suggests two groups of comparable. After the fifth course,in both groups the patient’s muscle strength and joint activities improved, there was no significant difference (degree of numbness:x2=0.056, P=0.972; attack frequency time:x2=0.151, P=0.927; limb muscle strength:x2=0.966, P=0.617; restricted joint activities:x2=2.793, P=0.247), prompt rather an effect of the two groups. Patients after the fifth course after eliminating cervical anteflexion activities and significant stretch activity difference (t=2.045, P=0.045and t=2.100, P=0.039), prompt cervical anteflexion activity effect of the treatment group is better than the control group; Other joints and cervical range and there was no significant difference were observed in the VAS score comparison significance (P>0.05), the prompt rather an effect of the two groups. 4Conclusions4.1Compared with the conventional exercise method, our method to strengthen and stretch the shortened gravational muscles seems better to improve the spinal column function, but further clinical trial is needed to ascertain its superiority.4.2The present study indicates that gravational muscle stretching and reinforcing exercise program, which stabilizes the spinal column and maintain the internal and external balance of spinal column, is suitable for the conservative and long-term management of LDH.4.3Post-contraction relax training is a convenient、practical and effective way to promote the symptoms of cervical radiculopathy based on the theory of muscle stretching and inverse myotatic relex.But it’s just a method of treating and should be combined with other therapies. |
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