| The increased pace of modern living, random incidents happen in the midst of labor and everyday life has fueled the rate of acute lumbar sprain cases. Acute lumbar sprain accounts for more than 12% of clinically diagnosed lower back injuries, as well as 10% of the outpatient cases in the orthopedics and trauma. It has become a problem of the modern lifestyle, with its rate of occurrence rising sharply in recent years, causing great pain and inconvenience to the patients. In the realm of medicine, acute lumbar sprain has been given widespread attention, with comprehensive clinical research conducted.The outcomes resulting from acute lumbar sprains such as lumbar pain, restriction of movement as well as other signs and symptoms usually happen over a short period of time. As a result, it is crucial to mitigate the signs and symptoms of patients in the shortest time possible in order to prevent the acute symptoms from turning into a chronic problem.Traditional Chinese Medicine (TCM) intervention is one of the effective methods in treating acute lumbar sprains. This method is characterized by advantages such minimal pains and would as well as reduced cost of treatment, high safety levels and precise treatment effects. It vividly reflects the distinct features of "simple", "practicality", "effectiveness" and "economical".There are a variety of treatment methods by means of TCM orthopedic interventions in treating acute lumbar sprains. These methods originate from different schools and they represent the extensive and profound scientific achievements of the traditional way of treating bone injuries which has proven to provide significant treatment outcomes. However, these methods are not systematic and lack a robust model; as a result, its treatment effects can appear unstable. It is due to this that treatment using TCM are constantly questioned in the realm of modern medicine. In fact, injuries caused by medical malpractices can always be seen in the news. As a result, the research into the production of a treatment method that is systematic, robust, effective and safe has drawn great interest from practitioners both local and abroad. This experimental topic is based on the achievement of thematic research on the state ten five "The academic ideology of The Prominent TCM Doctor and The Clinical Experiences of Manipulation ".The process of manipulation methods in the treatment of acute lumbar sprain is refined and the characteristic treatment style is defined, forms a unique clinical experience of the condensing of academic origin and common regularity.Moreover, in order to evaluate the effectiveness and safety of the characteristic manipulation, conventional manipulation is compared in a randomized clinical research. Initially, a series of evaluation system of the manipulation in curing acute lumbar sprain is established. The particular research bears the hope of achieving the objectives of simplifying the learning and using methods, as well as gaining convenience in promotion of the method.Mainly, this topic is going to probe further into these 2 fields:1. Combine the movement of lumbar spine, refine the treatment method of a Chinese medicine expert, rearrange and record the operation process accurately2. Arrange the difference between the characteristic treatment method and traditional treatment method to do a comparison clinical trial, observing the result after treatment by Roland-Morris Disability Questionnaire (RDQ), Visual Analogue Score (VAS), and range of motion (ROM), in order to evaluate the characteristic method thoroughly.The Clinical Research on Unique Manipulation in Treating Acute Lumbar SprainsFrom June 2008 to March 2009, 90 cases of acute lumbar sprain were selected from the Outpatient Center for Orthopaedics at WangJing Hospital of CACMS, in accordance to the disease's diagnostic criteria. The method of simple numerical randomization (envelope method) was utilized. In this randomized-control method, patients were indiscriminately divided into the unique manipulation group and the conventional manipulation group following their consultation sequence. In this clinical research, 44 cases from the unique manipulation group and 41 cases from the conventional diagonal-pulling method group were included in the final data analysis. The general conditions, as well as the signs and symptoms of patients from both groups were compared prior to treatments. Data analyses were conducted using SPSS 13.0 statistical software.1.1. Basis of DiagnosesDiagnoses referred to "The Standards of Traditional Chinese Medicine Industry in the People Republic of China: Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine for Acute Lumbar Sprain" published by the State Administration of Traditional Chinese Medicine in 1995.The Diagnosis Criteria for Acute Lumbar Sprain:1) Patients with a history of acute lumbar sprain which are commonly seen amongst strong youngsters;2) Patients with a severe pain on one or both sides in their lumbar areas are usually restricted in their activity. They are prohibited from turning their torso, sitting down and walking regularly. They are also forced to maintain their bodies in certain constrained poses in order to relieve the pain;3) Patients who experience spasms around the lumbar and hip muscle or who have touchable streak hardenings; patients whose wounded areas have an obvious pain punctual point and have alteration of the radian on their spinal nature.1.2. Inclusion Criteria for Subjectsa) Patients who fulfill the diagnostic criteria as listed above;b) Patients within the ages of 18 and 65 years old;1.3. Exclusion Criteria for Subjectsa) Patients who are under 18 years old and over 65 years old;b) Patients who are diagnosed or suspected with tumors/nodules in their vertebrae or intervertebral canal, osteomyelitis and severe osteoporosis; c) Patients who have severe heart, brain, lung, liver and/or kidney conditions; as well as patients with hematological diseases;d) Patients who have severe skin damage or any dermatological diseases in the sites of intervention;e) Patients who have undergone lumbar vertebrae surgery and those with severe congenital lumbar vertebra malformation, lumbar intervertebral disc herniation, lumbar canal stenosis, lumbar spondylolisthesis are withheld from intervention;f) Pregnant women;1.4. Criteria for Drop-out Casesa) Patients who experience adverse side effects, and are non compliant with the remaining interventions;b) Patients who withdraw in the middle of the experiment on their own wills, and have concrete reasons in supporting their withdrawals as well as the comments during intervention in record.1.5. Criteria for Eliminated CasesPatients who are not qualify to the diagnosis criteria at the final stage.2. TREATMENT METHODS2.1. Unique Manipulation GroupUnique manipulation utilized the techniques of: inspection technique, tendon-manipulation technique, sequence oblique-pulling technique, bouncing and standing upright technique, and bed-rolling technique. The treatment cycle was over one week (three times per week). Treatments were carried out every alternate day. Each treatment lasted for approximately twenty-five minutes.2.2. Conventional Manipulation GroupConventional manipulation utilized the techniques of: relaxation technique and conventional oblique-pulling method. The treatment cycle was over one week (three times per week). Treatments were carried out every alternate day. Each treatment lasted approximately twenty minutes.3. RESULTS3.1. Analysis of the Curative Effects of the Unique Manipulation on theTreatment of Acute Lumbar SprainThe cure of tendon injuries by orthopaedic treatments in Traditional Chinese Medicine has emphases on targeting the source, stressing on the lightness and softness in skill, as well as integrating both techniques in manipulation as well as the utilization of medication during intervention. Based on the expertise in the professional realm, Professor Zhangjun has combined both treatment methods from each school as well as his own extraordinary clinical experiences, in order to invent the curative method of acute lumbar sprain by orthopaedic treatment in TCM. The specialized manipulation methods included the inspection technique, tendon-manipulation technique, fractional and diagonal-pulling technique, bouncing and standing upright technique, and the bed-rolling technique.The results of the experiment showed that there was a positive effect when the unique manipulation method was used in curing acute lumbar sprains. Among the 44 cases in the unique manipulation group, 33 patients (75%) were cured after the first treatment, 38 patients were cured after completing the full treatment cycle, 5 patients showed positive improvement and 1 patient showed no progress. It demonstrated a total efficacy rate of 97.73%. Among the total of 41 cases in conventional diagonal-pulling method group, 19 patients (46.34%) were cured by the first treatment. 26 patients were cured after completing the full treatment cycle, 12 patients showed positive improvement and 3 patients showed no progress. The total efficacy rate was 92.68%.After both groups had completed the first treatment, the curative effects of the unique manipulation group and the conventional manipulation group were compared. The statistically significant result of Z= 2.359, P<0.05 indicated that the unique manipulation group showed increased positive curative effects over the conventional manipulation group.After both groups had completed the full treatment cycle, the curative effects of the unique manipulation group and conventional manipulation group were compared. The statistically significant result of Z= 2.439, P<0.05 represented that the unique manipulation group excelled against the conventional manipulation group.3.2. The Comparative Results of Roland-Morris Disability Questionnaire in Characteristic Manipulation Group and Conventional Manipulation Group3.2.1. Pre- and Post-Treatment Results of the Experimental GroupsThe comparison of RDQ scales pre- and post- treatment in characteristic manipulation group was P<0.001 which indicated the characteristic method had a distinctive effect on alleviating dysfunction cause by lumbar pain; whereas the comparison of RDQ scales pre- and post-treatment in conventional manipulation was P<0.001 which indicated a significant effect in soothing pains in the same areas.The statistical difference of both groups after comparing their RDQ scales was P<0.05. This significant result indicated that in alleviating pains in lumbar and limb areas, characteristic manipulation was preferable to conventional manipulation.3.2.2. The Comparison of Interview Sessions of the Experimental GroupsThere were no difference between the first, second and third interviews in both groups (P>0.05).3.3. The Analyses of VAS Evaluations in the Unique Manipulation Group andConventional Manipulation Group3.3.1 Pre- and Post-Treatment Results of the Experimental GroupThe comparison of VAS scales pre- and post- treatment in the unique manipulation group was P<0.001, which demonstrates that the unique method had a distinguishing effect on alleviating pains in lumbar and limb areas; whereas the comparison of VAS scales pre- and post-treatment in conventional manipulation group was P<0.001, which revealed a significant effect in easing pains in the same areas.When comparing VAS scales for both the unique manipulation group and conventional manipulation group, the statistical difference was P<0.05. This significant result indicated that in alleviating pains in the lumbar and limb areas, the former was superior to the latter.3.3.2. The Comparison of Interview Sessions of the Experimental GroupsThere was a difference after comparing the first, second and third interviews in both groups which indicated the unique manipulation group relieve pains sooner than the conventional manipulation group.3.4. The Comparative Results of Lumbar Spine Maneuver Range (ROM) in the Unique Manipulation Group and Conventional Manipulation Group3.4.1. Pre- and Post-Treatment Results of the Experimental GroupsThe comparison of the analysis on lumbar spine maneuver range in the unique manipulation group pre-and post treatment was P<0.001, which indicated the specified manipulation exerted an extraordinary effect in ameliorating the angles of lumbar spine's activities. In the conventional manipulation group however, the comparison of the analysis on lumbar spine maneuver range pre- and post-treatment was P<0.001, which also indicated a positive effect by this method.The statistical difference of both groups after comparing their analyses on lumbar spine maneuver range pre-and post-treatment was P<0.05. This significant result indicated that in ameliorating the movement range of lumbar spine activities, unique manipulation showed a more distinctive effect over conventional manipulation.3.4.2. The Comparison of Interview Sessions of the Experimental GroupsThere was a statistical difference of P<0.01 for lumbar movement range improvement when the unique manipulation method was utilized, while a improvements of a statistical difference of P<0.001 was seen when the conventional manipulation was used, demonstrating that this was also an effective method. However, there was a significant statistical difference (P<0.05) between the usage of the unique and conventional manipulation methods, indicating that the unique manipulation method had a superior ability in improving lumbar activity range when compared to conventional manipulation.CONCLUSIONS1. The treatment of the unique manipulation method excelled when compared to the conventional manipulation method given that the characteristic method showed distinctive effects in ameliorating signs and symptoms caused by lumbar pain in patients, as well as in enhancing the activity ranges in patients.2. Unique manipulation required a shorter time to how initial effectiveness in ameliorating pain and improving lumbar spine activity range in patients with acute lumbar sprain.3. Unique manipulation possesses the following benefits: elimination of abnormal exerting force on lumbar spine, recovery of normal anatomical sequence of lumbar joints, relaxation from intense muscle tension, revitalization or amelioration of abnormal muscle tension to its normal stage, and prevention and inhibition from malignant stimulation as so to stimulate the recovery of regular blood supply in lumbar area. |
PDF Full Text Request