[Effect of spinal manipulation on brain functional activity in patients with lumbar disc herniation].

OBJECTIVE: To investigate the effects of spinal manipulation (SM) on brain functional activity in patients with lumbar disc herniation (LDH). METHODS: Eleven patients with LDH were recruited in the study. All patients received 6 times of lumbar SM treatment and then clinical efficacy was evaluated. All patients received brain functional magnetic resonance imaging (fMRI) scans before and after SM treatment. RESULTS: Three subjects dropped out and 8 subjects completed the study, among whom 4 cases were effective and 4 ineffective after SM treatment. The required pressure value producing the same level (VAS 50) pain was (7.43 ± 1.47) kg and (10.53 ± 0.55) kg before and after SM treatment in effective patients(P<0.05); however, there was no significant difference in ineffective patients (P>0.05). Compared to pre-treatment level, the brain functional activity in effective patients was mainly inhibited, the inhibited areas were located in the right side of prefrontal cortex and cerebellum; while the brain functional activity was generally enhanced in ineffective patients. CONCLUSION: SM can affect the brain functional activity of patients with LDH, the inhibited areas is mainly located in prefrontal cortex and cerebellum when SM treatment is effective.

Tuina-focused integrative chinese medical therapies for inpatients with low back pain: a systematic review and meta-analysis.

Objective. To evaluate the effectiveness of Tuina-focused integrative Chinese medical therapies (TICMT) on inpatients with low back pain (LBP). Methods. 6 English and Chinese databases were searched for randomized controlled trials (RCTs) of TICMT for in-patients with LBP. The methodological quality of the included RCTs was assessed based on PEDro scale. And the meta-analyses of TICMT for LBP on pain and functional status were conducted. Results. 20 RCTs were included. The methodological quality of the included RCTs was poor. The meta-analyses' results showed that TICMT had statistically significant effects on pain and functional status, especially Tuina plus Chinese herbal medicine (standardised mean difference, SMD: 1.17; 95% CI 0.75 to 1.60 on pain; SMD: 1.31; 95% CI 0.49 to 2.14 on functional status) and Tuina plus acupuncture (SMD: 0.94; 95% CI 0.38 to 1.50 on pain; SMD: 0.53; 95% CI 0.21 to 0.85 on functional status). But Tuina plus moxibustion or hot pack did not show significant improvements on pain. And the long-term evidence of TICMT was far from sufficient. Conclusions. The preliminary evidence from current studies suggests that TICMT might be effective complementary and alternative treatments for in-patients with LBP. However, the poor methodological quality of the included RCTs means that high-quality RCTs with long follow-up are warranted.

Chinese massage combined with herbal ointment for athletes with nonspecific low back pain: a randomized controlled trial.

Non-specific low back pain (NLBP) is an increasing health problem for athletes. This randomized controlled trial was designed to investigate the effects of Chinese massage combined with herbal ointment for NLBP. 110 athletes with NLBP were randomly assigned to experimental group with Chinese massage combined with herbal ointment or control group with simple massage therapy. The primary outcome was pain by Chinese Short Form McGill Pain Questionnaire (C-SFMPQ). The secondary outcome was local muscle stiffness by Myotonometer. After 4 weeks, the experimental group experienced significant improvements in C-SFMPQ and in local muscle stiffness compared with control group (between-group difference in mean change from baseline, -1.24 points, P = 0.005 in sensory scores; -3.14 points, P < 0.001 in affective scores; -4.39 points, P < 0.001 in total scores; -0.64 points, P = 0.002 in VAS; -1.04 points, P = 0.005 in local muscle stiffness during relaxation state). The difference remained at one month followup, but it was only significant in affective scores (-2.83 points, P < 0.001) at three months followup. No adverse events were observed. These findings suggest that Chinese massage combined with herbal ointment may be a beneficial complementary and alternative therapy for athletes with NLBP.

The Effects of Tai Chi and Neck Exercises in the Treatment of Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.

UNLABELLED: This study aimed to test the efficacy of Tai Chi for treating chronic neck pain. Subjects with chronic nonspecific neck pain were randomly assigned to 12 weeks of group Tai Chi or conventional neck exercises with weekly sessions of 75 to 90 minutes, or a wait-list control. The primary outcome measure was pain intensity (visual analogue scale). Secondary outcomes included pain on movement, functional disability, quality of life, well-being and perceived stress, postural and interoceptive awareness, satisfaction, and safety. Altogether, 114 participants were included (91 women, 49.4 ± 11.7 years of age). After 12 weeks Tai Chi participants reported significantly less pain compared with the wait list group (average difference in mm on the visual analogue scale: -10.5; 95% confidence interval, -20.3 to -.9; P = .033). Group differences were also found for pain on movement, functional disability, and quality of life compared with the wait list group. No differences were found for Tai Chi compared with neck exercises. Patients' satisfaction with both exercise interventions was high, and only minor side effects were observed. Tai Chi was more effective than no treatment in improving pain in subjects with chronic nonspecific neck pain. Because Tai Chi is probably as effective as neck exercises it may be considered a suitable alternative to conventional exercises for those with a preference toward Tai Chi. PERSPECTIVE: This article presents results of a randomized controlled trial comparing Tai Chi, conventional neck exercises, and no treatment for chronic nonspecific neck pain. Results indicate that Tai Chi exercises and conventional neck exercises are equally effective in improving pain and quality of life therefore representing beneficial interventions for neck pain.

Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Several studies reported that Tai Chi showed potential effects for chronic pain, but its role remains controversial. This review assessed the evidence regarding the effects of Tai Chi for chronic pain conditions. 18 randomized controlled trials were included in our review. The aggregated results have indicated that Tai Chi showed positive evidence on immediate relief of chronic pain from osteoarthritis (standardized mean difference [SMD], -0.54; 95% confidence intervals [CI], -0.77 to -0.30; P < 0.05). The valid duration of Tai Chi practice for osteoarthritis may be more than 5 weeks. And there were some beneficial evidences regarding the effects of Tai Chi on immediate relief of chronic pain from low back pain (SMD, -0.81; 95% CI, -1.11 to -0.52; P < 0.05) and osteoporosis (SMD, -0.83; 95% CI, -1.37 to -0.28; P = 0.003). Therefore, clinicians may consider Tai Chi as a viable complementary and alternative medicine for chronic pain conditions.

[Experimental research on substance P content of hypothalamus and dorsal root ganglia in rats with lumbar vertebrae Gucuofeng model].

OBJECTIVE: To detect the effects of lumbar vertebrae Gucuofeng on the substance P content of hypothalamus and dorsal root ganglia in rat models. METHODS: A hundred and twenty SPF level SD male rats with the weight of 350 to 450 g were randomly divided into rotary fixation group (RF group), simple fixation group (SF group) and sham-operation group (Sham group). The external link fixation system was implanted into the L4-L6 of rats in RF group and SF group; and in RF group, that the L5 spinous process was rotated to the right resulted in L4, L5, L6 spinous process not collinear; in SF group, the external link fixation system was simply implanted and not rotated. The rats of Sham group were not implanted the external link fixation system and only open and suture. The substance P content of hypothalamus and dorsal root ganglia were detected at 1, 4, 8, 12 weeks after operation. RESULTS: Substance P content of hypothalamus in RF group and SF group was lower than Sham group at 1, 4, 8 weeks after operation (P<0.05). Substance P content of dorsal root ganglia was higher than Sham group at 1, 4, 8, 12 weeks after operation (P<0.05). There was no significant differences in the substance P content of hypothalamus among three groups at 12 weeks after operation (P>0.05). CONCLUSION: Lumbar vertebrae Gucuofeng can inhibit the analgesic activity of substance P in hypothalamus and promote the synthesis and transmission of substance P in dorsal root ganglia, so as to cause or aggravate the pain.

[Effectiveness of manual therapy and traction for lumbar disc herniation: a meta-analysis].

OBJECTIVE: To evaluate the effectiveness of manual therapy and traction for lumbar disc herniation and analyze the current status of this kind of randomized clinical trial (RCT). METHODS: Database of CNKI, VIP, WANFANG, PubMed and OVID were searched. Some relevant journals were manually retrieved. A total of 2 874 literatures on manual therapy and traction for lumbar disc herniation were collected, of which 17 articles met the inclusion criteria. The Jadad score scale was used to evaluate the quality,and RevMan5.0 was used for meta-analysis of literatures. RESULTS: The results of the meta-analysis of all trials involved were as followed:the combined effect of the effective rate was RR = 1.10, 95% CI [1.06, 1.14], the combined effect of the cure rate was RR = 1.36, 95% CI [1.21,1.52], the combined effect of the VAS was RR = 1.37, 95% CI [1.28, 1.45], the combined effect of the JOA was RR = 4.75, 95% CI [4.40, 5.09]. CONCLUSION: The overall quality of the current RCT researches about manual therapy for lumbar disc herniation was lower,and did not support the conclusion that manual therapy was more effective than traction for lumbar disc herniation.

[Experimental research on whole blood viscosity changes at different time points in rats model with lumbar vertebrae semidislocation].

OBJECTIVE: To investigate whole blood viscosity changes at different time points in rats model with lumbar vertebrae semidislocation, study Shi's theroy of qi and blood and "Gucuofeng and Jinchucao" [symbols: see text], also reveal pathological physiology characteristics of spinal disorder. METHODS: Thirty-six SPF male rats weighted 350 to 450 g were randomly divided into rotatory fixation group (RF group), simple fixation group (SF group) and Sham group (Sham group), 12 rats in each group. Exterior vertebrae implanted through L4-L6 segments of lumbar vertebrae in RF and SF group were connected fixed device. In RF group, L5 spinous process were rotated to right, and caused L5 spinous process was non collinear with L4 and L6; in SF group, external fixed device were simple connected without rotation. At 1, 4, 8 and 12 weeks after fixation, whole blood viscosity changes were tested. RESULTS: At 4 and 8 weeks after fixation, high (150/s), medium (60/s) and lower (10/s) shear rate in RF and SF group were higher than that of Sham group (P<0.05). At 1 and 12 weeks, there was no sigificant differences among three groups in whole blood viscosity (P>0.05). CONCLUSION: "Gucuofeng and Jinchucao" [symbols: see text] vertebrae could raise whole blood viscosity, increase degree of bloos stasis and induce or aggravate spinal disorder in further.

Massage therapy for neck and shoulder pain: a systematic review and meta-analysis.

Objective. To evaluate the effectiveness of massage therapy (MT) for neck and shoulder pain. Methods. Seven English and Chinese databases were searched until December 2011 for randomized controlled trials (RCTs) of MT for neck and shoulder pain. The methodological quality of RCTs was assessed based on PEDro scale. The meta-analyses of MT for neck and shoulder pain were performed. Results. Twelve high-quality studies were included. In immediate effects, the meta-analyses showed significant effects of MT for neck pain (standardised mean difference, SMD, 1.79; 95% confidence intervals, CI, 1.01 to 2.57; P < 0.00001) and shoulder pain (SMD, 1.50; 95% CI, 0.55 to 2.45; P = 0.002) versus inactive therapies. And MT showed short-term effects for shoulder pain (SMD, 1.51; 95% CI, 0.53 to 2.49; P = 0.003). But MT did not show better effects for neck pain (SMD, 0.13; 95% CI, -0.38 to 0.63; P = 0.63) or shoulder pain (SMD, 0.88; 95% CI, -0.74 to 2.51; P = 0.29) than active therapies. In addition, functional status of the shoulder was not significantly affected by MT. Conclusion. MT may provide immediate effects for neck and shoulder pain. However, MT does not show better effects on pain than other active therapies. No evidence suggests that MT is effective in functional status.

Integrative TCM Conservative Therapy for Low Back Pain due to Lumbar Disc Herniation: A Randomized Controlled Clinical Trial.

Low back pain due to lumbar disc herniation (LDH) is very common in clinic. This randomized controlled trial was designed to investigate the effects of integrative TCM conservative therapy for low back pain due to LDH. A total of 408 patients with low back pain due to LDH were randomly assigned to an experimental group with integrative TCM therapy and a control group with normal conservative treatment by the ratio of 3 : 1. The primary outcome was the pain by the visual analogue scale (VAS). The secondary outcome was the low back functional activities by Chinese Short Form Oswestry Disability Index (C-SFODI). Immediately after treatment, patients in the experimental group experienced significant improvements in VAS and C-SFODI compared with the control group (between-group difference in mean change from baseline, -16.62 points, P < 0.001 in VAS; -15.55 points, P < 0.001 in C-SFODI). The difference remained at one-month followup, but it is only significant in C-SFODI at six-month followup (-7.68 points, P < 0.001). No serious adverse events were observed. These findings suggest that integrative TCM therapy may be a beneficial complementary and alternative therapy for patients with low back pain due to LDH.

[Reliability research of spine stiffness test system].

OBJECTIVE: To investigate the reliability of the spine stiffness test system (SSTS) by animal experiments. METHODS: A hundred SD male rats with weight body of 350-450 g were divided randomly into 5 groups according to feeding time of 1, 2, 4, 8,12 weeks. The externally linked fixation systems were implanted into all rats in L4, L5, and L6. At the end of every feeding time, the stiffness of the fixed segment was measured by SSTS, and the relationship between linking time and the stiffness were observed. The parameters of pressure sensor of SSTS were demarcated before measuring the stiffness in order to ensure the accuracy of SSTS. RESULTS: The actual error of the spine stiffness test system was less than 0.04%. Its reliability was good, ICC = 0.948 (P < 0.01). And the stiffness of the fixed segment increased with linking times. CONCLUSION: The accuracy and reliability of SSTS were good. Its operating system was very simple to manipulate. And SSTS may accurately collect pressure load and infinitesimal displacement of the spinal motion segment. In order to fit more spinal injuries models, SSTS needs improvements in fixed accessories, measurement range, disturbance variable, and so on.

[Study on hypomobility of motion segment of rats with lumbar subluxation model].

OBJECTIVE: To observe the basic characteristics of rats with subluxation, which was hypomobility of motion. METHODS: One hundred and eight male SD rats (weighted, 350 to 450 g) were randomly divided into experimental group (simple fixation and rotatory fixation) and sham operation group. Each group was subdivided into four groups, including 2, 4, 8 and 12 weeks sub-groups. Simple fixation and rotatory fixation group were modeled by implanting external linked fixation system; Sham operation group was dealed with operation intervention. At the end of connection, X-ray films was used to observe posterier body angle (PBA); Spinal stiffness system for stiffness in simple fixation group and rotatory fixation group. RESULTS: Radiographic results showed that variation of PBA n experimental groups tended to decrease; and there was no significant difference between simple fixation group and rotatory fixation group at the end of linking time (P > 0.05). But there was significant difference between the experimental group and sham operation group (P < 0.05). The degree of stiffness showed that the stiffness in experimental group increased with the linking time, but no meaning between groups (P > 0.05). CONCLUSION: Rats with subluxation induced by external linked fixation system can effectively change biomechanical characteristics of spine, reduced the motion with linking time.

[Effects of manipulation on mechanical properties of cervical and degree of fatigue in patients with cervical spondylosis].

OBJECTIVE: To explore the mechanism of manipulation in treating cervical spondylosis. METHODS: From August 2008 to December 2009, 65 patients with cervical spondylosis were randomly divided into manipulation group and traction group. There were 32 patients in manipulation group, of which 30 cases obtained followed-up, including 10 males and 20 females, ranging in age from 30 to 65 years,with an average of (42.31 +/- 13.23) years; the mean course of diseases was (12.40 +/- 6.23) months, and the average weight was (61.21 +/- 10.23) kg. In traction group, there were 33 patients, 30 cases obtained follow-up, including 11 males and 19 males, ranging in age from 30 to 65 years, with an average of (45.54 +/- 14.35) years; the mean course of diseases was (13.25 +/- 6.06) months and average weight was (62.31 +/- 10.45) kg. Biodex III Isokinetic Testing System and TeleMyo 2400 T Surface EMG was applied to test the mechanical properties and fatigue of neck muscles before and after treatment. RESULTS: The mechanical properties of neck muscles: measuring in the 60 degrees/s and 120 degrees/s angular velocity, there were no significant difference (P > 0.05) in peak torque (PT), average power (AP), peak torque of flexor/extensor peak torque ratio (F/E) before treatment, while manipulation group was improved more than traction group in PT, AP, F/E after treatment (P < 0.05), and there was significant difference (P < 0.05). For the degree of fatigue: there was no significant difference (P > 0.05) in IEMG, MPF compared by two groups before treatment, but the manipulation group was improved more than the traction group in IEMG, MPF after treatment (P < 0.05), and there was significant difference (P < 0.05) on the right side. CONCLUSION: Manipulation can improve contraction forces and work efficiency of neck muscle, coordination ability of flexors and extensors muscles, efficiency of neck muscle, and recover mechanical properties and can alleviate fatigue of neck muscles in patients with cervical spondylosis.

[Thinking on conception and name of the "subluxation"].

"Subluxation" is the core of pathological conception of spinal injuries treated by spinal manipulation. The conception of "Subluxation" not only includes changes of joint anatomy,but also emphasizes on joint dysfunction which is caused by changes of the anatomical position. The name of "Subluxation" in manual medicine is the same as modern medicine,but the content is obviously different. Nonetheless, it would be confused and not reflect the characteristics of manual practices. So we can consider changing the name of "Subluxation" in manual medicine into "Yatuowei".

[Study on the effect of vertebrae semi-dislocation on the stress distribution in facet joint and interuertebral disc of patients with cervical syndrome based on the three dimensional finite element model].

OBJECTIVE: To study the effect of vertebrae semi-dislocation on the stress distribution in facet joint and interuertebral disc of patients with cervical syndrome using three dimensional finite element model. METHODS: A patient with cervical spondylosis was randomly chosen, who was male, 28 years old, and diagnosed as cervical vertebra semidislocation by dynamic and static palpation and X-ray, and scanned from C(1) to C(7) by 0.75 mm slice thickness of CT. Based on the CT data, the software was used to construct the three dimensional finite element model of cervical vertebra semidislocation (C(4)-C(6)). Based on the model,virtual manipulation was used to correct the vertebra semidislocation by the software, and the stress distribution was analyzed. RESULTS: The result of finite element analysis showed that the stress distribution of C(5-6) facet joint and intervertebral disc changed after virtual manipulation. CONCLUSION: The vertebra semidislocation leads to the abnormal stress distribution of facet joint and intervertebral disc.