You are on page 1of 7

ELSEVIER

World Journal of Acupuncture-Moxibustion


(WJAM)
Vol. 23,No.2, 30th Jun. 2013

51

Clinical Report
One hundred and twenty-four cases of lumbar
disc herniation treated with acupuncture and
massage manipulation

tJfiUit7*1irff lllftfBJf3:iliI2419Ji
SUN Chang-le (.f}i(:.*)
Orthopedics Department, Fuyang People's Hospital, Fuyang 236000, Anhui Province, China ( :t(i'{!

JrljirtJ

tf*I-, :t(fl J1im 236000,

AR TI C L E IN F O

Author: SUN Chang-le (1978-) male,


attending physician.
Research field: research and treatment
of
chronic pain.
E-mail:schl1978@163.com
Accepted on May 24, 2012

i:p )

A B STRA CT

Objective To discuss the clinical efficacy on lumbar disc herniation (LDH)


treated with acupuncture and massage manipulations. Methods One
hundred and twenty-four cases of LOH were treated with acupuncture at
Taichong
LR 3), Neiting ( l*J Jt! ST 44), Zulinqi()Ell(h GB 41), Vaotongdian

tf'P
(.Im

lumbar pain point). Tuntongdian (W:Jll buttock pain point) and


Zuogushenjingdian (1f
sciatic point) and massage
manipulations
[including gun/a (rolling technique), yizhichan tuifa (one-finger pushing
technique), qianyin doudong fa (shaking technique under traction), anyafa
(pressing technique) and zuoyou cebanfa (bilateral pulling technique)], once
a day,for 3 weeks totally. The lower back pain scoring system of the
Japanese Orthopedic Association (JOA) was adopted for the scoring
before and after treatment to assess the efficacy. Results At the end of
treatment, JOA score was reduced to (0.950.32) points as compared with
(6.140.97) points before treatment (P<0.01). Concerning to the efficacy
improvement rate, 96 cases were excellent,12 cases good, 5 cases fair and
3 cases poor.116 cases received the follow-up visit for 6 months averagely
and no case of recurrence was
reported. Conclusion Acupuncture combined with massage manipulate can
relieve rapidly acute pain in the lumbar region and legs and acts directly on
the foci. This therapy is safe and effective, achieves the high clinical curative
rate and brings less pain to the patients.

:Ill

KEY WORDS: lumbar disc herniation (LDH); a cupuncture; massage


manipulations

Lumbar disc herniation (LDH) is one of the


common lwnbar disorders in clinic and the
incidence is
about
The typical symptoms include lwnbar
111
15.2%

CLINICAL DATA
All of 124 cases were from the comprehensive

World Journal of Acupuncture-Moxibustion


ward of the orthopedics department, Anhui Fuyang

2
.
ELSEVIER
pain combined with unilateral or bilateral (WJAM)
Vol.
23,
No.2,
30th
Jun.
2013
People's Hospital. Of them, 75 cases were male,
alternative radiating pain and numbness of the
49 cases female; aged from 24 to 62 years,
lower limbs, limited lwnbar movement, difficulties
in standing and walking, and disturbance of daily
averagely (41 0.6) years old; being sick in the
life activity. The writer adopted acupuncture
range from 16 days to 34 months, averagely (226
combined with massage manipulations to treat 124
0.9) days. All the cases suffered from lumbar pain
cases of LDH from October 2009 to May 2012. The
to different extents, 97 cases were combined
report is as follows.
with unilateral

numbness and pain of the lower limb and 27 cases


with bilateral numbness and pain of the lower limbs.
The lumbar MRI or CT test showed there were
14 cases with L3/L4 disc herniation, 37 cases with LJ
L5 disc herniation, 45 cases with Ls/S1 disc herniation
and 28 cases with herniation of two or more than two
segments. With the lumbar X-ray film, spinal tumor,
tuberculosis and the other disorders were excluded.

METHODS
Acupuncture
Selection of points: the patients were in supine.
For those with LJ L5 and L/S1 LDH, manifested
chiefly as pain on the lateral side of the lower limb,
Shenmai ($.!!* BL 62), Neitf ng (l'gJl! ST 44) and
ZUlinqi (..@.lhb?ft GB 41) were selected on the
affected side. For those with Ly'L4 LDH,
(3)
manifested chiefly as pain and numbness on the
anterior and medial side of the lower limb,
TaichOng (:{If LR 3), Neiting (i:lg
Bl ST 44) and Zh.aoh!i (Jffi7fiJ: KI 6) were selected
on
the affected side. For those with serious lumbar
pain, Yaotongdian (Jfi
lumbar pain point,
located at the cross point of the midline of the
forehead) was selected; for those with serious
buttock pain,
TUn.tongdi (W buttock pain point, located at (4)
the midpoint from the acromion to the posterior axilla
line, in sitting or prone) was selected; and for those
with serious sciatic pain, the contralateral ZhOngzhii
(9=1lf TE 3) was selected.
Manipulation: the filiform needles, 0.25 mm X
50 mm, were used. After conventional sterilization
at the acupoints, except the oblique puncture at
YiiotOngdian, the perpendicular puncture was applied
to all the rest acupoints. The needles went deeply
to the contralateral skin, but should not penetrate it.
After inserted, the needles were lifted, thrust and
rotated rapidly.After the arrival of qi, the needles
were removed. In combination, the passive
elevation of straight leg was done on the affected
side for 3 to 5 times. The treatment was given
once a day, for 3 weeks totally. The acupoints
were selected alternatively according to the pain
sites.

Massage manipulations
(1) The patient was in prone. The therapist applied
gunfa (rolling technique) and yizhichan tuifa (onefinger pushing technique) from the lumbar region to
the extremity of the affected limb for 5 min to relax
the muscle tension.
(2) The first assistant stood on the head side of the
patient to pull the axilla of the patient while the

second assistant held the ankles of the patient. By the


coordination of two assistants and under the increasing
of the traction strength, the lumbar region was shook
for over 10 times. Afterward, the therapist stood on
the right side of the patient, pressed the spinal
process of the herniated disc with the palm root of the
right hand and put the left hand overlapping on the
dorsum of the right hand. The second assistant
increased the traction strength and vibration
amplitude suddenly when the patient's lumber region
was adequately relaxed. At the same time, the
therapist pressed the discs to the anterior and inferior
with the hands when the herniated vertebras were
shook to the highest level and the intervertebral
spaces were pulled maximally. At this moment, the
sliding sensation could be felt gently under the hands.
The patient was in lateral position. The zuoyou
cebanfa (bilateral oblique-pulling technique) was
applied. The lower limb in the lower was extended and
the one in the upper was flexed. The therapist stood
facing to the patient. One elbow pressed the anterior
of the patient' s shoulder and the other one pressed the
posterior superior iliac spine. By the opposite exertion,
the lumbar vertebras were rotated passively to the
maximal limit and a quick pulling was done in small
amplitude. Inthe operation, a clicking occurred.
Finally, the gunfa (rolling technique) and
yizhichan tuifa (one-finger pushing technique) from
the lumbar region to the extremity of the affected
limb were applied to recover the internal balance
of the body.
The massage manipulation was applied after
acupuncture for allthe patients .
The above manipulations were applied once a
day for 3 weeks totally. For the older patients with
poor constitution, the Step 2 and 3 should be done
cautiously or prohibitively. The mid-frequency electric
therapy and the magnetic vibration thermal therapy
could be assisted. During treatment, the patients were
required to rest on the hard bed strictly.At the recovery
stage, the patients were instructed to have the sparrow
like flying and the five-point functional exercises.

EFFICACY OBSERVATION
Observation indices and methods
Before and after treatment, according to the
lower back pain scoring method of ,JOA[21 in terms
of the lower back pain, leg pain or numbness, gait,
straight
leg raising test, sensory disturbance, motor disturbance

ELSEVIER

53 .

Vol. 23,No.2, 30th Jun. 2013

and bladder function, the efficacy was assessed.


The lower the scores were, the more obvious the
superficial function disturbance was. In light of
JOA standard scoring result, the rate of
improvement score was calculated.
The rate of improvement score (RIS)=[(scores
after treatment-scores before treatment)7(15-scores
before
treatment)]X100%,
RIS:::=:75%
was
determined to be excellent, 50%-74% was to be
good, 25%-49% was to be fair and < 25% was to be
poor.

Statistical management
SPSS 11.0 software was adopted to analyze all
the data. JOA scores were expressed with
meanstandard (X s) before and after treatment. The
paired t test was used for the comparison. P<0.05
indicated statistical significant difference.

RESULTS
Compared with those before treatment, JOA
scores were increased apparently after treatment,
indicating the statistical significant difference
(P<0.001). See Table 1.
Table 1 Comparison of JOA scores of the patients
with LDH before and after treatment (is,
score)

Items
Lower back pain

Cases Before treatment

After treatment

124

6.420.53 l)

0.620.84

Leg pain or numbness

124

1.130.76

6.850.41 ')

Gait

124

1.310.52

6.960.41 >

Straight leg raising test

124

0.710.48

6.790.36 1)

Sensory disturbance

124

0.910.43

5.840.40

l)

Motor disturbance

124

1.380.64

5.920.51

1
)

Bladder function

124

0.610.13

4.170.45 l)

Total score

124

0.950.32

6.140.97 1)

Note: compared with that before the treatment, 1>P<0.001.

According to RIS assessment standard, after


3 weeks treatment, 96 cases were determined to be
excellent, 12 cases to be good, 5 cases to be fair and
3 cases to be poor. The total effective rate was 97.4%.

EXPERIENCE
LOH is in the category of "lumbar pain" in
Chinese medicine, localized in the lumbar region.
It was determined that this disease should be
treated mainly with the points of the Governor
Vessels, Taiyang meridian and Shaoyang meridian.
Acupuncture of "three-foot-needles" (LR 3, ST 44,
GB 41) could enable the needling sensation to
transmit to the affected area through meridians and

collaterals, motivate the meridian qi and promote the


circulation

of qi and blood in meridians and collaterals. It


was reported that acupuncture at Yaotongdian
(the Governor Vessel), Tilntongdiln (Taiyang
meridian) and Zuogiishenjingdian (sciatic point,
Shaoyang meridian) was termed as "balance
acupuncture moxibustion therapy". Acupuncture
at these points provided the patients with a proper
positive stimulating signal and symptomatic
adjustment and control to the dysfunction and
disorder, also it improved the analgesic effect of
the human body, increased the anti inflammation
and metabolic actions and applied the indirect
intervention to the dysfunctional pathological state
and substantial metabolic disturbance and finally a
new balance state could be obtained through the
self
repair of the body31
The straight leg raising
movement
along with acupuncture could relax the lumbar
muscle and promote qi and blood circulation in
meridians. The needles were removed right after the
qi arrival without the needles retained. The patients
felt that pain was relieved apparently in a few
seconds. This therapy was characterized as less
selected point, no retained needle and quick obtained
effect. As a result, the sense of fear was alleviated
for the patients and the confidence was strengthened
in conquering the disease.
The massage manipulation therapy is one of
the important approaches as the conservative

treatment of LDH. The traction and shaking


technique could relax the muscle tension of the
lumbar region and the pressing and oblique
pulling techniques could shift the vertebral plate
position so that the local capacity of nerve root
could be increased relatively and the nerve
compression or adhesion be released. In association
with the rotation strength of the upper and lower
vertebras as well as the elasticity of the fibrous
ring and posterior longitudinal ligament, the
herniated nucleus pulposus could be returned, the
relative position of the herniated disc and nerve
root be altered, the compression to the nerve root be
alleviated and the recovery of the compressed nerve
root be promoted. In the meantime, the variation
of the facet joints and internal imbalance could be

rectified, which contributed


to the functional repair
of the local tissues in the lumbar region. The writer
applied acupuncture before massage manipulations
with the view of releasing the lumbar and leg pain
at the acute stage of the patients so that the patients
could endure the discomforts induced by the
traction, shaking, pressing and oblique pulling
techniques. As a result, the manipulations could be
done smoothly and the adverse reactions be
reduced. The patients were required to rest on the
hard bed at the acute stage and instructed to
strengthen the lumbar function and bilateral
lumbosacral muscle force at the recovery

stage, which was in favor of maintaining the spinal


balance and stability.
Acupuncture in combination with massage
manipulations can relieve acute lumbar and leg pain
in the treatment of LDH. It works directly on the
foci and promotes the repair of the local
pathological tissues. It achieves the high clinical
curative rate and brings less pain to the patients,
which is characterized as safe and quick effect.

observation of the elongated needle for treatment of


prolapse of lumbar intervertebral disk. Chin Acup-Mox
(Chin) 2004; 24(3): 171-172.
[2] Aiki H, Ohwada 0, Kobayashi H. Adjacent segment
stenosis after lumbar fusion returing second operation.
J Orthop Sci 2005; 10(5): 49Q--495.
[3] Liang SM, Wei SY, Wang WY. Summary of the first
national academic conference papers on balance
acupuncture and moxibustion. J Clin Acup-Mox
(Chin) 1995; 12(4): 48.

REFERENCES
[1] Yuan XL, LiuC, Chen J, He YZ, Li AH, Wang
F.Clinical

(Editor: QI Shu-lan Translator: WANG Fang)

AB S T RAC T IN C H I N E S E

it#J M-f * 11 DfiJ :fit tl:I ftlJ 1J$.lf..113it.o n71i: 124-!JiJ D riJ :fit tl:I .
l'A #J ( R.*../'f , P-.ul, Jt.1J$i;i, - *' *'
'f #.*) ll-f **211 ( @A
*' .t*.$.*, ] # *' J.li*J1...;61J!iJ.t&..*) , .ftl ik , . 3)i) o fl ]f k J!!t f.J '*-'f #il>
JOA ( Japanese Orthopedic Association ) rD;i ttlJ.t..ft->t :Jf-lJi..ftfl3<t-jf )t.o tti': *211 M t.k ,
JOA
->t w ]f ftlJ ( 6.14 0.97 ) '*11.:.
k ftlJ ( 0.95 0.32 ) ( P<0.01 ) o fl 3<t -i-*Jt. -it.961/L
1211tl , Of51ftJ, .!.311tl o Jt. 1161ftJ.i:t-*.-fti'- 6+JJ ftlJ M.-W , il:liil11tl o ttl'lt: #tl M.f
**211D
#flil :fit t1:1 , a or11!d..ttD-Jfi!. ti.
, x.or .t.41-t m -f
:,
(1i., 1.lf..iak1'- iii, .t.:t""
J',
;tf 3it.o
[- ] D-$fij :fit '" #*'J +*
[. J!] 13 ti(]:

;t,

(Continue from page 50)


Massage can relieve spasm of cervical muscle,
loosen the adhesion between the cervical vertebra and
muscle, and reduce the tension of soft tissue, besides,
it can also manipulate the abnormal shift or
dislocation of cervical segment, reduce the burden on
the cervical disc, improve the physiological curvature
of cervical vertebra, repair the dynamic and static
mechanical equilibrium, alleviate or relieve the
mechanical pressure and stimulation to the cervical
nerve and artery, dilate vertebral artery, alleviate
stimulation to the sympathetic nerve, effectively
increase the blood

AB S TRAC T IN C H IN E SE

supply to the vertebral artery, improve the anaerobic


condition of brain, so as to alleviate the symptoms.
This therapy is a method with quick and good
effect, safeness, reliability and is easy to be
accepted and promoted. Acupuncture for cervical
vertigo has better short-term effect, but its longterm effect and follow-up should also be
emphasized, the clinicians need to pay attention to
the problem how to give instructions about the
daily care and prevention to them.
(Editor: LIU Wan-ning Translator: ZHANG Yong-mei)

1*

[ J 13 ti{)= JIJL-tt-'tl fli t--@i *,ff.K n; n fli ti.irt ftli 1}$ a.113lt., 1J$.lf..*211fli ti. irt
11L7r*o n71i: 65-!JiJ flilirt .i::t#*'J.5Cit.1tlfli *-*"'
. fil i! r , J..t,ti! J ff- , :Jf-M
*J'

A R- , .ft a n;n1tk., ia'116 ik -n'1' ,


n; n 2+n$, J1Jl..f.. ::f ftlJ1J$a.'13it.o ti!i= *21t2s-ffL
Ji 38.5%; il!.3<t.181JJ! , Ji27.7%; ;ff 3<t.19'ff , Ji 29.2%;
3(t3-(fiJ , Ji 4.6%o . ;tf3<t.4195.4%a fi!
i}t: #*'J fli
.Jt.J,t- #.lf .*.R-*211 ortt. ti.irt '.f .i:tftli11.ta. :Pt . 1i...f.fftl.m.m o
LBJ
1irt:t
*.ff#J n*

'*

You might also like