Zhang Zhao-xing, Zhu Hong2, Wang Rui-hui, Du Xu, Qu Hong-yan

1 Shaanxi University of Chinese Medicine, Xianyang 712046, China

2 The First Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712046, China

CLINICAL STUDY

Tuina for Leg Length Discrepancy and Lumbosacral Pain Due to Sacroiliac Joint Subluxation

Zhang Zhao-xing1, Zhu Hong2, Wang Rui-hui1, Du Xu1, Qu Hong-yan1

1 Shaanxi University of Chinese Medicine, Xianyang 712046, China

2 The First Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712046, China

Author: Zhang Zhao-xing, master degree candidate.

E-mail: zzxaj1987@126.com

Objective: To observe the clinical effect of tuina reduction manipulation on leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation.

Methods: A total of 60 eligible cases were randomly allocated into an observation group and a control group, 30 in each group. Cases in the observation group were treated with conventional tuina plus reduction manipulation of sacroiliac joint subluxation; whereas cases in the control group were treated with conventional tuina plus acupuncture. The clinical effects were observed after 10 times of treatment. In addition, the relapse rates were observed 2 months after treatment.

Results: The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference (P＜0.05). The relapse rate of lumbosacral pain in the observation group was 12.5%, versus 66.7% in the control group, showing a statistically significant difference (P＜0.01). The relapse rate of leg length discrepancy in the observation group was 16.7%, versus 80.0% in the control group, showing a statistically significant difference (P＜0.01).

Conclusion: Tuina reduction manipulation can obtain substantial therapeutic effect for leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation, coupled with a low relapse rate.

Tuina; Massage; Acupuncture Therapy; Low Back Pain; Sacroiliac Joint; Subluxation; Lumbosacral Region

Subluxation of the sacroiliac joint refers to mechanical imbalance and soft tissue injury within the sacroiliac joint and subsequent local pain and functional impairment[1]. This often results from ligament or muscle injury, exceeding of the physiological range of motion and resultant joint subluxation due to external force or other pathogens. At present, numerous therapies are involved in this condition. We observed how Dr. Zhu Hong treated leg length discrepancy and lumbosacral pain due to sacroiliac joint subluxation between October 2011 and March 2013. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria of subluxation of the sacroiliac joint were stipulated based on theUpdated Diagnosis and Treatment for Low Back and Leg Pain[2]: radiating sacroiliac joint pain, tenderness upon deep pressure, percussion pain, and persistent dull pain on the inferior cornu of theposterior inferior iliac spine; inequality of bilateral posterior superior iliac spines in a prone position, leg length discrepancy, the pain that can be aggravated by coughing, sneezing, bending, rolling the body over and a supine position, and compulsive positions of flexed hip and knee joints and lying to the healthy side.

1.2 Inclusion criteria[3]

Those who met the above diagnostic criteria; asymmetrical rhomboid fossa; a 0.5-2.0 cm discrepancy in leg-length measurements; tenderness, soreness, distension and pain along the arc of sacroiliac joint space of the medial side of posterior superior iliac spine on the affected side, the pain may radiate towards the medial aspect of the thigh or the leg; decreased or elevated anterior superior iliac spine and iliac crest on the affected side; excessive internal or external rotation of the foot on the affected side; the pelvic compression and separation test or Patrick sign were associated with the duration: positive in an acute phase, suspected in lag phase stage and negative in remissive phase.

1.3 Exclusion criteria

Lumbosacral pain due to sciatica, lumbar intervertebral disc herniation or sacroilitis confirmed by X-ray, CT scan and/or straight leg raising test and Patrick sign test; those having complications of severe cardio-cerebrovascular diseases or other medical conditions.

1.4 Statistical method

Two-sided test was adopted in all statistical tests. The SPSS 19.0 version software was used for statistical data processing. Thewas used for expression of measurement data, pairedt-test for intra-group comparison before and after treatment, unpairedt-test for inter-group comparison,Riditanalysis for ranked data processing and Chi-square test for between-group comparison of the total effective rate.

1.5 General data

A total of 60 outpatients were recruited for this clinical trial. There were 10 males and 50 females, aged between 26 and 49. Their duration lasted from 6 to 24 months. The patients were randomly allocated into an observation group or a control group. There was no between-group statistical difference in general data (P＞0.05), indicating that the two groups were comparable (Table 1).

The age and leg length discrepancy of the patients were shown in Table 2.

Table 1. Between-group comparison of general data

Table 2. Age group and leg length difference (case)

2 Treatment Methods

2.1 Observation group

2.1.1 Basic relaxing tuina manipulations

The manipulations for sacroiliac joint injury in theTuina Therapeutics[4]were used.

The patient took a prone position and the practitioner stood on one side. First, apply 2-3 min of Gun-rolling manipulation to the sacrospinalis, sacroiliac joint and buttocks; then apply An-pressing and Rou-kneading manipulations using the thumb to sacroiliac joint on the affected side, particularly to Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Huantiao (GB 30) and Zhibian (BL 54) until the patient felt sore and distending. The therapeutic effect was observed after 10 times of treatment.

2.1.2 Reduction tuina manipulations of sacroiliac joint subluxation

The reduction tuina manipulations of sacroiliac joint subluxation in theTreatment of Spine-related Disorders[5]were used.

The patient took a prone position. First, stretch the patients’ lower limbs; then press the buttock and lift the leg (Figure 1). Alternatively, press the hip joint with extended hip and flexed knee (Figure 2). The patient took a supine position, fully extend the hip and knee, and vibrate 5-10 times perpendicularly. Finally, the practitioner conducted pulling of the lumbar vertebrae in a side-lying position (Figure 3).

The treatment lasted approximately 20 min. The basic manipulations were conducted once a day, and the reduction manipulations were conducted every other day.

Figure 1. Buttock-pressing, leg-lifting in a prone position

Figure 2. Hip-pressing with extended hip and flexed knee

Figure 3. Oblique pulling of the lumbar vertebrae in a side-lying position

2.2 Control group

2.2.1 Basic relaxing tuina manipulation

Same manipulations as those in the observation group were used.

2.2.2 Acupuncture

Points: Shangliao (BL 31), Ciliao (BL 32), Dachangshu (BL 25), Weizhong (BL 40), Huantiao (GB 30) and Ashi points.

Method: The patient took a prone position. After a routine sterilization, filiform needles of 0.3 mm in diameter and 75 mm in length were inserted

1.5-3 cun into the above points, followed by lifting, thrusting and twirling to enable the needling sensation to radiate towards the lumbosacral region and lower limbs. The needles were retained 30 min and manipulated once every 5 min. The acupuncture treatment was done once a day, for a total of 10 d.

3 Therapeutic Effect Analysis

3.1 Evaluation criteria for therapeutic effect

This was based on theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[6].

Recovery: In absence of symptoms and positive signs, coupled with normal life and daily activities.

Marked effect: The symptoms and positive signs were reduced by more than 2/3, coupled with almost normal life and daily activities.

Improvement: Improved symptoms and positives signs but treatment still necessary.

Failure: The symptoms and positive signs remained unchanged.

3.2 Treatment results

3.2.1 Short-term effect

The total effective rate in the observation group was 80.0%, versus 50.0% in the control group, showing a statistically significant difference (P＜0.05), indicating that the total effective rate in the observation group was better than that in the control group (Table 3).

3.2.2 Follow-up results

The follow-up was made 2 months after the treatment to observe the relapse of lumbosacral pain and leg length discrepancy (Table 4).

Table 3. Between-group comparison on therapeutic efficacies (case)

The relapse rate of lumbosacral pain in the observation group was 12.5%, versus 66.7% in the control group, showing a statistically significant difference (P＜0.05), indicating that the relapse rate in the observation group was lower than that in the control group.

The relapse rate of leg length discrepancy in the observation group was 16.7%, versus 80.0% in the control group, showing a statistically significant difference (P＜0.01), indicating that the relapse rate in the observation group was lower than that in the control group.

Table 4. Between-group comparison on follow-up results

4 Discussion

In Chinese medicine, sacroiliac joint subluxation falls under the category of ‘dislocated bones or tendons’. This condition has a high incidence and can result from multiple factors such as local soft tissue injury, degeneration of the spine and endocrine disorder[7-12]. Long CH, et al[13]found that approximately 40% patients with lumbar intervertebral disc herniation have complication of pelvic rotation side shift (including sacroiliac joint subluxation). Li YK[14]believes that lumbosacral pain in majority of patients is caused by interactions between local inflammatory reactions of neuropeptides (substance P, vasoactive intestinal peptide and calcitonin-gene related peptide) and repair of hyperplastic tissue. Pattern identification is needed prior to tuina treatment. Jin HZ[15]believes that long-term lumbosacral pain can result in increased muscle tone in the local area and subsequently lead to sacroiliac joint subluxation. Over time, this may trigger a vicious cycle: recurrent lumbosacral pain and may cause shift of the lumbar vertebrae, incoordination of muscle groups and sacroiliac joint subluxation. The reduction manipulation can relax soft tissue and adjust shifted or subluxated bony structure and facet joints. Oblique pulling of the lumbar vertebrae can relieve uncoordinated muscles, restore balance of the vertebrae and thus alleviate spasm or compression to the nerve root, blood vessels and muscles. As a result, this can regulate qi and blood, activate self-repair ability, relieve pain and correct the leg length discrepancy due to pain on the affected side and compensation on the healthy side. Although acupuncture has anti-inflammatory and pain-relief effect, it cannot correct subluxation. In addition, patients often have a poor compliance. Tuina is simple, convenient, low-cost and effective. However, we need to be aware that for sacroiliac joint subluxation or subsequent leg length discrepancy, it’s necessary to prevent and treat from balance of the entire body or stability of the sacroiliac joint. In daily life, it’s important to avoid cross-legged posture or standing on one leg and to have appropriate sitting, standing and walking postures. Qian QR, et al[16]found that sitting makes minimal stress force to the sacroiliac joint and standing on one leg makes maximal stress force to the sacroiliac joint; ligaments surrounding the sacroiliac joint act to maintain different positions of the joint and prevent subluxation. As for prevention, it’s important for children to have good postures.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by Shaanxi University of Chinese Medicine and the First Affiliated Hospital of Shaanxi University of Chinese Medicine.

Statement of Informed Consent

All patients included in this study knew and volunteered to participate this clinical trial.

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Translator: Han Chou-ping

R244.1

: A

Date: March 8, 2014