Chen Desheng (陳德生), Chen Hemu (陳和木)

aDepartment of Rehabilitation Medicine, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei 230031, China

bDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China

ABSTRACT OBJECTIVE: To evaluate the pain scores and rehabilitation of patientis with cervical spondylotic radiculopathy receiving massage therapy combined with traction and ultrashort wave therapy. METHODS: A total of 84 patients with cervical spondylotic radiculopathy treated in 105 Hospital of People's Liberation Army from June 2014 to June 2017 were included and divided into study group and control group according to different treatment regimens. A total of 42 patients in the study group was treated with cervical traction, ultrashort wave and massage therapy at the same time, whereas the other 42 patients in the control group were only treated with cervical traction and ultrashort wave. Comparison of the clinical efficacy and adverse reactions of the 2 groups was made and the Visual Analogue Scale (VAS) scores before and after treatment were observed to assess the patient's pain. Comparison of rehabilitation in the 2 groups was made by applying the Clinical Assessment Scale for Cervical Spondylosis (CASCS). RESULTS: After comparing the therapeutic effect between the study group and the control group, it showed that the total effective rate (90.48%) in the study group was significantly higher than that in the control group (73.81%), the difference was statistically significant (P ＜ 0.05). By comparing the incidence of adverse reactions in the study group and the control group, results showed that the incidence of adverse reactions such as nausea, palpitations, vomiting, sweating, dizziness and colorless complexion in the study group (9.52%) was significantly lower than that in the control group (21.43%), the difference was statistically significant(P ＜ 0.05). After the treatment, the VAS pain scores of the study group and the control group were both significantly improved (P ＜ 0.05), but the improvement of the patients in the study group was more significantly (P ＜ 0.05), and the difference was statistically significant. After treatment, the CASCS scores of the patients in the study group and the control group were significantly improved (P ＜ 0.05), but the improvement of the study group was more (P ＜ 0.05),and there was statistically significant difference. CONCLUSION: The combination of massage, traction and ultrashort wave therapy can significantly reduce the pain and reduce the incidence of adverse reactions in patients with cervical spondylotic radiculopathy, which is of great clinical significance to the rehabilitation of patients.

KEYWORDS: Massage; Traction; Ultrashort wave; Cervical spondylosic radiculopathy

Cervical spondylosis is a kind of disease caused by the compression of peripheral blood vessels, spinal cord and nerves due to degenerative changes of cervical joints and intervertebral discs[1]. Cervical spondylosis occurs in middle-aged and elderly people, but in recent years,due to the increasingly widespread use of computers in people's work, the age of onset is gradually younger and the incidence is increasing[2]. According to different clinical symptoms of patients with cervical spondylosis, cervical spondylosis is classified into radiculopathy type, vertebral artery type, spinal cord type, esophageal compression type and etc[3]. Among them, the incidence of radiculopathy type cervical spondylosis is the highest, and most of the clinical symptoms are neck and shoulder pain which radiates to the upper limbs and tends to worsen in short term, skin numbness accompanied by upper limb muscle weakness,and finger inflexibility[4,5]. At present, there are many treatments of cervical spondylotic radiculopathy in clinical practice, which are divided into surgical treatment and nonsurgical treatment. However, surgical treatment will cause greater trauma, with high cost and high recurrence rate for patients, and there are greater risks[6,7]. Most patients will choose non-surgical treatment. In recent years, the rehabilitation department of 105 Hospital of People's Liberation Army has adopted treatment which combines massage with traction and ultrashort wave therapy and has achieved satisfactory results.

MATERIALS AND METHODS

General information

According to the following inclusion and exclusion criteria, a total of 84 patients with cervical spondylotic radiculopathy admitted to the 105 Hospital of People's Liberation Army from June 2014 to June 2017 were collected. All patients met the diagnostic criteria for cervical spondylotic radiculopathy in the Criteria of Diagnosis and Efficacy for TCM Syndromes issued by the State Administration of Traditional Chinese Medicine in 1994[8].The patients were divided into study group and control group according to different treatment regimens, in which patients in the study group were treated with cervical traction,ultrashort wave and massage, while the patients in control group were treated with cervical traction and ultrashort wave alone. There was no significant difference between the 2 groups in terms of age, gender, disease duration and diseased sites, which could be compared. See Table 1.

Table 1. Comparison of basic data between the 2 groups

Inclusion criteria: (1) all patients met the diagnostic criteria for cervical spondylotic radiculopathy in the Criteria of Diagnosis and Efficacy for TCM Syndromes issued by the State Administration of Traditional Chinese Medicine in 1994[8]; (2) the duration of the disease was no more than 4 years; (3) the patients had not received other conservative treatment within 1 week; (4) the patients and their families were aware of the treatment risks and study contents and signed informed consent. Exclusion criteria:(1) pregnant women; (2) patients with malignant tumors; (3)patients with cardiovascular and cerebrovascular diseases;(4) patients with severe liver and kidney dysfunction; (5)patients with severe osteoporosis.

Methods

The patients in the control group were treated with cervical traction and ultrashort wave therapy alone.The LDT-CD31 instrument manufactured by Shanghai Medical Electronic Instrument Factory was used in the ultrashort wave therapy. The dose of slight heat was 80 mA, 20 min each time, once every day, 10 times for each course, and the patients were treated with 3 courses. In the cervical vertebra traction treatment, the patient was in sitting position and the neck was anteverted. The weight of the first traction was 6 kg, gradually increasing with the number of traction, and the maximum was 15 kg, depending on the patient's condition. The treatment duration was consistent with ultrashort wave therapy,which was administered for 3 courses.

On this basis, the patients in the study group were simultaneously given massage therapy. The patients were seated and the doctors stood behind the patients. (1) First, the top of the head was massaged, using the thumb and middle finger to massage Fengchi (GB 20), followed by kneading from Fengchi (GB 20) to the soft tissue on both sides of the neck root, and then the patient's upper limbs, upper back and shoulder and neck muscles were rolled to relax. (2) The next step was to massage the neck, pinching at Fengchi (GB 20)from top to bottom and fixing the patient's head, so that the head was relaxed, and the patient was told to lower his body.The force used was from light to heavy, and the action was repeated at the shoulder-neck junction. (3) The shoulder and back were massaged, and the patient's shoulders were lifted,using multiple fingers to knead the patient's biceps brachii and triceps brachii, crossing the nerve branches under the armpit, and resulting in the patient's finger numbness. (4)The shoulder and the neck were plucked and rubbed, and also the upper and lower spinous processes of the diseased neck, about 1 cun from outside to inside, looking for nodules,cord-like reactants or tender points near the shoulder swelling to perform massage. (5) The cervical spine was rotated. The range of motion should not be too large, and the range of flexion and extension of the head and neck should not be excessive. (6) Finally, using relaxation techniques, the shoulder and upper limbs of the patient were slapped, and the shoulder and back muscles were gently pinched, so that the patient had a lightness sense.

Table 2. Comparison of efficacy between the study group and the control group [n (%)]

Table 3. Comparison of adverse reactions between the study group and the control group [n (%)]

Observation indicators and efficacy judgment

The clinical effects and adverse reactions of the 2 groups were compared, and the VAS scores before and after treatment were observed to assess the pain of the patients.The rehabilitation of the 2 groups after the treatment was compared by the Clinical Evaluation Scale for Cervical Spondylosis (CASCS). (1) Curative effect judgment[9]:cured meant that after the treatment, the patient's clinical symptoms disappeared, the neck and limbs were normally active, and the patient was able to carry out normal work and life, and the curative effect index was over 90%;markedly effective meant that after the treatment, the patient's clinical symptoms basically disappeared, the neck and limbs were basically normal, and the patient was able to participate in normal work, and the curative effect index was 70%-90%; effective meant that after the treatment, the patient's clinical symptoms were improved, the neck and limbs were recovered, the living and working ability was improved, and the curative effect index was 30%-70%;ineffective meant that after the treatment, the patient's clinical symptoms, neck and limbs were not significantly improved, and the curative effect index was less than 30%.Total effective rate of treatment = (cured index + markedly effective index + effective index)/total cases×100%. (2)Adverse reactions include: nausea, palpitations, vomiting,sweating, dizziness, colourless complexion, etc. (3) The pain of the patient was rated on the Visual Analog Scale(VAS) from 0 to100. The lower was the score, the greater was the pain. (4) The score of the Clinical Evaluation Scale for Cervical Spondylosis (CASCS) mainly included three parts: clinical signs, life and work adaptability, and subjective symptoms. The total score was 100 points.The higher was the score, the better was the rehabilitation effect.

Statistical methods

In this study, SPSS 20.0 software was used to statistically process the experimental data. The enumeration data were expressed as percentiles and analyzed by χ2test; the measurement data were expressed as (xˉ±s)and analyzed by t-test. Let α = 0.05, when P ＜ 0.05 the difference was statistically significant.

RESULTS

Comparison of efficacy between the study group and the control group

Comparing the treatment effect between the study group and the control group, the results showed that the total effective rate of the study group (90.48%) was significantly higher than that of the control group (73.81%),and the difference had statistical significance (P ＜ 0.05).See Table 2.

Comparison of adverse reactions between the study group and the control group

The incidence of adverse reactions in the study group was compared with that in the control group, and the results showed that the incidence of adverse reactions such as nausea, palpitation, vomiting, sweating, vertigo and colourless complexion in the study group (9.52%) was significantly lower than that in the control group (21.43%),and the difference had statistical significance (P ＜ 0.05).See Table 3.

Comparison of VAS scores before and after treatment between the study group and the control group

After the treatment, the VAS pain scores of the patients in the study group and the control group were significantly improved compared with those before the treatment (P ＜ 0.05), but the improvement was more significant in the study group (P ＜ 0.05), with statistically significant differences. See Table 4.

Table 4. Comparison of VAS pain scores before and after treatment between the study group and the control group (x-±S)

Comparison of rehabilitation between patients in the study group and the control group

After the treatment, the CASCS scores of cervical spondylosis in the study group and the control group were significantly improved compared with those before the treatment (P ＜ 0.05), but the improvement was more significant in the study group (P ＜ 0.05), with statistically significant differences. See Table 5.

Table 5. Comparison of rehabilitation between the study group and the control group (x-±S)

DISCUSSION

Cervical vertebra is a small but active and flexible part of the spine. Its role is mainly to support the head,protect the spinal cord and perform flexion, extension and rotation movement[1]. However, the cervical spine is very fragile and susceptible to physical irritation and injury,leading to degenerative changes and a series of symptoms in the surrounding tissues[2]. Radiculopathy type of cervical spondylosis is the most common cervical spondylosis,and the symptoms are more complex. The patients with this kind of disease are becoming younger in recent years,which draws the attention of domestic and overseas researchers. Although there is no clear description of this kind of disease in traditional Chinese medicine (TCM), the symptoms of this disease are similar to many diseases in TCM, such as "paralysis" and "neck and shoulder pain".

Traditional Chinese medicine considers that the etiology of the disease is caused by factors such as sedentary lifestyle,weight-bearing neck or strain and injury in the neck,leading to poor meridian circulation, qi stagnation and blood stasis. It is a chronic disease[10,11].

Studies have reported that heat is generated under the action of an electric field at an ultra-high frequency,which increases the tissue temperature. The permeability after tissue congestion, enhances the biochemical reaction of tissue cells, improves edema due to poor metabolism in local tissues, and reduces the compression of cervical nerves, thus relieving clinical symptoms[12]. Ultrashort wave can also modulate chemical reactions, activate a series of enzymes, and change the tissue pH value, reduce the condition of inflammation, and reduce nerve excitatory transmission to relieve pain[13]. If it can be combined with massage therapy on this basis to further improve the blood circulation of the affected area and eliminate edema, it will significantly reduce nerve root compression to relieve pain[13]. The key of massage manipulation is "Qiao Li Cun Jin", which means relieving pain by relieving soft tissue adhesion and promotes metabolism and local blood circulation, thus relieving muscle spasm and sliding joints[14]. The rhythm need to be paid attention during massage, step by step process, and applying the force from light to heavy, so that patients fully relax. But the whole process is highly depending on the technique of the physician, and the physician needs to understand the patient's condition in time to adjust, summarize and evaluate it[15].

The results of this study showed that the total effective rate (90.48%) of the study group was significantly higher than that of the control group (73.81%), and the difference had statistical significance (P ＜ 0.05). The adverse reactions of the study group and the control group were compared, and the results showed that the incidence of adverse reactions such as nausea, palpitations, vomiting,sweating, vertigo and colourless complexion (9.52%) in the study group was significantly lower than that in the control group (21.43%), and the difference had statistical significance (P ＜ 0.05). After the treatment, the VAS pain scores of the study group and the control group were significantly improved than those before the treatment (P＜ 0.05), but the improvement of the study group was more significant (P ＜ 0.05). After the treatment, the CASCS scores of the study group and the control group were significantly improved than those before the treatment(P ＜ 0.05), but the improvement of the study group was more significant (P ＜ 0.05), and there was statistically significant difference.

In summary, massage manipulation combined with traction and ultrashort wave treatment for patients with cervical spondylotic radiculopathy has a significant clinical effect, can reduce the pain and the incidence of adverse reactions, and has important clinical significance for the rehabilitation of patients.