Clinical effect of myofascial release combined with acupuncture in treatment of lower limb spasticity after stroke

Zhang Jingzhi, Xu Simao, Sun Yang

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Journal of Chongqing Medical University ›› 2024, Vol. 49 ›› Issue (02) : 173-178. DOI: 10.13406/j.cnki.cyxb.003379
Clinical research

Clinical effect of myofascial release combined with acupuncture in treatment of lower limb spasticity after stroke

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Abstract

Objective To investigate the clinical effect of myofascial release combined with acupuncture in the treatment of lower limb spasticity after stroke. Methods A totalof 45 patients with lower limb spasticity after stroke were enrolled and randomly divided into control group with 22 patients and experimental group with 23 patients. The patients in the control group were given acupuncture alone,and those in the experimental group were given myofascial release combined with acupuncture. After 6 weeks of treatment,the two groups were compared in terms of the clinical effect of rehabilitation and the changes in related indicators. Modified Ashworth Scale(MAS) was used to evaluate the muscle tension of knee flexor muscles,and the treatment was considered effective if there was a reduction in MAS score. Fugl-Meyer Assessment of Lower Extremity(FAM-LE) was used to evaluate the motor function of lower limbs,Clinical Spasticity Index(CSI) was used to evaluate the degree of spasticity,and the serum level of homocysteine(Hcy) was measured. Results After treatment,the experimental group had a significantly higher response rate than the control group(P<0.05),and both groups had a significant reduction in the serum level of Hcy and significant increases in FMA-LE and CSI scores(P<0.05). Compared with the control group,the experimental group had significantly lower MAS score and serum Hcy level and significantly higher FMA-LE and CSI scores(P<0.05). Conclusion For patients with lower limb spasticity after stroke,myofascial release combined with acupuncture can effectively reduce muscle tension,alleviate spasticity,improve the motor function of lower limbs,and reduce serum Hcy level.

Key words

stroke / myofascial release / acupuncture / spasticity / muscle tension

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Zhang Jingzhi , Xu Simao , Sun Yang. Clinical effect of myofascial release combined with acupuncture in treatment of lower limb spasticity after stroke. Journal of Chongqing Medical University. 2024, 49(02): 173-178 https://doi.org/10.13406/j.cnki.cyxb.003379

References

1
李钰婷,甘海宁,赵自明,等. 柴芍安神解郁颗粒对脑卒中后抑郁的影响[J]. 中成药202042(9):2451-2454.
Li YT Gan HN Zhao ZM Zhan XY,et al. The effect of Chaishao Anshen Jieyu granules on poststroke depression[J]. Chinese Traditional Patent Medicine202042(09):2451-2454.
2
Wissel J Verrier M Simpson DM,et al. Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention[J]. PM R20157(1):60-67.
3
黄馨云,夏秋芳,朱慧雯,等. 运动针法联合康复训练治疗脑卒中后上肢痉挛性瘫痪疗效观察[J]. 中国针灸202040(5):473-478.
Huang XY Xia QF Zhu HW,et al. Therapeutic effect on post-stroke spastic paralysis of upper extremity treated with combination of kinematic-acupuncture therapy and rehabilitation training[J]. Chinese Acupuncture & Moxibustion202040(5):473-478.
4
Parravicini G Bergna A. Biological effects of direct and indirect manipulation of the fascial system. Narrative review[J]. J Bodyw Mov Ther201721(2).435-445.
5
叶 涛,朱路文,唐 强. 针刺结合康复训练治疗脑卒中后肢体痉挛的meta分析[J]. 中国康复医学杂志201732(3):318-324.
Ye T Zhu LW Tang Q. Meta-analysis of acupuncture combined with rehabilitation training for the treatment of limb spasms after stroke[J]. Chinese Journal of Rehabilitation Medicine201732(3):318-324.
6
范 琳,吉文彬. 针灸联合等速肌力训练干预脑卒中偏瘫恢复期的临床研究[J]. 中西医结合心脑血管病杂志202119(16):2826-2829.
Fan L Ji WB. Clinical study of acupuncture and moxibustion combined with isokinetic muscle strength training in the recovery period of hemiplegia after stroke[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascuiar Disease202119(16):2826-2829.
7
中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志2019(9):710-715.
Key diagnostic points for various major cerebrovascular diseases in China 2019[J]. Chinese Journal of Neurology2019(9):710-715.
8
张 通. 中国脑卒中康复治疗指南(2011完全版)[J]. 中国康复理论与实践201218(4):301-318.
Zhang T. Chinese Stroke Rehabilitation Treatment Guidelines(2011 Complete Edition)[J]. Chinese Journal of Rehabilitation Theory and Practice201218(4):301-318.
9
林志诚,薛偕华,江一静,等. 中医康复临床实践指南·脑卒中[J]. 康复学报201929(6):6-9,15.
Lin ZC Xue XH Jiang YJ,et al. Clinical practice guidelines for stroke of Chinese medicine rehabilitation[J]. Rehabilitation Medicine201929(6):6-9,15.
10
娄必丹,刘伍立. 泻阴补阳法论治脑卒中后痉挛性瘫痪[J]. 针灸临床杂志2002(12):3-4.
Lou BD Liu WL. Treatment of spastic paralysis after stroke using the method of purging yin and tonifying yang[J]. Journal of Clinical Acupuncture and Moxibustion2002(12):3-4.
11
Parikh RJ Sutaria JM Ahsan M,et al. Effects of myofascial release with tennis ball on spasticity and motor functions of upper limb in patients with chronic stroke: A randomized controlled trial[J]. Medicine2022101(31):e29926.
12
张心培,刘 楠,周谋望. 肌张力评定方法的研究进展[J]. 中国康复医学杂志202136(7):873-880.
Zhang XP Liu N Zhou MW. Research progress in muscle tone assessment methods[J]. Chinese Journal of Rehabilitation Medicine202136(0):873-880.
13
王福东,黄诗雅,赵宏宇. 急性缺血性脑卒中患者首次运动康复治疗时间对运动功能的影响研究[J]. 中国全科医学201821(25):3089-3094.
Wang FD Huang SY Zhao HY. Effect of timing of initiating exercise rehabilitation on the prognosis of motor function in acute ischemic stroke[J]. Chinese General Practice201821(25):3089-3094.
14
吴荷花,邓奕文,黄慧芝,等. 穴位注射联合生物反馈训练对脑卒中后痉挛性足下垂、足内翻及下肢运动功能的影响[J].中国老年学杂志202242(12):2872-2875.
Wu HH Deng YW Huang HZ,et al. Effects of acupoint injection combined with biofeedback training on spastic foot drop,varus and lower limb motor function after stroke[J]. Chinese Journal of Gerontology202242(12):2872-2875.
15
景福权,秦 虎,刘 欢,等. 针灸联合康复疗法对缺血性脑卒中偏瘫患者肢体运动功能及血清cAMP、cGMP的影响[J].中国针灸202040(6):581-585.
Jing FQ Qin H Liu H,et al. Influence of acupuncture combined with rehabilitation therapy on limb motor function and serum cAMP and cGMP in patients with hemiplegia of cerebral ischemic stroke[J]. Chinese Acupuncture & Moxibustion202040(6):581-585.
16
许梦雅,朱庆华,贾艳露,等. 基于交互抑制理论的肢体康复锻炼操对脑卒中偏瘫患者运动和平衡功能的影响[J]. 中国实用神经疾病杂志202225(2):192-196.
Xu MY Zhu QH Jia YL,et al. Influence of physical rehabilitation exercise based on interactive inhibition theory on motor and balance function of stroke patients with hemiplegia[J]. Chinese Journal of Practical Nervous Diseases202225(2):192-196.
17
李 颖,赵彦青. 王松龄教授治疗肌张力障碍经验总结[J].光明中医202237(9):1546-1549.
Li Y Zhao YQ. Experience of protessor Wang Songling in the treatment of dystonia[J]. Guangming Journal of Chinese Medicine202237(9):1546-1549.
18
邓 冬,刘文平,周 爽,等. 从“脑为元神之府”探讨中风急性期的辨治方略[J]. 中华中医药杂志202136(3):1485-1488.
Deng D Liu WP Zhou S,et al. Discussion on the strategy of distinguishing and treating acute stroke from the perspective of ‘brain is the house of the original domination’[J]. China Journal of Traditional Chinese Medicine and Pharmacy202136(3):1485-1488.
19
李秋佳,粟胜勇,覃晓燕. 针刺治疗中风后肢体痉挛研究述评[J]. 河南中医201939(4):644-648.
Li QJ Su SY Qin XY. A review of research on acupuncture treatment of poststroke limb spasm[J]. Henan Traditional Chinese Medicine201939(4):644-648.
20
谢 乐,伍大华,曹思佳,等. 中风后痉挛性瘫痪病因病机及治法[J]. 中医学报201934(9):1850-1854.
Xie L Wu DH Cao SJ,et al. Etiology,pathogenesis and treatment of post-stroke spastic paralysis[J]. Acta Chinese Medicine201934(9):1850-1854.
21
裴久国,彭秀娟,胡 琼,等. 论“泻阴补阳”针刺在缺血性中风痉挛期的应用[J]. 湖北中医药大学学报202123(4):55-57.
Pei GJ Peng XJ Hu Q,et al. The appliation of ‘reducing yin and nourishing yang’ acupuncture method on ischemic stroke in convulsion period[J]. Journal of Hubei University of Chinese Medicine202123(4):55-57.
22
唐 强,王 雪,穆姿辰,等. 针康法促进脑卒中后下肢运动功能重建的功能性近红外光谱研究[J]. 中国康复理论与实践202228(1):32-37.
Tang Q Wang X Mu ZC,et al. Effects of acupuncture and rehabilitation therapy on lower limb motor function after stroke: an fNIRS study[J]. Chinese Journal of Rehabilitation Theory and Practice202228(1):32-37.
23
舒国建,刘家庆. 针灸治疗中风后痉挛性瘫痪的选穴分析[J].中西医结合心脑血管病杂志202119(7):1180-1183.
Shu GJ Liu JQ. Analysis of acupoint selection in the treatment of spastic paralysis after stroke with acupuncture and moxibustion[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease202119(7):1180-1183.
24
苏立贤,张文玉,李仪丙,等. 缺血性脑卒中后血管新生及针刺干预研究进展[J]. 中国中医药信息杂志202229(4):137-144.
Su LX Zhang WY Li YB,et al. Research progress of angiogenesis and acupuncture intervention after cerebral ischemic stroke[J]. Chinese Journal of Information on Traditional Chinese Medicine202229(4):137-144.
25
王宝梅,项 颖,刘永宏,等. 脑梗死急性期血压变化与神经功能缺损的相关研究[J]. 西部医学201931(6):877-882.
Wang BM Xiang Y Liu YH,et al. The study of relationship between blood pressure and neurological impairment in acute cerebral infarction[J]. Medical Journal of West China201931(6):877-882.
26
关 莹,李 季,王 璐,等. 针康法对缺血性脑卒中患者同型半胱氨酸及认知功能的影响[J]. 中国康复理论与实践201925(3):289-293.
Guan Y Le J Wang L,et al. Effect of acupuncture-rehabilitation therapy on homocysteine and cognitive function for patients with ischemic stroke[J]. Chinese Journal of Rehabilitation Theory and Practice201925(3):289-293.
27
邱 毅,吴 波,白昌春,等. 脑卒中患者血清Hcy、NSE、PAF水平变化及临床意义[J]. 疑难病杂志201615(4):347-350.
Qiu Y Wu B Bai CC,et al. The relationship of the levels of Hcy,NSE,PAF and nerve function deficit in stroke patients[J]. Chinese Journal of Difficult and Complicated Cases201615(4):347-350.
28
李蕊彤,李 岩,韩 旭,等. 经颅重复针刺法结合认知康复训练对血管性痴呆患者的疗效及对Hcy水平的影响[J]. 针灸临床杂志202339(7):31-35.
Li RT Li Y Han X,et al. Efficacy of repeated transcranial acupuncture combined with cognitive rehabilitation training in treatment of VAD and its influence to Hcy level[J]. Journal of Clinical Acupuncture and Moxibustion202339(7):31-35.
29
Langevin HM Huijing PA. Communicating about fascia: history,pitfalls,and recommendations[J]. International journal of therapeutic massage & bodywork20092(4):3-8.
30
Schleip R Gabbiani G Wilke J,et al. Fascia is able to actively contract and may thereby influence musculoskeletal dynamics: A histochemical and mechanographic investigation[J]. Frontiers in Physiology201910:336.
31
刘 琳,黄强民,刘庆广,等. 肌筋膜触发点理论及其在运动康复临床实践中应用的研究进展[J]. 中国康复理论与实践201622(10):1167-1170.
Liu L Huang QM Liu QG,et al. Application of myofascial trigger points theory in clinical practice of sports rehabilitation(review)[J]. Chinese Journal of Rehabilitation Theory and Practice201622(10):1167-1170.
32
罗文轩,蔡秉洋,李佳玥,等. 经筋学说与肌筋膜链理论相关性初探[J]. 中医杂志202061(14):1220-1224.
Luo WX Cai BY Li JY,et al. Preliminary exploaration on the correlation between the theory of meridian sinews and the theory of myofascial chain[J]. Journal of Traditional Chinese Medicine202061(14):1220-1224.
33
宋亚芳,裴丽霞,李丹丹,等. 对现代经络实质研究方向的质疑[J]. 中华中医药杂志201732(7):2891-2894.
Song YF Pei LX Li DD,et al. Questioning the modern research on the essence of meridian[J]. China Journal of Traditional Chinese Medicine and Pharmacy201732(7):2891-2894.
34
范郁山,庞瑞康,贺 彩,等. 基于筋膜学理论探讨针刺效应的产生机制[J]. 中医杂志202162(23):2046-2050.
Fan YS Pang RK He C,et al. Discussion on the mechanism of acupuncture effect based on the fascia theory[J]. Journal of Traditional Chinese Medicine202162(23):2046-2050.
35
Franchi M Ottani V Stagni R,et al. Tendon and ligament fibrillar crimps give rise to left-handed helices of collagen fibrils in both planar and helical crimp[J]. J Anat2010216(3):301-309.
36
文英华,武俊英. 筋膜手法干预脑卒中后上肢痉挛的疗效观察[J].中西医结合心脑血管病杂志202119(3):486-488.
Wen YH Wu JY. Observation on the therapeutic effect of fascia manipulation on upper limb spasms after stroke[J]. Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease202119(3):486-488.
37
高玉宝,孙晓丽,曹 奕,等. 针刺督脉结合筋膜松解手法治疗脑卒中后上肢痉挛性瘫痪的临床疗效评价[J]. 辽宁中医杂志202350(1):167-171.
Gao YB Sun XL Cao Y,et al. Clinical observations on treatment of upper limb spastic paralysis after stroke by acupuncture at governor vessel combined with mysfascial release[J]. Liaoning Journal of Traditional Chinese Medicine202350(1):167-171.
38
Ajimsha MS Al-Mudahka NR Al-Madzhar JA. Effectiveness of myofascial release:Systematic review of randomized controlled trials[J]. J Bodyw Mov Ther201519(1):102-112.
39
Luomala T Pihlman M Heiskanen J,et al. Case study: Could ultrasound and elastography visualized densified areas inside the deep fascia?[J]. J Bodyw Mov Ther201418(3):462-468.
40
Loi CE Buysse CA Price KS,et al. Myofascial structural integration therapy on gross motor function and gait of young children with spastic cerebral palsy:a randomized controlled trial[J]. Front Pediatr20153:74.
41
Orellana-Urzúa S Rojas I Líbano L,et al. Pathophysiology of ischemic stroke: role of oxidative stress[J]. Curr Pharm des202026(34):4246-4260.
42
Minasny B. Understanding the process of fascial unwinding[J]. Int J ther Massage Bodywork20092(3):10-17.

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