悬吊推拿运动技术对产后骨盆带疼痛的效果

doi:10.3969/j.issn.1006-9771.2024.06.012

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (6): 719-725.doi: 10.3969/j.issn.1006-9771.2024.06.012

悬吊推拿运动技术对产后骨盆带疼痛的效果

王雪妍¹, 张鹏燕², 廖烜东¹, 丁懿², 许强强², 李丽²()

1.山东中医药大学康复医学院，山东济南市 250355
2.山东中医药大学第二附属医院，山东济南市 250000

收稿日期:2023-11-22 修回日期:2024-05-13 出版日期:2024-06-25 发布日期:2024-07-03
通讯作者: 李丽(1962-)，女，汉族，山东济南市人，主任医师，硕士研究生导师，主要研究方向：中西医结合康复，E-mail： 121560703@qq.com。
作者简介:王雪妍(1998-)，女，汉族，辽宁沈阳市人，硕士研究生，主要研究方向：中西医结合康复，颈肩腰腿痛的防治。
基金资助:
山东省重点研发计划项目(2017GSF19114);山东省中医药科技项目(2021M006);山东省中医药科技项目(Q-2023067)

Effect of sling massage exercise on postpartum pelvic girdle pain

WANG Xueyan¹, ZHANG Pengyan², LIAO Xuandong¹, DING Yi², XU Qiangqiang², LI Li²()

1. College of Rehabilitation, Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250355, China
2. The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, Shandong 250000, China

Received:2023-11-22 Revised:2024-05-13 Published:2024-06-25 Online:2024-07-03
Supported by:
Shandong Key Research and Development Plan(2017GSF19114);Shandong Traditional Chinese Medicine Science and Technology Project(2021M006);Shandong Traditional Chinese Medicine Science and Technology Project(Q-2023067)

摘要/Abstract

摘要：

目的探讨悬吊推拿运动技术对产后骨盆带疼痛(PPGP)的效果。

方法 2022年3月至2023年5月，山东中医药大学第二附属医院PPGP患者56例，随机分为对照组(n = 28)和观察组(n = 28)。两组均接受常规物理治疗和健康宣教，对照组接受运动疗法，观察组接受悬吊推拿运动技术，共6周。治疗前后采用视觉模拟量表(VAS)、骨盆带问卷(PGQ)、主动直腿抬高试验(ASLR)进行评估，采用超声测量腹横肌休息和收缩时厚度和收缩率，表面肌电图测量盆底肌积分肌电值(iEMG)、均方根值(RMS)、中位频率(MF)和平均功率频率(MPF)。

结果治疗后，观察组总有效率为96.43%，对照组为78.57% (Z = 2.728, P < 0.05)；除休息状态下腹横肌厚度外，两组各项指标均改善(|t| > 2.080, P < 0.05)，观察组优于对照组(|t| > 2.161, P < 0.05)。

结论悬吊推拿运动技术能够减轻疼痛，增强核心肌群稳定性，提高负荷转移能力和生活质量，优于单纯运动疗法。

关键词: 产后骨盆带疼痛, 悬吊推拿运动, 核心肌力, 疼痛

Abstract:

Objective To investigate the effect of the sling massage exercise on postpartum pelvic girdle pain (PPGP).

Methods From March, 2022 to May, 2023, 56 patients with PPGP in Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were randomly divided into control group (n = 28) and observation group (n = 28). Both groups received routine physical therapy and healthy education, while the control group received exercise therapy and the observation group received sling massage exercise, for six weeks. They were assessed with Visual Analog Scale (VAS), Pelvic Girdle Questionnaire (PGQ) and active straight leg raise (ASLR) test before and after treatment, and measured resting and contraction thickness of transversus abdominis with ultrasound; and integrated electromyography (iEMG), root mean square (RMS), median frequency (MF) and mean power frequency (MPF) of pelvic floor muscles with surface electromyography.

Results After treatment, the total effective rate was 96.43% in the observation group and 78.57% in the control group (Z = 2.728, P < 0.05). All the indexes improved in both groups (|t| > 2.080, P < 0.05) except resting thickness of transverse abdominis muscle, and improved more in the observation group than in the control group (|t| > 2.161, P < 0.05).

Conclusion The sling massage exercise can alleviate pain, enhance the stability of the core muscle group, and improve load transfer and quality of life, better than exercise therapy.

Key words: postpartum pelvic girdle pain, sling massage exercise, core muscle strength, pain

中图分类号:

R685

王雪妍, 张鹏燕, 廖烜东, 丁懿, 许强强, 李丽. 悬吊推拿运动技术对产后骨盆带疼痛的效果[J]. 《中国康复理论与实践》, 2024, 30(6): 719-725.

WANG Xueyan, ZHANG Pengyan, LIAO Xuandong, DING Yi, XU Qiangqiang, LI Li. Effect of sling massage exercise on postpartum pelvic girdle pain[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 719-725.

图/表 4

表1

表2

两组治疗前后各项临床测试评分比较"

变量	组别	n	测试	$x - ± s$	t值	P值
VAS	对照组	28	前测	6.87±2.03	6.073	< 0.001
			后测	4.53±0.88
	观察组	28	前测	6.95±1.98	9.901	< 0.001
			后测	3.05±0.71
	治疗前两组均值差			-0.08±2.70	-0.150	0.881
	治疗后两组均值差			1.48±1.18	6.887	< 0.001
PGQ	对照组	28	前测	27.59±5.13	6.252	< 0.001
			后测	19.60±3.25
	观察组	28	前测	28.42±5.78	11.961	< 0.001
			后测	13.29±2.85
	治疗前两组均值差			-0.82±7.44	-0.561	0.577
	治疗后两组均值差			6.30±4.69	7.723	< 0.001
ASLR	对照组	28	前测	3.94±1.05	12.501	< 0.001
			后测	1.53±0.61
	观察组	28	前测	4.05±1.02	14.033	< 0.001
			后测	1.06±0.55
	治疗前两组均值差			-0.11±1.32	-0.398	0.692
	治疗后两组均值差			0.47±0.88	3.029	0.004

表2

表3

两组治疗前后腹横肌厚度和收缩率比较"

变量	组别	n	测试	$x - ± s$	t值	P值
静息下腹横肌厚度/cm	对照组	28	前测	0.33±0.19	-0.139	0.890
			后测	0.34±0.10
	观察组	28	前测	0.35±0.14	-1.228	0.230
			后测	0.38±0.07
	治疗前两组均值差			-0.01±0.22	0.282	0.779
	治疗后两组均值差			-0.05±0.11	-2.011	0.049
收缩下腹横肌厚度/cm	对照组	28	前测	0.53±0.13	-3.980	< 0.001
			后测	0.68±0.19
	观察组	28	前测	0.54±0.17	-5.195	< 0.001
			后测	0.78±0.18
	治疗前两组均值差			-0.01±0.20	-0.303	0.973
	治疗后两组均值差			-0.11±0.26	-2.161	0.035
腹横肌收缩率/%	对照组	28	前测	65.68±22.46	-2.080	0.047
			后测	80.29±28.31
	观察组	28	前测	65.14±21.55	-5.255	< 0.001
			后测	98.18±30.07
	治疗前两组均值差			0.54±32.76	0.092	0.927
	治疗后两组均值差			-18.99±45.51	-2.434	0.018

表3

表4

两组治疗前后表面肌电值比较"

变量	组别	n	测试	$x - ± s$	t值	P值
iEMG/(μV·ms)	对照组	28	前测	11.98±2.26	-2.168	0.039
			后测	13.27±2.29
	观察组	28	前测	11.85±2.31	-7.496	< 0.001
			后测	15.83±2.33
	治疗前两组均值差			0.14±3.51	0.229	0.820
	治疗后两组均值差			-2.49±3.69	-4.026	< 0.001
RMS/μV	对照组	28	前测	16.23±3.36	-2.741	0.011
			后测	18.04±3.41
	观察组	28	前测	16.66±3.31	-3.859	0.001
			后测	20.12±3.39
	治疗前两组均值差			-0.43±4.37	-0.482	0.632
	治疗后两组均值差			-2.07±4.02	-2.278	0.027
MF/Hz	对照组	28	前测	40.25±10.17	-4.183	< 0.001
			后测	48.27±5.98
	观察组	28	前测	40.89±10.11	-6.480	< 0.001
			后测	53.13±5.47
	治疗前两组均值差			-0.64±13.50	-0.236	0.814
	治疗后两组均值差			-4.87±8.44	-3.179	0.002
MPF/Hz	对照组	28	前测	58.33±5.18	-2.186	0.038
			后测	61.65±6.21
	观察组	28	前测	59.45±5.31	-5.894	< 0.001
			后测	67.39±6.57
	治疗前两组均值差			-1.12±7.57	-0.799	0.428
	治疗后两组均值差			-5.74±8.70	-3.360	0.001

表4

参考文献 36

[1]	SWARD L, MANNING N, MURCHISON A B, et al. Pelvic girdle pain in pregnancy: a review[J]. Obstet Gynecol Surv, 2023, 78(6): 349-357. doi: 10.1097/OGX.0000000000001140 pmid: 37322996
[2]	STARZEC-PROSERPIO M, LIPA D, SZYMANSKI J, et al. Association among pelvic girdle pain, diastasis recti abdominis, pubic symphysis width, and pain catastrophizing: a matched case-control study[J]. Phys Ther, 2022, 102(4): pzab311.
[3]	WIEZER M, HAGE-FRANSEN M, OTTO A, et al. Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum: a systematic review and meta-analysis[J]. Musculoskelet Sci Pract, 2020, 48: 102154.
[4]	BURANI E, MARRUGANTI S, GIGLIONI G, et al. Predictive factors for pregnancy-related persistent pelvic girdle pain (PPGP): a systematic review[J]. Medicina (Kaunas), 2023, 59(12): 2123.
[5]	SAKAMOTO A, GAMADA K. Altered musculoskeletal mechanics as risk factors for postpartum pelvic girdle pain: a literature review[J]. J Phys Ther Sci, 2019, 31(10): 831-838. doi: 10.1589/jpts.31.831 pmid: 31645815
[6]	GASHAW M, YITAYAL M M, ZEMED A, et al. Level of activity limitations and predictors in women with pregnancy-related pelvic girdle pain: prospective cross-sectional study[J]. Ann Med Surg (Lond), 2022, 78: 103754.
[7]	GARTENBERG A, NESSIM A, CHO W. Sacroiliac joint dysfunction: pathophysiology, diagnosis, and treatment[J]. Eur Spine J, 2021, 30(10): 2936-2943. doi: 10.1007/s00586-021-06927-9 pmid: 34272605
[8]	PAI M, HOHL A, SOUZA L, et al. Acupuncture for pregnancy-related pain in the lower back and posterior pelvic girdle[J]. Rev Assoc Med Bras (1992), 2023, 69(suppl 1): e2023S101.
[9]	吴家满, 卓缘圆, 覃晓玲, 等. 盆骶调筋针法联合手法整复治疗产后骨盆痛:随机对照研究[J]. 中国针灸, 2020, 40(3): 262-266.
	WU J M, ZHUO Y Y, QIN X L, et al. Pelvic-sacral tendon-regulation needling technique of acupuncture combined with manipulative reduction in treatment of postpartum pelvic girdle pain: a randomized controlled trial[J]. Chin Acup Moxibus, 2020, 40(3): 262-266.
[10]	SVAHN E A, FAGEVIK O M, JENDMAN T, et al. Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial[J]. BMJ Open, 2021, 11(10): e46314.
[11]	DAVENPORT M H, MARCHAND A A, MOTTOLA M F, et al. Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis[J]. Br J Sports Med, 2019, 53(2): 90-98.
[12]	李丽, 常光哲, 孙国栋, 等. 中医康复临床实践指南·悬吊推拿运动技术[J]. 康复学报, 2023, 33(6): 486-492.
	LI L, CHANG G Z, SUN G D, et al. Operation Standard for Sling Exercise with Tuina Therapy of Traditional Chinese Medicine Rehabilitation Techniques[J]. Rehabil Med, 2023, 33(6): 486-492.
[13]	王欣, 田秀娟, 王金玲, 等. 悬吊运动训练治疗慢性非特异性腰痛的效果[J]. 中国康复理论与实践, 2019, 25(4): 385-389. doi: 10.3969/j.issn.1006-9771.2019.04.004
	WANG X, TIAN X J, WANG J L, et al. Effect of sling exercise therapy on chronic nonspecific low back pain[J]. Chin J Rehabil Theory Pract, 2019, 25(4): 385-389.
[14]	KANAKARIS N K, ROBERTS C S, GIANNOUDIS P V. Pregnancy-related pelvic girdle pain: an update[J]. BMC Med, 2011, 9: 15. doi: 10.1186/1741-7015-9-15 pmid: 21324134
[15]	王莎莎, 杨洪菊, 王敬芳, 等. 产妇分娩疼痛评估工具的研究进展[J]. 全科护理, 2023, 21(1): 26-30.
[16]	CONG H, LIU H, SUN Y, et al. Cross-cultural adaptation, reliability, and validity of a Chinese version of the Pelvic Girdle Questionnaire[J]. BMC Pregnancy Childbirth, 2021, 21(1): 470.
[17]	KIBSGARD T J, ROHRL S M, ROISE O, et al. Movement of the sacroiliac joint during the active straight leg raise test in patients with long-lasting severe sacroiliac joint pain[J]. Clin Biomech (Bristol, Avon), 2017, 47: 40-45.
[18]	郑筱萸. 中药新药临床研究指导原则[M]. 北京: 中国医药科技出版社, 2002.
	ZHENG X Y. Guiding principles for clinical research of new Chinese medicine[M]. Beijing: China Medical Science and Technology Press, 2002.
[19]	WUYTACK F, BEGLEY C, DALY D. Risk factors for pregnancy-related pelvic girdle pain: a scoping review[J]. BMC Pregnancy Childbirth, 2020, 20(1): 739.
[20]	VLEEMING A, SCHUENKE M. Form and force closure of the sacroiliac joints[J]. PM R, 2019, 11(Suppl 1): S24-S31.
[21]	MENS J M, POOL-GOUDZWAARD A. Contraction of the transverse abdominal muscle in pelvic girdle pain is enhanced by pain provocation during the task[J]. Musculoskelet Sci Pract, 2017, 32: 78-83.
[22]	FITZGERALD C M, BENNIS S, MARCOTTE M L, et al. The impact of a sacroiliac joint belt on function and pain using the active straight leg raise in pregnancy-related pelvic girdle pain[J]. PM R, 2022, 14(1): 19-29.
[23]	FERNANDEZ-LOPEZ I, PENA-OTERO D, ATIN-ARRATIBEL M, et al. Effects of manual therapy on the diaphragm in the musculoskeletal system: a systematic review[J]. Arch Phys Med Rehabil, 2021, 102(12): 2402-2415.
[24]	WU Q, ZHAO J, GUO W. Efficacy of massage therapy in improving outcomes in knee osteoarthritis: a systematic review and meta-analysis[J]. Complement Ther Clin Pract, 2022, 46: 101522.
[25]	GAUSEL A M, DALEN I, KJAERMANN I, et al. Adding chiropractic treatment to individual rehabilitation for persistent pelvic girdle pain 3 to 6 months after delivery: a pilot randomized trial[J]. J Manipulative Physiol Ther, 2019, 42(8): 601-607.
[26]	SASAKI T, KUROSAWA D, MURAKAMI E, et al. Physical therapeutic options for residual sacrotuberous ligament pain after treatment of sacroiliac joint dysfunction[J]. J Phys Ther Sci, 2021, 33(9): 646-652. doi: 10.1589/jpts.33.646 pmid: 34539068
[27]	VESTING S, GUTKE A, FAGEVIK O M, et al. Can clinical postpartum muscle assessment help predict the severity of postpartum pelvic girdle pain? A prospective cohort study[J]. Phys Ther, 2022, 103(1): pzacl52.
[28]	MAMIPOUR H, FARAZMEHR S, NEGAHBAN H, et al. Effect of core stabilization exercises on pain, functional disability, and quality of life in pregnant women with lumbar and pelvic girdle pain: a randomized controlled trial[J]. J Manipulative Physiol Ther, 2023, 46(1): 27-36.
[29]	程欢. 产后妇女骨盆带疼痛的现状及影响因素分析[D]. 北京: 北京协和医学院, 2021.
	CHENG H. Status and influencing factors of pelvic girdle pain in postpartum women[D]. Beijing: Peking Union Medical College, 2021.
[30]	ELDEEB A M, ABD-GHAFAR K S, AYAD W A, et al. Effect of segmental stabilizing exercises augmented by pelvic floor muscles training on women with postpartum pelvic girdle pain: a randomized controlled trial[J]. J Back Musculoskelet Rehabil, 2019, 32(5): 693-700. doi: 10.3233/BMR-181258 pmid: 30636728
[31]	KAZEMINIA M, RAJATI F, RAJATI M. The effect of pelvic floor muscle-strengthening exercises on low back pain: a systematic review and meta-analysis on randomized clinical trials[J]. Neurol Sci, 2023, 44(3): 859-872.
[32]	DUNE T J, GRIFFIN A, HOFFMAN E G, et al. Importance of internal vaginal pelvic floor muscle exams for women with external lumbar/hip/pelvic girdle pain[J]. Int Urogynecol J, 2023, 34(7): 1471-1476.
[33]	李亚, 白文佩, 张瑾, 等. 生物反馈电刺激疗法对经阴道分娩后盆底功能康复效果的临床随机对照研究[J]. 中国全科医学, 2024, 27(5): 547-551.
	LI Y, BAI W P, ZHANG J, et al. Biofeedback electrical stimulation therapy in the rehabilitation of pelvic floor function after vaginal delivery: a clinical randomized controlled study[J]. Chin Gen Pract, 2024, 27(5): 547-551.
[34]	VESTING S, OLSEN M F, GUTKE A, et al. Clinical assessment of pelvic floor and abdominal muscles 3 months post partum: an inter-rater reliability study[J]. BMJ Open, 2021, 11(9): e49082.
[35]	姜仁建, 李航, 周杰, 等. 悬吊训练疗法对产后压力性尿失禁患者盆底肌力的效果[J]. 中国康复理论与实践, 2019, 25(9): 1103-1106. doi: 10.3969/j.issn.1006-9771.2019.09.022
	JIANG R J, LI H, ZHOU J, et al. Effects of sling exercise therapy on muscle strength of pelvic floor for patients with postpartum stress urinary incontinence[J]. Chin J Rehabil Theory Pract, 2019, 25(9): 1103-1106.
[36]	陈振华, 郑其开, 陈水金, 等. 悬吊运动疗法对慢性非特异性下腰痛患者腰部功能的影响[J]. 康复学报, 2022, 32(6): 533-538.
	CHEN Z H, ZHENG Q K, CHEN S J, et al. Effect of sling exercise therapy on lumbar function of patients with chronic nonspecific low back pain[J]. Rehabil Med, 2022, 32(6): 533-538.

组别	n	年龄/岁	体质量指数/(kg·m^-2)	病程/周
对照组	28	33.05±4.00	24.19±3.11	5.17±1.13
观察组	28	32.03±3.91	23.86±3.05	4.86±1.10

悬吊推拿运动技术对产后骨盆带疼痛的效果

Effect of sling massage exercise on postpartum pelvic girdle pain

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 36

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	刘冬, 徐子涵, 李江, 鞠萍. M1区联合背外侧前额叶高频重复经颅磁刺激对脊髓损伤后神经病理性疼痛患者脑电图θ振幅的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 87-94.
[2]	张冠聪, 黄秋晨, 顾蕊, 刘四海, 胡春英, 刘克敏. 不同神经肌肉训练方法对早期膝骨关节炎患者疼痛和运动功能效果的比较[J]. 《中国康复理论与实践》, 2023, 29(9): 1090-1097.
[3]	解焕鑫,刘晓磊,李强,章耀华,张鸿悦,郭峰,张耀国,杨华清. 不稳定坐位躯干控制训练对髌股疼痛综合征的疗效[J]. 《中国康复理论与实践》, 2022, 28(7): 770-775.
[4]	蔡桂燕,陈瑞琳,徐姝蕊,陶静,刘娇. 膝骨关节炎和腰痛患者的脑低频振幅影像学特征比较[J]. 《中国康复理论与实践》, 2022, 28(5): 602-608.
[5]	李冉, 杜巨豹, 曹光磊, 李征, 李子怡, 葛亚丽, 钱龙. 骨科康复一体化模式对全膝关节置换术患者运动功能的效果[J]. 《中国康复理论与实践》, 2022, 28(2): 144-149.
[6]	张晓倓,李军,张玲玲,谢惠敏,孙丽君,潘昱,李春宝,贾子善,张立宁. 慢性髋关节疼痛患者的功能障碍及相关心理因素分析[J]. 《中国康复理论与实践》, 2022, 28(12): 1484-1488.
[7]	李向哲,丁洁,王庆华,董传明,王彤,吴勤峰. 减重平板训练对脊髓损伤大鼠神经病理性疼痛及脊髓后角谷氨酸脱羧酶-65/67表达的影响[J]. 《中国康复理论与实践》, 2021, 27(2): 131-136.
[8]	黄武杰,刘红,李雅萍,江征. 疼痛缓解对慢性非特异性腰痛患者步态特征的影响[J]. 《中国康复理论与实践》, 2021, 27(2): 197-202.
[9]	黄娜,张慧鑫,任浩,郭昱琪. 基于移动互联网的虚拟无痛病房对开颅手术后患者疼痛管理的效果[J]. 《中国康复理论与实践》, 2021, 27(2): 222-229.
[10]	符卫卫,燕文娟. 体轴回旋结合节律性呼吸训练对脑卒中偏瘫下肢功能的效果[J]. 《中国康复理论与实践》, 2021, 27(11): 1323-1328.
[11]	刘晓磊,李强,章耀华,张鸿悦,刘文辉,李佳,董明,杨云,杨华清. 离心运动训练对髌股疼痛综合征患者膝关节功能和神经肌肉控制的效果[J]. 《中国康复理论与实践》, 2021, 27(11): 1334-1339.
[12]	何佩珏, 黄敏, 王谦, 刘韬, 王清. 涡流浴缓解疼痛的疗效与机制研究进展[J]. 《中国康复理论与实践》, 2021, 27(1): 93-96.
[13]	谢亚辰,杨晓秋. 脊髓电刺激治疗神经病理性疼痛的应用进展[J]. 《中国康复理论与实践》, 2020, 26(6): 678-682.
[14]	古丽加克拉·艾山,陈婵,高天昊,凌骏麒,孙莉敏,白玉龙. 重复经颅磁刺激联合常规康复对桡骨远端骨折后复杂区域性疼痛综合征I型患者上肢功能影响1例报道[J]. 《中国康复理论与实践》, 2020, 26(2): 232-236.
[15]	陆斌,赵晨光,琚芬,孙玮,薛白洁,孙晓龙,牟翔,袁华. 肌内效贴联合深部肌肉刺激对非特异性颈痛的疗效[J]. 《中国康复理论与实践》, 2020, 26(11): 1349-1352.