Operational and Intervention Effects of Targeted Tuina in Lumbar Intervertebral Disc Degeneration Model Rabbits

Summary

The finger tactile measurement system quantifies tactile pressure on the finger using a highly sensitive electrosurgical pressure sensor, with software displaying and accurately recording the pressure data and video in real time. Two analysis modules unify the data processing for thumb tracking and conditioning during Tuina.

Abstract

Tui Na or massage therapy alleviates symptoms related to intervertebral disc degeneration (IDD). However, precise, repeatable, standardized instructions for Tuina manipulation are lacking. This study establishes IDD model rabbits induced by fibrous ring puncture, creates targeted Tuina stimulation protocols at the acupuncture points in the lumbar region, and describes in detail the operation methods and requirements of kneading, pointing, and flicking. New Zealand male white rabbits (n = 15) were selected and randomly divided into a blank group, a model group, and a Tuina group. The rabbits in the model group and the Tuina group were molded by fibrous ring puncture; the rabbits in the model group were only immobilized on the operating table without treatment. In contrast, the Tuina group used the “8N/10N, 30 cycles/min” prescription for kneading, pointing, and flicking to perform the intervention, using tactile sensory aids to monitor and regulate the intensity of the Tuina operation. Imaging diagnosis and pathological tests were used to assess the effect of Tuina in rabbits, and the results showed improved imaging features and significantly lowered pathology scores of lumbar disc degeneration in the Tuina group compared to the model group (P < 0.01). Targeted Tuina in the lumbar region may be beneficial in the alleviation of lumbar disc degeneration, but further verification is needed. By regularly performing Tuina and recording the mechanical information involved enables reproducible manipulation prescriptions and helps to observe the basic features of the underlying mechanism of Tuina for IDD.

Introduction

The age of onset of intervertebral disc degeneration (IDD) is becoming increasingly younger, with studies showing¹ that the prevalence of IDD is approximately 35% of subjects aged 20 to 39 years involving at least one lumbar level, and all individuals aged 60 to 80 years have IDD. The deleterious effects associated with IDD are widespread, and the disability is found to be positively associated with the degree of IDD in magnetic resonance imaging (MRI) studies^2,3. Although conventional treatments such as bed rest, functional exercise, non-steroidal anti-inflammatory drugs (NSAIDs), and surgery are widely used, they have had limited success in relieving pain⁴. Therefore, we emphasize the need for new treatment strategies to prevent and treat this disease and its co-morbid symptoms. Complementary and alternative medicine approaches (CAM) have been welcomed by a wide variety of patients with IDD, for instance⁵, in the United States alone, 44% of the population used at least one CAM in 1997, the most common symptom being low back pain with IDD and its associated pathology as the main cause. In fact, patients who are dissatisfied with the use of conventional treatment for IDD often turn to CAM such as Tui Na or Tuina.

Tuina therapy has a long history and is widely accepted as an effective method for restoring tissue function, relieving pain and tissue stress, and promoting overall health. According to Wu⁶, the first step in treating IDD disease is to use conservative approaches such as chiropractic and acupuncture treatments. Chiropractic or massage (60% of CAM) is a licensed treatment and is the most commonly used of the many CAM therapeutic options in the United States. A growing body of evidence⁷ has confirmed the considerable clinical benefits of chiropractic or massage for the treatment of lower back pain, not only in terms of safety but also in terms of significantly reducing costs after initial treatment compared to other CAM options such as acupuncture. The 2007 guidelines of the American College of Physicians (ACP) and the American Pain Society (APS)⁸, as well as related systematic evaluations and reviews^9,10, recommended chiropractic as a nonpharmacologic therapy option for acute, subacute, or chronic low back pain. The findings of a 2017 retrospective study on the benefits and harms of nonpharmacologic therapy for lower back pain¹¹ were also consistent with previous guidelines recommendations. The review found no serious harm and some evidence of high-quality, low-risk bias for the efficacy of chiropractic and massage for lower back pain. A recent study¹² found that US adults with disc herniation receiving chiropractic spinal manipulation were less likely to undergo discectomy compared to those receiving other cares. Tuina or massage as the primary therapy for IDD can reduce pain and improve skeletal muscles function in the short term by relaxing spastic muscles in the lower back, improving the abnormal anatomical position of the lumbar spine, reducing symptoms of nerve compression and lumbar disc pressure, and increasing internal spine stability¹³, and can also show good benefits in terms of improving symptoms, signs, and pain scores¹⁴.

Physical stimulation therapies, such as Tuina, can alleviate symptoms related to IDD, but one of the most significant challenges in conducting research is the lack of reproducible prescriptions for Tuina and the absence of uniform normative standards for Tuina treatment, which limits progress in the field and is not conducive to scientifically assessing the effects of Tuina therapies. More importantly, the lack of standardized treatment is also less conducive to studying the type and properties of Tuina in relation to the principles of therapeutic activity and mechanism. Some studies have reported intervention frequency but have ignored the possibility of a dose-response relationship for Tuina therapy; that is, there may be an optimal amplitude, duration, and frequency of Tuina that produces maximum recovery of muscle and joint function¹⁵. As a result, treatment parameters should include the type of massage, duration, and intensity or level of pressure or depth attained¹⁶. To address these issues, we used a tactile force measuring finger guard to quantify and monitor the magnitude and frequency of force during Tuina manipulation in this study. The measuring systems and software (see Table of Materials) originated from the Humanoid Robotics Research Laboratory at Harvard University and were developed with the support of the Defense Advanced Research Projects Agency (DARPA), the Army Research Laboratory, and the National Institutes of Health (NIH), and are currently the most accurate devices for quantifying human touch. Depending on the needs of the field environment, the user can choose to communicate data, observe and record tactile changes either wired or wirelessly.

TCM offers an alternative treatment and thought process for patients affected by IDD. We based the protocol presented here on the traditional Chinese medicine (TCM) meridian theory¹⁷, which states that proximal acupuncture points have a therapeutic effect on the affected area. TCM also indicates that the bladder meridian is located mainly on both sides of the paraspinal column, and its circulation location is closely related to the lumbar region, which is also closely related to the symptoms of lumbar pain, leg numbness, and leg pain that occur in patients with IDD. The bladder meridian is often used as the preferred meridian for the treatment of IDD in Chinese medicine clinics. Ying¹⁸ examined 240 patients with IDD who met the criteria for the exploration of force-sensitive acupuncture points¹⁹, and then determined whether these were force-sensitive points based on the presence or absence of the sensitization characteristics of the point. The force-sensitive acupuncture points in IDD were primarily distributed in the bladder meridian (41.37%). According to the findings of a data mining study²⁰, acupuncture points are mostly distributed in meridians that follow the areas of the pain-prone areas of the lower back and legs, i.e., primarily on the bladder meridian. As a result, in this study, we limited the treatment range by selecting three points near the lumbar vertebrae, Pishu (BL20), Sanjiaoshu (BL22), and Shenshu (BL23), as the operation sites for the stimulation focus in conjunction with the distribution of acupuncture points in rabbits with reference to the guidelines of the experimental acupuncture²¹.

Protocol

The Animal Experimental Ethics Committee at Chengdu University of Traditional Chinese Medicine reviewed and authorized all study protocols (approval number CUTCM-2021-23), and all operations of this protocol followed the committee's guidelines. New Zealand male young and strong white rabbits (n = 15) were selected weighing 2.5 ± 0.2 kg, provided by Chengdu Dashuo Experimental Animal Co., Ltd., experimental animal license number: SCXK (Su) 2017-0002. Standard animal housing conditions were 20-26 °C, 50%-70% …

Representative Results

Basic characteristics of the mechanical curve of Tuina operation Figure 1 depicts the software screenshots recording in real-time the graphs of pressure data over time for the kneading, pointing, and flicking methods with corresponding first-order velocity characteristics during the Tuina intervention IDD model rabbits. The curve is not completely straight or conforms to a certain functional relationship because of the change in the reaction force of the rabbit&#3…

Discussion

Considering the structural and functional complexity of IVD, we chose rabbits as a constructive model for IDD disease, which is characterized by an abnormal cell-mediated response to progressive structural damage. Animal models of various species, such as rabbits, rats, and dogs, have been used to study changes in structural, biological, and biochemical properties during degeneration^23,24,25. However, when comparing the results …

Materials

0.3 T Veterinary Maenetic Resonance lmaging(MRI)	NINGBO CHUANSHANJIA	CSJ-MR
Alcohol medical	LIRCON	20230107
Benzylpenicillin potassium	Jiangxi Keda Animal Pharmaceutical	140051251
FingerTPS Finger Tactile Measurement System	TPS
FingerTPS guard	TPS	CSU8-10N
Haemostatic forceps	SHINVA	20211239
Injection syringe	CONPUVON	20153151307	1 mL, 5 mL, 10 mL
Knife blades	Hons Medincal	20210615
Medical absorbent cotton ball	Cofoe	20210006
Medical suture needle	Shanghai Xiaoyi Medical Devices	20192020430
Medullo-puncture needle	Yangzhou Jiangzhou Medical Devices	20190902	Used to puncture lumbar disc
Physiological saline	NeilMed	C1210504D2
Povidone iodine solution	Sichuan IJIS Medical Technology	20221209
PPS Chameleon TVR software	TPS
Quasi-microbalance	Explorer
Rabbit dissection operating table	Zhenhua Biomedical	ZH-BXT-3Z	Used to immobilize rabbits
Shaver	AUX
Sterile gauze	Cofoe	20202140675
Surgical gloves	DR.LERSH	20172140028
Surgical knife	Hons Medincal	20210019
Surgical tweezers	SHINVA	20210233
USB-C data transmission line	KINI
White light photography microscope	Nikon	Eclipse Ci-L