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Case Report: Nerve Interface Therapy and Dry Needling Immediately Improved Complaints Associated with Lumbosacral Radiculopathy

病例報告:神經界面治療及乾針即時緩解腰薦椎神經根病變症狀

摘要


Background and purpose: Patients suffering from lumbosacral radiculopathies are slow to respond to standard physical therapy interventions. The benefits of nerve interface therapy (NIT) and dry needling (DN) have not been thoroughly investigated as therapeutic interventions to treat lumbosacral radiculopathy. This case report explores the effect of NIT and DN on a patient with radicular pain and piriformis muscle spasm associated with lumbosacral radiculopathy. Case description: 77 year-old female presenting with three weeks of intermittent low back pain, left buttock and left lateral lower leg pain, insidious in onset. Additional symptoms included left leg weakness and intermittent numbness proximal to the left ankle. MRI showed Grade 1 anterolisthesis of L4 on L5 and a large L4 ~ L5 disc extrusion with sequestration causing a mass effect on the cauda equina. Positional tests produced positive pain responses. Nerve Interface Therapy was applied to the subject’s left lower lumbar spine in a right side lying position and DN was applied to her piriformis muscle in the prone position. Outcomes: Following three minutes of NIT, sitting slump test became negative and remained negative for three months. After DN, the piriformis muscle spasm immediately relaxed and also remained pain free and spasm free for approximately three months. Discussion: It is believed that NIT relieved the lumbosacral nerve root tension from some unknown mechanism at the nervi nervosum, providing instant relief. The positive effect of DN to treat muscle spasms is supported in the literature. Future research is warranted to substantiate use of these techniques to encourage physical therapists to learn about them and use these interventions to treat lumbosacral radiculopathies.

並列摘要


背景及目的:傳統物理治療對於腰薦椎神經根病變效果緩慢。神經介面治療 (Nerve Interface Therapy-NIT)及乾針對腰薦椎神經根病變尚未被詳細研究。本個案探討NIT及乾針對腰薦椎神經根病變相關的神經根疼痛及梨狀肌痙攣的效果。個案描述:七十七歲女性病患主訴三星期前開始逐漸發生間斷性疼痛,包括腰痛,左側臀部及左小腿外側。伴隨著有左腿無力及間斷性左小腿麻。磁共振掃描顯示一度㐧四腰椎向前滑脫及腰四腰五之間椎間盤嚴重突出向下流出產生馬尾神經根實質壓擠。姿勢活動檢查呈現陽性疼痛反應。病患右側臥位時在左側下腰椎做NIT。俯臥時在左梨狀肌做DN。結果:進行三分鐘NIT,坐姿slump測試由陽性變成陰性反應,效果維持三個月。乾針治療之後,梨狀肌痙攣馬上緩解,效果也大約維持三個月。討論:NIT能夠即時解除腰薦椎神經根壓力相信是由於不明作用產生在神經根的nervi nervosum之內所造成。乾針治肌肉痙攣也是有文獻支持。未來研究有需要進一步探討這兩種治療技術,並鼓勵物理治療師去學習以便治療腰薦椎神經根病變。

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