Biomechanical comparisons of two types of Tuina in treating lumbar disc herniation : a finite element analysis

Abstract

Background: Prior research has demonstrated the clinical efficacy of two specialized Tuina techniques, namely, high-speed oblique Tuina (HSOT) and low-speed oblique Tuina (LSOT), in the treatment of lumbar disc herniation (LDH). These techniques integrate principles of traditional Chinese medicine with modern manual therapy. Despite their proven therapeutic benefits, the biomechanical effects of HSOT and LSOT on spinal structures remain poorly understood. Aim: Finite element analysis (FEA) was utilized to investigate the biomechanical effects of HSOT and LSOT on a patient with LDH, aiming to elucidate their underlying treatment mechanisms. Methods: The mechanical parameters of HSOT and LSOT applied to a participant with left L4/5 LDH were meticulously measured using a state-of-the-art Multipoint Thin Film Pressure Testing System. These comprehensive data, along with the corresponding high-resolution computerized tomography (CT) scan data, were subsequently input into four advanced finite element analysis (FEA) software programs. These programs were employed to conduct a detailed analysis of the stress–strain characteristics of both HSOT and LSOT on the spinal structures, enabling a thorough comparison of their biomechanical effects and potential therapeutic outcomes. Results: The maximum stress and average displacement of vertebral and ligamentous structures during HSOT in the lumbar vertebrae-pelvis model doubled those of LSOT. HSOT caused the maximum average displacement of the L4/5 right intertransverse ligament, whereas LSOT induced the maximal mean displacement of the L4/5 left intertransverse ligament. Additionally, HSOT caused the maximum average displacement of the right iliolumbar ligament, but the maximum mean displacement was observed in the left iliolumbar ligament during LSOT. Conclusion: Both HSOT and LSOT produced small displacements of the lumbar and pelvic structures, but HSOT elicited significantly greater displacement and stress on various spinal tissues than LSOT. These mechanical responses may be the biomechanical effects of HSOT and LSOT in people with LDH.