KJC Korea
Journal Central

Objectives Disuse muscle atrophy occurs in response to pathologies such as joint immobilization, inactivity or bed rest. Muscle disuse is accompanied by an increase in apoptotic signaling, which mediates some of the responses to unloading in the muscle. GB34 (Yanglingquan) is a acupuncture point on the lower leg and one of the most frequently used points in various skeletomuscular diseases. In this study, the hypothesis that the acupuncture at GB34 could attenuate immobilization-induced skeletal muscle atrophy was tested. Methods The left hindlimb immobilization was performed with casting tape in both GB34 group (n=10) and Control group (n=10). The rats in GB34 group were daily treated with acupuncture at GB34. After 2 weeks of immobilization, the morphology of right and left gastrocnemius muscles in both GB34 and Control groups were assessed by hematoxylin and eosin staining. To investigate the immobilization-induced muscular apoptosis, the immunohistochemical analysis of Bax and Bcl-2 was carried out. Results GB34 group represented the significant protective effects against the reductions of the left gastrocnemius muscles weight and average cross section area to compared with Control group. The acupuncture at GB34 significantly reduced the immunoreactivity of BAX and increased the immunoreactivity of Bcl-2 in gastrocnemius muscle compared with Control group. Conclusions These results suggest that the acupuncture at GB34 has protective effects against immobilization-induced muscle atrophy by regulating the activities of apoptosis-associated BAX/Bcl-2 proteins in gastrocnemius muscle. (J Korean Med Rehabil 2018;28(4):1-9)

Objectives To systematically explore the effects of acupuncture treatment for rotator cuff disorders and review the clinical trials. Methods We searched 9 electronic databases (PubMed, Cochrane central, Embase, China National Knowledge Infrastructure [CNKI], Korea Institute of Science and Technology Information [KISTI], National Digital Science Library [NDSL], Korean studies Information Service System [KISS], Research Information Sharing Service [RISS], Oriental Medicine Advanced Searching Integrated System [OASIS]) to find randomized controlled trials that used acupunture treatment for rotator cuff disorders. We assessed the designs of the randomized controlled trials and the method of acupuncture treatment according to the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The methodological quality of randomized controlled trials were assessed using the Cochrane Risk of Bias (RoB) tool. Results Total 5 trials were reviewed. 4 out of 5 randomized clinical trials reported meaningful effects of acupuncture treatments compared to control group. However risk of bias seemed high. Conclusions Although the results suggest that acupuncture treatment has favorable effects for rotator cuff disorders, most of the studies included methodologically high risk of bias. Thus, well designed randomized clinical trials which evaluate the effects of acupuncture treatment for rotator cuff disorders should be encouraged. (J Korean Med Rehabil 2018;28(4):11-20)

Objectives This study was designed to investigate the effects of wet cupping on Wisu (BL12) in non-acute low back pain patients. Methods We recruited 30 participants for this study. Fifteen patients were randomly assigned to the Wisu (BL21) treatment group (WT group) and 15 were assigned to the non-acupoint treatment group (NT group). Both groups were treated with the pricking-cupping bloodletting method three times. Values at baseline and follow-up were analyzed by Wilcoxon signed rank test and the differences between the two groups were determined by Wilcoxon rank sum test. p-values less than 0.05 were considered significant. The primary outcome was the visual analogue scale (VAS), and secondary outcomes were the Oswestry disability index (ODI), Rolland-Morris disability questionnaire (RMDQ), Euroqol-5 dimension questionnaire (EQ-5D) and finger-to-ground distance (FTGD). These outcomes were measured on the day of first treatment before the procedure and on follow-up 7 days after the last treatment. Results Significant changes were identified in the VAS for pain and ODI in each group after wet cupping treatment on Wisu (p＜0.05). However, no significant changes were found between groups. Meanwhile, RMDQ and EQ-5D were significantly decreased only in the NT group (p＜0.05) without any differences between groups. FTGD was decreased in both groups, but not significantly. Conclusions Wet cupping with both Wisu treatment and non-acupoint had significant effects on non-acute low back pain, although there were no differences between the two groups. A large-scale study is needed to identify the effect of wet cupping on Wisu. (J Korean Med Rehabil 2018;28(4):21-32)

Objectives The purpose of this study is to analyze the effects of Korean Medicine treatment on lumbar disc herniation (LDH) and predictive factors associated with disc resorption by magnetic resonance imaging (MRI). Methods A retrospective study was carried out in 79 lumbar disc herniation patients who had visited Haeundae Jaseng Hospital of Korean Medicine. Patients' diagnosis was based on MRI. MRI was performed on two or more occasions and patients were received Korean Medicine treatment within the period. The volume of each herniated disc was measured three-dimensionally and patient characteristics, interval between MRIs, herniated disc level, disc herniation type, disc migration, intactness of posterior longitudinal ligament (PLL), initial volume of herniated disc, modic change, disc resorption rate were statistically analyzed. Results The mean volumes of herniated discs before Korean Medicine treatment and after Korean Medicine treatment were 1,547.81±598.15 mm3 and 947.06±335.28 mm3, respectively. The mean resorption rate was 35.7±16.3%. Disc extent, intactness of PLL and initial volume of herniated discs were significantly correlated with resorption rate (p=0.003, p=0.001 and p=0.024, respectively). Conclusions Korean Medicine treatment is an effective conservative treatment for lumbar disc herniation. Factors such as disc migration, intactness of PLL, initial volume of herniated disc have a significant association with disc resorption rate. (J Korean Med Rehabil 2018;28(4):33-41)

Objectives Upper lumbar disc herniation (LDH) (L1/2, L2/3) has specific anatomical characteristics and different outcome after conventional treatment compared to lower LDH (L3/4, L4/5, L5/S1). The purpose of this study was to compare the clinical features and effects of korean medical treatment of upper LDH between lower LDH. Methods We retrospectively reviewed the clinical data collected from 121 patients who was had admitted at the Haeundae Jaseng Hospital of Korean Medicine from June 1st, 2014 to August 31th, 2018. The patients who had treated at L1/2, L2/3 level LDH were grouped and compared with those treated at the L3/4, L4/5, L5/S1 level. We reviewed the patient characteristics such as age, the positive rate of Straight Leg Raise Test (SLR test), the presence or absence of previous lumbar surgery. Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were evaluated at adimission and discharge. Results Mean age was significantly higher at upper LDH group and positive rate of SLR test was higher at lower LDH group. There was no significant difference of gender and previous lumbar surgery between two groups. Each group had a significant improvement of NRS, ODI scores. But between two groups, there was no significant difference of NRS, ODI scores. Conclusions Upper LDH group was older than lower LDH group. SLR test was useful tool to exclude upper LDH. Korean medical treatment was significantly effective to both upper and lower LDH groups. Further well designed prospective comparative studies are needed. (J Korean Med Rehabil 2018;28(4):43-50)

Objectives Low back disability, along with low back pain, places a significant social burden in terms of work loss and medical expenses. Motion-Style-Acupuncture-Treatment using Traction (T-MSAT) is employed as one of the conservative treatments to such conditions. In the present study, effectiveness of Korean Medical treatments, including T-MSAT, was investigated in inpatients with low back disability and low back pain. Methods Among the patients who were admitted between January 2018 to June 2018 with disabled low back function, ones that were treated with T-MSAT were identified. Pain and function were compared at the point of admission and discharge, using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI), respectively. Results Over the hospitalization period of 34.55 days, pain intensity significantly decreased from NRS score of 6.14 to 3.26 and low back function also significantly improved from ODI score of 50.93 to 33.73 upon receiving Korean Medical treatments including T-MSAT. Conclusions Korean Medical treatments including T-MSAT were found to be effective in inpatients with low back disability with a statistical significance. To evaluate the sole effectiveness of T-MSAT, rigorous clinical trials are necessitated in future. (J Korean Med Rehabil 2018;28(4):51-57)

Objectives This is one of the manuals of East-west integrative medicine which was created by the Committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision making and communication during the rehabilitation of patients after lumbar spine surgery. Methods The drafting was done by two rehabilitation specialists in Korean Medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the Committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision making for rehabilitation after lumbar microdiskectomy, interbody fusion, and kyphoplasty. Therefore it contains the schedule of rehabilitation treatment through the surgical technique, general goal of the rehabilitation by phase, scales for outcome measure and postoperative infection management. Conclusions The proposal of this manual has a significance for it provides information about decision making process and contents of treatment in one medical institution for East-west integrative rehabilitation treatment after lumbar spine surgery. (J Korean Med Rehabil 2018;28(4):59-69)

Objectives The aim of this study is to observe the effectiveness of complex Korean medicine treatment applied to the patients with degenerative meniscal tear and the correlation among clinical effectiveness, body mass index (BMI) and Kellgren-Lawrence grade (KL-grade). Methods The study participants were 38 patients who had been diagnosed with degenerative meniscal tear. Participants were classified by BMI, KL-grade and treated with acupuncture, electroacupuncture and pharmacopuncture. Clinical outcomes were assessed using Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC Index) and EuroQol-5 Dimension Index (EQ-5D Index). Results Both NRS and WOMAC scores were significantly reduced after treatment (p＜0.001). The EQ-5D for assessing quality of life showed further improvement (p＜0.05). A statistically significant correlation was observed between the BMI and NRS, EQ-5D. KL-grade was correlated with WOMAC. Conclusions These results show that complex Korean medicine treatment to the patient with degenerative meniscal tear may be effective as a conservative therapy. Further research is required to confirm the effectiveness of Korean medicine treatment. (J Korean Med Rehabil 2018;28(4):71-79)

Objectives The purpose of this study is to report the improvement of complex Korean Medicine treatment for patients with rotator cuff injuries and determine the clinical improvement by number of damaged lesion. Methods Forty-one patients who diagnosed with rotator cuff injury were included in the retrospective study. Patients were treated with acupuncture, electroacupuncture and pharmacopuncture. Clinical outcomes were assessed using Numeric Rating Scale (NRS), Shoulder Pain and Disablity Index (SPADI) and EuroQol-5 Dimension Index (EQ-5D Index). Results Both NRS and SPADI scores were significantly reduced after treatment (p＜0.01), but EQ-5D for assessing quality of life and clinical improvement by number of damaged lesion were no significant improvement (p＞0.05). Conclusions These results show that patients with rotator cuff injuries could gain improvement from complex Korean Medicine. Further research is required to confirm the effectiveness of Korean Medicine treatment. (J Korean Med Rehabil 2018;28(4):81-87)

Objectives To understand current status of clinical practice patterns on Korean Medicine treatment practice of traffic injury patients by 2nd on-line survey for developing Korean Medicine treatment clinical pratice guideline (CPG) for traffic injuries. Methods A revised questionnaire about current practice patterns of Korean Medicine treatments for traffic injuries was distributed by e-mail survey to 19,385 respondents of Korean Medicine doctors from May 21th in 2018 to June 21th in 2018. All data were statistically analysed. Results The response rate was 3.5%. Most of the respondents felt necessity of the development of Korean Medicine CPG for traffic injuries. The results showed the detailed usage and trend of current Korean Medicine treatment such as acupuncture, pharmacopuncture, moxibustion, Chuna manual therapy, cupping, Korean Medicine physiotherpy for traffic injury patients. Conclusions This survey helps to determine current Korea Medicine treatments' clinical practice patterns for traffic injury patients. All data from the survey will provide basic data for future clinical studies and adaptation for the revision of Korean Medicine CPG for traffic injuries. (J Korean Med Rehabil 2018;28(4):89-101)

Pathological laughing and crying (PLC) is a condition defined by relatively uncontrollable episodes of laughter, crying or both. PLC is an uncommon symptom usually caused by cerebral lesions. Midbrain involvement causing PLC is extremely unusual and the exact mechanism by which this condition develops is poorly understood. We recently experienced a 51-year-old woman who were diagnosed as PLC after midbrain infarction. She was treated by acupuncture, pulsed electromagnetic therapy (PEMT). After 6 weeks treatment, Pathological Laughter and Crying Scale (PLACS), Korean version of the Scale for the Assessment and Rating of Ataxia (K-SARA) are decreased and Korean version of Modified Barthel Index (K-MBI) is increased. Treatment of traditional Korean Medicine could be effective for stoke rehabilitation including post-stroke PLC. And we have considered mechanism of PLC associated with midbrain lesion, dysfunction of cortex-thalamus-hypothalamus-basal ganglia-mesencephalon and faciorespiratory nuclei pathways, cerebro-ponto-cerebellar pathways and damaged serotonergic neurotransmission can cause this based on recent neurobiology of emotion. To define exact mechanism and find effective treatment, further studies are needed. (J Korean Med Rehabil 2018;28(4):103-112)

This study is designed to report three cases of postoperative care after hip surgery using conventional Korean Medicine treatments including phototherapy. Three patients undergone hip fracture surgery were treated with acupuncture, herbal medicine, and phototherapy. We used Visual analogue scale (VAS), EuroQol five dimension scale (EQ-5D), and hip disability and osteoarthritis outcome score (HOOS) to evaluate treatment effectiveness. After the treatment, VAS score was improved in all three cases, while EQ-5D and HOOS showed different results by items. EQ-5D (pain/discomfort) and HOOS (pain, symptoms, activities of daily living) were improved in all three cases. EQ-5D (self-care) and HOOS (quality of life) showed improvements in two cases. EQ-5D (mobility, usual activities, anxiety/depression) and HOOS (sports/recreation) were improved in one case. Conventional Korean Medicine treatments including phototherapy can be effectively used to alleviate pain and symptoms after hip fracture surgery. (J Korean Med Rehabil 2018;28(4):113-124)

This case report was conducted to introduce the use of miniscalpel-acupuncture for the treatment of hand osteoarthritis. A-76-year old female patient who had pain on both hands due to osteoarthritis was treated with miniscalpel-acupuncture for 7 weeks. The main outcome were the Numeral Rating Scale (NRS) and the grip strength by dynamometer. After miniscalpel-acupuncture treatment, NRS was decreased and the strength of grasp was increased. The result of this study suggests that the treatment of miniscalpel-acupuncture may be effectively used to decrease pain and increase grip strength of patients who suffer from hand osteoarthritis. Further research is necessary by the reason of the limited sample size of this study. (J Korean Med Rehabil 2018;28(4):125-130)