Lumbar intervertebral disc that should not be “protruding”

In recent years, the number of people suffering from lumbar disc herniation has been increasing due to prolonged sitting and lack of exercise, as well as diet and coldness.

Lumbar disc herniation (abbreviated as “lumbar process”), refers to the clinical syndrome caused by the stimulation and (or) compression of nerve roots and cauda equina on the pathological basis of lumbar disc herniation, manifested as low back pain , Radiating pain of lower limbs, numbness of lower limbs, weakness of lower limbs, dysfunction of urine and bowel, etc Nowadays, this disease is very common among young and middle-aged people, especially in manual workers or workers who sit and stand for a long time. When the following symptoms appear, be alert to this disease:

1. Lumbar pain or unilateral lower limb pain after trauma.

2. The back pain is mostly located on one side of the lower waist, and the leg pain is mostly radioactive pain from the hip to the distal end, which may be accompanied by numbness.

3. Unilateral saddle area (the part where the bicycle is in contact with the seat) or one side (both sides) of the outside of the calf, outside or inside of the foot, pain or numbness, or both pain and numbness.

4. Pain in the waist or legs can be relieved after bed rest, and the pain will appear again after getting out of bed for a period of time.

5. Pain worsens when walking, unable to walk completely upright. Most patients need to support the painful side of the waist with their hands. The pain suddenly worsens when coughing, sneezing or lifting heavy objects.

6 Causes of lumbar disc herniation
Intervertebral disc refers to the disc between two vertebrae. It is mainly composed of cartilage endplates on the upper and lower sides, the nucleus pulposus in the middle, and the fibrous ring surrounding the nucleus pulposus. There are 23 adults in total, including 6 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. The position of the lumbar intervertebral disc is between the two lumbar vertebrae, behind which there are pedicles, laminas, muscles, myofascial membranes, and skin as a strong barrier.

Regarding the causes of lumbar disc herniation, the medical profession believes that there are mainly the following:

Degenerative changes The degenerative changes of the lumbar intervertebral disc are the basic cause of lumbar disc herniation.

Long-term repeated external forces caused damage to the supporting structure of the intervertebral disc, which aggravated the degree of degeneration.

The laxity of the posterior longitudinal ligament during pregnancy can easily cause the intervertebral disc to bulge. In addition to the weight gain after pregnancy, the incidence of low back pain in pregnant women is significantly higher than that of ordinary people.

Genetic factors of lumbar intervertebral disc herniation have been reported many times in familial onset. The University of Hong Kong and Guangzhou Zhongshan Medical University have done scientific research on this.

Congenital lumbosacral abnormalities include lumbar sacralization, sacral lumbarization, hemivertebral deformities, facet joint deformities, and asymmetry of articular processes. The above factors can change the stress on the lower lumbar spine, leading to increased intervertebral disc pressure. Prone to degeneration and damage.

The predisposing factors are based on the degenerative changes of the intervertebral disc, and a certain factor that can induce a sudden increase in intervertebral space pressure can cause nucleus pulposus herniation. Common predisposing factors include increased abdominal pressure (such as coughing, laughing, sneezing, and straining to relieve stool, etc.), incorrect waist posture, sudden weight bearing, cold and dampness.

Lumbar disc herniation ≠ lumbar disc herniation
In life, many people are not clear about the distinction between lumbar disc herniation and lumbar disc herniation. In fact, lumbar disc herniation refers to the concept of imaging, that is, it is found that the lumbar intervertebral disc is bulging, protruding, and protruding backward after CT or MRI examination. It is a degenerative pathological change, that is, as we age, everyone will have different degrees of body degeneration, and lumbar disc degeneration is one of them.

Lumbar disc herniation refers to a series of clinical symptoms such as lumbar pain, numbness, etc. caused by irritation or compression of adjacent tissues due to the degeneration of the lumbar intervertebral disc and the rupture of the annulus fibrosus. The prolapse is lighter, the protrusion is heavier, and the prolapse is the heaviest.

Simply put, the biggest difference between the two is-there are or not symptoms. Lumbar disc herniation (mild bulging and mild herniation) may not show any symptoms, while lumbar disc herniation and herniation will show low back pain, lower limb radiating pain, urinary and urinary disorders, etc. In severe cases, loss of control of urine and bowel may occur And incomplete paralysis of both lower limbs. It can be seen that lumbar disc herniation is a pathological disease and does not necessarily have symptoms; while lumbar disc herniation must have both pathological changes and symptoms.

Therefore, when we are undergoing an examination, if we are told that it is a lumbar disc herniation and there are no symptoms, we don’t need to be too anxious, we can appropriately strengthen the muscles of the back and change bad habits (such as poor sitting posture, maintaining the same posture for a long time, etc.) To prevent it from becoming “symptoms.” However, when typical symptoms such as waist and leg pain and numbness occur, they must be actively treated.

Conservative treatment has options
Most of the lumbar disc herniation can be relieved or cured by non-surgical treatment. The treatment principle is not to restore the degenerated and herniated intervertebral disc tissue to the original position, but to change the relative position or partial return of the intervertebral disc tissue and the compressed nerve root to reduce the pressure on the nerve root, loosen the nerve root adhesion, and eliminate the nerve root Inflammation, thereby alleviating symptoms. Non-surgical treatment is mainly suitable for those who are young, have a first attack, or have a short course; secondly, those who have mild symptoms and can relieve themselves after rest, and those who have no obvious spinal stenosis on imaging examination. Specific non-surgical treatments are as follows:

When absolute bed rest occurs for the first time, you should stay in bed strictly, emphasizing that you should not get out of bed or sit up when you urinate or urinate, so as to have a better effect. After resting in bed for 3 weeks, you can get up while wearing waist protection, and do not bend over and hold objects for 3 months. This method is simple and effective, but more difficult to adhere to. After remission, the back muscles should be strengthened to reduce the chance of recurrence.

Traction therapy adopts pelvic traction, which can increase the width of the intervertebral space, reduce the pressure of the intervertebral disc, promote the recuperation of the herniated disc, and reduce the stimulation and compression of the nerve root, but it needs to be carried out under the guidance of a professional doctor.

Tuina can relieve muscle spasms and reduce the pressure in the intervertebral disc. However, it should be cautious that violent massage (massage) can cause aggravation of the disease.

In addition, acupuncture, cupping, Chinese and Western medicine, and some physiotherapy methods are all effective, but most of them play a role in auxiliary treatment.

If conservative treatment is ineffective, or even worsening, surgery can be considered. The indications for surgery are: (1) The medical history is more than 3 months, strict conservative treatment is ineffective, or conservative treatment is effective but often relapses and the pain is severe; (2) The first attack, the pain is severe, especially the lower limb symptoms are obvious, the patient is difficult to move He sleeps and is in a compulsive position; (3) Complicated with cauda equina compression; (4) Single nerve root palsy, accompanied by muscle atrophy and decreased muscle strength; (5) Complicated with severe spinal stenosis.

There are many types of operations. In recent years, minimally invasive surgical techniques such as microscopic disc removal, microendoscopic disc removal, and percutaneous intervertebral disc removal have reduced surgical damage and achieved good results.

Patients with osteoporosis should be cautious in using “large traction reduction technique”
The large traction reduction technique is one of the characteristic therapies for the treatment of lumbar disc herniation in the Tuina Department of Anhui Provincial Hospital of Traditional Chinese Medicine. It was developed by Li Yefu, the master of Chinese Tuina and the master of Chinese medicine. This method organically combines the massage therapy in the motherland medicine with the traction therapy in modern medicine. Compared with simple Western medicine pelvic traction and Chinese medicine massage (massage), acupuncture, cupping and other treatments, it has a fast effect, good curative effect, and a shorter treatment course. And no sequelae and other characteristics.

There are two types of traction reduction techniques: supine and prone, and the objects and effects of traction are different. Those with lumbar kyphosis are adapted to prone traction, while lumbar lordosis is adapted to supine traction. Through this action against traction, the intervertebral space of the spine can be widened, the damage to the intervertebral disc tissue can be reduced, the internal negative pressure of the intervertebral space is generated, the posterior longitudinal ligament is tightened, and the tension and internal The suction generated by the negative pressure creates favorable conditions for the protruding nucleus pulposus to accommodate or loosen the nerve roots, and also creates a prerequisite for manual reduction. The main types are——

Suspension lower limb compression method is to traction in the prone position, straighten the patient’s lower limbs and lift them in the air, at an angle of 25 to 30 degrees with the bed surface, and the abdomen is suspended 6 to 12 cm from the bed surface; The doctor swings the patient’s lower limbs in an oval shape from side to side. Another doctor stands on the patient’s side with his hands folded and overlapped. Using the base of his palm, he uses the palm base to apply elastic shock pressure 30-50 times on the lumbar lesions or pain points. The strength of the patient should be flexibly controlled according to the patient’s physique, the severity of the disease and the degree of tolerance.

The stilt patient takes the prone position, puts a hard pillow on each of the chest and lower abdomen and the front root of the thigh, so that the abdomen is suspended 6-12 cm from the bed, and then tightened to resist traction. The doctor uses the forefoot or heel of one foot or both feet to focus on the patient’s waist lesion, stepping on stilts, and flexing and extending the knee joint to make the body fall together. During this period, pay attention that the forceful part of the foot cannot leave the lesion. The patient should open his mouth and inhale as the doctor bounces up and down on the stilt, that is, inhale when bounced, and exhale when falling back. Do not hold your breath and step on the stilt about 500 times. End. This method is also the most frequently used by doctors.

Knee flexion and hip flexion is the traction of the patient in the supine position. The doctor uses one palm to support the bottom of the patient’s feet and the other hand to support the knees to flex the knees and hip joints to a certain angle, and then roll the waist, turning left and right. Several times, then increase the flexion of the hips so that the thighs are close to the abdomen. Press down on both knees with one hand and hold up the hips with the other, so that the waist is extremely flexed. Each operation is performed 30-50 times, subject to the patient’s tolerance.

Of course, these techniques can be used alone or in combination. For example, when the effect of suspending the lower limbs and pressing the waist after 3 times is not significant, you can add push and pull methods or oblique pull methods; lumbar scoliosis and kyphosis can be treated for a long time. For those who are ineffective, the stilt method can be added after the lower limbs are pressed down, or the stilt method can be used after the push and pull method.

The above traction techniques are not only very effective for lumbar disc protrusion (prolapse), but also for lumbar spine dislocation, lumbar posterior joint joints, lumbar scoliosis, kyphosis, enlarged lordosis, lumbar hyperosteosis, lumbar spine Staggered joints of the sacral and sacroiliac joints, and lumbar synovial incarceration, etc., have obvious effects.

It should be reminded that the suspending lower limb compression method and the stilt method should be used with caution for people with obvious lumbar lordosis and large abdomen, especially for patients with enlarged lumbar lordosis accompanied by spondylolisthesis or isthmic rupture. Knee flexion and hip flexion can be used. Conversely, knee flexion and hip flexion should be used with caution or even forbidden for patients with obvious lumbar kyphosis or straight lumbar spine. In addition, more serious osteoporosis and hypertension, heart disease, spine compression fractures, etc. should also be used with caution.

TCM syndrome differentiation has good results
Traditional Chinese medicine believes that the onset of lumbar disc herniation is mostly due to deficiency of righteous qi, especially kidney deficiency and bone weakness. Exogenous wind, cold and damp pathogen invasion, fall and fall injury and strain are the predisposing factors, poor circulation of qi and blood, and obstruction of meridians are the main pathogenesis of the disease. The TCM syndrome is diagnosed as “back pain disease”, which requires syndrome differentiation and treatment.

Qi stagnation and blood stasis syndrome

Manifestations: low back and leg pain such as tingling, pain at fixed points, light and night, hard waist, limited pitch and rotation, refusing to press the pain, dark red tongue, thin white coating, tight or astringent pulse.

Treatment: Promoting blood circulation, removing stasis, regulating tendons and relieving pain.

Prescription: Modification of Shentong Zhuyu Decoction.

Composition: 3 grams each of Gentiana, Qianghuo and Cyperus rotundus, 9 grams each of peach kernel, safflower, Achyranthes, Angelica sinensis, 6 grams each of Ligusticum chuanxiong, Licorice, Myrrh, Lingzhi (stir-fried), and Dilong (removed soil).

Addition and subtraction: If the body is slightly hot, add 6 grams of Cangzhu and 9 grams of Phellodendron amurense; if the body is weak, add 30 grams of Astragalus.

Damp heat resistance syndrome

Manifestations: waist pain, weakness in the legs, heat in the sore area, increased pain when exposed to heat or rain, decreased pain after exercise, aversion to fever and thirst, short red urine, red tongue, yellow and greasy fur.

Therapy: clearing away heat and dampness, relaxing muscles and relieving pain.

Prescription: Shuanghe Decoction.

Composition: peach kernel, safflower, rehmannia glutinosa, peony, angelica, chuanxiong, pinellia, tuckahoe, tangerine peel, licorice, white mustard, bamboo, ginger, etc.

Wind-cold-dampness syndrome

Manifestations: severe cold and pain in the waist and legs (heavy knuckles and unfavorable flexion and extension), unfavorable turning, unabated pain in lying down, aggravated cold and rain, cold limbs, pale red tongue, thin white or greasy coating, tight pulse Or push or delay.

Treatment: Dispel wind and cold, dispel dampness and dredge collaterals.

Prescription: Ganjianglingshu Decoction.

Composition: 6 grams each of licorice and Atractylodes, 12 grams each of dried ginger and Poria. Take 1 liter of water, boil 600 ml, and take 3 times warm.

It should be reminded that each group of prescriptions in the article must be prescribed and administered under the guidance of a practicing Chinese medicine practitioner, and patients should not self-prescribe medications accordingly.

Wear a waistline to protect the lumbar spine
Patients with lumbar disc herniation have all used waist circumference. Some of them are waist circumference worn under the guidance of a doctor, and some are purchased and worn by themselves. They do not necessarily know the role of waist circumference and how to wear it. In fact, waist circumference is one of the commonly used orthopedic braces, and its main function is to brake and protect.

Braking waist is generally made of leather or canvas lined with steel or bamboo. The upper part reaches the lower rib arch, the lower part covers the iliac crest, and the front is tightened. Therefore, when the waist is worn, it will restrict the activities of the lumbar spine, especially the forward flexion, so that the local tissues of the lumbar spine can be relatively adequately rested, relieve muscle spasm, promote blood supply recovery, and dissipate pain-causing substances. The inflammation around nerve roots and intervertebral joints can be reduced or eliminated.

Protective effect Because the waist circumference can strengthen the stability of the lumbar spine, when the patient starts to move on the ground after bed rest or traction, wearing a waist circumference can restrict the amount of activity and range of the lumbar spine to consolidate the effect of the previous treatment.

At present, there are many types of waist circumference, such as medicine waist circumference, magnetic therapy waist circumference, etc. They can also be supplemented with traditional Chinese medicine iontophoresis and magnetic therapy in addition to braking and protection functions. Patients can also choose flexibly according to their condition. Of course, the wearing and use of waist circumference is not random, and the following issues should be noted:

1. Need to be flexible according to the condition. After vigorous traction or long-term bed treatment, the patient should strictly follow the doctor’s advice to wear a waistline to consolidate the therapeutic effect. When the condition is relieved and the symptoms disappear, you should not feel dependent on the waist circumference. You should remove the waist circumference in time, strengthen your own back muscles, and strengthen the support and protection of the lumbar spine with your own muscle strength. Otherwise, long-term unprincipled wearing of waist circumference will cause disuse atrophy of the back muscles and joint rigidity, patients will be inseparable from the waist circumference, and symptoms will aggravate, which is harmful to the treatment of lumbar disc herniation.

2. The specifications should be adapted to the patient’s body type. Generally, it goes up to the inferior costal arch and down to the iliac crest. The posterior side should not be too lordotic, and the front should not be too tight. The lumbar spine should be maintained with good physiological curvature. If the waist size does not conform to the specifications, not only will it cause discomfort after the patient wears it, but it will also fail to perform its due role.

In short, patients should choose or wear waist circumference under the guidance of a doctor, so that they can make the best use of them.