(1) Acute attack: At this stage, nerve root edema and aseptic inflammation are obvious, and bed rest should be the main method, and the bed rest time should not exceed 1 week; When you are active, you can fix it by your waistline; Hyperthermia is prohibited during physical therapy; Traction distance and time should not be too long; Manipulation therapy is mainly muscle relaxation; Isotonic exercise training of lower back should be avoided.
(2) Recovery period: Warm physical therapy can be used to improve blood circulation; Manipulation therapy is mainly based on loosening manipulation, such as the rotating wrench method of massage; Carry out muscle strength training of back muscles and abdominal muscles to improve the stability of lumbar spine; Encourage moderate activities; Avoid postures and postures that may aggravate symptoms; Reduce back pressure, improve working environment and prevent disease recurrence.
2. Rehabilitation treatment measures
According to different periods, bed rest, lumbar traction, physical factor therapy, manual therapy, exercise therapy and other treatment methods can be selected.
(1) Take a proper posture. In the acute stage of disc herniation, patients should avoid bending hips, knees or leaning forward. If it is necessary to sit up, the trunk should be placed in the back position (about 120), and the lumbar spine should be supported by cushions. When sitting, the hip bends, the knee bends, and the intervertebral disc pressure will increase by 50%. If the trunk leans forward again, the intervertebral disc pressure will double. The back of the chair leans back 120, and the lumbar semi-recumbent posture is supported by a pad with a thickness of 125px, which has the least pressure on the intervertebral disc.
(2) Bed rest in the acute stage of moderate-intensity exercise can relieve pain and is conducive to the healing of injured tissues, but you should get up often and do short stops, walks and moderate-intensity exercise. It is not appropriate to stay in bed completely.
(3) Lumbar traction Lumbar traction is an effective method to treat lumbar disc herniation. According to the size of traction and the length of action time, traction can be divided into slow traction and fast traction.
① Slow traction, that is, continuous traction with small weight, is a long-term method with positive effect. Slow traction is continuous traction, which has obvious effect on relieving lower back muscle spasm; When continuous traction, the lumbar intervertebral space is widened, which can partially accommodate the protrusion, reduce the mechanical stimulation to the nerve root and release the adhesion of the nerve root. Slow traction includes many methods, such as self-traction (gravity traction), pelvic traction and skin traction of both lower limbs. The common characteristics of these traction are long action time and small weight, so most patients are more comfortable in traction, and the traction weight can be increased or decreased according to the patient's feeling. The traction weight is generally 30%-60% of the body weight, and the traction time in the acute stage should not exceed 10 minute; The chronic phase is generally 20-30 minutes, 1-2 times/day, 10- 15 days as a course of treatment.
Indications of slow traction: lumbar disc herniation; Lumbago and leg pain caused by lumbar degeneration; Acute lumbar sprain; Lumbar facet joint diseases. Contraindications: Because of the long traction time and limited breathing movement, the elderly, especially those with cardiopulmonary diseases, should use it with caution.
② Rapid traction, that is, three-dimensional multifunctional traction, is controlled by computer, and three basic actions can be completed during treatment: horizontal traction, lumbar flexion or extension, and lumbar rotation. The weight of rapid traction is large, which is 1.5 ~ 2 times of the patient's weight, and the action time is short, 0.5 ~ 2s, and the traditional Chinese medicine bone-setting manipulation is often added at the same time. Multi-directional rapid traction includes three basic parameters: traction distance 45-60mm, inclination 10-15 degrees, and left-right rotation 10-18 degrees. Repeated traction 2-4 times per treatment, most of which can be treated once. If the second traction is needed, the interval should be 5-7 days. If both treatments fail, other treatments will be used. Adverse reactions: within 6 hours to 2 days after traction, some patients suffered from increased pain in waist and lower limbs, and some patients experienced abdominal distension and abdominal pain, and there were reports of rib fracture, incomplete paralysis of lower limbs and horsetail injury due to improper operation.
Indications for rapid traction: mild to moderate lumbar disc herniation; Lumbar facet joint dysfunction; Early ankylosing spondylitis; Chronic low back pain caused by degeneration. Contraindications: severe lumbar disc herniation; Lumbar tuberculosis and tumor; Tuberculosis of sacroiliac joint; Horsetail tumor; Acute suppurative spondylitis; Severe osteoporosis; Pregnant women; Lumbar deformity; Patients with severe hypertension, heart disease and bleeding tendency. In addition, it should be used with caution for patients with ossification of posterior longitudinal ligament, ossification of intervertebral disc protrusion and nucleus pulposus removal.
(4) Physical factor therapy Physical factor therapy has the functions of analgesia, anti-inflammation, relieving muscle tension and releasing adhesion, and is an indispensable treatment method for non-surgical treatment of lumbar disc herniation. Clinical application has proved that it plays a very important role in relieving pain caused by nerve root compression, improving microcirculation of affected part, eliminating nerve root edema, relieving spasm caused by nerve stimulation and promoting functional recovery of waist and affected limb. Commonly used ultrashort wave, computer intermediate frequency, infrared ray, paraffin, warm water bath and other therapies.
(5) Exercise therapy Patients with lumbar disc herniation should actively cooperate with exercise therapy to improve the tension of back muscles and abdominal muscles, change and correct abnormal force lines, enhance ligament elasticity, move intervertebral joints, and maintain spinal stability. In acute phase, isometric contraction exercises of lumbodorsal muscles and abdominal muscles are commonly used; Isotonic exercises, such as Williams gymnastics and spinal stretching gymnastics, can be used in the recovery period to enhance the muscle strength of back muscles and abdominal muscles and enhance the stability of the spine.