The symptoms of cervical spondylosis are intricate and complex, the main symptom is neck and shoulder pain, radiating to the head and neck and upper limbs, a few have vertigo, fall, or one side of the face fever, sweating abnormally, the severe cases of double lower limb activities are affected, and even paraplegia. Specifically, patients may have stiffness, hardness and pain in the neck, limited neck activities, heavy shoulders and back, hardening of muscles, weakness of the upper limbs, numbness of the fingers, decreased sensation of the skin of the limbs, and sometimes involuntary falling of the objects held in the hands, etc.; some patients may have stiffness of the lower limbs, which seem to be out of command, or the lower limbs may be limp and soft as if they were stepping on cotton; some other patients may even have headache, dizziness, and decreased vision, Some other patients may even have headache, dizziness, loss of vision, tinnitus, nausea and other abnormal sensations; a small number of patients may suffer from uncontrolled urination and defecation, sexual dysfunction, or even quadriplegia. Of course, not all the manifestations will be manifested in every patient with cervical spondylosis, often only part of the symptoms, and most of the patients with mild manifestations, the course of the disease is also relatively long, so there is no need to smell cervical spondylosis and color, not to mention randomly into the seat. x-ray cervical vertebrae front and side film, cervical vertebrae CT or MRI examination is to confirm the diagnosis of cervical spondylosis is one of the most important means. This disease should be noted with frozen shoulder, thoracic outlet syndrome, spinal canal tumors, Meniere's syndrome, etc.
Treatment of cervical spondylosis:
(1) traction
1. Indications Cervical traction is often used as the first choice of therapy for neurogenic, cervical, and sympathetic cervical spondylosis. However, it is not recommended for those with more pronounced spinal cord compression in spinal cord-type cervical spondylosis and those with significant cervical segmental instability.
2. The method of cervical traction Generally, cervical pillow traction belt is used for cervical traction.
(1) Position: the position can be seated or lying down, in order to facilitate, more stable sitting position, so that the neck from the longitudinal axis of the trunk forward about 10 ° - 3O °, to avoid hyperextension. The patient is required to fully relax the neck, shoulder and the entire trunk muscles. The traction position should be comfortable for the patient, and should be adjusted as appropriate if there is discomfort. In patients with vertebral artery type, the angle of anterior tilt should be smaller, and patients with spinal cord type cervical spondylosis should take a nearly vertical posture, avoiding anterior flexion traction.
(2) traction weight and duration: commonly used traction weight varies greatly, from the patient's own body weight of 1/10 to 1/5, most of the use of 6-7kg, the beginning of the smaller weight in order to facilitate the patient to adapt. Each traction near the end of the patient should be obvious neck stretching feeling, but no special discomfort, such as this feeling is not obvious, the weight should be increased as appropriate. The duration of each traction is usually 20-30 minutes. Traction weight and duration can be made in different combinations, generally shorter duration when the traction weight is larger, longer duration when the traction weight is smaller.
(3) Frequency and duration of traction: generally 1-2 times a day, but also 3 times a day, 10-20 days for a course of treatment, can be continued for several courses of treatment until the symptoms are basically eliminated.
(4) If sitting traction is not effective, or the patient's symptoms are more serious or weak and can not sit, can be used in the supine position traction. With a pillow cushion to maintain a proper posture, traction weight is generally 2-3kg. 2 hours of continuous traction and then rest for 15 minutes, and then again traction, traction up to a total of 1O-14 hours a day.
(5) The use of electric traction equipment can be intermittent traction, is considered beneficial to relax the muscles, improve local blood circulation. Generally, traction for 2 minutes, relax or reduce the traction weight for 1 minute, repeated for about half an hour.
(2) Tuina
1. Role and indications Chinese medicine believes that cervical spondylosis is due to long-term neck strain, qi and blood disharmony, coupled with external wind and cold, blockage of meridians due to the treatment of Tuina can harmonize qi and blood, gui wind dispersal of cold, dredge the tendons and pass through the collaterals, so as to achieve the spasmodic and pain relief effect. Tui na is applicable to all types of cervical spondylosis except spinal cord type with severe cervical spinal cord compression.
For spinal cord cervical spondylosis, the tradition does not advocate massage therapy, that may aggravate the spinal cord damage, but the domestic has been safe and effective traction and massage therapy reports, so the light spinal cord cervical spondylosis is not necessarily contraindicated massage therapy, but the technique should be gentle, exempt from the rotary wrenching maneuver.
2. The method of cervical spondylosis massage should be a combination of rigid and soft, do not be rough, commonly used procedures such as:
(1) in the back of the neck repeated palm kneading, probing and one-finger Zen push, and then in the neck and shoulders of the duchenous vein, the three Yang meridians of the hand, some of the Yu points such as Fengchi, Fengfu, shoulder Yu, shoulder wells, Tienzong, the lack of basin and other acupuncture points for the points, pressure or take the method, and then in the trapezius and the levator scapulae muscles, the popping and plucking method. If it is the nerve root type, manipulation should be used to treat it. If it is the nerve root type, the treatment should include the main acupoints of the shoulder, elbow and hand; if it is the vertebral artery type, it should include the acupoints of the head and face, such as Baihui and Sun. Next, use the rotary trigger maneuver. Finally, it is concluded with wiping, percussion, and patting.
(2) when the implementation of the rotary trigger maneuver, first asked the patient to rotate the neck to the side, the operator's two hands were placed on the patient's lower occipital and occipital part of the back of the trend at the same time a little force to rotate the head and neck. At this time, attention must be paid to: 1) the angle of rotation should not be too large; 2) the "click" sound that may be made when rotating the neck should not be pursued unilaterally; 3) spinal cord and vertebral artery-type cervical spondylosis should not be used as a rotary wrench maneuver.
(3) Physical therapy
Physical therapy can improve local blood circulation, relax spasmodic muscles and relieve symptoms. The method can choose high-frequency (microwave, ultrashort wave), low and medium frequency electrotherapy (such as TENS, intermittent electrotherapy, computerized intermediate frequency), ultrasound, magnetic therapy and so on.
(D) exercise therapy
1. The role of exercise therapy Exercise therapy for cervical spondylosis is mainly to do medical gymnastics exercises, cervical spondylosis, the purpose and effect of medical gymnastics are mainly two aspects: (1) through the relaxation of the neck in all directions of the movement, active cervical spine regional blood circulation, eliminate bruising and edema, while stretching the neck ligaments, spasmodic muscle relaxation, thus reducing the symptoms; (2) Strengthen the neck muscles, enhance their ability to tolerate fatigue and improve the stability of the cervical spine, thus consolidating the therapeutic effect and preventing recurrent episodes.
2. Indications and contraindications When the symptoms of all types of cervical spondylosis are basically relieved or in a chronic state, medical gymnastics can be started to promote further elimination of symptoms and consolidation of therapeutic effects. The acute onset of symptoms should be localized rest, should not increase the exercise stimulation. Exercise is contraindicated when there are obvious or progressive spinal cord compression symptoms, especially cervical backward movement should be contraindicated. In the case of vertebral artery type cervical spondylosis, cervical rotation should be gentle and slow, and the amplitude should be appropriately controlled.
(E) nerve block therapy
Intervertebral foraminal block (epidural cavity block) and paravertebral sympathetic nerve block, is an effective treatment method, repeated single block or continuous injection of drugs into the tube, can receive good results. Single block twice a week, 5 times for a course of treatment. Epidural cavity tube can be injected once a day, every 5 times for a course of treatment.
Stellar ganglion block, effective in the treatment of sympathetic cervical spondylosis (usually with intervertebral foramina, cervical pain point block). It is often used after the first block treatment to get immediate effect, but it is not able to maintain long-lasting effect, so it is necessary to repeat the operation to consolidate the effect, and at least 2 to 4 consecutive courses of treatment are required.
(F) drug therapy
Cervical spondylosis symptoms are significant when commonly used drugs as an adjunctive therapy to promote symptomatic relief, commonly used drugs are antispasmodic analgesics, non-steroidal anti-inflammatory pain relievers, neurotrophic drugs and vasodilators. Chinese medicine is also often used.
(VII) Psychotherapy
(VIII) Guidance on activities of daily living
1. Pillow and sleep: the center of the pillow should be slightly concave, with a height of 12-16cm, and the neck should be rested on the pillow, not suspended, so that the head remains slightly tilted back. Those who are used to side-lying position should make the pillow as high as the shoulder. When you sleep, don't lie down and read, and don't put your hands above your head for a long time.
2. Avoid over-extension and over-flexion of the neck: Patients with spinal cord cervical spondylosis should avoid over-extension and over-flexion of the neck when they wash their face, brush their teeth, drink water, or write.
3. Certain daily activities should be stopped: During the period of illness, you should stop doing certain activities that over-move the cervical spine, such as wiping high glass.
Cervical spondylosis is a common clinical disease that used to be seen in middle-aged and older people, and has a tendency to become younger in recent years; it used to be an occupational disease for accountants and teachers, but now it is a common occurrence in offices. The main symptom of cervical spondylosis is neck pain lag accompanied by pain and numbness of the upper limbs, but modern medical research shows that cervical spondylosis also produces headache, dizziness, tinnitus, eye swelling, chest tightness, shortness of breath, limb weakness and other symptoms. There are many ways to treat cervical spondylosis, massage, acupuncture, traction, physical therapy, local sealing, drugs, etc., as well as surgery, all of which can be very effective, but if the patient does not cooperate with the treatment and does not pay attention to self-maintenance and functional exercise, the condition will be delayed and prone to relapse.
I. Maintenance
1. Pillow appropriate One-third of life is spent in bed, the pillow height soft and hard on the cervical spine has a direct impact on the best pillow should be able to support the physiological curve of the cervical vertebrae, and to keep the cervical vertebrae straight. Pillow should have elasticity, pillow core to kapok, hollow high elasticity cotton or grain husk is appropriate. If you like to lie on your back, the height of the pillow is about 5 centimeters (the height after pressure); if you like to lie on your side, the height is about 10 centimeters. In the supine position, the lower edge of the pillow is best padded on the upper edge of the shoulder blades, not to make the neck off the air. In fact, the real name of the pillow should be called "pillow neck". Pillow is not appropriate, often resulting in pillow, repeated pillow is often a precursor of cervical spondylosis, to timely diagnosis and treatment; in addition to pay attention to the pillow mat, pillow mat to the grass for the best, the bamboo mat is too cool, the second is too hard, it is best not to use.
2. Neck warmth Neck cold stimulation will make the muscle vascular spasm, aggravate the neck lag pain. In the fall and winter seasons, it is best to wear high-necked clothes; the weather is a little hot, the night sleep should pay attention to prevent the neck and shoulders from being cold; hot season, the air conditioning temperature can not be too low.
3. Correct posture The main cause of cervical spondylosis is incorrect posture at work and study. Good posture can reduce strain and avoid injury. Low head time is too long, so that muscle fatigue, cervical disc aging, and chronic strain, will be secondary to a series of symptoms. The best working posture is to keep the neck straight, slightly leaning forward, do not twist, tilt; work more than 1 hour, should rest for a few minutes, do some neck movement or massage; should not head on the bed or sofa armrests to read books, watch TV.
4. Avoid injury Neck injury can also induce this disease, in addition to pay attention to the posture, ride fast transportation, meet the emergency braking, head forward, will occur "whip-like" injury, therefore, pay attention to protect themselves, do not doze off in the car, sitting in the seat can be appropriate to twist the body, side forward; Sports to avoid cervical spine injury; whiplash acute attack, cervical spine to reduce the activities, especially to avoid rapid head turning, if necessary, with neck brace protection.
II. Exercise
Exercise of the cervical spine should be cautious, to avoid purposeless rapid rotation or swaying, especially in the acute stage of cervical spondylosis, vertebral artery type cervical spondylosis or spinal cord type cervical spondylosis. The methods we recommend are simple and easy to use, but they must be consistent in order to achieve the goal of preventing and curing disease.
1. Neutral head position, forward flexion to the limit, back to the neutral position; backward extension to the limit, back to the neutral position; left rotation to the limit, back to the neutral position; right rotation to the limit, back to the neutral position; left lateral flexion to the limit, back to the neutral position; right lateral flexion to the limit, back to the neutral position. Movements should be slow and slightly forceful. When exercising, some patients can feel a ringing sound in the neck, if accompanied by pain, should reduce the number of exercises or stop exercising; if there is no pain, you can continue to exercise.
2. With the head in a neutral position and the fingers of both hands held at the back of the neck, the head slowly flexes and extends backward, while at the same time, both hands are exerting force against the movement of the head, in order to exercise the muscle strength of the back of the cervical vertebrae.
Prevention of cervical spondylosis
Prevention of cervical spondylosis should take measures from the causes and triggers of the disease, in order to effectively reduce the incidence rate and prevent the recurrence of patients who have been cured. The cervical spine is a part of the spine and should be prevented from the spine as a whole.
Prevention is one of the most important elements in preventing the onset of cervical spondylosis. It is commonly believed that the intervertebral discs of the spine begin to degenerate after development into adulthood. In fact, the degenerative changes in the intervertebral discs of each individual vary greatly. Observing from the aspect of age, Wei Zheng et al. analyzed the results of asymptomatic 100 cases of cervical spine X-rays suggesting that the degeneration of intervertebral discs and osteophytes increase with age: 2/20 people in the group under 20 years old; 2/20 people in the group between 20 and 29 years old; 4/20 people in the group between 30 and 39 years old; 16/20 people in the group between 40 and 49 years old, and 16/20 people in the group over 50 years old. Pan Zhiqing's research concluded that infants, young children and adolescents have the most opportunities for spinal trauma, therefore, the prevention of cervical spondylosis should begin in childhood. Strengthening physical exercise and promoting the soft tissues around the vertebrae to be strong and powerful will help to enhance the stability of the spine. More attention should be paid to preventing trauma and correcting bad postures in work and life. In addition to trauma, common triggering factors for cervical spondylosis include pillow fall, cold, over fatigue, forced position work, poor posture and other medical conditions. The causative factors of cervical spondylosis are complex, but in general, they can be divided into internal factors (internal factors) and external factors (acute and chronic trauma), which can be the cause and effect of each other. Internal factors are the basis of the disease. What we are talking about here is prevention in terms of external causes.
(1) prevent acute head, neck and shoulder trauma: head and neck injuries, bruises and whiplash injuries, are prone to cervical spine and surrounding soft tissue injuries, directly or indirectly caused by cervical spondylosis, so it should be actively prevented, and once it occurs, it should be promptly examined and thoroughly treated. Some traumatic injuries are not easy to draw people's attention, such as dozing off in the car, encountering emergency braking, head suddenly tilted back, can cause whiplash injury of the cervical spine; some people are angry when the child's ear twisted at random, the child in order to defend the acute twisting of the neck, or the child's head with a slap blow, etc., can cause cervical muscle and its surrounding soft tissue injuries; infants and young children with underdeveloped neck muscles, the neck is soft, such as too early to pick up or hold the child posture is not Infants and young children have underdeveloped neck muscles and soft necks, so if they are picked up too early or held in an inappropriate position, it is easy to cause hyperextension cervical spine injuries; some young people do not know how to do sports or do not pay attention to the preparatory activities before the sports, such as the top of the cow, the top of the head standing, rolling forward and riding the neck recreation and so on, all of which can cause sports injuries. Preventing trauma is a powerful measure to prevent spinal degeneration. Once trauma occurs, in addition to the treatment of soft tissue injuries, but also timely treatment of cervical spine small joint subluxation, in order to prevent the development of cervical spondylosis.
(2) correct the bad posture in life, prevent chronic injury: chronic strain injury to the soft tissues of the neck and shoulder is the pathological basis for the occurrence of cervical spondylosis, the bad posture in life is posture is one of the main reasons for the formation of chronic strain injury, so correcting the bad posture in daily life is of great significance to the prevention of cervical spondylosis. For example, some people like to lie prone, in order to breathe, can only twist the head to one side, this will occur 1~4 cervical spine sprain. Cervical axis lateral bending, to achieve the loss of compensation, there will be dizziness, headache and eye, ear, nose and throat and other symptoms. Due to damage to the normal mechanical imbalance of the cervical spine, will accelerate the cervical vertebrae disc degeneration; some people usually have a good posture, but when reading novels, watching TV, the habit of leaning his head on the bed rail or sofa armrests, resulting in flexion of the neck flexion back twisting, etc., so that will be due to the damage to the spinal column ligament of the spinal column intervertebral ligaments and lead to the section of the spine is unstable; women sleeping with children, often facing the child side, if the pillow does not fit the figure of the height, will be placed in the cervical and thoracic vertebrae in the forced The body position, the formation of scoliosis, can lead to spondylosis.
(3) reasonable use of pillows: pillow is a protective tool for the cervical column, an adult, sleep 6 ~ 9 hours a day, that is, every day there are? ~ 1 ~ 3 of the time is spent in sleep (pillow), so the pillow must be suitable for the physiological requirements of the neck. After a person is asleep, the neck and shoulder muscles are completely relaxed, relying only on the elasticity of the intervertebral ligaments and joint capsule to maintain the normal relationship between the intervertebral structures, if the long-term use of the height of an inappropriate pillow, so that the cervical vertebrae at a certain place of flexion is excessive, the ligaments and joint capsule will be here to pull the length of the ligament, joint capsule and damage, and cause cervical vertebrae destabilization, the occurrence of joint dislocations, which in turn develop into cervical spondylosis. These patients often show symptoms such as cervical discomfort, pillow fall, dizziness, headache or persistent insomnia during sleep or when waking up in the morning after sleep. Reasonable pillow is very important for the treatment and prevention of cervical spondylosis, which cannot be replaced by medication, but should be applied consistently for a long time. A reasonable pillow must have two items: scientific height and comfortable hardness. The height of the pillow, domestic and foreign scholars have attached great importance to, and put forward a variety of data. Our research believes that the pillow should not be too high or too low. Most people use their own jaw-shoulder line (the distance from the angle of the lower jaw to the shoulder crest) or the transverse diameter of the palm of the hand, as the height of the side or supine, this height is suitable for the vast majority of people; a small number of people need to be appropriate high-pillow, such as sphenoidal developmental deformities, kissing the spine, the pillow is too low, the symptom can be exacerbated. Pillow should have appropriate elasticity or plasticity, not too hard, to cottonwood or grain husk is better, after the application can form a saddle shape.
Sleeping in a good position is very important to the health of the spine. The human body trunk, shoulders and pelvis transverse diameter, side lying, the spine due to the influence of the mattress and curved, if the long-term bias in a side lying position, the spine will gradually lateral curvature, the light woke up stiff back discomfort, the need to get up and activities can be restored to normal, the heavier can be developed into a spinal disease. Sleeping on the back should be the main side of the bed, supplemented by the side of the bed, to alternate between left and right, the side of the bed when the left and right knee joints slightly flexion opposite. Prone, half-prone, half-supine or upper and lower part of the body twisted to sleep, are bad sleeping posture, should be corrected in time. The head should be placed in the center of the pillow to prevent pillow fall. Spinal disease patients should be suitable for plank beds, spring beds on the physiological balance of the spine is not beneficial.
(D) prevention of chronic strain injury: due to work, some types of work require special posture or work in a forced position for a longer period of time, if you do not pay attention to, the Commission is prone to chronic strain injury, and gradually develop into spinal disease. For example, long-term microscope personnel, pit operations personnel, accountants, sewing and embroidery, dentists, aircraft mechanics, typists, telegraph operators, such as flexion of the neck, slanting the neck, twisting the neck, shrugging the shoulders of the workers, as well as long-term ambulatory work of the study of the people, if you do not pay attention to the height of the table and chair with their own body size, but also do not pay attention to the balance of the movement of the spare time (and the work of the opposite postures of the posture exercise, such as ambulatory workers make), time, time, time, time and time. Stretching action), over time will occur shoulder and neck soft tissue load, not only easy to occur lumbar soft tissue strain, and can further develop into cervical, thoracic and lumbar spine joint dysfunction. Prevention of chronic strain injury, in addition to work or spare time for the balance of the movement, but also according to different age and physical conditions, choose a certain exercise program, to enhance muscle strength and strengthen the physical exercise.
Sleeping in the car, emergency braking, very easy to cause cervical spine injury, so should try to prevent. Swimmers diving in shallow water, often caused by the cervical spine serious injury, so diving should be to deep water.
(E) prevention of the elderly: the elderly over 50 years of age, the spine has degenerative changes, so more attention should be paid to the prevention of spinal disease. Pillow must be selected in accordance with personal specifications (health pillow is divided into king-size, large, medium, small, extra-small 5 specifications, men with the same number of pillows according to the number of personal shirts; women with a small pillow according to the number of shirts), regardless of the home or go out, we must attach importance to the use of pillows; pay attention to the neck and waist to keep warm in cold weather to reduce the shrinkage of the neck, shrugging, bending over and other bad postures in the winter should pay attention to the prevention of neck and shoulder cold, in particular, to keep the neck and shoulder warm when sleeping. Sleeping neck and shoulder to keep warm, to avoid cold stimulation and occurs pillow, induced cervical spondylosis and frozen shoulder. When talking with others, watching TV, watching movies or reading books and newspapers, you should focus on the front as much as possible, and do not twist and bend your neck excessively. In short, to maintain the normal physiological curvature of the spine, straight, to prevent poor posture and induced cervical spondylosis.