(1) traction
1. Indications Cervical traction is often the first choice for nerve root type, cervical type and sympathetic cervical spondylosis. However, cervical spondylotic myelopathy with obvious spinal cord compression and obvious cervical segmental instability is not suitable for use.
2. The method of cervical traction generally uses cervical pillow traction belt for cervical traction.
(1) posture: The posture can be sitting or lying. For convenience, take a stable sitting posture, so that the neck tilts forward about 10-3o from the longitudinal axis of the trunk to avoid overstretching. Patients are required to fully relax the muscles of neck, shoulders and whole body. The traction posture should make the patient feel comfortable, and if there is discomfort, it should be adjusted as appropriate. Patients with vertebral artery type should lean forward at a small angle, and patients with cervical spondylotic myelopathy should take a nearly vertical posture to avoid flexion and traction.
(2) Traction weight and duration: The commonly used traction weight varies greatly, ranging from 65,438+0/65,438+00 to 65,438+0/5 of the patient's own weight, and most of them use 6-7kg. Use less weight at the beginning to facilitate the patient's adaptation. At the end of each traction, the patient should have obvious neck stretching feeling, but there is no special discomfort. If this feeling is not obvious, it is necessary to increase the weight appropriately. Each traction usually lasts 20-30 minutes. Traction weight and duration can be combined in different ways. Generally speaking, when the traction weight is large, the duration is short, and when the traction weight is small, the duration is long.
(3) Traction frequency and course of treatment: generally traction 1-2 times/day, or 3 times/day, 10-20 days is a course of treatment, which can last for several courses until the symptoms are basically eliminated.
(4) If traction in sitting position is ineffective, or if the patient has severe symptoms or is weak and cannot sit for a long time, traction in supine position can be adopted. Keep the correct posture with a pillow, and the traction weight is generally 2-3kg. After continuous traction for 2 hours, rest for 15 minutes before traction. The total daily traction time can reach 1O- 14 hours.
(5) Electric traction equipment can be used for intermittent traction, which is considered to be beneficial to relax muscles and improve local blood circulation. Generally tow for 2 minutes, relax or reduce the traction weight 1 minute, and repeat for about half an hour.
(2) Massage
1. Functions and indications Chinese medicine believes that cervical spondylosis is caused by long-term neck fatigue, disharmony between qi and blood, exogenous cold, and obstruction of meridians. Massage therapy can reconcile qi and blood, dispel cold, relax muscles and collaterals, thus achieving the effect of spasmolysis and pain relief. Massage is suitable for all types of cervical spondylosis except the spinal cord type with severe cervical spinal cord compression.
For cervical spondylotic myelopathy, massage therapy is not traditionally advocated, which may aggravate spinal cord injury. However, there are reports of safe and effective traction massage therapy in China. Therefore, for mild cervical spondylotic myelopathy, massage therapy is not necessarily taboo, but the technique should be gentle and the wrench method can be avoided.
2. Methods The manipulation of cervical spondylosis should be both rigid and flexible, and not rude. Common operating procedures are as follows:
(1) Repeatedly do palm rubbing, probing and one-finger Zen massage on the neck and back, then click, press and hold some acupoints of the Du Meridian of the neck and shoulder and the Sanyang Meridian of the hand, such as Fengchi, Fengfu, Shounei Shu, Jianjing, Tianzong and Quepen, and then pull out the needles at the trapezius and levator scapulae. If it is nerve root type, manual therapy should include the main acupoints of shoulder, elbow and hand; If it is vertebral artery type, it should include Baihui and temples in the head and face. Then use the wrench method. Finally, it ends with wiping, patting and patting.
(2) When pulling, instruct the patient to rotate the neck to one side. The performer puts his hands under the patient's pillow and occipital back respectively, and slightly rotates the head and neck. At this time, be sure to pay attention to: 1) The rotation angle cannot be too large. 2) Don't unilaterally pursue the "click" sound that may be made when turning your neck. 3) Cervical spondylosis of spinal cord type and vertebral artery type should not be treated with wrench.
(3) Physical therapy
Physical therapy can improve local blood circulation, relax spasmodic muscles and relieve symptoms. Methods High frequency (microwave, ultrashort wave), low intermediate frequency electrotherapy (such as TENS, intermittent electrotherapy, computer intermediate frequency), ultrasound and magnetic therapy can be selected.
motortherapy
1. The effect of exercise therapy on cervical spondylosis is mainly to do medical gymnastics. There are two main purposes and functions of medical gymnastics for cervical spondylosis: (1) activating blood circulation in the neck, eliminating congestion and edema, stretching cervical ligaments and relaxing spasmodic muscles at the same time, thus relieving symptoms; (2) Strengthen the neck muscles, enhance their fatigue tolerance, and improve the stability of the cervical spine, thus consolidating the therapeutic effect and preventing recurrence.
2. Indications and contraindications When the symptoms of various cervical spondylosis are basically relieved or in a chronic state, medical gymnastics can be started to promote the further elimination of symptoms and consolidate the curative effect. When the symptoms are acute, it is necessary to rest locally, and it is not appropriate to increase exercise stimulation. Exercise should be prohibited when there are obvious or progressive symptoms of spinal cord compression, especially when the cervical vertebra moves backward. When cervical spondylosis of vertebral artery type occurs, the neck rotation should be gentle and slow, and the amplitude should be properly controlled.
(5) Nerve block therapy
Intervertebral foramen block (epidural block) and paraspinal sympathetic nerve block are effective treatment methods, and repeated single block or continuous injection of drugs can achieve good results. Block twice a week, 5 times as a course of treatment. Epidural catheter can be injected once a day, and every 5 times is a course of treatment.
Stellate ganglion block is very effective in the treatment of sympathetic cervical spondylosis (generally combined with intervertebral foramen and neck pain point block). The first blocking treatment can often achieve immediate results, but most of them can not maintain long-term curative effect, and it needs repeated surgery to consolidate the effect, at least 2 ~ 4 courses of treatment.
(6) drug therapy
When the symptoms of cervical spondylosis are obvious, drugs are often used as adjuvant treatment to promote the relief of symptoms. Commonly used drugs include antispasmodic analgesics, non-steroidal anti-inflammatory analgesics, neurotrophics and vasodilators. Chinese medicine is also often used.
(7) Psychotherapy
(eight) guidance of daily life activities
1. Pillow and sleep: the center of the pillow should be slightly concave, and the height is 12~ 16cm. Put your neck on the pillow so that your head can stay slightly backward. People who are used to lying on their side should have their pillows shoulder-high. Don't read while sleeping, and don't put your hands above your head for a long time.
2. Avoid neck hyperextension and flexion: Patients with cervical spondylotic myelopathy should avoid neck hyperextension and flexion when washing their faces, brushing their teeth, drinking water and writing.
3. Some daily activities should be stopped: during the illness, you should stop doing some activities that excessively move the cervical spine, such as wiping glass at a height.