Intervertebral disc is a fibrocartilage disc between the upper and lower vertebral bodies of the spine. It consists of cartilage plate, fibrous ring and nucleus pulposus. Cartilage plate and fibrous ring are composed of different types of cartilage, arranged in a bunch of squares and woven together, which can strengthen the connection between upper and lower vertebral bodies and prevent excessive rotation between vertebral bodies. There is a circle around the nucleus pulposus, which is semi-fluid tissue. Because the intervertebral disc itself has no blood vessels to provide nutrition, but depends on the infiltration of vertebral body tissue to obtain nutrition, it is easy to degenerate, and the latter stimulates the nearby ligaments or nerve roots to cause vibration between vertebral bodies, ensuring the free movement of the spine.

The common causes of lumbar disc herniation are physical overload, such as heavy physical labor and weight lifting, which leads to early degeneration of lumbar disc; When workers who bend over for a long time extract heavy objects, the pressure in the intervertebral disc increases greatly, which is easy to cause the fiber ring to rupture; Long-term vibration is another important cause of disc herniation, such as car and tractor drivers; In addition, there are some factors that induce disc herniation, such as the loss of protection of back muscles caused by acute trauma, spinal deformity, degeneration caused by age and genetic factors.

Lumbar disc herniation is actually a partial or total rupture of the fibrous ring, and the nucleus pulposus protrudes through the crevasse. After protrusion, the nerve roots of one or both sides of the spinal cord or cauda equina are stimulated or compressed, which leads to congestion, edema or adhesion of tissues, and nerve degeneration leads to sciatica or cauda equina symptoms. In addition, due to the protrusion of nucleus pulposus, the intervertebral space is narrowed, which also changes the normal relationship between the related facet joints and ligaments, causing facet joint inflammation and low back pain. The clinical symptoms of lumbar disc herniation are severe low back pain and unilateral sciatica. Some people only have low back pain at first, and then gradually one side of the lower limb becomes numb, and some people have low back pain first. Pain often radiates to the buttocks, thighs, lateral calves and soles of the feet. Cough, sneezing and defecation will aggravate the pain and numbness of the legs, and the pain will also increase when the waist is active. Because the position of lumbar disc herniation and the degree of lumbar spinal stenosis are different, some people have obvious pain when bending forward, and the pain is relieved when bending back; Some people have no pain in flexion, and it is obvious that their back is sore and their legs are numb when they bend back. Kneeling on the bed often can relieve the pain. Individuals with severe pain are forced to adopt special bed posture to relieve the pain. The onset of pain is mostly sudden and periodic, that is, it suddenly occurs after a clear improvement after rest. However, a considerable number of patients have atypical symptoms and unclear trauma history. The occurrence of lumbar disc herniation in the elderly, some people committed it when they were young, and they were asymptomatic for many years after treatment. The onset of this kind of pain is often related to lifting heavy objects, bumping in the car for a long time or moving the waist too fast. Sometimes it seems that there is no obvious trauma, and it can also make the pain suddenly appear.

Second, the health care and rehabilitation of lumbar disc herniation

1. Preventive self-massage-massage waist and eyes

Manual workers, drivers, athletes and the elderly can carry out preventive self-massage-rubbing the waist and rubbing the eyes, so that the blood circulation in the waist is good and the muscle flexibility is improved, which has a certain effect on preventing low back pain and lumbar disc herniation. The specific method is: after heating your hands, press the waist eye tightly, rub it down to the tail, and then retreat to the buttocks, and count it once. * * * Rub hard for 30-50 times. In addition, make a fist gently with both hands, hit the waist eye gently with the fist eye or the back of the fist, or make a fist with both hands and massage the waist eye with the joint of the back of the hand. You can also pinch the muscles at the waist and eyes with both hands, starting from the hip flexion and downward to the lower end of the sacrum, 10 times. When pinching, the two thumbs, forefinger and middle finger will pick up the psoas muscle, and the thumb will push it from top to bottom, and the middle finger will move down, so that the muscle can be rolled up and pinched 1 ~ 2 times a day.

2. Waist exercise activities

Preparation posture: Stand upright and relax, with your feet shoulder-width apart and your hands akimbo.

the first paragraph

1 ~ 2 beat: put your arms back as far as possible when you hold your chest out.

3 ~ 4 beats: Return to the standby position.

5 ~ 6 beats: When the chest is included, the arms should be retracted as far as possible and the elbow joint should be forward.

7 ~ 8 beats: Return to the standby position.

the second part

Repeat the first part.

the third part

1 ~ 2 beats: the upper body moves parallel to the left, the lower limbs and buttocks remain motionless, and the arms are raised horizontally.

3 ~ 4 beats: Return to the standby position.

5 ~ 6 beats: the upper body moves parallel to the right, the lower limbs and buttocks remain motionless, and the arms are raised horizontally.

7 ~ 8 beats: Return to the standby position.

Section iv

Repeat the first part.

Section 5

1 ~ 2 beat: the action of akimbo or 1 ~ 2 beat in the first quarter.

3 ~ 4 beats: hands akimbo or 65438+ 0 ~ 2 beats in the third quarter.

5 ~ 6 beats: hands akimbo or 5 ~ 6 beats in the first quarter.

7 ~ 8 beats: hands akimbo or 5 ~ 6 beats in the third quarter.

Section 6

1 ~ 2 beat: the action of akimbo or 1 ~ 2 beat in the first quarter.

3 ~ 4 beats: hands akimbo or 5 ~ 6 beats in the third quarter.

5 ~ 6 beats: hands akimbo or 5 ~ 6 beats in the first quarter.

7 ~ 8 beats: hands akimbo or 65438+ 0 ~ 2 beats in the third quarter.

Section 7

Repeat the actions in Section 5.

Section 8

Repeat the actions in section 6.

3. Rehabilitation treatment measures:

(1) Acute bed rest

After committing lumbar disc herniation, you should stay in bed for 3 ~ 4 weeks. In the meantime, you should try to urinate, eat and wash in bed, so as to be completely cured.

(2) Traction

Pelvic traction can begin about a week after injury. At first, the traction weight is light (about 10 kg), and it is towed once a day for 30 minutes each time. After traction several times, the traction weight can be gradually increased (20 ~ 25 kg). After ~ 2 courses of traction treatment, the symptoms of low back pain, numbness of lower limbs and pain were obviously improved. For those with obvious kyphosis and pain, the symptoms may be aggravated after traction, so traction treatment should be cautious.

(3) Physical therapy

In the early stage, ultrashort wave, magnetic therapy, direct current plus Chinese medicine can be performed. Physical therapy can also be combined with traction and massage, and most people have better curative effect.

(4) Massage therapy

It can be roughly divided into two categories: Chinese medicine massage and western medicine massage. The focus of western medicine massage is to open the intervertebral space and relax the soft tissue of the waist, and sometimes the opposite pulling method is used. The purpose is to restore or rupture the prominent intervertebral disc, so that the prominent nucleus pulposus can spread around the nerve root, be absorbed or fiberized, thus reducing the pressure. After the symptoms are obviously relieved, use the waist protector for 2 ~ 3 months, and then resume daily activities and exercise. Acupoint massage is often used in TCM massage. Most people use the massage technique of combining traditional Chinese and western medicine, and the effect is better.

(5) Medical gymnastics

The purpose of medical gymnastics is to develop low back strength, exaggerate the capacity of spinal canal and correct lumbar deformity. Medical gymnastics can be composed of upper and lower limbs and waist and abdomen activities. Most of them begin gradually after the pain is obviously relieved, and it is easy first and then difficult. At first, you can lift your waist and hips under your knees in your supine position and repeat 5- 10 times. Hold 10 second after each waist lift and hip lift. After 3 ~ 4 weeks of practice, you can practice the back muscles in prone position, commonly known as "double-headed stilts". After continuing to practice for a period of time, we will increase the rolling exercise of the knee to expand the volume of the spinal canal and increase the flexibility of the waist. General medical gymnastics, especially back muscle exercise, will last for a long time (about half a year) to achieve a relatively solid effect.

After the above rehabilitation treatment, about 80% of patients with lumbar disc herniation can be basically cured. But we should pay attention to prevent recurrence. When a few patients can't live normally or have obvious symptoms of nerve compression after long-term treatment, surgical treatment should be considered.