How to perform regular non-surgical treatment of lumbar disc herniation

Based on the urgency of the disease and the severity of the pain, lumbar disc herniation can be roughly divided into 3 phases: acute onset, remission and functional recovery, and the duration of each phase can be different for each individual. In line with this, the goal, method and focus of non-surgical treatment should also be different in each phase. The acute phase is generally defined as within 2 weeks of the onset of the disease, and the pathological features of this phase are mainly inflammatory stimulation from medullary chemicals and immune response, with severe clinical manifestations of pain, muscle tension and nerve root signs in the low back. We do not advocate intense functional exercise, heavy manipulation, high-dose traction and repeated epidural closure to avoid aggravating pain symptoms, complicating the condition and making follow-up treatment more difficult. The remission period refers to 3 weeks after the onset of the disease, the pathology is mainly from the compression of protrusions and secondary adhesions, clinically marked by pain relief, at this time most advocate the adoption of moderate massage techniques, lumbar heat fumigation and other physical therapy measures, aimed at promoting blood circulation in the lumbar region, release the lumbar back muscle spasm and release adhesions. The time concept of functional recovery period varies greatly, which is related to the individual characteristics of disease regression and the efficacy of therapeutic measures. In this period, the biochemical damage of the protruding nucleus pulposus to the affected nerve roots is no longer obvious, and the pain has been removed, or there is only numbness, muscle atrophy and motor weakness in the affected limbs, etc. The goal should be to eliminate these residual nerve symptoms and signs, and focus on guiding patients to perform orderly functional exercises in a pain-free state to promote rehabilitation of motor function. This is the basic content of the “treatment of acute conditions and staging”, but there may be differences in the understanding and experience of various clinical schools. Based on careful study and repeated practice, we propose the so-called “three-stage therapy”. In view of the obvious pain in the acute stage and the difficulty of conventional analgesics, we adopted “single point electro-acupuncture” therapy and “Shi’s wound” to actively analgesic treatment by tonifying the kidney and activating the blood, and most of the results were satisfactory. Patients with good analgesic effect have fast functional recovery and few residual symptoms. For patients with poor analgesic effect, another characteristic therapy of our department, “Big massage under anesthesia”, is often used directly to control pain as soon as possible. For patients whose pain is basically eliminated, various massage techniques are used to adjust the coordination of the lumbar back and abdominal muscles, strengthen their “soft pillar” and “elastic protection”, and maintain the balance of the internal and external spinal canal and the dynamic and static force systems, with the aim of consolidating the therapeutic effect and preventing recurrence. To prevent recurrence. For the residual numbness and other neurological symptoms of some patients in remission, we still mainly use neurotrophic drugs, as well as symptomatic treatments such as massage, acupuncture and Chinese medicine, and encourage patients to adhere to voluntary functional exercises, but the recovery period is often long, so we still need to help patients gradually establish a correct view of the disease.