First, many people are examined and found to have lumbar spondylolisthesis degree I, but they do not have symptoms of back pain. What does lumbar spondylolisthesis degree I mean?
The spine is “stacked” by one vertebrae, under normal circumstances the two adjacent vertebrae are “aligned”, if the vertebrae become misaligned, that is, the upper vertebrae slide forward or backward relative to the lower vertebrae, it is called lumbar spine slippage, usually the upper It is usually more common for the upper vertebrae to slip forward.
What does lumbar spondylolisthesis degree I mean? Lumbar spondylolisthesis is classified into different degrees according to the degree of misalignment of the two vertebrae, which is mainly determined by imaging tests such as X-rays. We divide the surface of the vertebral body below into four equal parts, and if the degree of slippage and displacement of the vertebral body above does not exceed 1/4 vertebral body, it is a degree I slippage; if the degree of slippage and displacement is between 1/4 and 1/2 vertebral body, it is a degree II slippage, and by analogy, it is a degree III and a degree IV slippage. It can be commonly understood that Ⅰ degree slippage is mild slippage, Ⅱ degree slippage is moderate, and if it reaches Ⅲ degree and Ⅳ degree, it belongs to severe slippage.
Second, the lumbar spine slipped Ⅰ degree, but no symptoms, this situation needs to be treated? What should the patient do at this point to stop the condition from worsening?
Many lumbar spondylolisthesis are found in adolescence and are often asymptomatic in the early stages, and most of them are found by chance when examining other problems and do not require special treatment, much less surgery. However, no treatment does not mean that patients can pay no attention to anything. Once this condition is detected, it is important to properly strengthen the functional exercise of the muscles of the lumbar back, avoid bending and sitting for a long time, lifting and carrying heavy objects to prevent further aggravation of the slippage.
For patients who are found to have lumbar spondylolisthesis but do not have symptoms such as back pain, what issues should be paid attention to in life? What exercises are appropriate? Which movements are not allowed?
Third, for patients who are examined and found to have lumbar spondylolisthesis but do not have symptoms such as back pain, I have several suggestions on what they should do to stop their condition from worsening
First, as mentioned above, try to avoid bending, sitting, lifting heavy objects, carrying heavy objects and other dangerous movements that put a lot of force on the lumbar spine in daily life, as these movements will aggravate the degree of slippage.
Secondly, properly strengthen the functional exercise of the lumbar back muscles, you can do some small swallow flying or swimming, jogging and other aerobic exercises. It is not recommended to do strenuous confrontational sports, such as playing soccer, basketball, because the process of these sports have twisting waist, sharp stop and turn action, which is more harmful to the lumbar spine.
In addition, it is not recommended to do strength exercises that require lumbar force, such as pushing the barbell. Weightlifters lift weights when they have to wear a waist brace, indicating that the process of weightlifting lumbar spine stress is relatively large, so these movements are not recommended.
Fourth, many people think of lumbar spine misalignment, think of looking for Chinese medicine orthopedic, lumbar spine slippage is also considered lumbar spine misalignment, can do orthopedic? Why?
Can lumbar spondylolisthesis be orthopedic or not? On this issue, there is still a big difference between Western orthopedic surgeons and Chinese orthopedic surgeons. Western orthopedic surgeons believe that all spinal disorders should not be treated with orthopedic treatment because of the anatomy of the spine, which contains the spinal cord and nerves, and there are certain risks associated with orthopedic treatment. The orthopedic surgeons in Chinese medicine recommend massage and orthopedic treatment based on meridian science. It is true that some patients have certain effects after orthopedic treatment, but we believe that at the same time, there are certain risks hidden in the orthopedic treatment techniques.
I personally believe that orthopedic treatment should be carefully considered for patients with lumbar spondylolisthesis. Although there are many Chinese osteopathic techniques, in the final analysis, they are all about resetting the misaligned small joints and making the structure of the lumbar joints relatively normal. Often, the initial treatment effect is better after the orthopedic treatment. But lumbar spondylolisthesis is different from other lumbar spondylolisthesis, it is not simply a misalignment of the joint, but a relative slip of the two vertebrae, which involves mechanical factors, that is, there is a force in the body that allows the relative slip of the two vertebrae, the scientific name is shear force. Even if you do a manual reset, the vertebral body back to its normal position, as long as this shear force still exists, it will still let it slip to the original degree of slippage, the effect can not be long-term maintenance, so it is not recommended that patients with lumbar spondylolisthesis do orthopedic treatment.
Fifth, some patients have obvious lumbar pain and soreness, and the examination reveals lumbar spine slippage, does this situation need to be operated? If surgery is not recommended, what can be done to reduce the symptoms of lumbar pain? Is bed rest, physiotherapy, external ointment, oral Chinese medicine or anti-inflammatory and pain-relieving drugs useful?
This situation requires specific analysis of the problem. There are two main reasons for lumbar back pain in patients with lumbar spondylolisthesis, the first is due to the instability of the spine caused by lumbar spondylolisthesis, and generally this pain is intermittent; the second is that after lumbar spondylolisthesis, the muscles of the lumbar back will take on more force, which over time causes muscle weakness in the lumbar back or soft tissue problems such as chronic lumbar muscle strain, resulting in lumbar pain in patients.
If it is the first time that the patient has symptoms of low back pain and soreness, or if there is an obvious trigger for each low back pain, such as a sprain or low back pain after moving something, I think surgery should be done with caution in this case. Most of this kind of back pain is caused by soft tissue problems such as muscle strain or fasciitis in the patient’s low back after a lumbar spondylolisthesis. Generally, through a certain period of conservative treatment, a better treatment effect can be achieved without the need for immediate surgery. Patients can try bed rest, appropriate physical therapy, such as medium-frequency electrotherapy, heat therapy, infrared light, etc., can also use external ointment, oral anti-inflammatory and pain-relieving drugs or tendon-enhancing Chinese medicine, depending on the patient’s condition, so that the attending doctor can help to allocate.
For patients with intermittent lumbar pain caused by lumbar instability, the main thing is to make the lumbar spine stable, usually the doctor will let the patient wear a peri-waist for a short time, if it can relieve this intermittent lumbar pain also further confirm that the lumbar pain comes from the lumbar instability. However, the peri-waist should not be worn for too long, generally not more than 3 months, otherwise there will be disuse weakness and atrophy of the lumbar back muscles.
Six, bed rest is always lying in bed motionless? Flat, lying down or side lying? Bed rest and physical therapy, how long does it usually take to work? Plaster or painkillers, how long does it usually take to work?
Bed rest is not the same as lying motionless in bed, you can move, posture lying flat, side can, but try to ensure that the body in a straight line, do not have to twist the waist action. If the upper body is lying flat, then the lower body as far as possible is also lying flat position, if the upper body lying on its side, the lower body should also be lying on its side. If it is muscle, fascia and other soft tissue problems resulting in pain, generally after bed rest, physiotherapy and other conservative treatment, 3 to 4 weeks to be able to see results; eat anti-inflammatory pain medication, then the effect will be obvious, after eating will have an immediate effect.
Seven, how long do I have to wear the waist in general? Can I keep wearing the waist since it doesn’t hurt when I put it on?
In the acute stage of attack, the patient’s back pain is strong. Usually the treatment course for low back pain is 4~6 weeks, and the time to wear the peri-waist fixed is also 4~6 weeks, which should not be too long, generally the longest is not more than three months. If the waist is used for a long time, the muscles of the low back will become dependent on the waist, causing weakness of the muscles of the low back, and once the waist is taken off the patient will feel weakness of the waist. Therefore, it is recommended that after 4 to 6 weeks of wearing it, the symptoms gradually improve, we should take it off to carry out functional exercises for the muscles of the low back.
It is important to emphasize to the patient that both taking anti-inflammatory painkillers and wearing a peri-waist are only treating the symptoms of lumbar pain, not the root cause of the pathological changes of lumbar spondylolisthesis. These conservative treatments have a certain course limit, usually 4 to 6 weeks, and cannot be conservative for too long. Taking anti-inflammatory painkillers for a long time can bring certain side effects, such as irritating the stomach and affecting the blood system. If the symptoms still do not improve after regular and strict conservative treatment, or if the back pain recurs and occurs after minor external force, trauma, cold or exertion, then the patient needs to be re-evaluated for the need of surgery.