We have summarized the frequently asked questions of outpatients with low back pain, from which we have selected some easy-to-understand ones, and hope they can be of some help to patients with low back pain.
1.Which department should a patient with low back pain see if he/she does not have surgery?
Patients with low back pain who do not undergo surgery can basically be divided into 3 types of cases: those who do not need to do it, those who do not want to do it and those who cannot do it. “Don’t need to do” means that the degree of lesion and clinical symptoms of low back and leg pain caused by various reasons are not too heavy and not to the extent that surgery is necessary; “don’t want to do” means that the degree of lesion is heavy and the clinical symptoms seriously affect life, study and work, when it is due to economic, family and other external reasons or the patient himself. “can’t do it” means that the degree of lesion is serious, and in terms of the original disease of low back pain, surgery should be done, but the patient can’t bear the risk of surgery because of advanced age, frailty or other serious concomitant diseases of the system.
Regardless of which cause of low back pain patients do not have surgery, they can try to relieve symptoms and delay the course of the disease through rest, braking, medication, physical therapy, traction, manipulation, exercise, and conservative treatment methods such as Chinese medicine. In addition to orthopedics, you can also choose to visit rehabilitation, physical therapy, Chinese medicine, acupuncture and other related departments.
2.What are the rehabilitation treatments for low back and leg pain?
There are many rehabilitation treatment methods for low back pain, including massage, lumbar traction, exercise therapy, auxiliary brace and various physical factors such as electricity, sound, light, magnetism, heat, cold, etc. In clinical practice, multiple methods can be applied simultaneously to obtain the “superposition” effect. However, it must be noted that although rehabilitation treatment is not open and bloodless, it is not absolutely safe, and any rehabilitation treatment should be preceded by regular diagnosis and guidance from clinicians to avoid aggravation of the condition due to improper choice of treatment.
3.How to judge the efficacy of conservative treatment for back and leg pain?
From the current data, it seems that the percentage of patients who must undergo surgery for low back pain due to various reasons is about 15-20%, while most patients with low back pain can be relieved by conservative treatment. Many patients with low back and leg pain like to ask their doctors if conservative treatment is effective during their first visit to the rehabilitation clinic, a question that can sometimes be difficult for the clinician. If the outpatient physician is able to determine, through consultation, examination and film review, that the patient falls into the “don’t do it” category in question 2, he should be able to tell the patient with certainty that conservative treatment will work. However, if the patient falls into the “don’t want to do it” or “can’t do it” category, it is difficult for the outpatient physician to tell the patient at the first visit whether conservative treatment is effective. In this case, a more objective approach is to try conservative treatment for 1 to 2 weeks and use the facts to speak for themselves.
After 1 to 2 weeks of conservative treatment, if the patient’s symptoms change in one of the following ways, conservative treatment can be considered effective and can be continued for 1 to 2 weeks to consolidate the effect: the pain level decreases or disappears; the pain area moves to the central region of the spine (the so-called “centripetal phenomenon” of pain, such as the most distal part of the original lower extremity radiating pain up to The most distal end of the lower extremity radiating pain can reach the toes, but after treatment the most distal end moves up to the lower leg); the duration of pain is shortened; the movement that causes pain is reduced; and the range of motion of the lower back is expanded.
It is important to understand that most conservative treatments, especially physiotherapy, are dependent on the cumulative effect, with the exception of medications or invasive treatments, which can have an “immediate” effect. Therefore, do not think that conservative treatment is ineffective because after one or two treatments do not see obvious results.
4.Can manipulation massage “press the herniated disc back”?
Massage therapy for low back pain mainly refers to traditional Chinese medicine massage and Western-style manipulation. The former’s main mechanism of action is to relax the meridians, move the qi and blood, tendons and knots. The latter includes McKenzie therapy, American chiropractic, Australian joint relaxation, etc., which are based on local anatomy, biomechanics and kinematics, aiming at correcting small joint disorders and soft tissue alignment, changing local anatomical position and mechanical environment.
Regardless of the type of manipulation, it is possible to relieve pain symptoms by relaxing local soft tissues, reducing inflammation and edema, repositioning small joints, and lowering intervertebral pressure, and even to “return” the displaced nucleus pulposus due to increased intervertebral pressure. However, please review the anatomy of the disc as described earlier in this book. When the peripheral annulus fibrosus has ruptured pathologically and the contents have protruded beyond the annulus fibrosus, i.e., when the disc has reached the level of “herniation”, the soft “stuffing” can be removed through manual therapy. The “hard shell” is unlikely to be stuffed back through manipulation. Therefore, strictly speaking, manipulation does not “press the herniated disc back”. Some hospitals or manufacturers’ advertisements show that the “protruding tissue is smaller” on the imaging after treatment, but it is just an illusion caused by the acute inflammatory products shrinking or disappearing after treatment.
5, low back pain when what can not do manipulation massage therapy?
Most patients with low back and leg pain can relieve their symptoms to varying degrees through massage therapy. However, in the attempt to apply medium and severe manipulation massage treatment, must be strictly selected for the indications, otherwise the condition may worsen, the pain is aggravated, and even cause the corresponding nerve, spinal cord injury, serious cases can lead to limb paralysis. Contraindicated to do manipulation massage treatment of lumbar pain include the following cases.
(1) lumbar spine tumors (primary lumbar vertebral body tumors, primary tumors of the lumbar spine adnexa, primary lumbar intraspinal tumors, primary extraspinal tumors in the lumbar spinal canal, primary pelvic tumors, metastatic spinal tumors, etc.)
(2) inflammatory low back pain (lumbar spine tuberculosis, ankylosing spondylitis, lumbar spine bacterial inflammation, lumbar spine parasitic disease, etc.)
(3) lumbar pain due to visceral diseases
(4) deformity of the lumbar spine (deformity of the lumbar vertebral body, deformity of the lumbar accessory vertebrae, abnormalities of the lumbosacral vertebrae, deformity of the anterior lumbar convexity, etc.)
(5) severe osteoporosis of the lumbar spine
(6) diabetic low back pain.
(7) Paget’s disease low back pain and lower back pain due to hyperthyroidism.
(8) lumbosacral region in pregnant women and menstruating women
(9) Those with bleeding tendencies.
(10) Extreme fatigue, after alcohol.
(11) Patients with local skin breakdown or skin diseases.
(12) patients with mental illness and can not cooperate with the therapist.
6, manipulation massage process, the therapist force a wrench, there is a “click” sound is how?
This situation is mostly seen in the application of Chinese medicine massage techniques in the “wrench” method of treatment. The “tug” method refers to the physiologically permissible range, the patient to do more than their own range of motion flexion and extension and rotation activities. The lumbar spine tug method has lying lumbar spine oblique tug method, as the lumbar spine oblique tug method, lumbar spine posterior extension tug method and lumbar spine rotation reset method, the maneuver success can be heard more “click” sound. The technique has the effect of loosening the adhesions, rectifying the misalignments, repositioning, soothing the tendons and opening the ligaments, etc., which can often have an immediate effect. However, it should be noted that this technique on the patient’s condition and therapist / massage therapist skills have certain requirements, must be administered in a regular hospital, not by non-professionals according to the gourd drawing on the “so a little”, so as not to cause aggravation of disc herniation or acute disc prolapse, causing cone, cauda equina nerve injury, resulting in lower limb paralysis The “to so” to avoid aggravation of disc herniation or acute disc prolapse, causing conus, cauda equina nerve damage, resulting in lower limb paralysis, incontinence and other serious consequences.
7, community massage store massage for low back pain is safe?
Massage according to the role can be divided into therapeutic massage and relaxation massage. As the name implies, the former mainly for organic changes resulting in pain or other body dysfunction, while the latter is aimed at relaxing the whole body or local soft tissue.
Community massage stores to relaxation massage mostly, a single treatment time is longer, for subhealthy people have a good effect of fatigue relief. However, practitioners do not necessarily have a medical background, massage training related to the lack of professionalism, often through short-term training, learn some basic “routine” can be on the job. Therefore, if the organic pathology such as lumbar disc herniation caused by lumbar pain, it is best not to try to “treatment” in the community massage store, especially do not easily try to “trigger” and other heavy manipulation of the treatment, so as not to cause disc herniation aggravated or acute intervertebral disc The prolapse of the disc, causing cone, cauda equina injury, resulting in lower limb paralysis, urinary and fecal incontinence and other serious consequences.
8.Can traction “return the herniated disc”?
Traction therapy is a very important means of rehabilitation for patients with lumbar pain. The main functions of lumbar traction include: (1) relaxing the tense and spastic muscles and reducing the congestion and edema of the nerve roots; (2) separating the adjacent vertebrae, enlarging the corresponding vertebral space and intervertebral foramen and reducing the pressure on the nerve roots; (3) reducing the internal pressure of the intervertebral disc and facilitating the return of the herniated disc.
But is traction really that miraculous that it can “return the herniated disc”? According to the previous part of this book, we know that there are different degrees of lumbar disc herniation. The so-called “retraction” is limited to cases where the annulus fibrosus is still intact and the pressure between the vertebrae increases in the acute phase. When the peripheral annulus fibrosus has ruptured pathologically and the contents have protruded beyond the annulus fibrosus, it is unlikely that the soft “filling” can be stuffed back through the “hard shell” by conservative treatment. Some hospitals or manufacturers’ advertisements show that the “protruding tissue has become smaller” on the imaging after treatment, but this is just an illusion caused by the acute inflammatory products shrinking or disappearing after treatment.
9.Can patients with lumbar and leg pain have traction on their own? Under what circumstances can traction treatment not be done?
Some patients with lumbar and leg pain try to “self-traction” by hanging from a double bar or door frame with both hands. In this case, gravity acts as an axial pulling force, which is indeed therapeutic for some patients with lumbar pain. However, due to the different degrees of relaxation of the upper limbs and trunk, it is difficult to control the traction force and therefore the efficacy cannot be guaranteed. Moreover, it is important to know that not all patients with low back and leg pain are able to do traction therapy. Conditions that contraindicate lumbar traction include: pregnancy, severe osteoporosis, more serious hypertension or cardiovascular disease, disc protrusion significantly compressing the spinal cord or cauda equina, obvious lumbar spine slippage, various bony tumors or atopic inflammation (tuberculosis, intervertebral discitis), etc.
10.What is the difference between computer traction and ordinary traction?
Computerized traction is to precisely control the dose, site and angle of traction through the computerized operation platform, so that the prescription is more scientific and reasonable and the therapeutic effect is more reliable.
11.Is traction treatment in community hospitals as effective as in tertiary hospitals?
Many patients believe in the level of the hospital and think that the equipment of the tertiary hospital must be better than the community hospital, so they would rather go to the tertiary hospital for treatment even if they have to travel for one or two hours. In fact, traction therapy is a very common treatment technique, and as long as the appropriate equipment is available, there is not much difference in efficacy. For patients in the acute stage, we recommend treatment in the vicinity, so as not to travel to make the treatment effect is greatly reduced. Of course, if the patient does not feel comfortable with the technology of the community hospital, you can also go to a large hospital first, according to the corresponding treatment prescription, in the dose, intensity of the community hospital operation to give some guidance.
12.Is physical therapy and “baking” the same thing?
The term “baking electricity” is a term that appears more frequently in rehabilitation clinics, and many patients think that physical therapy is “baking electricity”. It is not known that physical therapy (also known as physical factor therapy) is a method of treating and preventing diseases by applying natural or artificial physical factors to the human body, and it is not just what people call “baking electricity”.
There are two major types of physical factors that can be used for rehabilitation: one is the physical factors from nature, such as sunlight, air, seawater, hot springs, mud and mineral springs, etc.; the other is the artificial physical factors, such as electricity, light, ultrasound, magnetism, heat, cold, water and biofeedback, etc.
13, physical therapy may be harmful to the human body?
Most physical therapy is harmless to the human body, but there are a few physical therapy effects on the human body will produce certain side effects. Such as high-frequency electrotherapy may lead to neurasthenia syndrome, resulting in dizziness, sleep disorders, memory loss, emotional instability, excessive sweating, etc.. Therefore, it should be noted that physical therapy should not be excessive.
14.What are the physiotherapy options available for patients with low back pain? Which one is the best?
Physical therapy for patients with low back and leg pain includes high frequency electricity (short wave/ultra-short wave/microwave/decimeter wave/mm wave), interference electricity, low frequency electricity, direct current drug ionization, ultrasound, ultrasonic drug penetration, wax therapy, heat therapy, cold therapy, traction, massage, etc.
Many patients love to ask which physical therapy is the best and most effective. In fact, each of the physical therapy mentioned above has its own characteristics, and the physician should choose according to the site, nature and scope of pain when prescribing treatment. In addition, even the same treatment may have different therapeutic effects due to different machine models. Therefore, it is important to take the advice of the physician for the specific application. In most cases, physicians will choose several physical factors for patients at the same time to obtain the “superimposed” effect of treatment and obtain better results.
15.What is Chinese medicine introduction? Is it useful for relieving back and leg pain?
Chinese medicine ionization method is a kind of treatment that uses direct current electric field (or low frequency pulse electric field) to introduce molecules or ionic groups in Chinese medicine liquid into human body through skin or mucous membrane. This therapy has the dual effect of electrotherapy and Chinese medicine treatment, with the function of activating blood circulation, anti-inflammatory and analgesic, softening and dispersing, which can relieve back and leg pain to a certain extent.
16.What is the difference between the thermal effect of high frequency electrotherapy and hot water bag?
Commonly used high-frequency electrotherapy, including short-wave, ultra-short-wave, microwave, sub-meter wave and millimeter wave therapy, is the use of electromagnetic waves in the high-frequency part of the radio waves generated by the energy caused by the movement of different molecules and ions in the deep tissue, resulting in frictional heat. This thermal effect is generally referred to as “endogenous heat”, which can act deep in the body’s muscles, fascia and other deep tissues, the principle is somewhat like using a home microwave oven to heat food, is the central region first hot up.
Hot water bags, hot treasure, hot water baths, etc. belong to the conduction of heat therapy, the thermal effect from the outside to the inside, due to the thermal effect of local vasodilation, resulting in the heat is easy to spread out, to make the local deep tissue heat is relatively difficult. This explains why when people soak their feet in hot water, their whole body gets hot and even sweats.
17.What is paraffin therapy? What is the difference with hot water bag?
Paraffin wax therapy is a method of using heated paraffin wax to treat diseases, which is a very good conduction heat therapy. The melting point of medical paraffin wax is 50-55℃, and its characteristics are large heat capacity, low thermal conductivity, more heat absorbed after heating, and long heat preservation time, compared with hot water bags, the temperature is more constant, the heating is more durable, less likely to burn the skin, and more comfortable and safe. Moreover, in addition to the thermal effect, paraffin wax has a therapeutic effect that hot water bags do not have: first of all, because paraffin wax has good plasticity, flexibility, adhesion and stretching, hot wax can be applied to the human body when the skin, when cooled, the volume is reduced, which produces mechanical compression of the tissue, which helps to reduce swelling; secondly, paraffin wax has an oily nature, after applying wax skin lubrication, which is conducive to skin care, scar softening.
For patients with back and leg pain, paraffin wax therapy is more comfortable, safe and durable, and the mechanical effect of cooling has the effect of massage, which is a very good treatment method.
18.What is laser? Is it useful for relieving low back pain?
Laser is the use of molecules or atoms are excited to emit radiation to achieve the amplification of light, the essence is a kind of electromagnetic wave. Laser has the physical properties of general light, but also has high brightness, good monochromaticity, strong directionality, good coherence and other characteristics, has become a physical factor treatment method commonly used in rehabilitation clinics.
Most of the lasers used in rehabilitation clinics are low-intensity lasers, which can produce stimulation, activation and photochemical effects on tissues, which can improve circulation, analgesia, enhance immunity and accelerate tissue repair, and are effective in relieving low back pain.
19.Some physical therapy does not feel when it is done, will it be ineffective?
Many people think that physical therapy must be “sensory” and local must be “hot”, mainly because most physical therapy has thermal effect, which makes people have a misunderstanding. In fact, many physical factor treatments rely on the “non-thermal effect” to work. Take the common physical therapy for back and leg pain as an example, such as short time laser therapy, ultrasonic pulse wave therapy, magnetic therapy, etc., in the process of treatment, although not necessarily “feel”, but the efficacy is certain. Even the most familiar ultrashort wave therapy, there is a “no heat” treatment dose, the application of its non-thermal effect.
20.Is physical therapy in a community hospital as effective as in a tertiary hospital?
Nowadays, most community hospitals are equipped with corresponding professional physical therapy equipment, which is not much different from the so-called “big hospitals” such as the tertiary hospitals, so for most patients, we recommend treatment in the vicinity. Of course, large hospitals have the advantage of being able to diagnose and select prescriptions with certain accuracy due to the relatively large number and complexity of the diseases they treat. Therefore, if a patient is not comfortable with a community hospital, he or she can also choose to go to a large hospital, and then go to a community hospital for treatment after the doctor has confirmed the diagnosis and prescribed a specific physical therapy prescription.
21.Can I do physiotherapy at home?
Although physical therapy is called “treatment”, it is not only available in hospitals. For patients with back and leg pain, they can do some simple cold therapy or heat therapy at home using ice bags and hot water bags, which can also be effective. Some elderly people have the habit of lying in bed in the sun, which also has a theoretical basis. Visible light, infrared and ultraviolet light in sunlight are beneficial to the human body, visible light and infrared heat effect can effectively improve local blood circulation, antispasmodic and analgesic, while ultraviolet light is conducive to the transformation of vitamin D in the body, helping to relieve osteoporotic back pain.
22.Does the spectrum meter and other home physiotherapy instruments work?
At present, there are many home physical therapy instruments on the market, such as ** spectrum instrument, ** electrotherapy instrument and so on. These instruments are theoretically effective, such as the principle of the spectrum instrument is the use of electromagnetic radiation on the body and produce therapeutic effects, its composition is mainly visible light and infrared, the main application of its thermal effect in the treatment, can be used at home under the guidance of doctors. However, before forming a regular treatment, it is still recommended to go to a regular hospital, to be diagnosed and prescribed by a physician, and to determine whether the patient has any contraindications to the relevant physical therapy.
23.Can patients with low back and leg pain do cold therapy?
Many patients with low back and leg pain think that they must pay attention to keeping warm and refuse cold therapy for fear of “catching cold”. Cold therapy refers to the application of low temperature below body temperature and surrounding air temperature, but above 0℃ to treat diseases. When cold stimulation is applied to the body, the immediate axonal reflex will cause small blood vessel constriction and reduced blood flow, but the application of cold for more than 15min can reflexively cause secondary vasodilator response, which can improve local circulation and promote the discharge of metabolites and pain-causing substances. In other words, cold therapy can play a similar role to heat therapy for patients with low back and leg pain after a certain period of time, with a certain “thermal effect”. Moreover, compared with heat therapy, the effect of cold stimulation is deeper and more likely to reach deeper tissues.
In addition, cold therapy has effects that heat therapy does not have for patients with low back pain: cold stimulation can reduce the conduction speed of sensory nerves, especially the fine fibers that conduct nociception, so that the patient’s pain threshold is increased, thus reducing pain; cold stimulation for a certain period of time can reduce the conduction speed of motor nerves, muscle tone and muscle strength, thus playing the role of antispasmodic; cold stimulation can also reduce the temperature of skin, subcutaneous, muscle, joint Cold stimulation can also lower the temperature of skin, subcutaneous, muscles, joints and other tissues, so that the metabolic rate of tissues decreases and oxygen consumption is reduced, which is conducive to controlling acute inflammation and reducing edema.
To sum up, for patients with low back pain, cold therapy can play a role similar to heat therapy, but also has the efficacy that heat therapy does not have. However, it has not been well promoted in China due to the deep-rooted concept of “keeping warm”.