Notes on different stages of conservative treatment of lumbar disc herniation

Based on the severity of lumbar pain and the urgency of the onset, conservative treatment of lumbar disc herniation is divided into three phases: acute onset, remission and functional recovery, with different goals, methods and priorities for each phase of treatment. The acute phase is within 2 weeks of onset, during which the clinical manifestation of pain is severe, muscle spasm of the low back and nerve root irritation signs are obvious, and the pathological manifestation is mainly inflammatory irritation of chemical substances in the nucleus pulposus and immune response, so the treatment goal should be active analgesia, bed rest, acupuncture, traction or with static steroids, dehydrating agents, opioid analgesic drugs if necessary, or supplemented with herbal medicines to activate blood, relieve pain and reduce swelling. Do not perform intense functional exercises or heavy manipulation to avoid aggravating the pain symptoms. Many patients are eager to seek medical treatment and often ask the therapist to aggravate the treatment or increase the functional exercise on their own, which is often counterproductive and requires attention. The remission period is 2 to 3 weeks after the onset of the disease, clinically marked by pain relief, the pathological manifestation of the protrusion of continuous compression and secondary adhesions as the main, should be to promote blood circulation in the lumbar region and lower limbs, release the lumbar back muscle spasm and release adhesions as the treatment goal, to take moderate tui-na manipulation, lumbar traction, Chinese medicine fumigation, medicine jar therapy, red light irradiation and other physical therapy measures, or oral non-steroidal anti-inflammatory painkillers, or supplemented with herbal medicines to invigorate blood and dredge the meridians. Many patients are often afraid to engage in functional exercise after suffering from severe pain, fearing that the condition will be repeatedly aggravated. During this period, patients should be encouraged to carry out a moderate amount of functional exercise to achieve the effect of releasing spasm and promoting muscle strength recovery. The functional recovery period is 4 to 6 weeks later, which is related to the individual characteristics of the disease and the efficacy of the treatment measures. During this period, the pain has been removed, or there is only numbness of the affected limb, muscle atrophy, motor weakness, etc. The pathological manifestations of the prominent nucleus have reduced the biochemical damage to the affected nerve roots, etc. The treatment goal should be to eliminate these residual neurological symptoms and signs. The treatment goal should be to eliminate these residual nerve signs and symptoms. Patients should be actively guided to perform orderly functional exercises in a pain-free state, and muscle splinting should be achieved through muscle training to prevent recurrence of the disease.