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Lumbar disc herniation
What is lumbar disc herniation?
Lumbar disc herniation is a condition caused by the rupture of the fibrous ring of the intervertebral disc, protrusion of the central nucleus pulposus, which compresses the nerve roots or the spinal cord, resulting in a series of symptoms. For example, it can cause pain in the lower limbs and instability in the lumbar spine, leading to pain in the waist, as well as pain in the waist when walking or standing, and even sensations of numbness and tingling in the lower limbs. In severe cases, it can cause symptoms affecting urination and defecation.
How to exercise with lumbar disc herniation
For patients with lumbar disc herniation, self-exercise is a very important and effective treatment method. First, it is important to maintain the correct sitting posture, sit up straight without leaning sideways, and avoid sitting for extended periods. It is also necessary to keep the waist warm to prevent catching cold. Second, it is necessary to strengthen the exercise of the back muscles, especially the erector spinae and multifidus, with exercises such as single-leg bridges, double-leg bridges, and the "little swallow" exercise. Third, maintain the correct posture in daily life, such as when lifting or holding objects, to avoid increasing tension in the waist and causing unnecessary damage. Fourth, regarding rest, it is crucial to lie on a firm bed and possibly add a thin pad under the waist to keep the hips and knees in a certain alignment, ensuring the waist muscles can fully relax. Fifth, always wear a waist belt during exercise. The waist belt is one of the most important orthopedic supports, serving to immobilize and protect the waist, limiting movement during activity to solidify the effects of earlier treatments. Therefore, patients with lumbar disc herniation must develop a complete and reasonable treatment plan at a regular medical institution and normal physiotherapy institution.
Lumbar disc herniation symptoms
Patients with lumbar disc herniation can exhibit a variety of clinical symptoms which may differ according to age, gender, duration of illness, and the location of the herniation. Among these, back pain is a symptom that occurs in over 90% of the patients. The pain is primarily located in the lower back and the sacral area, most commonly presenting as persistent dull pain. Another common symptom is radiating pain in the lower limbs, which may extend from the lower back and buttocks to the back of the thigh, front or back of the calf, all the way to the heel. The nature of the pain is primarily radiating and piercing. Additionally, there may be reduced sensory and motor functions in the lower limbs as well as cauda equina syndrome symptoms.
Lumbar disc herniation is where?
Where does lumbar disc herniation occur? Let's first discuss what a lumbar disc is. A lumbar disc is a fibrous pad located between the upper and lower vertebrae, which can be understood as a joint between the two vertebrae. Its outer layer is made up of a dense fibrous ring, formed in different combinations and arrangements, with a nucleus pulposus in the middle, which primarily functions to bear pressure from various directions and disperse it. Lumbar disc herniation occurs when, for various reasons such as aging, trauma, or pathological changes, the lumbar disc protrudes. If the protrusion does not break through the fibrous ring, it is called bulging. If it compresses and causes the fibrous ring to rupture, it is called herniation. Thus, the herniation can protrude backward, upward, or forward; however, it is mostly the backward protrusion that can cause symptoms by compressing nearby tissues, such as the spinal cord, blood vessels, and nerve roots.
Where to apply moxibustion for lumbar disc herniation
If moxibustion is used to treat a lumbar disc herniation, the main acupoint is the Jiaji acupoint located on both sides of the herniated disc, along with the Jiaji acupoints immediately above and below it. For example, if you have a herniation between the 3rd and 4th lumbar discs, you should moxibust the 2nd, 3rd, and 4th Jiaji acupoints, and so on. In addition to the main acupoint, there are auxiliary acupoints chosen based on the different symptoms of different patients. Generally, if there is significant back pain, the acupoint on the affected side is the Yaoyan. If there is muscle tension and tenderness in the buttocks, match with Huanjiao and Yibian. If there is muscle tension on the back of the thigh, match with Chengfu, Yinmen, and Weizhong. If there is numbness on the outer side of the thigh, match with Fengshi, and for calf numbness, match with Weiyang, Chengshan, and Yanglingquan. If there is numbness on the top of the foot, followed by weakness in the foot or toe region, match with Taixi, Jiexi, and Xiexi.
How to care for lumbar disc herniation
The intervertebral discs of a normal human body, according to related evidence-based medical research, begin to degenerate around the age of twenty-five. How should we maintain them in daily life? First, when lifting heavy objects in everyday life, it is necessary to do so by squatting partially and then lifting the weight with the strength of your knees and hips when standing up. Do not bend at the waist with straight knees and hips to lift heavy objects, as this can cause severe loading on the lumbar spine, leading to herniated discs. If symptoms are already present, maintenance measures include wearing a lumbar support, sleeping on a hard bed, and undergoing relevant physical therapy, among others.
Lumbar disc herniation has what manifestations?
Lumbar disc herniation has the following clinical manifestations. First, lower back pain accompanied by unilateral radiating pain in the lower limbs. Second, numbness in the localized area. Third, weakness in the toes. Fourth, decreased temperature in the affected limb. Upon examination, the first finding is a reduced natural anterior curve of the lumbar spine, which we refer to as a flat or board-like back. Second, it can also cause the lumbar spine to bend to one side, possibly toward the affected side or the healthy side, depending on the location of the herniation. Third, there is a fixed tender point beside the lumbar spine, which plays an active role in diagnosis and treatment. Fourth, due to pain, there is a limitation in the movement of the lower back; normally, the lumbar spine can flex 45 degrees forward, extend 20 degrees backward, and bend 30 degrees to each side. If these ranges of motion are not achievable, it indicates a significant limitation in lumbar activity. Fifth is the neurological localization examination, which primarily involves different sensory disturbances, motor disturbances, or muscle atrophy depending on the site of compression. There are also some special tests, like the straight leg raise test, reinforcement test, healthy side leg raise test, as well as the neck flexion test and femoral nerve stretch test. Lastly, additional diagnostic tests like CT or MRI can provide specific information on the location and stage of the lumbar disc herniation.
Where to press for lumbar disc herniation
Massage for lumbar disc herniation involves main and auxiliary acupoints. The main acupoint is the Jiaji acupoint at the affected disc side, followed by the Jiaji acupoints immediately above and below it. Auxiliary acupoints are chosen based on the patient's specific symptoms. Typically, if there is significant lower back pain, the affected side's Yaoyan acupoint is used. For tense gluteal muscles with tenderness, the Huanjiao acupoint is selected. If there is muscle tension on the back of the thigh, the Yinmen and Hebei acupoints are advisable. If numbness occurs on the outer side of the thigh, the Fengsi acupoint should be used. For numbness in the lower legs, the Yanglingquan acupoint is suitable. If numbness affects the foot, the Taixi and Yibian acupoints are recommended.
What should I do if I have a lumbar disc herniation?
After a lumbar disc herniation, it is essential to first determine the type of herniation you have. Clinically, lumbar disc herniations can be categorized into protrusion, prolapse, extrusion, and sequestration, with protrusion being the most common. Once the type of herniation is identified, treatment can begin. Currently, the treatment methods are diverse and can be broadly classified into six categories. The first is internal treatment with traditional Chinese medicine. Traditional Chinese medicine classifies lumbar disc herniation into four types, each treated with different medications. The second is external treatment with traditional Chinese medicine, such as herbal fumigation and plaster application. The third is traction, which includes bed traction and manual massage. The fourth is acupuncture. The fifth category includes other therapies, starting with resting on a hard board bed for approximately a week, followed by techniques like small needle knife therapy, intradiscal injection, sacral canal injection, and ozone therapy. If conservative treatments prove ineffective, or if symptoms worsen during treatment, surgical intervention may be necessary. Surgical treatment is generally indicated in the following four situations: patients with spinal stenosis, patients who do not respond to conservative treatment or who experience recurrent symptoms after recovery, patients with worsening neurological symptoms, and patients with central lumbar disc herniation causing incontinence. These are the conditions mentioned above.
Is moxibustion effective for lumbar disc herniation?
As an important treatment method in traditional Chinese medicine, moxibustion has very good therapeutic effects for treating lumbar disc herniation. As long as the acupuncture points are correctly selected, the treatment effect is very good. Specifically, if you choose to use moxibustion for treatment, the main point would be the Jiaji points, and this should include the two adjacent vertebrae. For example, for a L4-L5 disc herniation, you should select points L1 to L5. Auxiliary points should be chosen based on different symptoms of the patient, in combination with different acupoints. For example, if the waist pain is significant, combine with the affected side's Yaoyan point. If the buttock muscles are tense, combine with Huanjiao and Yibian points. If the posterior thigh muscles are tense, combine with Chengfu, Yinmen, and Weizhong points. If there is numbness on the lateral thigh, combine with Fengshi. For numbness in the calf, combine with Weiyang, Chengshan, Yanglingquan, Zusanli, and Xuanzhong points. If the dorsum of the foot is numb, combine with Taixi, Jiexi, and Xiexi.