How to treat a lumbar disc herniation?

Written by Na Hong Wei
Orthopedics
Updated on September 08, 2024
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Clinically, the treatment of lumbar disc herniation usually involves the following three aspects. The first is conservative treatment, which is mainly for those patients whose lumbar disc herniation is not very severe and does not cause substantial compression of the nerve roots and spinal cord. The first step includes general treatment, that is, after developing a lumbar disc herniation, one needs to lie flat in bed, rest on a hard bed, and then rest. The second is treatment with Chinese herbal medicine, the third with Western medicine, and the fourth is traditional Chinese medicine rehabilitation treatment, which includes traction, massage, acupuncture, and others. There is also physical therapy, which includes treatments like shockwave thermotherapy and microwave therapy. Often, some patients experience symptom relief after conservative treatment. There are also some patients whose symptoms do not improve during treatment, and even worsen, at which point surgical treatment is needed. Surgical treatment has its strict indications. However, once within the range of these indications, surgical treatment should be considered. Surgical treatment now is divided into minimally invasive therapy and conventional surgical treatment. The third is other treatments, which are also numerous, including ozone therapy, sacral canal treatment, intradiscal injections, and so on. Therefore, the treatment of lumbar disc herniation mainly depends on the degree of protrusion and clinical symptoms, which are analyzed comprehensively to select a suitable treatment method.

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Written by Na Hong Wei
Orthopedics
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Is massage useful for lumbar disc herniation?

Can massage be used for lumbar disc herniation? Its clinical effects are quite good. The primary function of massage therapy is to relieve muscle spasms, then dilate blood vessels, increase local blood circulation, and promote peripheral metabolism, thereby achieving the purpose of curing diseases. It mainly uses rolling and pushing techniques, with the main acupoint being the Jiaji acupoint. Auxiliary acupoints generally include Yangguan, Yaoyangguan, Mingmen, Shenshu, Weizhong, Chengshan, and Yanglingquan, among others. Additionally, it includes two board techniques. These board techniques are very effective for minor joint disorders of the lumbar spine. There are two board techniques, one is the slant board technique, and the other is the rotating tube board technique, with the slant board technique being relatively easier to perform. Generally, patients experience varying degrees of symptom relief after proper and effective massage, and many people's symptoms disappear altogether.

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Written by Guan Yu Hua
Orthopedic Surgery
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Can lumbar disc herniation be treated with an injection block?

Lumbar disc herniation can be treated with an injection, which mainly uses caudal epidural steroid injections. This approach has a certain therapeutic effect but is limited. For example, it may relieve the patient's pain for about a week, after which symptoms may gradually reappear. I believe that this treatment method is more about addressing the symptoms rather than the root cause. For ineffective conservative treatments, such as resting on a hard bed, applying local heat, minimizing prolonged sitting, and lying down as much as possible except for going to the toilet or eating, symptoms will generally gradually alleviate over about 10-14 days. This can be combined with drugs that promote blood circulation and relieve pain, and drugs that nourish the nerves, as well as some diuretic drugs to relieve the pressure on the intervertebral discs. This can alleviate the stimulation of the nerve roots by the nucleus pulposus of the intervertebral discs, affecting nerves from L4 to S3, which may cause numbness and pain in the back of the thighs, the dorsum of the calves, or feet. The symptoms vary depending on the stage of compression but the difference isn't significantly large. For cases where conservative treatment or injections are ineffective, we can consider interventional surgeries like ozone nucleolysis, which are currently performed skillfully with minimal damage and quick recovery. You can consult a hospital for more information.

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Written by Na Hong Wei
Orthopedics
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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.

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Written by Na Hong Wei
Orthopedics
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Where to apply moxibustion for lumbar disc herniation

After a lumbar disc herniation, if moxibustion treatment is used, there is a concept of main and supplementary acupuncture points. The main point is the Jiaji point at the herniated lumbar disc segment, accompanied by the Jiaji points directly above and below it. For example, for an L4-5 disc herniation, moxibustion would be applied to the Jiaji points of L3-4, L4-5, and L5-S1. Additionally, supplementary points are chosen based on the patient's other symptoms. If there is significant lumbar pain, the Yao Yan (Lumbar Eyes) point on the affected side is used. If there is muscle tension in the buttocks, the Huan Tiao and Yi Bian points are used. If there is tension in the back of the thigh, support would include the Fu Cheng, Yin Men, and Wei Zhong points. If numbness occurs on the outer side of the thigh, the Feng Shi point is used. For numbness in the calf, the Wei Yang, Cheng Shan, Yang Ling Quan, Zu San Li, and Xuan Zhong points are used. For numbness on the dorsum or sole of the foot, the Tai Xi, Jie Xi, and Xia Xi points are included.

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Written by Na Hong Wei
Orthopedics
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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.