Let's discuss a very common spinal disease - intervertebral disc herniation. But first, let’s look at the concept of osteochondrosis, a complication of which is a herniated disc.
Center for Neurosurgery Dr. Baklanov A.N. successfully treats spinal hernia. We will answer all your questions by phone: +7 (499) 746 - 99 - 50. You can also ask a question by filling out the request form below.
Osteochondrosis is a degenerative-dystrophic disease of the spine. It is based on a dystrophic disorder (lack of vascular nutrition).
So, how to prevent the formation of osteochondrosis? How to treat it? No way! Osteochondrosis is a physiological process of degeneration and dystrophy of the disc, that is, the changes that occur to us during the aging process are called osteochondrosis. Osteochondrosis manifests itself in disc degeneration - the process of its drying out: all the water leaves and a degeneratively changed “dry” disc is formed. At the same time, the height of the m/n disk decreases.
Very often during consultations, patients are interested in how to treat osteochondrosis or how to prevent it. This question can be answered philosophically: how can you stop the aging process in the body? When a cure for aging is invented, then it will be possible to stop the phenomena of osteochondrosis. In the meantime, this is a normal process of the body that should occur in everyone. Faster or slower - depends on various factors, for example:
- lifting weights;
- overweight;
- sports, etc.
None of the medications restore a degeneratively changed disc (this is the opinion of our Center for Clinical Practice). If this were so, then on MRI images, where “dry” discs are very clearly visible, we would see the disc filling with water. However, this does not happen. So what does a spine specialist do then? Treats complications of osteochondrosis.
Complications of osteochondrosis include:
- Asymmetric protrusion in congenital spinal canal stenosis
- Intervertebral disc herniation
- Spondyloarthrosis (facet syndrome)
- Vertebral displacement (spondylolisthesis)
- Spondylosis (osteophytes)
I propose to dwell on each of the complications in more detail. First, let's look at the concept of “protrusion”. So what is it?
Protrusion is a protrusion of the intervertebral disc into the cavity of the spinal canal.
It is often written that protrusion is a pre-hernia condition, and a hernia will occur immediately after the protrusion. In fact, protrusion is a common occurrence , and everyone who has an MRI or CT scan will have several protrusions.
A protrusion that does not cause pain does not need to be treated . Very often, protrusion can cause a problem with a congenital narrow spinal canal. At the same time, the nerve structures do not have the opportunity to move anywhere, which is why the nerve is compressed.
As part of our job, many of us periodically lift weights. The work can also be sedentary. In both cases, the load on the spine increases, which leads to the formation of protrusion. So, let us repeat once again that protrusion is a common occurrence. If you are not bothered by back pain, there is no need to treat it! Everyone will have a protrusion in the pictures and there is no need to behave in any special way. Taking drugs to treat protrusion is no less pointless (such drugs do not exist!).
The next point in our conversation is spondyloarthrosis , or disease of the facet joints (they are called facet joints). The disease develops when the disc degenerates and its height decreases.
The process is physiological. There is an increase in the area of the articular surfaces (osteophytes), and all in order to hold the vertebral bodies and prevent their displacement from developing.
This process can be complicated by pain due to tension in the joint capsule. This pain is treated with radiofrequency ablation.
The next stage of the conversation concerns vertebral displacement , which develops in the last stage of complications of osteochondrosis. When the disc and musculo-ligamentous apparatus + facet joints no longer hold the vertebral bodies, displacement occurs.
It is possible to assess whether the patient has a displacement using an x-ray examination: x-ray of the lumbar spine in direct and lateral projections + functional (flexion and extension in lateral projection). From these images, it is possible to assess whether PDS instability (displacement) is developing and indicate the degree of displacement.
The next subtopic is spondylosis. This is the body’s protective reaction to disc degeneration and spondyloarthrosis. With excessive axial load on the spine (weight lifting, obesity, etc.) and a lack of musculo-ligamentous apparatus, bone tissue grows to increase the area of the articular surfaces. This is done in order to retain the affected PDS.
MRI/CT scans often show spondylosis, but it rarely causes problems. For the most part, these growths don't put pressure on anything. In cases where the growths are directed towards the nerve structures (nerve root or cauda equina), a narrowing of the central canal or lateral recess occurs (stenosis). Then a microsurgical operation to remove osteophytes or an operation to eliminate stenosis is needed.
So, we have touched on the main aspects of osteochondrosis. Now let’s return to the main issue – intervertebral disc herniation.
What it is?
Protrusion of intervertebral discs is one of the stages of hernia development. Intervertebral disc protrusion is a pathological process that occurs in the spine in which the intervertebral disc bulges into the spinal canal without rupture of the fibrous ring.
Scheme of formation of disc protrusion
At this stage, it is possible to completely cure degenerative-dystrophic changes, but only with proper treatment . In the absence of proper treatment, the disease begins to progress, as a result of which a person may develop a herniated disc, which will be very problematic (almost impossible) to get rid of.
According to statistics, this disease occurs, as a rule, in people over 30 years of age. In addition, such a pathological process can develop due to systematically excessive load or acquired injury.
Prevention
The main task of prevention in this case is to develop and maintain healthy muscle tone and their strength value. In the future, this will reduce the risk of complications and further development of osteochondrosis, protrusions, intervertebral hernia, as well as permanently consolidate the results of treatment. The list of preventive measures includes the following measures:
- From early childhood it is necessary to develop correct, healthy posture, and also maintain it in later life;
- Eliminate non-physiological loads on the spinal region from your life;
- Getting rid of bad habits and abstaining from them;
- Proper nutrition, taking into account the characteristics of the body;
- Regularity of sports exercises with a selected load and alternation with unloading.
And although this list is aimed at preventing protrusions, compliance with it will also help improve the quality of life in general. An organism that receives the required amount of nutrients, training and stress copes better with diseases and is less subject to degeneration and deformation. In a situation with bulging intervertebral discs, it is true that it is easier to prevent them than to cure them.
How is it treated?
Treatment of degenerative changes in the tissues of intervertebral discs, including protrusion of any part, is a long-term and multicomponent process .
If the disease is in an acute stage, then bed rest is required. To reduce pain, a special collar or orthopedic belt is used. In the future, it is allowed to maintain a gentle motor regimen without prolonged sitting or lying down.
Treatment for protrusion includes:
- Taking medications . To relieve inflammation, NSAIDs are used, for example, Diclofenac, Ibuprofen. For pain associated with edema, the doctor may often prescribe paravertebral blockades or antispasmodic medications, for example, Lidocaine, Procaine, Novocaine, Eufillin, NO-SPA. In severe cases, corticosteroid medications such as Dexamethasone and Hydrocortisone may also be prescribed.
- Exercise therapy . After relief of the pain syndrome, the recovery process begins, i.e. yoga and exercise classes. This achieves warming of the muscle fiber, its gradual stretching, which ultimately leads to the relief of chronic spasm, as well as improvement of metabolic processes in the tissues of the intervertebral and paravertebral muscles.
- Yoga . It has an additional calming effect on the central nervous system, having a positive effect on patients who also suffer from neuroses and depression.
- Traction is the stretching of the spinal column using various weights. Traction is performed gradually, taking into account the patient’s well-being and under the strict supervision of a doctor.
- Acupuncture . The fight against chronic muscle spasm is of great importance in relieving pain, as well as returning to work capacity. In this regard, it is recommended to work on finding and further destroying the pain trigger in muscle tissue. Acupuncture plays a huge role in this process. With this method of treatment, the pain disappears quite quickly, and the positive results last for a long time.
- Operation . The decision to carry out this type of treatment should be made on an individual basis, taking into account all morphological forms of protrusion, its clinical picture and localization. And in the overwhelming percentage of cases, the operation does not lead to the complete disappearance of the clinical symptoms of the disease, and many patients continue to experience the same pain symptoms that they experienced before the operation.
- Maintaining proper nutrition.
Basic principles of diagnosis
Despite the fact that exclusively clinical signs were described above, the only way to accurately and reliably distinguish protrusion from hernia is neuroimaging techniques, and first of all, magnetic resonance imaging (MRI). It is important that the magnetic field strength on the tomograph ring must be at least 1.5 Tesla. This tension makes it possible to distinguish the minimum size of the formation, equal to 1 mm; this is quite enough to make the correct morphological diagnosis of protrusion or hernia. Other routine diagnostic methods such as radiography and even myelography will be ineffective because they cannot show the cartilage tissue, and therefore the nature of the process.
MRI image.
Massage for protrusion
Massage ranks second in the treatment of disc protrusion after therapeutic exercises . The fact is that it is he who activates reflex ligaments, improves tissue trophism, and also starts the processes of blood circulation and innervation. By ensuring the necessary influx of active substances to the site of protrusion, massage begins to trigger the mechanisms of restoration of the affected area.
The massage activates the ligaments and improves blood circulation in the tissues of the back
Massage treatment is based on techniques such as vibration, rubbing, kneading, stroking . They are performed in a gentle manner, painlessly, quite often with the use of special medications, for example, balms or ointments. The course lasts 10-15 procedures .
The greatest results can be achieved by combining massage with exercise therapy, physiotherapy, hydrotherapy, and reflexology. Under no circumstances should massage be done if the disease is acute.
Impact on the body
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Next fact
Carrying out massage during protrusion has a positive effect on the course of the disease. It occurs with less pain intensity, the mobility of the spinal column improves, and the inflammatory process is partially or completely eliminated.
It is worth considering that during a single session there will be practically no benefit . This session can be used for short-term relief of pain or stiffness.
Regular massage is as effective as:
- Reducing the severity of inflammation;
- Partial or complete elimination of pain;
- Improving the mobility of the vertebrae (in any department);
- Relaxation of the muscle corset, and as a result, elimination of compensatory muscle spasm;
- Improving regenerative parameters at the site of massage, thereby slowing down the progress of the disease;
- Prevention of venous stagnation.
Massage has a number of indications and contraindications, among which are symptoms such as:
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Find out in more detail what types of protrusions there are and how they are treated.:
- You can read more about the causes of diffuse disc protrusion at the link
- How is therapeutic exercise performed for lumbar protrusion?
- Find out why dorsal disc protrusion is dangerous by going here
- You can find out what circular protrusion is here
- What exercises should you do for protrusion of the cervical spine?
- Symptoms and treatment methods for foraminal protrusion are on the page
General symptoms
The common symptoms of a stable protrusion and a newly formed hernia will be primarily pain of a local nature, at the corresponding level of the spine. Most often, lumbodynia or lumbago occurs, as a synonym for acute radicular back pain. The development of pain syndrome is primarily due to irritation of pain receptors of the posterior longitudinal ligament.
This pain impulse will be periodic during protrusion, since it will irritate the posterior ligament quite often during movements, and especially during exacerbation (hypothermia, awkward movement).
The hernia will irritate the ligament much more or tear it. This will cause very severe pain, during which motor activity and changing posture is almost impossible (an acute attack of lumbago).
In this case, a characteristic sign in both cases will be tension in the paravertebral or paravertebral muscles. Upon examination, the patient will have a noticeable smoothness of the lumbar lordosis, he will have limited back mobility, and upon palpation, the paravertebral muscles will be dense and painful, especially on the affected side.
Protrusion, especially mildly expressed, ceases to irritate the ligament, acute pain soon disappears, only its muscle component remains. A hernia, once violating its integrity, will cause sharp pain, which then changes its character with the appearance of compression symptoms of prolapse. The muscle component in the case of a hernia will be even more pronounced.
Types of massage
Several types of massage are used in the treatment of intervertebral protrusion. Which one to choose should be decided only by the doctor, based on the degree of the disease and the general condition of the patient. Each of them has its own advantages, as well as a therapeutic effect. For example, some affect deep tissues, while others affect superficial muscles .
The most popular types of massage are::
- Can;
- Hydromassage;
- Honey;
- Spot;
- Classical;
- Reflex-segmental.
Cervical
Neck protrusion usually affects the cervical spine. The impact on the affected area should be careful so that the patient's condition does not worsen. As a rule, the classic version of massage is used .
When a disc bulges in the cervical region, only classic massage is used
Hydromassage can also be prescribed, but only after a full examination, as well as after determining all the characteristics of the patient’s health condition. It is worth understanding that Thai massage in this part of the spine is contraindicated.
Thoracic region
To treat protrusion in the thoracic spine, classic and bath types of massage are prescribed . The first involves influencing different areas of the chest, regardless of the location of the “affected” area. Close attention is paid to the affected areas, however, the doctor works on all areas, thereby achieving a tonic and restorative effect.
The bath type of massage is carried out in a bathhouse. Its effectiveness is complemented by the beneficial properties that steam, as well as high temperatures, have on humans. This procedure should be approached with extreme caution, because it is contraindicated for people who have cardiovascular diseases.
Video: “How to treat intervertebral disc protrusion: exercises”
Lumbar
To combat protrusion in the lumbar region, the doctor can use one of the types of massage:
- Classic . It is carried out according to the same principles as in other parts of the spine
- Honey . Sessions of this type of massage help normalize metabolism, get rid of joint problems, and improve the skin. Under the influence of honey film, the blood supply to the skin is activated, as well as the pores are cleansed. Due to this, any ointments applied after a massage penetrate much better into the upper layer of the epidermis.
. The benefit of this massage is that it improves lymph circulation and blood circulation in the tissues. This procedure cannot be performed if there are moles at the site of cupping.
Familiarize yourself with the methods of massage for protrusion in the lumbar region. Cupping- Thai . This type of massage is used extremely rarely: some are not familiar with this type of treatment, while others simply cannot afford it financially. Massage involves pressing on points with various parts of the body.
- Reflex-segmental . This type of massage is based on massaging the paravertebral area, i.e. exit of the spinal cord roots from the spine. Due to this, improved functioning and performance of the lumbar region is achieved. This massage uses rubbing, pressing, and kneading.
- Hydromassage . This type of massage is one of the most suitable methods for treating lumbar hernia. A stream of water in a short time helps to improve the patient’s condition, relieving symptoms. It relieves stress from the spine, increases disc mobility, and also accelerates the process of physical activity.
Contraindications
Massage for a hernia cannot be done in the acute stage. Also contraindications for this procedure are:
- acute pain with a hernia;
- acute heart failure;
- skin diseases, open wounds, scratches in the massage area;
- infectious or inflammatory diseases, incl. flu, colds;
- heat;
- high blood pressure;
- blood diseases;
- osteomyelitis, bone tuberculosis;
- thrombosis;
- oncology;
- period;
- other serious pathologies.
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