lumbar degenerative disc disease.pptx

7/28/2019 Lumbar Degenerative Disc Disease.pptx

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Lumbar DegenerativDi

MUHAMM

PHYSICAL MEDICINE & REH

IV. CL


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Lumbar (low back) degenerative disc disease (DDD) is a commoin aging adults. The intervertebral discs serve as the spines shoand, as we age, discs gradually dry out, losing strength and resimost people, these changes are gradual. In fact, many of our pknow they have degenerative disc disease. They may only becothe condition when being examined for another health problem

routine checkup.


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Pathophysiology

Phase I

The dysfunctional phase, or phase I, is characterized histologcircumferential tears or fissures in the outer annulus. Tears caccompanied by endplate separation or failure, interruptingthe disk and impairing nutritional supply and waste removalmay be the result of repetitive microtrauma. Since the outer

annular wall is innervated, tears or fissures in this area may bStrong experimental evidence suggests that most episodes consequence of disk injury, rather than musculotendinous ostrain. Circumferential tears may coalesce to form radial teapulposus may lose its normal water-imbibing abilities as a rebiochemical changes in aggregating proteoglycans.


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Phase II

The unstable phase, or phase II, may result from progressivmechanical integrity of the trijoint complex. Disk-related chmultiple annular tears (eg, radial, circumferential), internal

(IDD) and resorption, or loss of disk-space height. Concurrezygapophyseal joints include cartilage degeneration, capsusubluxation. The biomechanical result of these alterations lsegmental instability. Clinical syndromes of segmental instasyndrome, and herniated disk seem to fit in this phase.

Phase III

The third and final phase, stabilization, is characterized by fresorption, disk-space narrowing, endplate destruction, disosteophyte formation. Diskogenic pain from such disks mayincidence than that of the pain from the disks in phases I angreat variation of phases can be expected in different disks individual and individuals of similar ages vary greatly.


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Symptoms

Disc degeneration is a normal part ofaging, and usually is not aproblem. However, DDD can causediscs to lose height and becomestiff. When disc height is lost, nerveimpingement, bone and joint

inflammation, and resultant pain canoccur. Disc degeneration causes lossof the joint space, similar to arthritispain and inflammation. In severecases, pain may be constant.


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Diagnosis

Medical history. Questions about symptoms, their severity, ayou have already tried.

Physical examination. Carefully examined for limitations of mproblems with balance, and pain. During the exam, looks for reflexes, muscle weakness, loss of sensation or other signs ofinjury.

Diagnostic tests. Most start with x-rays, which helps to rule problems such a tumor or infection. The films also reveal lossbetween the vertebrae. In some cases, a test called Discograthe diagnosis. Discography involves injecting contrast dye intdisc (or discs) to create a clearer image and temporarily replic


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Medications

Initial treatment of lumbar disc disease consists of antiinflammatory meibuprofen (Motrin, Advil) or naproxen (Aleve). These medications can hepain and inflammation associated with lumbar disc disease.

A short course of oral corticosteroids, such as prednisone, can also be ofterm use of corticosteroids is not recommended. Long-term use is assoside effects, such as peptic ulcer disease, swelling and fluid retention, slconfusion or mood changes, and an increased risk ofosteoporosis. For lthat causes severe, radiating nerve pain down the leg (sciatica), an epidcorticosteroids may be considered to provide a more prompt antiinflam

Muscle relaxants, such as cyclobenzaprine (Flexeril), can provide short-tpeople. These medications can cause drowsiness and should not be useor consuming alcohol. Additional side effects ofmuscle relaxants includblurred vision, urine retention, and constipation.

Medications that contain narcotic pain relievers, such as codeine, morpcan also provide relief of the pain associated with lumbar disc disease. Tshould not be continuously administered for chronic pain if alternative tused. Common side effects include drowsiness, constipation, or nightmadvised to take only as prescribed to avoid toxicity of the narcotic or othsuch as acetaminophen (Tylenol), that narcotic pain relievers may conta
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Nonoperative Treatment The good news is that most cases of lumbar degenerative disc dis

require surgery. Many different nonsurgical treatments help relie

symptoms. These include:

Medications, such as an anti-inflammatory to reduce swelling and

relaxants to calm spasm, and occasionally narcotic painkillers to a

pain.

Cold/heat therapy, especially during the first 24-48 hours.

Spinal injections (i.e. epidural) may help relieve low back and leg p

Physical therapy, which may include gentle massage, stretching, t

exercise, bracing, or traction to decrease pain and increase functio

Chiropractic or alternative therapy (i.e. acupuncture).

In conjunction with these treatments, our staff will educate you ab

posture and proper body mechanics.


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Acupuncture Treatment Protoc

First needle the empirical points and move the patient's body to a pothe pain begins to appear. Manipulate the needle with reducing methminutes. If the patient responds well, repeat this process a few times auxillary /local points and retain for 15-20 minutes.

Empirical Points:

GV 26 - if pain is only on the midline of the back and patient has flexion/exte

SI 3 - if pain is on the posterior-midline and also lateral and/or patient has todifficulty

Yaotongxue - if pain is on either side of the posterior midline, pain above UB

UB 40 - acute back pain on the UB meridian, pain below UB 23

UB 37 - in lieu ofUB 40 if there is pain and tenderness here and no congestiovessels at UB 40

GV 8 - stiff and/or rigid spine

Treatment Points: Trauma
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Treatment Points: Cold/Wind/Damp

GV 3 - expels cold damp

UB 23 - expels damp, tonifies the Kidney

UB 52 - chronic back pain above UB 23, direct needle toward

UB 32 - sacral pain

UB 54 - expels cold and damp

Treatment Points: Kidney Qi Deficiency

UB 23, GV 3, GV 4, KD 3 - strengthen the Qi of the Kidney
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Massage Techniques

Deep Transverse-Friction Techniques

A deep transverse-friction technique involves using the thumbs to puthe center of the back and slowly move them towards the sides. This reduces the amount of binding between adjacent tissues. This, in turninjured muscle fibers to one region. To enhance this technique, considtissue mobilization techniques. This will also help encourage the locaadjacent muscle fibers.

Deep Longitudinal-Stripping Methods

In addition to working the area where the pain is located, it is importatightness in muscles surrounding the pain. Deep longitudinal-strippinreduce the amount of tightness in the muscles surrounding the lumbatechnique is performed by placing the thumbs in the center of the bapressure and slowly moving upwards. This technique also reduces thehypertonicity, which is increased muscle tension, in the lumbar region


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Static Compression Techniques

Static compression techniques may also help alleviate pain in the

This technique is performed by placing pressure on the region and

pressure there, until the muscle relaxes. To place pressure, you caknuckles or other pressure tools. In fact, using the palm of your ha

broad application of pressure along the painful area of the lumbar

Stretching

In addition to massage techniques, stretching is another great wa

in the lumbar region of your back. In most cases, you can perform

yourself. However, facilitated stretching with a massage therapist

necessary, if it is too painful to put pressure on the lumbar region.


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lumbar degenerative disc disease.pptx

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