Cute little bird Non-Surgical Therapy For Prolapse of Lumbar Intervertebral Disc

Appearing originally in The Journal of Traditional Chinese Medicine

by Wang Heshan
Department of Medical Service,#C Training Bureau of the State Sports Committee, Beijing 100061


Satisfactory therapeutic effects were achieved in 116 cases with prolapse of lumbar intervertebral disc treated with non- surgical therapy. The results are reported as follows.

Clinical Data

There were 79 male and 37 female cases in this series of patients (116 cases). Their ages ranged from 20 to 70 years, with histories of the disease for 3 days to 26 years. Of the prolapsed discs,

12 prolapsed discs were of central type, 43 of levo-posterior type and 61 of dextro-posterior type. Prolapse or ectasia was shown in all the affected discs on CT and MRI scanning. 47 cases had history of apparent trauma or sprain.

Methods of Treatment

Massage

Massage with traditional maneuvers is applied from above downward along both sides of the spinal column to relax the lumbar muscles. This was the preparatory step. Then, according to the symptoms of individual cases, two to four of the following six maneuvers can be selected.
  1. Digital pressing at the Juliao (GB 29) acupoint, and pushing and pressing along the lumbar and sacral regions.
  2. Digital pressing at the tender point, while asking the patient to stand upright, facing closely to a wall.
  3. Ask the patient to take a sitting position. The massagist sits at the back of the patient to swing the patient's lumbar region, press and knead the affected part with his single hand, while the patient is asked to flex and extent his waist.
  4. Laterally moving manipulation: Ask the patient to take a lateral recumbent position, extent his lower limb and flex the upper one. After the massagist puts his one hand at the buttock and the other at the shoulder, moving the patient forward with one hand and backwards with the other simultaneously. Sometimes a crack sound can be heard during the manipulation. Then, the same manipulation is applied to the opposite side.
  5. Reposition with rotating manipulation: Ask the patient to sit upright on a square bench and slightly lower his head. An assistant stands facing the patient and uses his both knees to press the patient's left upper leg from both sides, in the mean time the assistant holds the patient's left upper leg firmly with both of his hands to maintain the patient sitting upright. The massagist stands behind the patient, stretches his right arm under the right axilla of the patient and puts his palm against the nape. While the massagist keeps holding at the L#-[4-5] lumbar spinal process with his left thumb, he forcefully rotates the affected trunk with his right arm posteriorly and medially and simultaneously pushes the spinal processes with his left äthumb. Reduction of the affected spinal process can be felt by the thumb, and sometimes, a crack sound can be heard. The same manipulation is then performed on the opposite side.
  6. Traction with pushing and pressing: The patient takes a prone position, the massagist pushes and presses the area of the affected vertebrae while two assistants pull the patient's both legs.

Medication

According to the basic theories of TCM and an overall analysis of symptoms and signs, the condition can be divided into the following three types.
  1. For patients with qi stagnation and blood stasis, modified Shen Tong Zhu Yu Tang (Decoction for Relieving Pantalgia due to Blood stagnation) and Shu Jin Huo Xue Tang (Decoction for Relaxing Muscles and Tendons to Promote Blood Circulation) are prescribed, which have the actions of promoting blood circulation, removing blood stasis, invigorating qi and relieving pain.
  2. For patients affected by wind, cold and dampness, the therapeutic principles are to dispel wind and resolve dampness. Modified Du Huo Ji Sheng Tang (Pubescent Angelica and Loranthus Decoction) is given.
  3. For patients with kidney deficiency, the therapeutic principle is to strengthen the body resistance to consolidate the constitution. Zuo Gui Yin (Decoction of Kidney YinTonic), You Gui Yin (the Kidney Yang Reinforcing Decoction), Zhuang Yao Jian Shen Wan (Bolus for Strengthening the Loin and Kidney) are prescribed with addition of herbs for promoting blood circulation, removing blood stasis, dispelling wind and removing obstruction in the channels.

Therapeutic Results

Criteria for therapeutic effects: By referring Mensor's criteria for evaluation of the therapeutic effect on prolapse of lumbar inter-vertebral disc by manual treatment, the following criteria were formulated: