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Physical therapy and physiotherapy

A frequent consequence of the process of wear on the spine or an acute disc prolapse ois the so-called vertebrogen pain; a pain that originates primarily from reflex muscle strain and secondarily leads to poor posture or discharge position. The body wants to calm the injured region, like a sprained joint that makes every movement painful. This "immobilization" happens by a strain of the back muscles, which leads to the famous myogelosis. Although this can really put the segment quiet, but often leads to an increase in disc pressure and thus the pressure on the nerves. A chronically increased muscle tone "captivates" the spine but in the wrong position, i.e. stretching posture or scoliosis (lateral curvature). Physiotherapy and physical measures as an acute treatment of the herniated disc aims to relax the muscles (or to calm) and to relieve the disc so that the nerve is relieved as well. They must be seen as a complement to a drug therapy and possible local injections.

Expanded treatment
The goal of this therapy is to expand the intervertebral space, and thus to lead the bulges (protrusions) from the spinal canal back into the disc tray.  The pressure - which caused the pain  - is taken from the nerve root and thus, these will be relieved. The therapy is suitable only for disc bulges (protrusion), the already herniated disc tissue (sequestered) can therefore not be brought back into the disc tray. Nevertheless, even with sequestered disc herniation, pain relief, can be achieved through the strain.

Heat application
Also  warm water is a relief for the spine; a warm bath offers the advantage of a tension soothing effect on the back muscles, which can be achieved by other heating applications such as mud or shortwave radiation. The healing clay (mud) is composed so that it has a strong insulating property and thermal conductivity, i.e. on one hand to be able to save up the heat and on the other, to deliver the healing heat during the treatment, slow, smooth and long-lasting and therefore deep down, to the skin and underlying tissues and nerves. This leads to an increase in blood flow and an relaxation of the muscle tissue. The metabolism in the muscles is stimulated, allowing a extended acidity and an improved energy supply. Heat treatment is also useful just before a traditional massage.

Electrotherapy with TENS
In a transcutaneous electrical nerve stimulation (TENS), a stimulation device produces  current pulses that are conducted into the tissue through adhesive electrodes on the skin . There are two methods: Mostly pulses with high frequency (80-100 Hz), but less intensity are being used. They are supposed to act as a counter-irritant to prevent back pain and pain-nerves to conduct pain impulses to the brain. The effect is usually felt immediately, but disappears quickly after the end of the stimulation. Pulses at low frequency (50-10 Hz) and high intensity trigger muscle contractions. They are designed to stimulate the secretion of endogenous pain substances (endorphins). The analgesic effect does not begin immediately, but often stays longer.
It is a tailored treatment; strength, duration and frequency of the pulses in the transcutaneous electrical nerve stimulation, can be customized individually to the complaints  and to the from back pain suffering patients. The electrical stimulation treatment is only supposed to cause a tingling. The size of the electrodes also play a role.

The placement of the electrodes is variable , it depends on the site of pain, the course of affected nerves and the type of back pain.

A TENS session normally takes about 20-50 minutes. Since the analgesic effect usually lasts only a few hours, treatment will be repeated several times a day (two to four times). Acute symptoms often disappear after a few treatments. For chronic pain on the other hand,  TENS is often used for years (in home care).

The physical therapy is working with a variety of exercises that take the particular disease into account. Specific exercises designed with the patients, improve blood circulation, eliminate tensions and lead to muscle strength. The need to strengthen the muscles is undoubted. Strength training for stabilization of the front and rear muscle groups is essential for the "back injured," but also for prevention. A trainability of the force is given at any age. With age, the growth is indeed slow, but still possible. There is scientific evidence that in addition to an increase of the pure power, a significant improvement in the intermuscular coordination, as well as their harmonious interaction, occurs. The aim of the muscle training is to make the muscles efficient for the demands of daily life.

It is however important that in the acute stage of a herniated disc, no strong activation is being made as with this, complaints may be increased. In the acute stage, the muscles are tightened reflexively and the intervertebral disc pressure increased. An effort in this phase may increase the tension and in the worst case, push out more disc tissue and thus extend an incident. Therefore relaxation exercises will only be used in the acute stage of a herniated disc. Only after a healing of the incident, the phase of activationbegins.

When a conservative treatment, which should be carried out stationary or within an extended outpatient physiotherapy (EAP), does not lead to an improvement, then the introduction to a neurosurgical consultation with an appropriate current imaging (computed tomography or magnetic resonance imaging) should be made.