腰椎间盘突出是怎么形成的动画

椎间盘有两个主要部分组成椎间盘的中心是果冻状髓核，椎间盘的外层则称为纤维环。这两种成分有助于脊柱运动，并为椎骨提供支撑。 椎间盘损伤时，纤维环破裂形成薄弱处，水和组织从此处突出于后方或椎管内。当腰椎间盘突出时，由于薄弱处和纤维环位于脊神经根的下方，所以这个区域的突出会直接压迫神经根。 由于神经根会延伸到腿上的神经，所以任何类型的压迫神经和下脊柱 都会引起疼痛、麻木、刺痛感或无力感沿着神经在腿部的路径放手。许多人的磁共振扫描显示有椎间盘突出，但是平常并没有相关的疼痛，所以并不是所有的椎间盘突出都会引起症状。

每个腰椎骨之间便是柔软的腰间盘，他在骨头之间起到很好的缓冲、震荡和压力的作用。当我们弯腰的时候，腰间盘的压力会增加百分之五十以上，坐姿弯腰时，腰间盘压力增加接近一倍，时间久了足以导致腰间盘突出， 并且腰间盘是在很深的位置，在腰突发生的过程中，周围的骨头、肌肉、筋膜也早就发生了劳损。

大家对于腰椎间盘突出啊，既熟悉又陌生，这是一个人体的一个腰椎模型，今天我把幺三四的键盘单独拿出来跟大家说一下，什么是腰椎间盘突出，这是腰三椎体，这是腰四椎体，这是腰三四的键盘。先把腰三 隐藏一下，现在可以看到一个间盘，这就是间盘的纤维环，这是髓核组织在腰椎活动过程中产生一个劳损，劳损之后，纤维环这个内伤可能会出现损伤， 出现一个裂口，有裂口之后，随和就会通过裂口到椎管内这个地方的椎管，椎管内走形的是咱们神经，一旦裂口内随和突出到纤维环以外 到椎管内就会压迫压迫神经，出现神经症状，这个就是腰椎间盘突出。有的人问有什么里突外突，其实并没有存在里突外突的，就是腰椎 髓核通过纤维环的裂隙突出到椎管内，压迫神经，导致下肢腿疼腿麻的症状，我们就叫他腰椎间盘突出症，这下你明白了吗？

这个是呃腰椎间盘突出的一个模拟的模型，我们能看到这个呃绿色的是 腰椎的椎体，白色的呢是椎间盘，那么这个红色的区域呢？是模拟的椎间盘的突出的一个模型，那么黄色的是神经根，当椎间盘突出之后呢，对黄色的神经根造成卡压， 就会导致患者出现下肢的放射性的疼痛和麻木，这就是腰椎间盘突出的一个非常重要的一个发病机制。

腰椎退行性改变造成了我们纤维环的损伤或者破裂，使椎体间的椎环破裂和受伤的纤维环的间隙里突出了压迫椎管里的神经温和脊髓引起的下肢疼痛。

four dash l five disc bulge and l four dash l five herniation we're gonna include a couple self tests right try to determine whether or not you have it of course we prefer that you go to professional get it it's properly but for sure if you are new to our channel， please take a second to subscribe to us weeks with herniations or symptoms at this level for all of us including myself very common so don't get too excited it is treatable often times not a hundred percent of times through therapy right， so you certainly want to give it a goal because you don't want to look at surgery right， away， unless you know you have severe week right now if you're watching this video and you've already had an mri and the mri says you have her needed or bulging disc at l fourl five disc let's see if you've got that， but you don't have any symptoms down the leg or in other words there's no pain or none， there's no sciatica， but you may have a back thing with it that's pretty good news it means it's not too serious we should say right here brad that actually they do mris on people that are having no pain west whatever， sometimes and they'll find disc bulge and herniations in them especially as you get older， it's kind of like gray hair wrinkles right， it's part of the aging process that things start to break down so don't panic when you get these diagnoses because it's very common right that it may not be a problem your body's adapted to it however， if you are having symptoms down the leg then it all makes sense we're going to show you a couple simple tests now if you do have a diagnosis of this and you don't have paint on the leg or any and all down the leg and just minor back paint at the end of this video we're gonna show off some exercises and passion and stuff that you're gonna want to do as well， even though you don't have the symptoms， but before we go that let's talk about where is this because if you understand the anatomy and some of the tests you're gonna do better you're gonna have a much better chance of when you have increased knowledge it always is a positive thing it's gonna make you more likely to have positive results exactly， so if you look here at sam l four l five we're gonna look here's a lumbar vertebra here's l five here's l four l three and so on and upwards if you look here's l five l four so it's your lowest two lumbar vertebra and this yellow then this is pretty realistic you know it's about this diameter and the nerves are kind of yellowish more whitish actually， but it comes out here and then it goes through the pelvis and at this point it is part of their sciatic nerve there's a nerve bundle it's just not l four l five nerve or l four is actually what we're looking at it goes to the bundle and as it comes down it starts to separate and l four nerve root is what we're looking at at the l four l five disc and it comes into the front of the leg and the front of the knee and down and into the foot okay， so that just gives you a general mapping of that nerve now if you look here this red bulge is a model sam's model of a bulging or her needed design this would have to be right here you can see where that would push into the nerve irritating the nerve and creating those symptoms so the whole goal is to get that bulge out of there without surgery， which is not always but it can be possible through therapy body wants to heal that's really allowed and you want to show this snob right yeah， so i want to show you the dermatoma the location you're going to feel typically it's numbnu's burning cold feeling all these symptoms are related to a nerve pinch and so we put some green tape on the location and the mapping of where you're gonna feel it on the l four on there so it's in the middle of the back now sometimes i have people that don't feel anything here but it'll come down the leg can you turn by it goes to the front of the thigh over the kneecap down the front of the shin and actually down to the top of the foot and that's four l five actually is part of the big toys they kind of good mission matches there a little bit so that's where a typical pattern is and so yeah that's gives you a clue what where the problem is that like if we see somebody they come in they got pain here the first thing we're thinking is al four l five right exactly and the next thing that you can then this is a real simple test you can do is a muscle test now one of the muscle groups that al four innovates is the dorsaflection and tier your tib so if this is my involved side and if if you can do this that means the nerve is not pinched so bad that it turned off that muscle group one of the typical tests that doctors and therapists do is they say can you walk in your heels like this and that's a good indication of elf or is intact now if you do this and your left lake isn't good like you can do it easy there and you try to hear it it just plopped down like that that means you better go see the doctor yeah we a lot of times call it foot slap if it's not working great right now you're walking you here to slap going on the right side foot drop if that's the case you need to you see in the therapist or the doctors and i'll remember safety first when you're doing this test to hang on to something i don't want anybody falling you can just go like that you want to walk you hold on to this and if you do this and that one foot always drops like that because you cannot hold it up that's that's more serious stage of the nerve impingement and so when i want to go to my nexus let's say you have the nerve impingement but you pass a manual muscle test but you have the symptoms hang on that leg now we got to get to the exercise now we're gonna go to the mackenzie， routine robin beckenzie started a whole system treating symptoms just like this and it's been going on since in eighteen sixties it's a whole worldwide system country up we're going right to the best yeah why don't you show one of the most common exercises that works for this so what we're looking for here by the way is we're looking for the symptoms to get better on the distal， which is the furthest part away from your body right what i'm looking on let's say i got paint all the way down my leg here what do we want to see first bread we want to see that foot paint right， so or synthems we're going to do the exercise that right show you in a second and if all of a sudden you know and i've had this app in the patient so many times they do ten press ups and oh my foot doesn't feel how i ask him because i go any change in no， no i go well how's the foot feel？ i don't feel it now i don't feel the pain i don't feel the tinkling i don't feel the numbness there you go so that's what you want to feel right and if it gets better and better it starts going down further and further right right this goes away so that's all a really good sign if you're doing the exercises and that's what you're going for that's called centralization of the pain or the symptoms right and the way you get that one of my real common exercises is prone so the tribe is going right， so usually start off you might lay like this for a bit sometimes we even have you lay on pillows to start off with， but eventually you get up onto your elbow and maybe lay there for a little bit but then eventually you can do what we call micro press ups？ so you're not pushing all the way up yet because you're just starting these and you're not sure what your range emotion of your spine is what you don't want to see is this you don't want to be you're so stiff you're not able to keep your pelvis down if you can't keep your pelvis down just keep it down as far as you can and just start some again micropress， ups now if you do ten micropress ups and all of a sudden the foot starts to feel better you are gold things are there's a really good chance then if you continue this progression you're gonna get rid of that legs it does a very good side because and then eventually even get up to this point oh yeah you're gonna start seen some real games if you keep the pelvis down now if you do these and it's not getting better or it's even getting worse then you need to try some of these advanced things right should we go to the banana sure let's go to the banana let's say i know just for their sake let's say the pain is on this lake brad sure yeah i would actually shift my hip away from the painful side and i would shift my shoulders over to the painful side so if you're looking at me i'm making a banana if you look from the top down yeah his body occurs so that the painful side is on a c inch in car in the what the kind cave side the kind cave side there you go so it looks like a banana looking for the ceiling and then in that position you actually do some mini presents yeah and i would even lottech red i maybe have way like this first and then maybe you can get up on their elbows again sure yeah just to see how they're doing something just we go back and forth a little bit here and then yeah we try some press up again the micro press ups you don't do fall once with this position right exactly and again you're looking for the same thing is that taking the pain out of the foot out of the leg is it going up the leg or is the numbers are tingling getting better right it doesn't always just have to be the pain right exactly if anything is improving did you know you want to do road kills yeah we can throw one more advanced on it so road kill i would actually take the leg and go like this yeah i'm putting my foot against my opposite knee it's kind of hard to see black on black but his foot is like i just just knee here and this is the same thing i'm going to start this way and maybe just lay it for a bit i might leave on my elbows a little bit the pro pop i might wiggle a little bit and then i might try some press ups like this and you know bob is saying might do this might do that and that's the way it is we have to work the whole idea is that these positions are going to get that bulge to centralize go back in take pressure off the nerve so be patient with it we do have other videos if you do bob and brad cyatic well actually we have a whole series on this right so i think you go to bobbinbrad com go to the program section up and look for sciatic and we have forty videos on scientists and so we go up to great detail on all this right， so， and you can go take out the video on leg pain difficulty reducing leg pain right pick that video out and isolately they want to go over a few more things always that you want to do brand yes， now the other thing particularly regardless of whether you have symptoms you have a bulging disc or you have the paint on the leg is posture right seeded posture in particular a lot of this was probably cost by bad posture in place the slumped bad posture may have contributed to your bulging desk or it could have been the whole start of it possible right right for sure if you have a throw pillow that can be helpful but they're not always the best but it's still a step in the right direction and a culture or a soft chair there you go you're gonna know it's the right thing as soon as you put it in there it's gonna feel like oh that feels like really good support everything feels better this is a little bit broad if you're gonna have if you have an l four l five probably need something more specific you can start out with a towel roll you just roll it up like this we put tape on it and about this size may be good for you and you're going to put it right about it that area at the belt line area the position is going to be critical but you'll know it's like you go back to it like boy feel like it's too high then just shift it down and it's like oh that feels better it's that highly recommended for your car that if your car doesn't have lumbar that you can adjust i would try a tall eventually if that tall feels fine take out a lumbar support off the internet and that's actually a mackenzie roll right c， k， e and z i e and it's actually you want to get one that fits you right if you're a thin guy you probably want a thinner support if you're a big person with a large box and a large gap here then you want a larger support as simple as that and they make there are so many varieties of these you have to look at them carefully on the internet and there there's a little bit of a chance at the wrong size but they're squishy they're soft and they're more comfortable than a towel typically and you'll use that now the other thing i want to address is pastures when you're standing or if you're going to bend over to pick something up yeah because a lot of again you can trace the start of a lot of dispalging and herdiations do poor bending or poor lifting you got it roll rounding out your back like that so if you take a stick about five foot long or so we use a buoya stick you could use a broomstick or anything that's straight you'll see what i'm gonna do here i'm going to put it and i use this with my patients to train them how to do proper body mechanics for lifting these to have three points of contacts it's got a contact on his dead mid back and low back look how straight i am that takes pressure off that bulge and i'm just going to practice squats now the reason i'm doing there so i'll say do ten of these three times a day and then use that same body mechanics when you squat to pick something up you know you can go down on one knee if you're gonna pick up even a pencil because we don't want to do this and get that bulge to come back out and you have to picture like that stick is in place even when it's not right exactly visualize it so so that's actually bonus because i said one exercise but primary exercises that press ups right but the posture and mechanics of bending the lifting are very important brad i could fix this one except for a broken heart there you go bob but we'll continue to work on that。

之前的五号视频提到了弯腰负重久坐是腰椎间盘受力最大的动作，也是最容易导致腰椎间盘突出的动作。这是什么原因呢？ 看一下这个腰椎模型，当腰伸直时，是腰的自然状态，腰椎间盘受力均匀，几乎没有突出的趋势。当弯腰负重久坐时，腰椎间盘前方受到挤压，后方受到千张 椎间盘随和，就会有向后方突出压迫神经的趋势。如果弯腰负重力量足够大时， 腰椎间盘突出就可能发生在一瞬间，您学会了吗？