LUMBAR HERNIATED DISC

Written by Jean-Jacques Abitbol, MD and Regis W. Haid Jr., MD; Reviewed by Edward C. Benzel, MD

A common cause of lower back and leg pain is a lumbar ruptured disc or herniated disc. Symptoms of a herniated disc may include dull or sharp pain, muscle spasm or cramping, sciatica, and leg weakness or loss of leg function. Sneezing, coughing, or bending usually intensify the pain.

Rarely bowel or bladder control is lost, and if this occurs, seek medical attention at once.

Sciatica is a symptom frequently associated with a lumbar herniated disc. Pressure on one or several nerves that contribute to the sciatic nerve can cause pain, burning, tingling, and numbness that extends from the buttock into the leg and sometimes into the foot. Usually one side (left or right) is affected.

Anatomy: Normal Lumbar Intervertebral Disc

First, a brief overview of spinal anatomy so that you can better understand how a lumbar herniated disc can cause lower back pain and leg pain.

In between each of the 5 lumbar vertebrae (bones) is a disc—a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Every disc has a tire-like outer band (annulus fibrosus) that encases a gel-like substance (nucleus pulposus).

Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape. This is called a herniated nucleus pulposus or herniated disc, although you may have also heard it called a ruptured disc or abulging disc.

When a disc herniates, it can press on the spinal cord or spinal nerves.  All along your spine, nerves are branching off from the spinal cord and travelling to various parts of your body (to help you feel and move).  The nerves pass through small passageways between the vertebrae and discs, so if a herniated disc presses into that passageway, it can compress (or "pinch") the nerve.  That can lead to the pain associated with herniated discs. 

(In the illustration below, you can see a close-up look at a herniated disc pressing on a spinal nerve.)

This article on lumbar herniated discs will cover the symptoms, causes, and (most importantly) treatments.

Lumbar Herniated Disc Risk Factors

Many factors increase the risk for disc herniation:

1. Lifestyle choices such as tobacco use, lack of regular exercise, and inadequate nutrition substantially contribute to poor disc health.
2. As the body ages, natural biochemical changes cause discs to gradually dry out, which can affect disc strength and resiliency.  In other words, the aging process can make your intervertebral discs less capable of absorbing the shock from your movements, which is one of their main jobs.
3. Poor posture combined with the habitual use of incorrect body mechanics stresses the lumbar spine and affects its normal ability to carry the bulk of the body's weight.

Combine these factors with the affects from daily wear and tear, injury, incorrect lifting, or twisting and it is easy to understand why a disc may herniate. For example, lifting something incorrectly can cause disc pressure to rise to several hundred pounds per square inch!

How a Disc Herniates

A herniation may develop suddenly or gradually over weeks or months. The 4 stages to a herniated disc are:

1) Disc Degeneration: Chemical changes associated with aging causes discs to weaken, but without a herniation.

2) Prolapse: The form or position of the disc changes with some slight impingement into the spinal canal and/or spinal nerves. This stage is also called a bulging disc or a protruding disc.

3) Extrusion: The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.

4) Sequestration or Sequestered Disc: The nucleus pulposus breaks through the annulus fibrosus and can then go outside the intervertebral disc.

How a Lumbar Herniated Disc is Diagnosed

Interestingly, not every herniated disc causes symptoms. Some people discover they have a bulging disc or herniated disc after an x-ray for an unrelated reason.

Most of the time, the symptoms, especially the pain, prompt the patient to seek medical care. The visit with the doctor usually includes a physical exam andneurological exam.  He or she will also review your medical history, and ask about what symptoms you've experienced and what treatments you've tried for pain relief.

An x-ray may be needed to rule out other causes of back pain such as osteoarthritis (spondylosis) or spondylolisthesis.

A CT or MRI scan verifies the extent and location of disc damage.These imaging tests can show the soft tissues (such as the disc).

Sometimes a myelogram is necessary.  In that test, you will receive an injection of a dye; the dye will show up well on a CT scan, enabling your doctor to more easily see problem areas.

Nonsurgical Treatment of Lumbar Disc Herniation

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• After the initial injury, the doctor may recommend cold therapy andmedications.

• During the first 24 to 48 hours, cold therapy helps to reduce swelling, muscle spasm, and pain by reducing blood flow. Never apply cold or ice directly to skin; instead wrap the ice pack or cold product in a towel and apply for no longer than 15 minutes.

• Medications may include an anti-inflammatory to reduce swelling, amuscle relaxant to calm spasm, and a pain-killer to alleviate intense but short-lived pain (acute pain).

• Mild to moderate pain may be treated with non-steroidal anti-inflammatory drugs (NSAIDs). These work by relieving both swelling and pain.

With any of these medications, please discuss use with your physician first.

• Usually, after the first 48 hours, heat therapy can be applied. Heat increases blood flow to warm and relax soft tissues. Increased blood flow helps to flush away irritating toxins that may accumulate in tissues as a result of muscle spasm and intervertebral disc injury. Never apply heat directly to skin (just as with cold); instead, wrap the heat source in a thick towel for no longer than 20 minutes.

Spinal Injection
If leg pain is severe, or leg weakness is developing, the doctor may prescribe anepidural steroid injection. An epidural steroid injection puts anti-inflammatory medication into the space near the affected nerves in your lumbar spine. You should discuss this option with your doctor and ask about potential side effects before beginning this treatment.

Physical Therapy
The doctor may recommend physical therapy. The doctor's orders are transmitted to the physical therapist by prescription. Physical therapy includes a combination of treatments to decrease pain and increase flexibility. Ice and heat therapy, gentle massage, stretching, and pelvic traction are some examples, but your physical therapist will work with you to develop the best treatment plan for your pain and other symptoms.

Here's the good news:  In 4 to 6 weeks, the majority of patients find their symptoms are relieved without surgery.

Surgical Treatment of a Lumbar Herniated Disc

Spine surgery is considered if non-surgical treatment does not relieve symptoms. Constant pain, leg weakness, or loss of function requires further evaluation. Rarely, does a lumbar herniated disc cause bowel/bladder incontinence or groin/genital numbness, which requires immediate medical attention.

If surgery is recommended, always ask the purpose of the operation and what results you can expect.  You need to understand all details of what is being recommended, and don't hesitate to get a second opinion from another spine surgeon.  Spine surgery is a big decision, so you odn't want to rush into it.

To relieve nerve pressure and leg pain, surgery usually involves a discectomy(removal of all or part of the intervertebral disc).

In addition, the surgeon may need to access the herniated disc by removing a portion of the bone covering the nerve. This procedure is called a laminotomy.

Fortunately, these procedures can often be done utilizing minimally invasive techniques. Minimally invasive spine surgery does not require large incisions, but instead uses small cuts and tiny specialized instruments and devices such as a microscope and endoscope during the operation.

Can You Prevent a Lumbar Herniated Disc?

Earlier in this article, we told you that a common cause of a lumbar herniated disc is aging, and we can't avoid that.  Does that mean that you can't do anything to prevent a lumbar herniated disc?

Of course not.  There are several factors that are within your control, and to take good care of your spine, watch your posture, don't smoke, make healthy food choices, exercise, and use good body mechanics, especially when you're lifting something.

Doing all of those things won't guarantee that you never get a lumbar herniated disc, but they are generally healthy steps you can take to try to prevent lower back pain caused by a herniated disc.

Low Back Pain

The Treatment of Acute Low Back Pain — Bed Rest, Exercises, or Ordinary Activity?

Antti Malmivaara, M.D., Ph.D., Unto Häkkinen, M.Sc., Ph.D., Timo Aro, M.D., Ph.D., Maj-Len Heinrichs, R.N., Liisa Koskenniemi, M.D., Eeva Kuosma, M.Sc., Seppo Lappi, M.D., Raili Paloheimo, M.D., Carita Servo, M.D., Vesa Vaaranen, M.D., Ph.D., and Sven Hernberg, M.D., Ph.D.

Acute low back pain is one of the most common reasons for consulting a primary care physician in the industrialized countries. The direct cost of medical care and the indirect costs to society of absenteeism from work due to backache are huge.1 Physicians commonly prescribe bed rest for acute low back pain, although only a few controlled trials have assessed its effectiveness.2 Among military recruits with acute low back pain, bed rest led to more rapid recovery than remaining on foot.3 In a family practice, patients presenting with acute low back pain did not benefit from either bed rest or isometric flexion exercises.4 Two days of bed rest produced as good clinical recovery as did seven days of rest and, moreover, was associated with fewer days lost from work.5 In patients with acute low back pain, back-extension exercises were superior to education about back care,6 but a study comparing exercise therapy with placebo found no difference.7

The controversy persists over the relative merits of bed rest and exercise in the treatment of acute back pain. Many leading experts suggest two days or less of bed rest,8-10 whereas others advocate back-extension exercises.6,11 The present study was designed to compare bed rest with rapid mobilization in the management of acute backache. We conducted a randomized, controlled trial of the effectiveness and costs of two days of bed rest as compared with those of light back-mobilizing exercises in patients with acute low back pain. A third group of control patients was advised to avoid bed rest, not to engage in mobilizing exercises, and to continue normal activity to the extent that they were able to tolerate it.

METHODS

Selection and Evaluation of Subjects

The population available for inclusion in the study comprised all employees of the city of Helsinki, Finland, except those working in public transport or the electricity-supply services. The study subjects were patients who presented with low back pain as their main symptom at the city's occupational health care centers. They included patients with acute low back pain or exacerbations of chronic pain lasting less than three weeks. Patients with pain radiating below the knee were included, but not patients with a sciatic syndrome (defined by the presence of at least one neurologic deficit or a positive Lasègue's sign of 60 degrees or less). Also excluded were pregnant patients and those with a history of cancer, a fracture of the lumbar spine, or urinary tract disease.

Patients meeting the criteria for inclusion in the study were given written information by occupational health nurses on the aims and content of the study before they were asked to decide about participation. They were told that according to current knowledge, the three treatment protocols were considered to be equally effective. After the patients gave informed consent, they completed a base-line questionnaire. The researchers dealing with the base-line and outcome data were unaware of the patients' treatment assignments. Base-line data were gathered on potential confounding variables, effect-modifying factors, and factors related to the back disorder (Table 1TABLE 1Demographic and Clinical Characteristics of the Study Subjects at Randomization.). Functional status was assessed by the Oswestry low-back-pain disability questionnaire12 and a health-related measure of quality of life,13 on which 9 of 15 items were relevant to low back pain and were included in the questionnaire for that reason. A score on the health-related quality-of-life index was calculated from the weighted scores assigned to the responses to the nine items; for the six items excluded from the questionnaire, means and respective weighted scores for the Finnish adult population under 65 years of age were used. The duration of absence from work due to low back pain was assessed from the medical records, but only after all the data that would have revealed the treatment assignment had been removed. All the workers were insured for absence due to illness, and the exact duration and diagnosis of illness were required to be stated in the medical records. Straight-leg raising and lumbar flexion were measured by a study physiotherapist. All base-line and follow-up measurements were made without the physiotherapist's knowledge of the treatment.

Randomization and Treatments

A simple randomization was performed before recruitment with random-number tables, and written instructions for the three treatments were sealed in envelopes. The patients were examined by occupational health physicians at the centers, at which time the criteria for inclusion in the study were checked. The physicians opened the envelopes and gave the treatment instructions to each patient at the end of the initial visit. Physicians were asked to decide whether the patient's condition necessitated sick leave or follow-up visits before randomization and at later visits independently of the treatment protocol.

The patients in the bed-rest group were instructed to take two days of complete bed rest, with only essential walking allowed. They were advised about suitable resting positions and were given an illustration of a patient lying supine with the knees supported in a flexed position (the semi-Fowler position). Those in the exercise group received individual instruction from a physiotherapist in one session, as well as written recommendations for back-extension and lateral bending movements to be done at home every other hour during the day until the pain subsided. The recommendations called for these movements to be done 10 times in each direction, but slowly, to avoid aggravating the pain. The patients in the control group were told to avoid bed rest and advised to continue their routines as actively as possible within the limits permitted by their back pain. These instructions were also given to the patients in the exercise group. Those in the bed-rest group were advised to resume routine activities as tolerated only after two days of complete rest. All the treatments were approved by the ethics committee of the Finnish Institute of Occupational Health. Patients were enrolled beginning in January 1992, and enrollment ended in April 1993.

Compliance and Other Interventions

The follow-up questionnaires asked all the patients on how many days they had taken some bed rest during the day, and for how many hours on average. The patients were also asked on how many days they had done back exercises and how often they did them per day, on average. If they received any health care services apart from those prescribed in the protocols, these were recorded.

Follow-up and Outcome Assessment

The patients visited the physiotherapists after 3 and 12 weeks, at which time they completed follow-up questionnaires. Those who did not return for follow-up were contacted by phone and asked to participate. The outcome assessments were based on questionnaire data, measurements by physiotherapists, and sick-leave data from the medical records.

To assess any possible bias on the part of the physicians, nurses, and physiotherapists toward the treatments, we asked them to rate the value of the treatments before the results were known. They either rated the treatments from best to worst (i.e., 1,2,3) or rated two or all three treatments as equally effective (i.e., 1,1,2; 1,2,2; or 1,1,1).

Economic Analysis

The economic analysis was based on the responses to the 12-week follow-up questionnaire, which concerned the use and costs of health care services and help at home. The costs of medicines were estimated from the data entered on the questionnaires and from the medical records. The costs of public health services (visits to a physician, a nurse, or a physiotherapist) were calculated from the unit costs of these services in the City of Helsinki Occupational Health Care Centers. The costs of similar services provided privately were recorded on the basis of the patients' own expenditures.

Home help was defined to include help from the patients' spouses and children or their families, relatives, and friends. The monetary value of these voluntary contributions is hard to assess.14Two alternative calculations were applied. First, half the current wage of a municipal home helper was used, unless the helper had taken time from work, in which case the total wage was used. In the second calculation, the total wage was used for all the help.

Subjects with missing data were excluded from the economic analyses, making the three groups smaller than in the outcome analyses. The single subject who underwent surgery was also excluded from the economic analysis, since such a high-cost event might have affected the cost analysis disproportionately.15

Sample Size and Statistical Analysis

The calculations of power showed a need for 64 subjects in each treatment group in order to achieve a statistical power of 0.80 with an alpha of 0.05.

An analysis of covariance was performed to compare treatments (bed rest vs. control and exercise vs. control).16 In calculating the prevalence of pain radiating below the knee (expressed as a percentage of the group), binomial regression models were used.17 The covariates entered into the model included the base-line data and the patient's age, the patient's sex, and confounding variables at base line: the patient's degree of satisfaction with his or her work (very satisfied vs. not very satisfied), the performance of physically heavy work for over five hours daily (yes vs. no), the presence of pain radiating below the knee (yes vs. no), pain for over 30 days in the previous 12 months (yes vs. no), and the number of medical visits due to backache during the previous 12 months. The estimated differences in outcomes between the treatment groups and their standard errors from the models were used to determine 95 percent confidence intervals and statistical significance.

RESULTS

Study Population

A total of 186 subjects were randomly assigned to the three treatment groups. Two days of bed rest was recommended for 67 patients, exercise for 52 patients, and normal activity as tolerated for 67 patients (the control group). Follow-up information was obtained three weeks later for 165 of these subjects (89 percent); 5 subjects were absent from the bed-rest group, 10 from the exercise group, and 6 from the control group. After 12 weeks, information was obtained on 162 subjects (87 percent); this time, 8 subjects were missing from the bed-rest group, 11 from the exercise group, and 5 from the control group. The base-line characteristics of the patients who did not return for follow-up did not differ markedly from the characteristics of those who returned.

Sixteen subjects were not included in the final study population of 186 patients because their base-line questionnaires were not obtained or were filled in too late or because the physicians' initial determination that they fulfilled the criteria for inclusion in the study proved to be incorrect. The decision to withdraw these patients from the study was made without knowledge of their treatment assignments. Nine of the 16 would have been in the exercise group, 4 in the bed-rest group, and 3 in the control group.

Characteristics of the Subjects

The demographic and clinical characteristics of the study subjects are shown in Table 1. The three groups were similar with regard to most of the base-line characteristics. The control group contained a few more people engaged in heavy physical work, the bed-rest group had more patients with pain radiating below the knee, and the exercise group had more patients with prolonged pain during the previous 12 months. Two patients in the exercise group had undergone previous back surgery. The patients in all three groups worked in a wide variety of municipal occupations.

Compliance and Other Interventions

At the three-week follow-up, the patients in the bed-rest group had spent an average of 22 hours at rest, as compared with only 2 hours for the patients in the control group. The patients in the exercise group had performed an average of 61 sets of exercises as compared with 3 sets in the control group (Table 2TABLE 2Outcomes in the Bed-Rest, Exercise, and Control Groups at the Three-Week Follow-up.).

Antiinflammatory drugs or analgesics were prescribed for 93, 91, and 93 percent of the patients in the bed-rest, exercise, and control groups, respectively. In the bed-rest group, one patient underwent back surgery because of a disk prolapse.

Assessments by Health Care Personnel

Before learning the results of the study, 10 of the 36 doctors, nurses, and physiotherapists rated exercise as the best of the three treatments, 3 favored the control treatment, and 3 considered bed rest the best treatment. In all, 10 physicians, 6 nurses, and 6 physiotherapists were able to prioritize the treatments, whereas the remaining 14 could not rank the treatments at all.

Three-Week Outcomes

After adjustment for base-line measurements, the control group had statistically significant advantages over the bed-rest group in terms of the duration of absence from work due to sickness and the ability to work (assessed subjectively) (Table 2). As compared with the patients in the exercise group, the control patients recovered significantly better in terms of the number of sick days, the duration of pain, and scores on the Oswestry back-disability index. The median number of sick days was five in both the bed-rest group and the exercise group, and four in the control group. After one week the percentage of patients still out from work was 41, 36, and 20 percent in the bed-rest, exercise, and control groups, respectively; at two weeks it was 19, 11, and 2 percent; and at three weeks it was 5, 6, and 2 percent. There were statistically significant differences between the bed-rest group and the control group at one and two weeks (P = 0.01 and P = 0.002 by Fisher's exact test), respectively.

12-Week Outcomes

After adjustment for base-line values, the patients assigned to bed rest recovered significantly more slowly than the controls in terms of the number of sick days, the intensity of pain, the ability to work (assessed subjectively), lumbar flexion, and the Oswestry back-disability index (Table 3TABLE 3Outcomes in the Bed-Rest, Exercise, and Control Groups at the 12-Week Follow-up.). The recovery was slower in the exercise group than in the control group in terms of the number of sick days and capacity for lumbar flexion. The median duration of absence from work was six days in the bed-rest group, five days in the exercise group, and four days in the control group. No one was still out from work at 12 weeks of follow-up.

Costs and Use of Services

After adjustment for base-line values, visits to doctors were significantly more frequent in the exercise group than in the control group (Table 4TABLE 4Costs and Use of Services Associated with Back Disorders in the Three Study Groups at the 12-Week Follow-up.). There were other appreciable differences, but they were not statistically significant. The cost of health care services was lowest in the control group. The patients in the exercise group needed home help the most often of the three groups, and those in the control group least often.

DISCUSSION

Our study was conducted in an occupational health care setting in which the subjects were engaged in various types of work for the municipality. The continuity of care in these health care centers is very good because all the employees have easy access to the services and treatment is free. Thus, the sample represents a working population with acute, nonspecific low back pain that required the services of a physician.

Simple randomization was used to assign patients to one of three treatments, and with this method the base-line characteristics in the three groups were successfully balanced (Table 1). Minor imbalances in base-line characteristics were controlled for in the multivariate analyses.

Compliance was adequate to show significant differences in the amount of bed rest and exercise between the patients assigned to those two treatments and the control patients assigned to continue their usual activities as tolerated. The actual compliance may have been poorer than that shown by our data, since compliance tends to be overestimated when questionnaires are used.

In our study design it was not possible for the health care personnel to remain completely unaware of the treatment assignments. However, a placebo effect seems an unlikely explanation for the success of the control treatment, because in general the doctors, nurses, and physiotherapists thought exercise was the most effective treatment and considered resting in bed and continuing normal activity to have more or less equal efficacy. Patients may express satisfaction with a treatment because they assume that the treatment they are given is effective. Because the degree of satisfaction with treatment did not differ among the three groups, the higher degree of recovery in the control group cannot be regarded as a placebo effect. The results favoring the control group were remarkably consistent across the measures used to determine the outcome.

Our findings agree with those of two previous reports about the poor results of bed rest4,5 and suggest that as little as two days of bed rest may lead to a slower recovery than the avoidance of bed rest, as well as to longer sick leaves. A study of young, healthy army recruits found that bed rest led to substantially more improvement after two weeks than a regimen in which the recruits did not participate in any physical exercise but were on their feet the whole day.3 It may be that excessive walking and standing delayed recovery in this latter group. This would accord with our results, which show that even light exercise resulted in a slower recovery after three weeks.

In a recent, careful review of the effectiveness of physiotherapy in patients with acute, nonspecific low back pain, only one of four randomized, controlled trials was found to show a positive effect of exercise therapy in such patients.18 That study used back-extension exercises,6 but the treatment regimen differed from that in our study, as did the recommendations for the control group, since those patients were advised to rest several times each day. In a recent study, an exercise treatment was found not to be effective in patients with acute low back pain.7

Our economic analysis showed that the cost associated with continuing normal activity was somewhat lower than that of treatment with either bed rest or back-mobilizing exercises. When a monetary value was applied to the home help needed in the various groups, that value was lowest for the controls and highest for the patients in the exercise group. However, because of the wide variation among patients in the costs and use of services, the differences between groups were not statistically significant. If a cost–benefit analysis based on the value of human capital were used, with a monetary value placed on lost production due to absence from work,14 the control treatment would definitely emerge as the most economical.

Our controlled study of workers with acute low back pain suggests that avoiding bed rest and maintaining ordinary activity as tolerated lead to the most rapid recovery. Widespread use of this approach in clinical practice would result in substantial monetary savings.

Torcicolo e Tratamento

by Fisioterapia Rubiera

O que é o torcicolo?
O torcicolo no pescoço é um distúrbio caracterizado pelo bloqueio de movimentos do pescoço para um lado (para á direita ou para á esquerda) e para trás.

Torcicolo à direita

Girar e dobrar para o lado saudável é possível e não causar nenhuma dor no pescoço.
Geralmente você acorda de manhã com om pescoço rígido ou bloqueado, mas a noite antes de dormir não sentia sintomas.
A rigidez do pescoço pode ser acompanhada de dor de cabeça, dor cervical e aos ombro.
A pessooa deve girar em torno do corpo para girar o lado afetado.
Tipicamente, os sintomas duram alguns dias a uma semana e pode causar dor de pescoço, que varia desde ligeiramente irritante para extremamente dolorosa e limitante. Enquanto alguns casos de extrema rigidez do pescoço são o sinal de uma doença grave, a maioria dos episódios agudos de dor ou rigidez do pescoço para curar rapidamente a resistência da coluna cervical.

Classificação

O torcicolo pode ser:

• Congênito, é causado por o encurtamento do músculo esternocleidomastóideo que provoca a inclinação lateral para um lado e a rotação no sentido oposto. O tratamento é cirúrgico.
• Congênito ósseo, é visto entre os recém-nascidos e é causada pela fusão entre Atlas e occipício, síndrome de Klippel-Feil ou outras anormalidades ósseas. O tratamento envolve o uso de um colar ortopédico;
• Adquirido, pode ser causada por uma inflamação (reumatismo, tuberculose, abscesso), uma lesão ou um tumor. O torcicolo ocular faz parte deste tipo, nesse caso a postura do pescoço muda quando cobrimos um olho.

O torcicolo neurogênico pode ser causado por hemorragia intracraniana ou sangramento da siringomielia.

Além destes tipos de torcicolo grave, os adultos e especialmente crianças muitas vezes sofrem desta desordem devido a contraturas musculares.

As causas mais comuns de um torcicolo de tipo muscular são:

• A fadiga muscular é a causa mais comum de torcicolo, na prática, é uma entorse ou uma contratura muscular, principalmente do músculo elevador da escápula.
  Localizado na parte de trás do pescoço, o elevador da escápula liga a coluna cervical para o ombro.
• O músculo levantador da escápula pode ser esticado ou puxado quando você realizar muitas atividades da vida diária
• Dormir em uma posição que alonga os músculos do pescoço.
• As lesões esportivas que causam um alongamento no pescoço.
• Má postura, enquanto observa o monitor do computador.
• O stress excessivo pode levar a tensão muscular no pescoço.
• Manter o pescoço em uma posição anormal por um longo período, tal como apoiar o celular entre o pescoço e ombro.
• O frio ou uma exposição ao ar frio
• Um travisseiro muito alto
• Dormir com o arcondicionado e o ventilador

Um torcicolo juntamente com febre alta, dor de cabeça, náuseas, vómitos, tonturas, sonolência, linfonodos inchados podem ser indicativos de meningite, que é uma infecção bacteriana, que causa a inflamação das membranas protetiva que envolvem o cérebro e a medula espinhal.
Outras infecções podem causar sintomas de torcicolo como a de infecção meningocócica na coluna cervical. No momento em que um torcicolo é acompanhado de febre, você tem que ir imediatamente ao médico para ser controlado.
Muitas doenças da cervical pode dar torcicolo. A rigidez pode ser uma reacção para o problema subjacente da coluna vertebral. Por exemplo, um disco herniado ou a artrose cervical pode causar a rigidez
Uma vez que as estruturas nervosas da coluna cervical são todos interligadas, um problema em qualquer área podem causar espasmos ou rigidez muscular.

Sintomas do torcicolo

Como regra geral, você deve consultar um médico se os sintomas do torcicolo não passa depois de uma semana. Devemos ir imediatamente ao pronto socorro, se a rigidez do pescoço é causada por trauma ou se há outros sintomas e incómodos, tais como febre alta.
A maioria de nós já tiveram pelo menos um episódio de torcicolo na vida, geramente não há motivos para se preocupar. Na maioria dos casos, os cuidados médicos não são necessários, existem muitas maneiras para aliviar os sintomas e  melhorar à dor no pescoço.
A rigidez é muitas vezes causada pelo stress ou por contracções da musculatura na zona, o tratamento é utilizado para relaxar os músculos e restaurar a flexibilidade da coluna cervical.
Geralmente, a dor é fortissíma é imediata mas não se sente quando você ficar parado em uma posição que alonga os músculos.

Normalmente o torcicolo não provoca inchaço nem vermelhidão.

Tratamento e remédios naturais

Na maioria dos casos, um torcicolo é um distúrbio de tipo agudo e passa sem tratamento entre poucos dias, é rarissimo um torcicolo crônico.
Repouso e apoio do pescoço
Uma maneira de aliviar a rigidez do pescoço é para relaxar os músculos. Você pode se beneficiar através do uso de um colar cervical macio, disponível em toda lojas de produtos ortopédicos, ou você pode colocar qualquer coisa parecida em casa. Coloque uma toalha enrolada em seu colarinho da camisa ou ao longo do pescoço e junte as extremidades, de modo a mantê-lo apertado até o pescoço. Para uma melhor postura na cama, é melhor dormir do seu lado com um travesseiro na cabeça e um pequeno entre os joelhos para apoiar a coluna vertebral.
Evitar de dormir sem travesseiro ou com dois travesseiros.

É necessário descansar o pescoço até que a dor passe. Isso significa que temos de evitar qualquer atividade que possa endurecer ainda mais os músculos. Evite correr, nadar e outros esportes que causam cargas pesadas no pescoço.
Esportes como o golfe podem causar rápida torção e esforço, é melhor fazer uma pausa até que esteja totalmente recuperado.
Tente não levantar objetos pesados ​​até mesmo as coisas que estão no quintal, pois pode causar a contração muscular e, assim agrava a lesão que já è presente.

É melhor o frio ou o calor

Se a dor no pescoço é causada por uma lesão,a aplicação de gelo envolto em uma toalha pode ajudar a reduzir a inflamação e facilitar a cicatrização.
Aplicar o gelo durante 20 minutos de cada vez, 3/4 vezes por dia.

No caso de torcicolo por contração muscular, é necessário aquecer o pescoço para acelerar o processo de cura do corpo.
Entre os remédios rápidos um banho quente ou a aplicação de água morna na coluna cervical pode ajudar o relaxamento dos músculos.

Massagem e alongamento

A massagem pode ajudar a relaxar os músculos e diminuir a rigidez, mas isso deve ser feito com muito cuidado. A massagem deve ser muito leve, você tem que se concentrar no relaxamento e não deve ser destinado a afastar a tensão muscular com manobras de amassamento.
Mover o pescoço lentamente para cima, para baixo e para os lados para estirar os músculos. Colocar uma pressão adicional sobre os músculos do pescoço pode agravar o problema, por isso não deve mover o pescoço muito rápido e evitar todas as atividades que pioram os sintomas.

Tratamentos com ervas

Medicamentos naturais podem ser de grande ajuda a relaxar os músculos rígidos. Você pode tentar espalhar óleos ou ervas, como hortelã, tomilho, calêndula ou milefólio é útil passar uma pomada com arnica e a garra do diabo.
Para preparar o óleo de massagem, aquecer algumas gotas de óleo de aromaterapia em uma colher, juntamente com um óleo, tal como óleo de azeitona, abacate ou sementes de uva. Uma vez que o óleo está pronto, você pode espalhar nos músculos rígidos.

Medicamentos para a dor

A dor do torcicolo, muitas vezes não desaparece imediatamente após a aplicação dos recursos mencionados, então analgésicos, como a aspirina ou Brufen pode ser útil.

Os anti-inflamatórios como o diclofenaco (Voltaren) e analgésicos, como paracetamol devem reduzir a dor nos músculos.
É possível aplicar um adesivo contendo a medicação, ou você pode aplicar uma pomada ou gel com ibuprofeno como o (Alivium).

Os medicamentos ajudam à relaxar, portanto são importantes porque quando sentimos muita dor é dificíl permanecer relaxado.

Método Mckenzie

McKenzie tratamento para torcicolo

O método McKenzie é ótimo para tratar torcicolo.
O fisioterapeuta tenta mover o pescoço na direção bloqueada, antes de colocar a cabeça do paciente em um travesseiro,e em seguida soltaram.
Desta maneira no fim da primeira sessão já se vê uma migioramento e em duas sessões, o paciente deve curar-se completamente.

Alguns fisioterapeutas aplicam o kinesio taping para favorecer o relaxamento dos músculos.

Prevenção do torcicolo

Quem sofrem de torcicolo deve regularmente dar uma olhada os hábitos diários para remover fatores de risco. Estresse, má postura, frio, vento, pode causar tensão e dor no pescoço.
Aproveite o tempo para relaxar ou fazer algo que você gosta todos os dias, mesmo que apenas por alguns minutos.
Você deve ficar longe de correntes de ar e usar um lenço quando está frio.
O pescoço e a coluna vertebral precisa de um bom apoio enquanto se dorme, isso pode ajudar a aliviar a rigidez e é útil na prevenção de dor no pescoço.
A má postura pode ser melhorada com um programa regular de alongamento e ginástica.
Você também pode executar muitos exercícios em sua mesa, no ônibus ou enquanto assistir televisão por alguns minutos a cada hora.
Com um pouco de esforço para manter o pescoço em uma posição adequada, com o tempo se tornar natural e espontâneo.
Você tem que colocar o monitor do computador a uma altura que permite que você mantenha seu pescoço reto e relaxado.
Evite atividades que sobrecarregam o pescoço, como segurar o telefone entre a cabeça e o ombro.

Quando precisa ir ao médico

Em alguns casos, a rigidez do pescoço é o sintoma de outra doença e pode indicar a presença de uma lesão grave.
Se sua dor não melhorar dentro de uma semana você tem que ir ao médico para ver se há algo mais sério que está causando a dor.
Quando se sofre um acidente de carro ou outro trauma,como o clássico golpe de chicote que provoca danos às vértebras do pescoço. Você pode precisar de uma radiografia ou outros exames de diagnóstico para descartar uma lesão grave.
A menos que haja uma fratura grave, um colar cervical não é recomendado no tratamento desta doença.
Se você não ver uma melhoria rápida não se assuste, mas se a dor e a rigidez não passar, há provavelmente uma patologia associada e precisa de um exame minucioso do médico.
Se a dor piorar ou é acompanhada de outros sintomas, poderia ser um sinal de um problema de saúde grave, então você precisa consultar um médico imediatamente.
Sintomas como dor de cabeça, sonolência, febre, tonturas juntamente com a rigidez do pescoço, podem ser sintomas de uma doença como a meningite.
A dor no pescoço e no braço pode ser causada por um ataque cardíaco, especialmente quando eles são acompanhados pela dificuldade em respirar, náuseas e transpiração. Nessas situações, você tem que ir imediatamente ao pronto socorro.

Quanto dura? Quando passa? O prognóstico

No caso de contratura muscular que provoca o torcicolo ao acordar de manhã, a duração média é de cerca de 2 dias ou 48 horas.
Se o distúrbio é causado por uma doença grave, o tempo de recuperação depende de quando é efetuado o tratamento.